Advanced pathophysiology

Assignment (1- to 2-page case study analysis)

case study:

42-year-old man presents to ED with 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, respirations 24. PaO2 96% on room air. Digital rectal exam (DRE) reveals the prostate to be enlarged, extremely tender, swollen, and warm to touch.

Please respond only to the prompts or questions relating to this case. For example, the anemia prompts do not correlate with this case.

In your Case Study Analysis related to the scenario provided, explain the following:

· The factors that affect fertility (STDs).

· Why inflammatory markers rise in STD/PID.

· Why prostatitis and infection happens. Also explain the causes of systemic reaction.

· Why a patient would need a splenectomy after a diagnosis of ITP.

· Anemia and the different kinds of anemia (i.e., micro and macrocytic)

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references.

ANSWER

1) STDs can also affect male infertility. Most frequently, the presence of dysuria reflects a urogenital infection such as urethritis, prostatitis, epididymitis, or urinary tract infection. Chlamydia, when left untreated, may spread to the testicles from the urethra, causing permanent sterility and disability. Pelvic inflammatory disease (PID) is a common STD that affects fertility. Many chlamydia and gonorrhea cases left untreated can lead to PID.

2) The inflammatory markers rise in prostatitis may be triggered by different molecular pathways of the immune system, which are dysregulated secondarily to different factors: infectious bacterial agents, viruses, or other sexually transmitted microorganisms, urinary reflux, aging, dietary factors, hormones, autoimmune response.

3) Prostatitis can be caused by bacteria that leak into the prostate gland from the urinary tract (the most common bacterial cause) and from direct extension or lymphatic spread from the rectum. It can also result from various sexually transmitted organisms such as Neisseria gonorrhoeae, Chlamydia trachomatis, or HIV. Acute bacterial prostatitis is often caused by common strains of bacteria. The infection can start when bacteria in urine leak into your prostate. Antibiotics are used to treat the infection.

4) There are four types of prostatitis;

· Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) - It is characterized by an inflammation of the prostate and an irritation of the nerves which supply this area. 

· Chronic Bacterial Prostatitis- This is an uncommon type of bacterial protatitis that requires a urine and prostate fluid culture to verify this as present.

· Acute (Sudden) Bacterial Prostatitis- This is also an uncommon type of bacterial prostatitis which requires a urine test to see if there are any bacteria. Symptoms for this problem are sudden and can be painful. 

· Asymptomatic Inflammatory Prostatitis- This is an inflammation of the prostate but does not cause symptoms.

5) According to researchers, the pathophysiology of prostatitis is described by an infection ascending from the urethra, chemical damage caused by the reflux of urine through the ejaculatory and prostatic ducts and autoimmune involvement are a few possible theories related to the pathogenesis of various types of prostatitis. Chronic prostatitis/chronic pelvic pain syndrome is thought to be caused by an abnormality in the hypothalamic-pituitary-adrenal axis and hormonal derangements involving the adrenocortical hormone that can stem from variable response to stress, neurogenic inflammation, and myofascial pain syndrome. On microscopic examination, neutrophils or lymphocytes can be seen inside the prostate gland, among the cells of the epithelium or inside the stromal component of the gland.