Case Study for Sara Smith

Case Study for Sara Smith

List your differentials for her current problems

The patient has an elevated level of blood sugar, indicating DMII. The possible diseases for this condition are abdominal obesity, type 1 diabetes, and Pancreatic cancer. Diabetes mellitus type 2 is characterized by insulin resistance and can cause a fasting plasma glucose that records 126mg/dl or higher. It is also characterized by random plasma glucose that records 200mg/dl and 2-hour plasma glucose that records 200mg/dl. Type 1 diabetes is a disease that develops in childhood and can also develop in adults. It involves the pancreas producing less or no insulin. It causes high blood sugar in the body.

Abdominal obesity could also cause high blood pressure. This is caused by the high about of fat deposited in the abdominal part of the body, causing metabolic complications such as glucose intolerance and insulin resistance. Abdominal obesity could also be caused by excessive intake of alcohol, which the patient claims to be taking. Pancreatic cancer, on the other end, can cause the malfunctioning o the pancreas. The cancer cells cause destruction to the insulin-making cells. Insulin is produced in limited bits and is unable to control the sugar levels in the blood.

Wheezing can be caused by either asthma chronic obstructive pulmonary disease or lung cancer. COPD causes inflammation to the airways preventing enough air from entering the air pipes, and this causes difficulty in breathing. Asthma also causes wheezing by preventing the airpipes from taking in enough air. Lung cancer affects the ability of lungs to function appropriately, causing air shortage and wheezing.

Slowly healing wounds with smelly discharge would also be a sign of diabetes type 1 and 2 and infections. Infections involve bacteria proliferation in a wound, causing it to discharge a smelly discharge. Both diabetes and diabetes II are also associated with wounds that slowly heal.

At this time, what medical diagnoses are you most concerned about? Do they impact other diagnoses?

I am mostly concerned with pancreatic cancer and abdominal obesity. Pancreatic cancer is connected with the other diabetes type 1 and type 2 because diabetes is caused by a lack of enough insulin to regulate blood sugars. The patient was previously diagnosed with DM II, which might have progressed to pancreatic cancer. Abdominal obesity is also connected to other diseases. Obesity can cause a person to develop insulin resistance, and increases exposes one to the chances of developing DM II. Obesity causes a lot of fat to be stored in the lower part of the abdomen and may affect the proper functioning of the breathing system. The fats compresses the diaphragm, lungs, and the chest cavity. It could lead to pulmonary damage. When the fats are in excess, they increase pulmonary resistance by reducing the strength of the respiratory muscle. Also, fat can clog on the airways and on the lung walls. This may lead to wheezing or wheezing.

What diagnostic images would you order? Provide your rationale. What are you trying to rule in or out?

I would order magnetic resonance imaging for both the pancreas and the lower abdomen. The MRI will show images for the pancreas and the bile ducts. Here, it can show if there are any tumors that have formed in the pancreas. MRI will also help show the pancreatic cysts and any presence of blockages in the bile ducts. If these features are present, then the patient is suffering from a pancreatic duct, but if not, this option is overruled.  The second MRI for the lower abdomen will help to analyze the concentration n of fats with the absence of ionizing radiation. It measures the fat levels in the body organs, abdomen, and on the skin. If the fats are found to be high, then the patient is likely suffering from obesity. I am trying to rule in the possibility of the patient having obesity instead of pancreatic cancer.

What laboratory work would you order? What would you anticipate to be abnormal? Provide your rationale for each.

For pancreatic cancer, I would order blood tests and biopsy. Biopsy will include removing a tissue sample for examination and can detect cancer cells in the pancreas. Blood tests will test the blood for certain proteins that are produced by pancreatic cancer cells, which are tumor markers. This will unveil if the patient is suffering from cancer or not. For abdominal obesity, lab tests will include calculation of BMI, blood tests, level stress, measuring absolute waist circumference, waist-hip ratio, and sagittal abdominal diameter. These measurements show if the abdomen has stored too many fats that is should. The patient will also undergo a general physical examination, including heart rate, blood pressure, the functioning of the heart and the lungs, and weight. Increased heart rate and blood pressure would also confirm obesity since the heart is working harder to pump blood throughout the body. Obesity affects the normal functioning of the heart and lungs as fats could be stored in the airways, causing wheezing and the heart to murmur. The calculation of BMI also shows if one is obese. A BMI of 30 or higher will show that the patient is obese. In these tests, I hope to eliminate pancreatic cancer.

What is your comprehensive plan of care?

The treatment plan’s goals will be to change the patient’s lifestyle. Firstly, I will aim at encouraging the patient to reduce weight 250lbs is not a healthy weight. Losing weight will exercises and good eating habits. Dietary changes will involve eating foods that contain fewer calories, avoiding foods that have excessive fats. The patient will also undergo behavior therapy to address issues of overheating or coping with stress in a healthy way—support groups for weight loss. The patient can also be offered insulin, increasing drugs to reduce the blood sugars. Antibiotics such as amoxicillin can also be administered to treat the wound.

References

Mayo Clinic. (n.d). Obesity. Retrieved from https://www.mayoclinic.org/diseases-conditions/obesity/diagnosis-treatment/drc-20375749

Mayo Clinic. (n.d). Pancreatic Cancer. Retrieved from https://www.mayoclinic.org/diseases-conditions/pancreatic-cancer/diagnosis-treatment/drc-20355427

Ohio State University. (n.d). Diabetes Mellitus Type 2. Retrieved from https://u.osu.edu/diabetestype2/differential-diagnosis/

Medical News Today. (n.d). What’s the difference between Expiratory and inspiratory Wheezing. Retrieved from https://www.medicalnewstoday.com/articles/325370#diagnosis

Mayo Clinic. (n.d). Obesity. Retrieved from https://www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742