[ANSWERED] A 32-year-old female presents to the ED with

Our learning objectives for the week are to:

•     Analyze concepts and principles of pathophysiology across the life span

•     Analyze processes related to women’s and men’s health, infections, and hematologic disorders

•     Identify racial/ethnic variables that may impact physiological functioning

•     Evaluate the impact of patient characteristics on disorders and altered physiology

A 32-year-old female presents to the ED with a chief complaint of fever chills nausea vomiting and vaginal discharge. She states these symptoms started about 3 days ago, but she thought she had the flu. She has begun to have LLQ pain and notes bilateral lower back pain. She denies dysuria, foul-smelling urine, or frequency. States she is married and has sexual intercourse with her husband. PMH negative.

Labs: CBC-WBC 18, Hgb 16, Hct 44, Plat 325, ¬ Neuts & Lymphs, sed rate 46 mm/hr, C-reactive protein 67 mg/L CMP wnl

Vital signs T 103.2 F Pulse 120 Resp 22 and PaO2

99% on room air. Cardio-respiratory exam WNL with the exception of tachycardia but no murmurs, rubs, clicks, or gallops. Abdominal exam + for LLQ pain on deep palpation but no rebound or rigidity. Pelvic exam demonstrates copious foul-smelling green drainage with reddened cervix and + bilateral adenexal tenderness. + chandelier sign. Wet prep in ER + clue cells and gram stain in ER + gram negative diplococci.

In your Case Study Analysis related to the scenario provided, explain the following:

• The factors that affect fertility (STDs).

• Why inflammatory markers rise in STD/PID.

• Why prostatitis and infection happens. Also explain the causes of systemic reaction.

• Why a patient would need a splenectomy after a diagnosis of ITP.

• Anemia and the different kinds of anemia (i.e., micro and macrocytic).

Submit your Case Study Analysis Assignment by Day 7 of Week 10

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Expert Answer and Explanation

The factors that affect fertility (STDs)

            The fertility of an individual is their success rate in their attempts to get pregnant or impregnate another person. The common factors that affect infertility rate include age, the frequency of sexual intercourse, and also the timing for the same. Some lifestyle factors that could affect fertility include weight, alcohol, recreational drugs, and caffeine (Pedro et al., 2018). Another factor that is rarely discussed is medical conditions which range from vitamin D deficiency, thyroid disease, and STDs. Regarding STDs, gonorrhea and chlamydia have a development process in which they cause pelvic inflammatory disease, leading to inflammation and blockage of the fallopian tubes and other organs, which prevent the travelling of the egg from the ovaries to the uterus, hence causing infertility (Pedro et al., 2018). For the 32 y.o. female patient who presents to the facility, it is evident from the symptoms that she has a sexually transmitted disease, and that she could be a candidate for infertility.

Why inflammatory markers rise in STD/PID

            Inflammatory markers are used to detect the presence and extent of inflammations. One of these is the C Reactive protein (CRP), which is normally present in the body at regular amounts but in increased amounts on the sight of an inflammation (Safrai et al., 2020). During Pelvic Inflammatory Disease (PID), inflammations spread from the cervical region to the uterus and upper reproductive system, which causes an ultimate increase in the levels of CRP (Safrai et al., 2020). However, this should not be the only way to diagnose an STD as the levels could be as a result of many other body inflammation or other factors.

Why prostatitis and infection happens and the causes of systemic reaction

            Prostatitis occurs when the prostate region including the groin is inflamed, leading to symptoms such as a difficulty in urination (Condorelli et al., 2017). The common causes of the systemic reaction is a leakage of bacteria from urine to the prostate region. Treatment is usually done using antibiotics such as trimethoprim-sulfamethoxazole (Condorelli et al., 2017).

Why a patient would need a splenectomy after a diagnosis of ITP

            Idiopatic thrombocytopenic purpura (ITP) is a condition of the blood tissues in which the body is not able to efficiently manage the clotting process of blood. It often results from the absence of a sufficient number of platelets in the blood, possibly following an immune attack, and can lead to excessive bleeding and loss of blood by patients. Compared to other therapies on ITP patients, splenectomy is the most effective as it works by removing the platelet clearance primary site, giving a success rate of up to 70% (Worrest et al., 2020).

Anemia and the different kinds of anemia (i.e., micro and macrocytic)

            Anemia is when the body had RBCs that are fewer than the standard recommended levels, making it hard for the process of transporting oxygen to different parts of the body. When differentiating microcytic from macrocytic anemia, the primary factors that are assessed is the size of the RBCs. Microcytic anemia patients have RBCs that are smaller than the standard normal size while macrocytic patients have RBCs that are too large, mostly due to the absence of sufficient amount of folate and vitamin B-12 (Oliveira et al., 2018). These specific types have further classifications based on the course of presentation in the patient.

References

Condorelli, R. A., Russo, G. I., Calogero, A. E., Morgia, G., & La Vignera, S. (2017). Chronic prostatitis and its detrimental impact on sperm parameters: a systematic review and meta-analysis. Journal of endocrinological investigation, 40(11), 1209-1218. https://doi.org/10.1007/s40618-017-0684-0

Oliveira, D. C., Nogueira-Pedro, A., Santos, E. W., Hastreiter, A., Silva, G. B., Borelli, P., & Fock, R. A. (2018). A review of select minerals influencing the haematopoietic process. Nutrition research reviews, 31(2), 267-280. DOI: 10.1017/S0954422418000112

Pedro, J., Brandão, T., Schmidt, L., Costa, M. E., & Martins, M. V. (2018). What do people know about fertility? A systematic review on fertility awareness and its associated factors. Upsala journal of medical sciences, 123(2), 71-81. https://doi.org/10.1080/03009734.2018.1480186

Safrai, M., Rottenstreich, A., Shushan, A., Gilad, R., Benshushan, A., & Levin, G. (2020). Risk factors for recurrent pelvic inflammatory disease. European Journal of Obstetrics & Gynecology and Reproductive Biology, 244, 40-44. https://doi.org/10.1016/j.ejogrb.2019.11.004

Worrest, T., Cunningham, A., Dewey, E., Deloughery, T. G., Gilbert, E., Sheppard, B. C., & Fischer, L. E. (2020). Immune thrombocytopenic purpura splenectomy in the context of new medical therapies. Journal of Surgical Research, 245, 643-648. https://doi.org/10.1016/j.jss.2019.06.092

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