After evaluating the First case study the feature that indicates the hypertensive emergency to the 55-year-old businessman and he is facing altered vision that can be due to the retinal bleeding. Some of the risk factors that are associated with retinal bleeding and present in the patient information are hypertensive state.
One of the disorders that occur due to the bleeding in the retina that directly affect the vision of the individual is retinal bleeding. The leakage of the blood occurs from the ruptured vessel that increases the complication in the vision. The retinal bleeding occurs due to multiple of reason but one of the important risk factors is the hypertensive state that led to the leakage of the blood. Some other factor that directly increases the chances of the retinal bleeding includes diabetes, hypertension and anaemia (Naik et al., 2019). The two main risk factor that is associated with the retinal bleeding includes hypertension and hypertensive emergency that are correlating with the case study. The reason to choice behind the retinal bleeding is due to relation with the hypertensive emergency state.
Some different signs and symptoms are related to the retinal bleeding and they increase the vision issue for the patient. Some of the complications include floaters in the vision, cobwebs in the vision and distorted vision. The retinal bleeding is a serious issue thus patient encountered with retinal bleeding should immediately treat to reduce the chances of the complication. The retina is one of the important parts that send signals to the optic nerve for the visual information but the retinal bleeding directly affects the retina (Binenbaum et al., 2016). The altered vision of the patient is due to the retinal bleeding that has directly led to reducing transduction of the optical signals.
Hypertensive emergency is the state that arises due to the uncontrolled blood pressure that directly can be life-threatening due to several organ damages. The persistent increased blood pressure is the reason behind the hypertensive emergency. Some of the symptoms that directly indicate the presence of the hypertensive emergency include blurred vision, nausea, anxiety, headache and retinal bleeding. The untreated high blood pressure leads to the hypertensive emergency that demands the immediate attention of the health care professional for the intervention. Visual abnormalities are one of the most common signs for the hypertensive emergency that increase complication for the patient (Seeman et al., 2019). The patient medical history reveals the persistent state of high blood pressure and reluctance toward the treatment for hypertension. The carelessness toward the increased blood pressure is the reason behind the patient has encountered a hypertensive emergency state. The result of the hypertensive emergency is the retinal bleeding that leads to an altered vision of the patient.
Naik, A. U., Rishi, E., & Rishi, P. (2019). Pediatric vitreous hemorrhage: A narrative review. Indian Journal Ophthalmology, 67, 732-739. http://www.ijo.in/text.asp?2019/67/6/732/259049
Binenbaum, G., Chen, W., Huang, J., Ying, G. S., & Forbes, B. J. (2016). The natural history of retinal hemorrhage in pediatric head trauma. Journal of AAPOS: the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 20(2), 131–135. https://doi.org/10.1016/j.jaapos.2015.12.008
Seeman, T., Hamdani, G. & Mitsnefes, M. (2019). Hypertensive crisis in children and adolescents. Pediatr Nephrol 34, 2523–2537. https://doi.org/10.1007/s00467-018-4092-2
The case study discusses the different symptoms faced by the student while hospitalization with information regarding his medical history. The analysis after considering all the aspect reveals that the reason behind the abdominal pain is due to the occurrence of chronic pancreatitis.
The study presented by Lew et al. (2017) describes the progressive inflammation and fibrotic changes lead to structural damage to the pancreas is known as chronic pancreatitis. The condition gets worse over the time that ultimately leads to permanent damage to the pancreases that impair food digestion. Some of the complications that are associated with chronic pancreatitis include infection, malnutrition and the further episode of pancreatitis. Another article presented by Lin et al. (2018) describes how persistent acute pancreatitis results in the chronic condition that increases issue for the patient. The patient having a medical history of multiple episodes of acute pancreatitis faces chronic pancreatitis with an intermediate state of recurrent acute pancreatitis. The poor treatment or lack of diagnosis results in the patient to transit from acute pancreatitis to recurrent pancreatitis followed by a chronic condition. The medical history of the patient reveals the past 4 episode of acute pancreatitis that has resulted in the chronic pancreatitis condition.
There are different risk factors other than recurrent acute pancreatitis that lead to chronic pancreatitis. Some of the factors include alcohols that increase the chances of the prevalence of chronic pancreatitis. The increased alcohol consumption leads to the sensitization of the acinar cell that leads to the prognosis of the inflammation. The continuous alcohol consumption closely increases the rate of inflammation and lead to irreversible damage to the pancreases (Pham & Forsmark, 2018).
The lifestyle information about the patient reveals that he is a drinker that has increased has increased his complication with acute pancreatitis. Some of the symptoms that indicate the presence of chronic pancreatitis and it can be used for the diagnosis of the disease. Pain in the belly and diarrhea are the two most common issues that are observed in the patient suffering from chronic pancreatitis. Nausea and vomiting are some other signs that are related to chronic pancreatitis. Chronic pancreatitis does not get improve but it gets worse over the time that directly impacts the body of the patient causing poor health status (Machicado & Yadav, 2017).
The case study indicates the patient will be facing issue due to chronic pancreatitis that is due to the recurrent acute pancreatitis. There are different options but the second option is most appropriate concerning the case and patient medical history. The patient sign and symptoms indicate the presence of chronic pancreatitis and it needs to be addressed soon to decrease complication.
Lew, D., Afghani, E., & Pandol, S. (2017). Chronic pancreatitis: current status and challenges for prevention and treatment. Digestive Diseases and Sciences, 62(7), 1702–1712. https://doi.org/10.1007/s10620-017-4602-2
Lin, Y. C., Kor, C. T., Su, W. W., & Hsu, Y. C. (2018). Risk factors and prediction score for chronic pancreatitis: A nationwide population-based cohort study. World Journal of Gastroenterology, 24(44), 5034–5045. https://doi.org/10.3748/wjg.v24.i44.5034
Machicado, J. D., & Yadav, D. (2017). Epidemiology of recurrent acute and chronic pancreatitis: similarities and differences. Digestive Diseases and Sciences, 62(7), 1683–1691. https://doi.org/10.1007/s10620-017-4510-5
Pham, A., & Forsmark, C. (2018). Chronic pancreatitis: review and update of etiology, risk factors, and management. F1000Research, 7, 1-11. https://doi.org/10.12688/f1000research.12852.1
The patient in the case study complains about the abdominal fullness that is continuous from the 6 weeks. The current condition of the patient reveals that there is a need to perform paracentesis to understand the issue with patient health.
Paracentesis is the test that is used to decrease the intra-abdominal tension by removing the fluid that is present in the abdomen. It has both diagnostic and therapeutic purposes that help in the removal of fluid for the testing. The abdominal paracentesis is performed by puncturing the abdominal wall using abdominal trochar and cannula (Sudulagunta et al., 2015). Ascites is the condition where the fluids accumulate in the abdominal cavities that increase the complication for the patient. The ignored ascites can increase complication as the usual complication face by the patient includes shortness of breath, abdominal discomfort and increase abdominal pressure. If a patient is suffering from ascites then health care professional should immediately perform paracentesis to decrease discomfort. It is useful to decrease the abdominal pressure by removing the fluid that helps to improve health status and reduce the symptoms that increase the difficulty of the patient (Chiejina et al., 2020). The diagnosis of the Ascites in the patient discussed in the case study immediately need paracentesis to reduce the accumulation of the fluid and improve health status.
The removal of fluid by the paracentesis is performed lateral decubitus or supine position that is necessary to reduce the peritoneal fluid. The paracentesis not only decrease the abdominal pressure but it is also important to peritoneal fluid analysis for the diagnosis of the infectious agent. Paracentesis is considered to be the safe procedure but there are some complications thus health care professional should continuously monitor the patient before, during and after the process (Aponte & O'Rourke, 2020).
Moreover, another study presented by Chin (2018) describes that patient underlying the ascites is considered to be the indicator for the primary hepatocellular carcinoma. The patient newly diagnosed with the ascites should perform the paracentesis that is important to diagnose the liver disorder of the patient. Thus there is a need to improve the diagnosis of the patient suffering from the ascites to reduce the discomfort and improve the diagnosis (Lizaola et al., 2017).
The patient has recently diagnosed with the ascites and having discomfort need immediate paracentesis to improve the health status and assist in the diagnosis. The paracentesis will help to diagnosis the actual infectious agent causing the ascites that help in the treatment and is also helpful to reduce the discomfort that is important for patient current state.
Aponte, E. M., & O'Rourke, M. C. (2020). Paracentesis. StatPearls. Treasure Island, United Kingdom: StatPearls Publishing.
Chiejina, M., Kudaravalli, P., & Samant H. (2020). Ascites. StatPearls. Treasure Island, United Kingdom: StatPearls Publishing.
Chin M. A. (2018). EUS-guided paracentesis and ascitic fluid analysis. Endoscopic Ultrasound, 7(4), 223–227. https://doi.org/ https://doi.org/10.4103/eus.eus_31_18
Lizaola, B., Bonder, A., Trivedi, H. D., Tapper, E. B., & Cardenas, A. (2017). Review article: the diagnostic approach and current management of chylous ascites. Alimentary Pharmacology & Therapeutics, 46, 816–824. https://doi.org/10.1111/apt.14284
Sudulagunta, S. R., Sodalagunta, M. B., Bangalore Raja, S. K., Khorram, H., Sepehrar, M., & Noroozpour, Z. (2015). Clinical profile and complications of paracentesis in refractory ascites patients with cirrhosis. Gastroenterology Research, 8(3-4), 228–233. https://doi.org/ 10.14740/gr661w
The case study doesn’t specifically discuss any symptoms of the patient but there was a piece of information regarding the blood culture that reveals the presence of smear cell that is the sign of chronic lymphocytic leukemia. According to Jimenez Vera et al., (2019) blood flow cytometry is important to analyse the blood to evaluate the number of different cells. Peripheral blood flow cytometry is considered to be a reliable method to gain information about the health of the individual that is necessary for the diagnosis of the leukaemia or lymphoma. The blood flow cytometry is useful for evaluating the physical as well as cell antigen that is necessary to understand the current status. It evaluates the size, cytoplasm, DNA content and markers.
On the other hand, another article presented by Betters (2015) describes the quantifiable measurement system of the flow cytometry that is useful to understand the cell attributes. The peripheral blood flow cytometry is considered to be robust due to their four-layer systems that improve the evaluation process. It is necessary to detect the benign and malignant hematologic process that helps to improve the intervention for the patient. This is the best method that should be applied for the diagnosis purpose of the patient when it comes to chronic lymphocytic leukemia.
The reason behind choosing the blood flow cytometry for the diagnostic purpose concerning the leukaemia is due to its increased sensitivity toward the hematopoietic cells. The peripheral blood cytometry help to reveal about the cell type, cell lineage and cell maturation stage. These aspects are necessary to understand the status of the cell that is important for the diagnostic point of view. The increased efficiency of the blood flow cytometry is due to its combined system that is necessary for the working which includes fluids, optics and electronics (Aires et al., 2018).
Flow cytometry is one essential tool in the clinical immunology for the analysis of leukocyte subsets to evaluate the health and unhealthy cells. It is considered to be a powerful diagnostic tool that is utilized for different disorder by evaluating the intracellular and extracellular protein. The method is important to early diagnosis of leukemia that is necessary for the treatment process for the patient. The process of the flow cytometry is difficult as it requires extensive sample preparation for the evaluation process (Salzer et al., 2019).
The case study indicates that the patient health status indicates the chances for leukemia but there is need for the confirmation thus peripheral blood flow cytometry is necessary. The last-second section is important as per the case study to detect the presence of leukemia that is important for the treatment process.
Aires, A., Teixeira, M., & Lau, C. (2018). A pilot study on the usefulness of peripheral blood flow cytometry for the diagnosis of lower-risk myelodysplastic syndromes: the “MDS thermometer”. BMC Hematol, 18(6), 1-20. https://doi.org/10.1186/s12878-018-0101-8
Betters, D. M. (2015). Use of flow cytometry in clinical practice. Journal of the Advanced Practitioner in Oncology, 6(5), 435–440. https://doi.org/10.6004/jadpro.2015.6.5.4
Jimenez Vera, E., Chew, Y. V., Nicholson, L., Burns, H., Anderson, P., Chen, H. T., Williams, L., Keung, K., Zanjani, N. T., Dervish, S., Patrick, E., Wang, X. M., Yi, S., Hawthorne, W., Alexander, S., O'Connell, P. J., & Hu, M. (2019). Standardisation of flow cytometry for whole blood immunophenotyping of islet transplant and transplant clinical trial recipients. PloS one, 14(5), 1-28. https://doi.org/ 10.1371/journal.pone.0217163
Salzer, U., Sack, U., & Fuchs, I. (2019). Flow cytometry in the diagnosis and follow up of human primary immunodeficiencies. EJIFCC, 30(4), 407–422.
The Case study discusses the 70-year-old man having clinical manifestation like a swollen right calf, mild wheeze and shortness of breath. The case study indicates toward different factor that can be responsible for the prognosis of the pulmonary embolism but one of the major factors is the metastasis stage of cancer.
Pulmonary embolism can be provoked by the malignancy as it one of the factors concerning the prevalence of the pulmonary embolism. The obstructions of the pulmonary artery or its branches by a thrombus lead to the prognosis of the pulmonary embolism. The blockage of the lung artery leads to the symptoms that increase the breathing difficulty of the patient. The prognoses of the pulmonary embolism lead to the lung damage that occurs due to the restricted blood flow and restricted oxygen level (Morrone & Morrone, V. (2018). Different symptoms directly indicate the presence of the pulmonary embolism and they are considered to be the first diagnosis method. Some of the symptoms that are related to the pulmonary embolism are shortness of breath, rapid breathing, chest pain, cough and worsened breathing. Different other symptoms are uncovered after the physical examination important for the diagnosis of the pulmonary embolism. The persistent pulmonary embolism result in the lung infarction and small effusions that increase the complication for the patient (Ji et al., 2017). The case study discusses the patient symptoms that are related to the pulmonary embolism includes chest pain, shortness of breath, wheeze and fever. These symptoms indicate that the patient may have encountered the pulmonary embolism due to similarities of the signs and symptoms.
Different risk factors are related to pulmonary embolism and some of them related to the case study. The risk factor for the pulmonary embolism includes inactivity, surgery, cancer, chronic obstructive pulmonary disease and deep vein thrombosis. The intensity of the pulmonary embolism depends upon the size of the thrombus that divided it into three sections which are small, medium and massive. The pulmonary embolism needs to be immediately addressed as prolong increased dead space can increase lung damage that is harmful to the patient (Gjonbrataj et al., 2017). The patient has a medical history of cancer with the chronic obstructive pulmonary disease that is the two risk factors that can lead to the prognosis of the pulmonary embolism as per the case study.
It was also discussed in the study presented by Abdol Razak et al., (2018) by adding the fact that cancer patient mostly encounters the pulmonary embolism at the metastasis stage that increases the rate of mortality in the patient. The metastasis of cancer leads to the travelling of the thrombus from the main cancer site to the lung artery that leads to the blockage and deterioration of the lung activity. Thus patient having a past medical history of cancer with metastasis should be aware of the symptoms so that proper diagnosis can be done to initiate the treatment. Chemotherapy also increases the risk to encounter the pulmonary embolism that directly disturbs the breathing pattern which decreases the health status of the patient. The patient current chemotherapy session can also be one of the reasons behind the prevalence of the pulmonary embolism that is increasing the complication of the patient.
The case study and risk factors of the pulmonary embolism directly relate to each other and that is the reason behind choosing the second option as the patient is at metastasis state of cancer. The pulmonary embolism has directly impacted over the breathing system that increases that complication.
Abdol Razak, N. B., Jones, G., Bhandari, M., Berndt, M. C., & Metharom, P. (2018). Cancer-associated thrombosis: an overview of mechanisms, risk factors, and treatment. Cancers, 10(380), 1-21. https://doi.org/10.3390/cancers10100380
Gjonbrataj, E., Kim, J. N., Gjonbrataj, J., Jung, H. I., Kim, H. J., & Choi, W. I. (2017). Risk factors associated with provoked pulmonary embolism. The Korean Journal of Internal medicine, 32(1), 95–101. https://doi.org/10.3904/kjim.2015.118
Ji, Q., Wang, M., & Su, C. (2017). Clinical symptoms and related risk factors in pulmonary embolism patients and cluster analysis based on these symptoms. Sci Rep 7(14887), 1-9. https://doi.org/10.1038/s41598-017-14888-7
Morrone, D., & Morrone, V. (2018). Acute pulmonary embolism: focus on the clinical picture. Korean Circulation Journal, 48(5), 365–381. https://doi.org/10.4070/kcj.2017.0314
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