Mary the Nursing Student
Mary is 39 -year-old LPN and single mother who is attending a local community college to prepare for an A.S. degree in nursing so she can then become an RN. Mary has not been feeling well for several months. She has had bouts of nausea, a low fever, and has found that she no longer enjoys eating and smoking as much as she used to. She has also noticed that her urine is darker than usual and she has yellowing of her eyes. She has noted that she has a puffy appearance. Results of blood tests at her doctor’s office reveal that her ALT, AST , alkaline phosphatase, and bilirubin levels are elevated and that she also has an elevated count of lymphocytes. Further tests reveal that she is positive for the presence of the anti-HCV in her blood. Biopsy reveals necrosis, fibrosis, and cirrhosis.
What is Mary’s diagnosis? Discuss the different ways that she might have acquired this illness. Based on the information above, in what stage of illness is Mary? Mary’s diagnosis is Hepatitis C. This illness is acquired by blood-to-blood contact in most cases. In some cases its through the sharing of needles also known as intravenous. In, addition, one may receive a blood transfusion with infected blood or be exposed to improperly sterilized surgical equipment. Other ways she could have been exposed are through sexual intercourse, sharing personal items, or she could have inherited it. Based on the information given and the presence of necrosis, fibrosis, and cirrhosis she is more than likely in stage IV.
What organ is being attacked? Describe this organ’s role in carbohydrate, lipid (including triglyceride and cholesterol), and protein metabolism.
Her liver is being attacked.
With carbohydrate metabolism sugars enter the liver from the small intestine via the hepatic portal vein. The liver maintains the blood glucose level at about 90 mg glucose per 100cm3 of blood. Initiated by insulin, the liver converts all sugars to glucose and stores them as glycogen through the process of glycogenesis. While the process of breaking glucose back down is called glycogenolysis and stimulated by glucagon. This function of the liver is key in maintaing homeostasis of the blood glucose level of 60 mg glucose per 100cm3 of blood. It can also be broken down in times of danger, stress, and drop in body temp. Page 894 text
In protein metabolism there are many processes involved: Deamination, urea formation, transamination, and plasma protein synthesis.
Deamination is the process that gets the amino acid ready for breakdown in the citric acid cycle. It is the removal of a hydrogen atom and an amino group where it produces NH4+. This Ammonium ion is used by enzymes to synthesize urea. In the liver excess amino acids are removed from the bloodstream to synthesize proteins where hepatocytes synthesize and release most of the plasma proteins. These proteins include albumins, transport proteins, clotting proteins, and complement proteins and are used in various areas of the body as needed. page 933
In lipid metabolism the liver regulates circulating levels of triglycerides, fatty acids, and cholesterol. Anytime the levels of any of these decline the liver breaks down what it has in storage into the bloodstream and likewise if the levels are increased then they are stored.
What impact does the illness have on the endocrine system? Include the impact on the renin-angiotensin mechanism, growth hormone, pancreatic hormones, thyroid hormones, and steroid hormones.
An enzyme/hormone called renin causes a cascade system called renin-angiotensin. This enzyme converts angiotensin to angiotensin I which eventually assist in stimulation of angiotensin II---> aldosterone and ADH --> restricts salt and water loss by the kidneys. Angiotensin II also stimulates thirst and elevates blood pressure.
Growth hormone is produced and used in the absorptive and post absorptive states in the GI tract. If hormones...
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