Case Study 1: Alterations of the Endocrine Function

C.B. is a significantly overweight, 48-year-old woman from the Winnebago Indian tribe who had high blood sugar and cholesterol levels three years ago but did not follow up with a clinical diagnostic work-up. She had participated in the states annual health screening program and noticed that her fasting blood sugar was 141 and her cholesterol was 225. However, she felt perfectly fine at the time and could not afford any more medications. Except for a number of female infections, she has felt fine until recently. Today, she presents to the Indian Hospital general practitioner complaining that her left foot has been weak and numb for nearly three weeks and that the foot is difficult to flex. She denies any other weakness or numbness at this time. However, she reports that she has been very thirsty lately and gets up more often at night to urinate. She has attributed these symptoms to the extremely warm weather and drinking more water to keep hydrated. She has gained a total of 65 pounds since her last pregnancy 14 years ago, 15 pounds in the last 6 months alone.

Case Study Questions

Clinical signs are objective manifestations of a disease that can be identified by someone other than the patient. List a minimum of four signs from the case study above that support a diagnosis of type 2 diabetes in this patient.
Why do stress and infection promote hyperglycemia in patients with diabetes?
Why should medications other than glipizide or glyburide be considered for management of diabetes in this patient?

Case Study 2: Alterations of the Digestive Systems Function

R.H.  is a 74-year-old black woman, who presents to the family practice clinic for a scheduled appointment.  She complains of feeling bloated and constipated for the past month, some-times going an entire week with only one bowel movement. Until this episode, she has been very regular all of her life, having a bowel movement every day or every other day.  She reports straining most of the time and it often takes her 10 minutes at a minimum to initiate a bowel movement. Stools have been extremely hard. She denies pain during straining. A recent colonoscopy was negative for tumors or other lesions. She has not yet taken any medications to provide relief for her constipation. Furthermore, she reports frequent heartburn (34 times each week), most often occur-ring soon after retiring to bed. She uses three pillows to keep herself in a more upright position during sleep. On a friends advice, she purchased a package of over-the-counter aluminum hydroxide tablets to help relieve the heartburn. She has had some improvement since she began taking the medicine. She reports using naproxen as needed for arthritic pain her hands and knees.  She states that her hands and knees are extremely stiff when she rises in the morning. Because her arthritis has been getting worse, she has stopped taking her daily walks and now gets very little exercise.

Case Study Question

List a minimum of five risk factors that may be contributing to constipation.
List five clinical signs and symptoms that are consistent with constipation.
Why is anemia not a suspected complication of this condition?
Would a urinalysis, series of liver function tests, or serum uric acid level be appropriate for this patient?

Submission Instructions:

You must complete both case studies.
Your initial post should be at least 500 words per case study, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
All replies must be constructive and use literature where possible.
Please post your initial response by 23:59 Thursday, and comment on the posts of two classmates by 23:59 Sunday.
You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.