CASE STUDY ANALYSIS

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Women’s and Men’s Health, Infections, and Hematologic disorders: Case Study Analysis

Grace Masioge

Master of Science in Nursing, Walden University

NURS 6501: Advanced Pathophysiology

Dr. Rutherford

May 9th, 2022

Women’s and Men’s Health, Infections, and Hematologic disorders: Case Study Analysis

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Scenario

A 42-year-old man presents to ED with a 2-day history of dysuria, low back pain, inability

to fully empty his bladder, severe perineal pain along with fevers and chills. He says the

pain is worse when he stands up and is somewhat relieved when he lies down, vital signs T

104.0 F, pulse 138, R 24, PaO2 96% on room air. Digital rectal exam (DRE) reveals the

prostate to be enlarged extremely tender, swollen, and warm to touch.

Introduction

Prostate is a male reproductive gland that makes and produces the fluid for semen which protects

and energizes the sperm during ejaculation. The gland surrounds the urethra, a tube through

which urine is expelled out of the body. Enlargement of the prostate gland is associated with

inflammation which applies pressure on the urethra causing pain, redness, and swollen tissues

leading to difficult urination and all other kinds of urination problems. Most common problems

include trouble beginning to urinate, dribbling, and lack of complete emptying of the bladder.

Incomplete emptying of the bladder may lead to infection, cause extra bathroom trips, especially

at night, and even potential loss of bladder control. The patient in the scenario will be diagnosed

with prostatitis, an ascending infection or inflammation of the prostate with multiple causes, and

closely associated with urinary tract and sexually transmitted infections, present in 4 to 36% of

the general male population and increasing to 50% in older men (Curry et al 2019).

Pathophysiology of Prostatitis

According to McCance and Huether (2019), Prostatitis is an inflammation usually limited to a

few glands’ excretory ducts with syndromes classified by the National Institutes of Health as

acute bacterial prostatitis (ABP), chronic bacterial prostatitis (CBP), chronic pelvic pain

syndrome (CPPS), and asymptomatic inflammatory prostatitis (AIP). Prostatitis is caused by

bacteria organisms such as E. coli, klebsiella species, P. aeruginosa, Serratia species, the

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common gram-negative cultured microorganisms, and or various sexually transmitted organisms

such as Neisseria gonorrhoeae, chlamydia trachomatis, and HIV. ABP is caused by common

strains of bacteria, where the infection starts when bacteria in the urine leak into the prostate

glands and are treated with antibiotics. Nonbacterial infections caused by cascade of

inflammatory, immunologic, neuroendocrine, and neuropathic mechanisms, are treated with

warm sitz baths, muscle relaxants, and anti-inflammatory or anxiolytics drugs.

Factors that affect fertility (STDs)

Prostatitis is caused by either urinary tract infections (UTIs), infections bacterial such as E; coli

or sexually transmitted infections (STIs). STIs cause most PID cases including bacterial

vaginosis and a group of infectious processes that damage the endometrium, fallopian tubes,

ovaries, and pelvic peritoneum (Curry et al 2019). The most common STDs causing ABP are

chlamydia and gonorrhea. Chlamydia or gonorrhea are bacterial infections which enters the

reproductive system leading to PID a disease that causes scarring of the cervix, vagina, ovaries,

fallopian tubes, the uterus, and other surrounding tubes causing sterility. AIP and CBP induces

sperms to mix with white blood cells (WBCs) affecting the fertility of an individual. Park et al

(2017) research shows that when WBCs establish in the prostate secretions, it inhibits the

function of the sperms making them sterile. In the research according to Park et al (2017),

chlamydia infection in PID is associated with serious complications including ectopic pregnancy,

tubal infertility, Fitz-Hugh-Curtis syndrome, and tubo-ovarian abscess (TOA)

Why inflammatory markers rise in STD/PID

Inflammation is the body’s innate response to injury or insult, including infection, trauma,

surgery, burns, and cancer (Andriole 2020). Inflammatory markers known for prostatitis and

STD/PID are indicated by C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)

abundance in the blood. Bacterium STDs have local and systemic manifestations causing

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inflammatory markers to be released into the bloodstream during inflammation. The research

according to Park et al (2017) shows that, ESR, CRP, and CA-125 level were higher in

chlamydia patients therefore, Chlamydia infection in acute PID is associated with increased

levels of inflammatory markers, such as CA-125, ESR and CRP, incidence of TOA, operation

risk, and longer hospitalization. The markers are elevated because the body reacts to the

infection which triggers CRP and fix itself both in macrophages and bacterial triggering

complement system (McCance & Huether 2019).

Why prostatitis and infection happen. And the causes of systemic reaction

Prostatitis is caused by the common strains of bacteria ascending from other parts of the urinary

tract or reproductive systems, which tend to occur in men between 30 and 50 years of age. The

bacteria in ABP causes systemic infection where the lymph nodes enlarge and become tender

because lymphocytes proliferate with symptoms such as malaise, fever, chills, and myalgia with

generalized sepsis syndrome characterized by hypotension, tachycardia, and tachypnea. The

bacteria cause infection, inflammation, and pain, changing the inflammatory marker proteins in

the blood. Andriole (2020) research states that, “when the markers increase or decrease by at

least 25%, they can be used as systemic inflammatory markers”. Systemic reactions can be

caused by bacterial infection of the blood also known as bacteremia, Inflammation of the coiled

tube attached to the epididymitis, the Pus-filled cavity in the prostate also known as prostatic

abscess, and the infection that spreads to the upper pelvic bone or lower spine (Mayo Clinic).

Conclusion

The leading cause of prostatitis is the infection from the urinary tract and reproductive systems

which also cause PID cases. The cost of having PID according to Curry et al (2019) research has

been estimated at $1,995 per patient, and approximately one in six women with salpingitis

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develops infertility. In the same research Curry et al indicates that, approximately 15% of

untreated chlamydial infections progress to PID and higher with gonococcal infections.

Inflammatory consequences such as infertility, ectopic pregnancy, and chronic pelvic pain result

from delayed diagnosis of PID. Untreated PID cause permanent damage which results into

infertility.

References

Andriole (2020). “Prostatitis - Genitourinary Disorders.” Merck Manuals Professional Edition, 8

Nov. 2020, www.merckmanuals.com/professional/genitourinary-disorders/benign-

prostate-disease/prostatitis.

Curry et al (2019). “Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention.”

American Family Physician, vol. 100, no. 6, 2019, pp. 357–364,

www.aafp.org/afp/2019/0915/p357.html.

Mayo Clinic. “Prostatitis - Symptoms and Causes.” Mayo Clinic, 2018,

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www.mayoclinic.org/diseases-conditions/prostatitis/symptoms-causes/syc-20355766.

McCance, K. L., & Huether, S. E. (2019). Pathophysiology: the biologic basis for disease adult

and children (8t ed). St. Louis, MO: Mosby/Elsevier

Park et al (2017). “Clinical Characteristics of Genital Chlamydia Infection in Pelvic

Inflammatory Disease.” BMC Women’s Health, vol. 17, no. 1, 13 Jan. 2017,

Zhang et al (2020). Voiding Dysfunction in Old Male Rats Associated with Enlarged Prostate

and Irregular Afferent-Triggered Reflex Responses. International Neurourology

Journal, 24(3), 258–269. https://doi.org/10.5213/inj.2040114.057

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