Pathophysiology wk 8 Assg Case Study Analysis
Introduction
This paper discusses the case study of a 58-year-old white man who presented with fever, chills, pain, and swelling of the right big toe that was of acute onset such that he could not put weight on his foot. On physical examination, he looks obese. On local examination, there is tenderness at the metatarsophalangeal joint. The patient is known to have hypertension and diabetes mellitus type 2. He is on hydrochlorothiazide 50mg once a day and metformin 500mg three times a day. His laboratory findings; the complete blood count is normal, ESR is elevated at 33mm/hr, C-reactive proteins at 24mg/l, uric acid is at 6.7mg/dl, and the metabolic panel is normal.Pathophysiology wk 8 Assg Case Study Analysis
Background Information
According to the presentations of the patient, the definitive diagnosis is gout. Gout is a metabolic disease that causes inflammation of the joints. It is more prevalent in African male patients between the ages of 30-70years. Causes of gout are categorized into primary causes and secondary causes. The primary cause is genetic predisposition, which is associated with hyperuricemia due to overproduction and an inability to excrete the uric acid. Secondary causes are due to reduced excretion of uric acid in kidney injury, dehydration, starvation, use of ethanol, and lead neuropathy (Singh et al, 2020). It is associated with comorbidities like hypertension, diabetes mellitus, kidney injury, hypercholesterolemia, hypertriglyceridemia, and anemia. Consumption of sweetened foods and foods rich in purines like kidney, liver, and meat extracts is associated with an increased risk of gout. Other causes are drugs like loop-diuretics pyrazinamide and low dose aspirin.
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Neurological and Musculoskeletal Pathophysiology
Gout is a metabolic disorder caused by the accumulation of uric acid and urea in the blood and tissues. When the tissues become oversaturated with uric acid and urea, they precipitate and form crystals. These crystals are usually deposited in the bone, skin, tissue, tendons, ligaments, and kidneys (Martinon et al, 2017). The monosodium urate crystals are usually insoluble in acidic conditions and low temperatures as it occurs in the peripheral joints such as the metatarsophalangeal joint of the big toe. The urate precipitates forming needle-like crystals that are mostly seen under a microscope. These crystals are usually in the synovial tissues and cartilage surfaces without causing inflammation of the joint. A gout attack is triggered by the release of urate crystals or precipitation of crystals in an oversaturated environment (McCance, 2019). Following an attack, inflammatory cytokines are produced which causes flare-ups that involve multiple joints.
Racial/Ethnic Variables Affecting Physiological Functioning
In a recent study in the U.S, the prevalence of gout is higher in Africans compared to Americans by 5% (Dehlin, et al 2019). Both whites and blacks have the locus for serum uric acid levels but it seems to be common among the minorities. Africans are more prevalent to have lifestyle diseases that are a gout risk. According to McCance (2019), they are hypertension, type 2 diabetes mellitus, and obesity. Other factors that increase the prevalence in blacks are low socioeconomic status, barriers to access health care, illiteracy on the causes and complications of gout, and non-adherence to medicine.Pathophysiology wk 8 Assg Case Study Analysis
How These Processes Interact to Affect the Patient
The inflammatory process in gout causes severe pain at the metatarsophalangeal of the big toe associated with tenderness, redness, and peeling of the skin. The pain is usually very severe such that the toe cannot bear any weight (Richette et al 2017). Other presentations are multiple joint pains, fever, chills are rigors. These symptoms affect the daily activities of the patient. Gout is an inflammatory disease caused by the accumulation of uric acid levels.
References
Dehlin, M., Jacobsson, L., & Roddy, E. (2020). Global epidemiology of gout: prevalence, incidence, treatment patterns, and risk factors. Nature Reviews Rheumatology, 1-11.
McCance, K. (2019). Pathophysiology: The Biologic Basis for Disease in Adults and Children, eighth edition. C.V. Mosby Co.
Singh, J. A., & Gaffo, A. (2020, June). Gout epidemiology and comorbidities. In Seminars in Arthritis and Rheumatism (Vol. 50, No. 3, pp. S11-S16). WB Saunders. Pathophysiology wk 8 Assg Case Study Analysis