Human Biological Science

Generally, people can experience a severe breathing difficulty at a higher elevation. This is due to the fact that at higher altitudes the body is forced to work more than its capacity at the same levels of oxygen reserves present in the body. It might put an additional constrain on the lungs, making it a bit difficult for the person to breathe normally. An exposure to such an elevation in elderlies, can be found to be closely associated with them developing symptoms such as hypoxemia and pulmonary hypertension (Kylhammar, 2017). These symptoms are cumulatively responsible for developing acute mountain sickness in the individuals. It can be due to the maladaptiveness of the person after being exposed to higher altitudes or elevations. This evidently brings about a reduced exercise capacity in the individual, leading to an imbalance in the performance of lung volumes and capacity (Siques, 2019). Ideally few days are provided to the person to get acclimatized with the surrounding, so that the overall negative impact of higher altitudes can be lowered in these individuals.

With a progressive reduction in the biometric pressure, there is a subsequent reduction in oxygen pressure reserves is observed. This might lead to multiple physiological changes in the person (Petrassi, 2018). The impact can advance by multiple folds when an elderly is involved as mentioned in our case study with Stuart. He recently had to visit higher altitudes without any prior preparations and was experiencing some side effects after coming back from his journey. Even after getting back from the place, the body might take a little bit longer to slowly recover back from the insufficiencies. It is commonly observed in cases, as our case study that altitude exposure can bring about a hyperventilative state (Vizcardo, 2020). This can be accompanied by reduced ventilation, elevated heart rate and a sudden increase in the blood pressure, as a compensatory mechanism. At rest however, ventilation is observed to be increased with the significant increase in the tidal volume. This also triggers a rise in the breathing rate of the person. There is also an increase in the tidal volume observed at rest, at an attempt to normalize the ventilatory pattern in the individual. At higher altitude there can be a respiratory compromise, leading to poor ventilation as given in case study of Stuart. This inspirational hypoxia is found to bring about a mismatch in the ventilation and perfusion ratio, which is a direct index for noting the impact on the blood gas exchange (Flaherty, 2016). Higher altitudes tend to bring about an overall decrease in the atmospheric pressure, which indirectly caused a decrease in partial oxygen reserves in the body. This brings about a reduced gaseous exchange in the body between pulmonary blood and alveolar air, bringing about a respiratory deficiency in the person, as reflected in our case study. The percentage of oxygen inspired through air remains constant at higher altitudes. However, due to fall in atmospheric pressure, the overall partial pressure of inspired oxygen also falls below defined levels thus, exerting an additional pressure on lungs to promote healthy gaseous exchange (Siebenmann, 2017). The rate of gaseous exchange would have been observed to be reduced in Stuart as well. Thus, leading to breathlessness and more negative impact even after getting back from the trip.

Enteric nervous system in mainly responsible for carrying out well orchestrated gastrointestinal functions. This system can act as an independent body apart from the central nervous system as well. This system mainly helps in controlling digestion with the help of regulated mobility, secretion and growth. Enteric nervous system also provides the body with a fast and internal response to the digestive stimuli through the means of short reflex (Gidwaney, 2016). Thus, in the given case study of Stuart, this system can be of utter importance in managing digestion for the patient, even after having a heavy meal and with effective results as well. The main hormone that might play a vital role in this process can include incretin glucagon-like peptide. This hormone helps by regulating the various neural networks, which evidently help in promoting glucose homeostasis. This hormone acts by enhancing the overall secretion of glucose-stimulated insulin secretion (Cavin, 2017) thus, helping in easy breakdown of the food. This can be having best possible and faster outcomes in Stuart, as he had a heavy meal and requires body function to break down the food. This is to done to enhance the overall digestion, as well as to provide energy conserves to the body with the help of breakdown of food during enhanced digestion. Kidney functions can be observed to be hampered with elderlies.

Posterior pituitary gland produces antidiuretic hormone, which helps in lowering the osmolarity (Kanbay, 2019). This is helpful in reducing the sodium concentration, by increasing the amount of water reabsorption process within the kidneys. This is a productive mechanism for overall diluting the fluid present in the body. Thus, kidney is able to prevent osmolarity from falling below the anticipated normal levels and helps in overall regulation of the renal system. This leads to reabsorption of sodium in the distal nephrons. As per the urine analysis of Stuart has an acidic urine and is also having an increased concentration of ketone bodies present. Both of these elements will prevent Stuart from maintaining a good hemostatic fluid balance. High ketone bodies can lead to a condition called ketosis. This condition brings about by an increased level of ketones in urine, can lead to severe complications such as diabetic ketoacidosis and dehydration in patients (Fedorovich, 2018). Stuart is also a high risk of developing diabetic coma if the condition is left untreated and undiagnosed for a longer duration. Urine analysis can be considered as one of the strongest diagnostic tools, which can be used for a wide range of disorders. These can be urinary tract infection, underlying kidney disease or development of diabetes in patients (Shu, 2018). It also gives insight on the specific details like appearance, concentration or content of urine, which can also be a direct indicator of development of any underlying disease. The significance of the same is vital in this case, as with advancing age the chances of the person to develop incidences of these conditions is more likely to occur that their younger counterpart. Therefore, it can be effective screening tool to be used in Stuart’s case for diagnosing any hidden clinical condition. Urine analysis is also a vital method to analyze whether the person is having a normal kidney function or not. The presence of glucose in urine can not be deemed as a normal sign. This can be direct indication of presence of increased glucose levels, resulting in renal glycosuria. It can cause kidney damage in person and can be indicative of person having either type-1 or type-2 diabetes (Gong, 2017).

However, Stuart is reflecting on a near normal blood pressure reading, in elderlies there are multiple physiological changes that might alter with the mean arterial blood pressure. An increased pulse pressure leads to a decreased ability to respond to these abrupt physiological changes, as the age advances. The similar thing might have happened with Stuart, during his visit to such high grounds. Due to increased cardiac and respiratory function, the patient is bound to have such abnormal changes. As the age progresses there is a reduced vascular development. These anatomical and structural variations can lead to variation in the lumen, by constricting the same. This causes increased resistance to the blood flow through these capillaries and thus, promotes a defective autoregulation of blood flow (Tedla, 2017). Therefore, directly impacting the arterial blood pressure measurements in the individual of older age. The constantly increased blood pressure can cause the arteries in the kidney to narrow down. Over the due course of time these arteries tend to weaken or calcify as well. thus, causing a deficient blood supply to the kidney and ultimately damaging the same. With these progressive structural damages in place, the renin-angiotensin system can act as a helper (Braschi, 2019). As in the case it is seen that Stuart has hypotension and thus, this system will in managing fluid balance in the body and thus, helping the sodium levels low. This helps in self-regulation of kidney functions and thereby helping in maintaining normal blood pressure.

Being an A+ person Stuart can ideally take blood only from individuals who are of blood group A or O. Taking blood from a person of B blood group will not be safe for Stuart. Individuals who are having the A antigen in the surface of their red blood cells are generally against the B antigen (Arnolds, 2020). Thus, receiving blood from a B blood group person can lead to compatibility issue and can have an adverse impact on Stuart’s clinical condition. The patient in the given case study is found to have low levels of plasminogens. It helps in producing plasmin which has the main role of breaking down fibrin. The deficiency of plasminogen in Stuart can thus, lead to defective breakdown of clots. This will evidently result in increased risk of development of blood clot in the patient (Saes, 2019). Thereby, subjecting Stuart to the risk of developing any cardiovascular incidence or stroke.

Elderlies might be suffering from impaired functioning of various body systems. With advancing age, the impact of the diseases increases in the person in a negative manner. It is therefore, imperative to keep a close vigil on the progress of the patient’s condition, with the means of various diagnostic tools. This will be helpful in early detection and prevention of the diseased condition.

References for Intestinal Adaptations After Bariatric Surgery

Arnolds, K. L., Martin, C. G., & Lozupone, C. A. (2020). Blood type and the microbiome-untangling a complex relationship with lessons from pathogens. Current Opinion in Microbiology56, 59-66. https://doi.org/10.1016/j.mib.2020.06.008

Braschi, A. (2019). Potential protective role of blood pressure-lowering drugs on the balance between hemostasis and fibrinolysis in hypertensive patients at rest and during exercise. American Journal of Cardiovascular Drugs19(2), 133-171. https://doi.org/10.1007/s40256-018-00316-2

Cavin, J. B., Bado, A., & Le Gall, M. (2017). Intestinal adaptations after bariatric surgery: Consequences on glucose homeostasis. Trends in Endocrinology & Metabolism28(5), 354-364. https://doi.org/10.1016/j.tem.2017.01.002

Fedorovich, S. V., Voronina, P. P., & Waseem, T. V. (2018). Ketogenic diet versus ketoacidosis: what determines the influence of ketone bodies on neurons?. Neural Regeneration Research13(12), 2060. https://dx.doi.org/10.4103%2F1673-5374.241442

Flaherty, G., O'Connor, R., & Johnston, N. (2016). Altitude training for elite endurance athletes: A review for the travel medicine practitioner. Travel Medicine and Infectious Disease14(3), 200-211. https://doi.org/10.1016/j.tmaid.2016.03.015

Gidwaney, N. G., Bajpai, M., & Chokhavatia, S. S. (2016). Gastrointestinal dysmotility in the elderly. Journal of Clinical Gastroenterology50(10), 819-827. https://doi.org/10.1097/MCG.0000000000000650

Gong, S., Guo, J., Han, X., Li, M., Zhou, L., Cai, X., ... & Ma, Y. (2017). Clinical and genetic features of patients with type 2 diabetes and renal glycosuria. The Journal of Clinical Endocrinology & Metabolism102(5), 1548-1556. https://doi.org/10.1210/jc.2016-2332

Kanbay, M., Yilmaz, S., Dincer, N., Ortiz, A., Sag, A. A., Covic, A., ... & Afsar, B. (2019). Antidiuretic hormone and serum osmolarity physiology and related outcomes: What is old, what is new, and what is unknown?. The Journal of Clinical Endocrinology & Metabolism104(11), 5406-5420. https://doi.org/10.1210/jc.2019-01049

Kylhammar, D., & Rådegran, G. (2017). The principal pathways involved in the in vivo modulation of hypoxic pulmonary vasoconstriction, pulmonary arterial remodelling and pulmonary hypertension. Acta Physiologica219(4), 728-756. https://doi.org/10.1111/apha.12749

Petrassi, F. A., Davis, J. T., Beasley, K. M., Evero, O., Elliott, J. E., Goodman, R. D., ... & Roach, R. C. (2018). AltitudeOmics: Effect of reduced barometric pressure on detection of intrapulmonary shunt, pulmonary gas exchange efficiency, and total pulmonary resistance. Journal of Applied Physiology124(5), 1363-1376. https://doi.org/10.1152/japplphysiol.00474.2017

Saes, J. L., Schols, S. E., Betbadal, K. F., van Geffen, M., Verbeek‐Knobbe, K., Gupta, S., ... & van Heerde, W. L. (2019). Thrombin and plasmin generation in patients with plasminogen or plasminogen activator inhibitor type 1 deficiency. Haemophilia25(6), 1073-1082. https://doi.org/10.1111/hae.13842

Shu, A., Paulasir, S., Batool, F., Corpron, C. A., Purtill, M. A., Wahl, W. L., & Mary-Margaret Brandt MD, M. H. S. A. (2018). Elderly fall patients need a urinalysis. The American surgeon84(8), 299-301. https://dx.doi.org/10.4103%2F1673-5374.241442

Siebenmann, C., Robach, P., & Lundby, C. (2017). Regulation of blood volume in lowlanders exposed to high altitude. Journal of Applied Physiology123(4), 957-966. https://doi.org/10.1152/japplphysiol.00118.2017

Siques, P., Brito, J., Schwedhelm, E., Pena, E., León-Velarde, F., De La Cruz, J. J., ... & Hannemann, J. (2019). Asymmetric dimethylarginine at sea level is a predictive marker of hypoxic pulmonary arterial hypertension at high altitude. Frontiers in Physiology10, 651. https://doi.org/10.3389/fphys.2019.00651

Tedla, Y. G., Yano, Y., Carnethon, M., & Greenland, P. (2017). Association between long-term blood pressure variability and 10-year progression in arterial stiffness: The multiethnic study of atherosclerosis. Hypertension69(1), 118-127. https://doi.org/10.1161/HYPERTENSIONAHA.116.08427

Vizcardo-Galindo, G., León-Velarde, F., & Villafuerte, F. C. (2020). High-altitude hypoxia decreases plasma erythropoietin soluble receptor concentration in lowlanders. High Altitude Medicine & Biology21(1), 92-98. https://doi.org/10.1089/ham.2019.0118

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