Major Issues in Clinical Biochemistry - Case Study Example

? Clinical Cases; Questions and Answer Part Case Study Glycaemic status Question Blood glucose monitoring has been an important tool in the effective management of out-patients with diabetes. This tool which entails self monitoring of blood glucose level in a specified period has been designed to help in glycaemic control and lowered the risk associated with high blood sugar level. Considering the result of the biochemical analysis done for the patient, it can be concluded that the patient has not been monitoring his blood sugar effectively. Each of those outlined results point towards different analysis and help in the assessment of a poorly controlled blood sugar. Fasting blood glucose clearly shows a higher value that is far beyond the normal range hence an impaired fasting glycaemia. The main implication of the impaired fasting glucose is that of excessively high glycaemic level. The Urea value for the patient is also very high compared to the normal range. This simply indicates a higher concentration of urea in the blood which is an indication of a poorly functioning kidney with poor control of waste products. The HbA1c is also high hence an unsatisfactory assessment for the glycaemic control by the patient. This is because of the importance of the analysis which helps in analysing the average blood glucose level for an average of three months. The osmolality which is slightly lower than normal range does not actually support a high concentration of chemical particles or electrolytes in the blood but a reduced concentration which support a normal glycaemic control for the patient. However, it can be fully concluded that this osmolality is slightly lower than the normal range might be as a result of slight increased in fluid intake and poor control of water intake by the kidney. Question 2 In-house glycaemic monitoring has been an important mode of managing diabetes mellitus in out-patients. It has been found that a tightly controlled blood glucose level in patients with diabetes mellitus helps in reducing various forms of associated microvascular and macrovascular complications that could be seen in those patients (Gerich, J, 2005). Microvascular complications in those poorly controlled or monitored blood glucose level has been found to be the major cause of morbidity and mortality in people (Edelman, 1998). Those complications can also be seen in some groups of patient even before they are being diagnosed. It has been concluded by various researches that glycaemic monitoring has helped in achieving a normal HbA1c range over time and associated with the lowest risk of complications (Ousman & Sharma 2001). When the glycaemic control is being achieved effectively, the risk of manifestations of those immediate and late associated effects will be reduced and the patient will have his or her biochemical analysis results within the normal range. The major issue about the condition is that of those associated complications which the affected individuals tend to manifest when they are with a poorly controlled blood sugar. The major effects which are described as microvascular or macrovascular complications, shows their manifestation in most major systems of the body. The immediate effects of poorly controlled glycaemic level could be described in terms of disruption of the basic concentration of the body electrolytes with subsequent immediate and delayed effects. The derangement of the blood electrolytes will affects the functioning of the body's system hence deranged metabolic activity. One major effect is what is called the diabetic ketoacidosis and accelerated atherosclerosis which could lead to major systemic consequences which includes; cardiovascular effects, neurovascular effects, kidney failure, blindness, loss of hearing (American diabetes association, 2011). Question 3 Tight control program that could actually help this patient who has type 2 diabetes include; trying to lose the weight, and checking the blood glucose regularly. For this patient, achieving a weight loss could be accomplished by eating less and doing more exercise. There are different eating plans that the patient could actually stick to and those plans would help in achieving a tight control. The important aspect of this program is for the patient to be able to stick to a basic exercise plan that won't be too stressful but could help in building a strong body with a normal blood glucose level (American diabetes association, 2011). These basic plans will help the patient to prevent the glycaemic surge and the associated complications mostly experienced by patients with type 2 diabetes. The patient’s physician/endocrinologist must be aware of the patient’s plan of sugar control before the patient starts. Another major aspect of this plan is that, in a situation where the two modalities are not working for the patient, the endocrinologist may prescribe certain pills for the patient. In another situation the patient may be placed on insulin so as to effectively control the patient's sugar level. There are different classes of medication the patient could be placed on if the exercise and weight losing plans are not effectively working for him. Such medications include the Metformin, Glicazide, Acarbose, and Avandia. Each of those medications has different mechanism of actions and side effects but help in tight glycaemic control. Metformin and Glicazide are the most prescribed of those medications that could help this patient in the tight control if his diet and weight control are not working. Part 2 Case study 2: Bilirubin Metabolism Question 1 The implication of the results from the liver function test for the patient is towards the likelihood of metastasis of the previous carcinoma to the liver hence impairing the liver functions. For patients with high bilirubin level as in this 70 year old woman, the case of extreme liver damage would be suspected because of the imbalance between production and excretion of the breakdown heam product in the body. This hyperbilirubinaemia might also be as a result of chemotherapy the patient might be undergoing so as to achieve a cure or prevention of metastasis to other region of the body. In the case of the Alanine aminotransferase, this is an enzyme found in the serum or other body tissues and it is an enzyme found associated with liver and its measurement is important in the analysis of the liver function because it helps in evaluating hepatocellular injury. Its measurement alone is not sufficient for diagnosis of the liver cell damage but requires other analysis to make a diagnosis. The most important prediction provided by the extreme high level of the enzyme is that of active hepatitis or damage from some drugs. In this situation, it might likely be the effects of chemotherapy used in managing the patients for surgery or liver damage from carcinoma. Alkaline phosphatase is another important enzyme measured in liver function test. This enzyme in the case of this woman was found to be extremely high and this point towards the likelihood of damage to the bile ducts of the liver because the enzyme is usually found in the biliary ducts. Infiltrative disease is another major cause of the blood elevation apart from the obstruction of the duct. Question 2 This patient’s condition simply points towards an impaired liver function. This occurs when the liver is unable to perform its primary function of detoxification of the blood of its toxic waste products i.e. the bilirubin. The bilirubin is supposed to be mopped up by the liver’s hepatocyte from the blood and then converted into bile (water soluble) easier to excrete from the body. The impairment of the ability of the hepatocyte to achieve this will lead to the accumulation of the bilirubin in the body of the woman and subsequently leading to the clinical manifestation of jaundiced state. The two major enzymes that were measured with bilirubin level in the liver function test also helps to show that this patient is actually having a state of liver dysfunction which is likely to be as a result of damage to the hepatocytes. The two enzymes are associated with the liver parenchymal cells hence are major diagnostic indicator for liver damage. Considering the previous colorectal surgery the patient undergone before the clinical detection of the bilirubin, conduction of the liver function tests and the associated test’s result with their differential blood level; it can be concluded that there is a liver dysfunction and the probable cause could either be the effects of chemotherapy or metastastasis to the liver from the colorectal cancer. Chemotherapy could be used as adjuvant in management of some colorectal cancer cases while metastasis is known to occur from the cancer to other part of the body occasionally. Question 3 There are various further tests to Alpha-fetoprotein blood test (AFP test) is a major biochemical investigation that could also be conducted on the woman because AFP protein is produced by both the tumours and foetal tissue and it has been found to be raised in large numbers of individuals with hepatocellular carcinoma (Eurolab, 2011). That investigation is not done frequently but could be done in this case to actually help have a definite diagnosis. Aspartate transaminase level could also be checked for as part of the biochemical analysis for the liver function test because it is associated with the liver parenchyma cells. Further investigations that could be performed for the women include the hepatic ultrasound, computerized tomography (CT) scan of the liver and the magnetic resonance imaging (MRI) scan (Eurolab, 2011). Those investigations can then be followed by the liver biopsy. All those investigations would actually help to know the extent of damage to the liver tissue. References American Diabetes Association,(2011). Tight Diabetes Control. Living with Diabetes. American Diabetes Association. Available at; http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/tight-diabetes-control.html Edelman, (1998). Importance of glucose control. PubMed. US National Library of Medicine. Available at; http://www.ncbi.nlm.nih.gov/pubmed/9706116 Eurolab, (2011). Alpha-feto protein (AFP). Markers of oncological sicknessess. Biochemical investigations. Available at; http://clinic.eurolab.ua/en/eurolab/pricelist/tests/156/166/480/ Gerich, J, (2005). The importance of tight glycemic control. The American journal of medicine. Volume 118, Issue 9. Available at http://www.amjmed.com/article/S0002-9343(05)00663-7/abstract Mayo Clinic, (2011). Tests and Diagnosis. Liver Cancer. Diseases and Conditions. Mayo Clinic. Available at; http://www.mayoclinic.com/health/liver-cancer/DS00399/DSECTION=tests-and-diagnosis Sapna et al, (2009). Hyperuricemia, High serum urea and hypoproteinemia are the risk factors for diabetes. Asian Journal of Medical Sciences. Available at; http://maxwellsci.com/print/ajms/(2)33-34.pdf Ousman & Sharma (2001). The Irrefutable importance of Glycemic control. Clinical Diabetes. American Diabetes Association. Available at; http://clinical.diabetesjournals.org/content/19/2/71.full Webmd, (2011). Surgery to Treat Colorectal Cancer. Colorectal Cancer Health Center. Cancer Health Center. Available at; http://www.webmd.com/colorectal-cancer/colorectal-cancer-surgery-treatments World Health Organization, (2003). Screening for type 2 Diabetes. World Health Organization 2003. Available at; http://www.who.int/diabetes/publications/en/screening_mnc03.pdf Read More