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Anatomy and Physiology

Q1- (i)- Thermoregulation is the self-regulatory mechanism of the body to keep the body temperature normal, in accordance with the environmental temperature. However, the normal body temperature might not change that much with the aging of the person. With the advancing age, the tendency of the body to be able to control the body temperature might get difficult. An elderly individual might take twice the time longer than a younger person, in order to get the body temperature back to normal. Shivering and peripheral vasodilation can be deemed as an example of the involuntary temperature regulation mechanism of the body (Fu 2016, pp. 189-200). This tendency to not being able to maintain body temperature usually reduces after the age of 50 years.

As the age progresses not only the blood vessels get more and more dilated, the blood circulation also impedes speed as compared to a younger individual. The fat deposit beneath the skin layer plays a vital role in temperature regulation. This body fat gets reduced and decreases considerably in amount, making it difficult for the body to stay warm on its own (Xiong 2019, pp. 117-122).

(ii)- For maintaining thermoregulation for Katherine her body might make use of three main mechanisms as follow:

  1. Vasoconstriction- In this process, the vessels under the skin become narrower. This allows a reduction in the blood flow to the skin and thus, helping the body to retain the body heat, without bearing any losses (Ma 2017, pp. 2-14).
  2. Thermogenesis- This mechanism can be deemed as an involuntary mechanism of the body to produce heat. One of the most common examples is the mechanism of shivering. Various body organs, muscles, and brains as well, can help in producing the required body heat.
  3. Hormonal thermogenesis- The thyroid gland is responsible for producing and releasing hormones. This hormonal discharge increases the overall metabolism of the body. Through the means of this metabolism, the body is able to produce a sufficient amount of body heat, required for thermoregulation (Franceschi 2019, pp. 1250-1270).

Q2- (i)- Fracture can be deemed as a discontinuity of the structure of the bone cortex (Vennin 2017, pp. 233-242). It might also bring about an injury to the surrounding tissues of the particular joint at which the fracture has occurred. Immediately after the fracture the healing process begins and it is mainly divided into four different stages as follow:

  1. Hematoma formation- This stage mainly follows exactly after the occurrence of the fracture. There are multiple blood vessels that surround the bone and periosteum. These blood vessels get ruptured with fractures, leading to the formation of a hematoma at the injury site. These hematomas and clots also make grounds for the initial healing process of the fracture. Cytokines are also released which help in reducing the impact of the necrotizing of the tissues and removing the damaged tissue structure from the site (Clark 2017, pp. 601-608).
  2. Callus formation which is fibrocartilaginous in nature- There is a release of vascular endothelial growth factor which leads to angiogenesis. This helps in forming a fibrin-rich granulation tissue (Bahney 2019, pp. 35-50). The formation than begins to differentiate into various cells such as fibroblasts, chondroblasts, and osteoblasts. This helps in forming a woven layer of bone rich with hyaline cartilage at the fracture site.
  3. Bony callus formation- The callus formed then undergoes endochondral ossification. This process further stimulates the formation of various differentiating cells such as chondroclasts, osteoblasts, and osteoclasts cells. This cartilaginous callus gets reabsorbed and then starts to calcify (Schlundt 2018, pp.78-89). This woven network of bone tends to settle down and thus, allows further penetration and migration of mesenchymal stem cells. At the end of this phase, a hard-immature bone callus is formed.
  4. Bone remodeling- This process mainly involves the setting of the bone. The hard callus is subjected to repeated stages of remodeling, also commonly known as the coupled remodeling. This process helps in reabsorption of the bone cells in a balanced manner (Cheung 2016, pp. 21-26). The main center of this callus is finally replaced by a hard-calcified bone structure that is good enough to bear weight and stress as per the load it is subjected to.

However, in older patients, the process can be a little delayed. These age-related changes might hamper the healing process of the bone. The outcomes can be in the form of delayed healing and increased morbidity.

(ii)- The three main factors that may have contributed to Katherine getting easy fracture after falling can be as follow:

  1. Reduced bone mass due to osteoporosis. It can also be attributed to the advancing age of the patient (Zanker 2019, pp. 831-840).
  2. Bone density can also be directly related to the occurrence of fractures, especially in elderlies. The elder individuals are found to have a low bone density which is a major risk factor for the patient to have a fracture with a simple fall (Laroche 2017, pp. 427-432).
  3. Cognitive impairment with advancing age is another factor that might lead to a fall in elderlies. With balance and cognitive impairment issues, the chances of falls increase by multiple folds, leading to easy fractures (Welmer 2017, pp. 669-675).

Q3- (i)- The two main functions of bile are digestion and absorption.

  1. Digestion- Bile mainly helps in the complete digestion of the fats, proteins, and carbohydrates. The bile salts mainly act on the food product. It helps in reducing the surface tension, which in turn helps in converting the fat into an emulsion. This also helps in pacing up the process of digestion and thus the easy and fast breakdown of complex food. Bile also acts as an activator for various lipases. Bile also acts as a good solvent (Copple 2016, pp. 9-21). This property of bile helps with the easy interaction of fats and the enzymes as well.
  2. Absorption- With the presence of various salts in bile, it also helps in the absorptions of various food products. Fat absorption is mainly carried out with the help of two processes. The first process is the hydrotropic action which makes the fat to be readily available to be absorbed. The second process is with the help of bile salts that help in reducing the surface tension and increasing the permeability of the epithelium (Chen 2019, pp. 851-861). This also helps in facilitating the absorption process.

(ii)- The ability of the liver to metabolize various substances, let alone bile can reduce with the aging process. Also, there can be few drugs that might not get inactivated quickly in elderlies, as they might get in their younger counterparts. With the advancing age, the liver might also not be able to withstand the stress it is being subjected to, leading to the reduced bile production in the body. With reduced bile production the mechanism of digestion, absorption, and elimination can also alter. Due to insufficient excretion of toxins out of the body, there can be damage to the other organs. The repair process also slows down with the increasing age. Due to reduced or hampered bile production, the person might also develop gallstones (Hegyi 2018, pp. 1983-2023). Patients can also develop drug-induced cholestasis. This can evidently lead to drug toxicity in severe cases. The patient might have symptoms such as high-grade fever due to infection and chest palpitations or generalized discomfort due to reduced digestion as well as absorption.

Q4- Vitamin D deficiency is one of the most common deficiencies observed in elderlies, especially after the age of 60 and above. Females are more affected by this deficiency as compared to their male counterparts. Osteoporosis and vitamin D also has a direct correlation in elderlies, in terms of depreciating values. Vitamin D can also be deemed as the most effective and appropriate treatment method for elder individuals (Hill 2017, pp. 89-95). With the lack of exposure of sunlight, as given in our case scenario, as Katherine stays in the home only, there are greater chances of developing vitamin D deficiency. It is also impossible to compensate for the levels of vitamin D through nutritional resources only. There is always the dire need for additional supplements required for treatment purposes.

It is also vital for the elderly to have a good intake of calcium to help maintain bone strength and keep the bones healthy and intact. Intake of calcium is also important in reducing the chances of fracture in the patient. It also enhances the process of bone mineralization, bone formation, and healing of microfracture. Calcium intake is also important for Katherine for enhancing bone mineral deficiency and thus, lowering the risk of osteoporosis and its harmful effects on the patient (Reid 2019, pp. 468-473). Calcium intake is also important for improving muscle action. It helps with the easy contractibility and relaxation of the muscles. It is also important to promote the strength of muscles to support the joints and thus, promoting balance and coordination.

References for Katherine Case Study

Bahney, C.S., Zondervan, R.L., Allison, P., Theologis, A., Ashley, J.W., Ahn, J., Miclau, T., Marcucio, R.S. and Hankenson, K.D. 2019. Cellular biology of fracture healing. Journal of Orthopaedic Research37(1), pp.35-50. https://doi.org/10.1002/jor.24170

Chen, M.L., Takeda, K. and Sundrud, M.S. 2019. Emerging roles of bile acids in mucosal immunity and inflammation. Mucosal Immunology12(4), pp.851-861. https://doi.org/10.1038/s41385-019-0162-4

Cheung, W.H., Miclau, T., Chow, S.K.H., Yang, F.F., and Alt, V. 2016. Fracture healing in osteoporotic bone. Injury47, pp.21-26. https://doi.org/10.1016/S0020-1383(16)47004-X

Clark, D., Nakamura, M., Miclau, T., and Marcucio, R. 2017. Effects of aging on fracture healing. Current Osteoporosis Reports15(6), pp.601-608. https://doi.org/10.1007/s11914-017-0413-9

Copple, B.L., and Li, T. 2016. Pharmacology of bile acid receptors: Evolution of bile acids from simple detergents to complex signaling molecules. Pharmacological Research104, pp.9-21. https://doi.org/10.1016/j.phrs.2015.12.007

Franceschi, C., Ostan, R., Mariotti, S., Monti, D., and Vitale, G. 2019. The aging thyroid: a reappraisal within the geroscience integrated perspective. Endocrine Reviews40(5), pp.1250-1270. https://doi.org/10.1210/er.2018-00170

Fu, M., Weng, W., Chen, W., and Luo, N. 2016. Review on modeling heat transfer and thermoregulatory responses in the human body. Journal of Thermal Biology62, pp.189-200. https://doi.org/10.1016/j.jtherbio.2016.06.018

Hegyi, P., Maléth, J., Walters, J.R., Hofmann, A.F. and Keely, S.J. 2018. Guts and gall: Bile acids in the regulation of intestinal epithelial function in health and disease. Physiological Reviews98(4), pp.1983-2023. https://doi.org/10.1152/physrev.00054.2017

Hill, T.R., and Aspray, T.J. 2017. The role of vitamin D in maintaining bone health in older people. Therapeutic Advances in Musculoskeletal Disease9(4), pp.89-95. https://doi.org/10.1177%2F1759720X17692502

Laroche, M., Pécourneau, V., Blain, H., Breuil, V., Chapurlat, R., Cortet, B., Sutter, B., and Debbie, Y. 2017. Osteoporosis and ischemic cardiovascular disease. Joint Bone Spine84(4), pp.427-432. https://doi.org/10.1016/j.jbspin.2016.09.022

Ma, T., Xiong, J. and Lian, Z. 2017. A human thermoregulation model for the Chinese elderly. Journal of Thermal Biology70, pp.2-14. https://doi.org/10.1016/j.jtherbio.2017.08.002

Reid, I.R. and Bolland, M.J. 2019. Controversies in medicine: the role of calcium and vitamin D supplements in adults. Medical Journal of Australia211(10), pp.468-473. https://doi.org/10.5694/mja2.50393

Schlundt, C., El Khassawna, T., Serra, A., Dienelt, A., Wendler, S., Schell, H., van Rooijen, N., Radbruch, A., Lucius, R., Hartmann, S. and Duda, G.N. 2018. Macrophages in bone fracture healing: Their essential role in endochondral ossification. Bone106, pp.78-89. https://doi.org/10.1016/j.bone.2015.10.019

Vennin, S., Desyatova, A., Turner, J.A., Watson, P.A., Lappe, J.M., Recker, R.R., and Akhter, M.P. 2017. Intrinsic material property differences in bone tissue from patients suffering low-trauma osteoporotic fractures, compared to matched non-fracturing women. Bone97, pp.233-242. https://doi.org/10.1016/j.bone.2017.01.031

Welcome, A.K., Rizzuto, D., Laukka, E.J., Johnell, K. and Fratiglioni, L. 2017. Cognitive and physical function in relation to the risk of injurious falls in older adults: A population-based study. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences72(5), pp.669-675. https://doi.org/10.1093/gerona/glw141

Xiong, J., Ma, T., Lian, Z., and de Dear, R. 2019. Perceptual and physiological responses of elderly subjects to moderate temperatures. Building and Environment156, pp.117-122. https://doi.org/10.1016/j.buildenv.2019.04.012

Zanker, J., and Duque, G. 2019. Osteoporosis in older persons: old and new players. Journal of the American Geriatrics Society67(4), pp.831-840. https://doi.org/10.1111/jgs.15716

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