Advanced pathophysiology

case study

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.

Running head: case study analysis 1

case study analysis 8

Prostatitis is a clinical condition that causes the presence of inflammation of excretory ducts of the prostate gland.

There are four clinical variants of prostatitis syndrome identified as (1) asymptomatic inflammatory prostatitis, (2) chronic pelvic pain syndrome, (3) chronic bacterial prostatitis (CBP), and (4) acute bacterial prostatitis (ABP). Enterococci species, as well as gram-negative Enterobacteriaceae are the known causes for CBP and ABP. It has been noted that E-coli can be linked to primary cause of infections associated with the gram-negative cultured microorganisms such as P-euroginos, Serratia species, and Klebsiella species (McCance & Huether, 2018). The most common diagnosis of bacterial prostatitis is that of a urinary tract infection. Upon onset patient often exhibits low back perineal pain, fevers, and chills. Most patients develop some level of dysuria. Occasionally patients may experience lower urinary tract obstruction characterized by constricted urinary stream that requires medical intervention. Upon standing patient experiences pain due to pelvic muscle contraction. Palpitation of prostate often will reveal enlarged gland that is hard and warm to the touch (McCance & Huether, 2018).

STD’s Impact on Fertility

ABP in often linked to sexually transmitted diseases, or urinary tract infections. Acute prostatitis is reflected in an inflammation of the prostate gland located just beneath the bladder in men. The fertility of an individual can be affected by both chronic prostatitis and asymptomatic inflammatory prostatitis that results in sperm being mixed with white blood cells, however, it should be noted that this condition is not associated with chronic pelvic pain. Medical research has shown that the function of the sperm; subsequently impacting the quality of the sperm, and resulting in infertility in males (Iliades et al., 2011).

Rise in Inflammatory Markers

High levels of C-reactive protein (CRP) in the blood is an indicator of inflammation. The natural body response to an injury or infection is through the development of inflammation. As the body responds the level of pro-inflammatory, as well as CRP, and cytokine increase levels. According to information provided by McCance and Huether (2018), CRP affixes itself in macrophages, as well as via bacteria in the complementary system. Factors which are causally related to STD’s are linked especially to mycoplasma genitalium and chlamydia trachomatis, both which subsequently are linked to chronic bacterial prostatitis. It has been proposed that the use of molecular techniques to establish the presence of STD’s contribute to infertility in both the infected individual and subsequent sexual partners (Magri et al, 2018).

Prostatitis – Causes of Systematic Reaction

Inflammation linked to prostatitis is an essential facet of prostatic growth and has been linked as an indicator in the presence of advanced prostatitis and that of benign prostatic hyperplasia (BPH). If a patient fails to address the concerns and have proper medical management of the condition this can lead to acute chronic neuro-inflammation, which has been linked to affecting the nervous, and immune systems (Magri, 2018). Patients who have medical history of clinical chronic prostatitis are often lined as being predisposed to future developments of prostate cancer.

Splenectomy After Diagnosis of ITP

In the case of ITP, the spleen is linked to the destruction of platelets due to the antibodies which are coating platelet cells. Splenectomy is a treatment method that could raise the platelet counts and to mitigate the elimination of cells which are in circulation. Some studies have shown that the spleen can be a site related to antibody production there fore the removal of the spleen can decrease the production of anti-platelet antibodies. Splenectomies however are only recommended in severe circumstances, as there is medical research which has linked this procedure to increased risk of infection, as well as thrombosis (Magri, 2018).

Different Forms of Anemia

Anemia is a medical condition wherein there is not sufficient levels of red blood cells to deliver adequate oxygen to the body cells. Often classified under three general kinds: microcytic, macrocytic, and normocytic. The classification is based upon the size and hemoglobin content within the red blood cells. Microcytic is when red blood cells are smaller than normal, they often contain lower levels of oxygen. This form of anemia is often caused by iron deficiency, thalassemia, and pregnancy. Normocytic anemia is where red blood cells are oversized and is linked to chronic conditions. This form is linked to kidney disease, cancer, and chronic inflammatory disease. Macrocytic anemia is condition where red blood cell is larger, yet hemoglobin content is normal. This is often linked to vitamin B12, and folate deficiencies. (McCance & Huether, 2018).

Conclusion

Based on an assessment of the case study details provided the patient’s condition can be diagnosed as acute bacterial prostatitis. This condition is an excretory inflammation duct of the prostate glands. This condition is most associated with the presence of a urinary tract infection and characterized by a constricted urinary stream. Patients who are experiencing UTI exhibit symptoms such as fever, chills, lower back perineal pain, and subsequent development of dysuria. Treatment of ABP is crucial as when not treated properly can lead to infertility.

References

McCance, K. L., & Huether, S. E. (2018). Pathophysiology-E-book: the biologic basis for disease in adults and children. Elsevier Health Sciences.

Iliades, B. C., Levine, B., Divina, D., Alkon, C., Dunleavy, B. P., & Robinson, K. (2011.). Chronic Prostatitis and Fertility – Men’s Health Center – Everyday Health. Retrieved from https://www.everydayhealth.com/mens-health/chronic-prostatitis-and-fertility.aspx

Magri, V., Boltri, M., Cai, T., Colombo, R., Cuzzocrea, S., De Visschere, P., … & Leli, C. (2018). Multidisciplinary approach to prostatitis. 90(4), 227-248.

Prostatitis-Men’s Health

A 42-year-old male arrives at the Emergency Department with a two-day complaint of dysuria, lower back pain, unable to fully empty his bladder, perineal pain, fever, and chills. The patient also explains the pain worsens when he stands up, but decreases when lying down. Vital signs show the patient to be febrile with a temperature of 104°F, tachycardic with a pulse rate of 138 bpm, and tachypneic with a respiration rate of 24. The digital rectal exam (DRE) reveals the prostate to be enlarged, incredibly tender, swollen, and warm to touch. The patient is diagnosed with acute bacterial prostatitis (ABP). The purpose of this paper is to explore the pathophysiology, system reaction of prostatitis, and its effect on male fertility.

Pathophysiology/System Reaction

Prostatitis is an inflammation of the prostate. Some degree of inflammation of the prostate is present in 4% to 36% of the male population, increasing to 50% in older men (McCance & Huether, 2019). Prostatitis can be classified into four categories; acute bacterial prostatitis (ABP), chronic bacterial prostatitis (CBP), chronic pelvic pain syndrome, and nonbacterial prostatitis (McCance & Huether, 2019). ABP and CBP are caused mostly by gram-negative Enterobacteriaceae and Enterococci species, which originate in the gastrointestinal flora (McCance & Huether, 2019). The most common microorganism is E. Coli. The organisms responsible for sexually transmitted diseases that can cause prostatic infection includes; Neisseria gonorrhea, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Trichomonas vaginalis, and Gardnerella vaginalis (Paulis, 2018). In the scenario, the patient complains of dysuria, lower back pain, inability to entirely empty bladder, perineal pain, fever, and chills. Upon the digital rectal exam revealed an enlarged, tender, swollen, and warm prostate. The patient is exemplifying signs and symptoms of acute bacterial prostatitis. ABP is an ascending infection of the urinary tract that tends to occur in men between the ages of 30 and 50 years old (McCance & Huether, 2019). Clinical manifestations of ABP are similar to those with a urinary tract infection or pyelonephritis (McCance & Huether, 2019). The infection stimulates an inflammatory response in which the prostate becomes enlarged, tender, firm, or boggy (McCance & Huether, 2019). Other symptoms include malaise, low back pain, perineal pain, high fever, chills, dysuria, inability to empty bladder, nocturia, and urinary retention (McCance & Huether, 2019). The patient’s pain worsens in an upright position because the pelvic floor muscles tighten with standing, and the prostate gland is compressed (McCance & Huether, 2019).

Why does prostatitis happen?

Unfortunately, the cause of prostatitis in men is still a mystery. However, certain factors can increase the chances of prostatitis, such as dehydration, catheterization, cystoscopy, recent bladder infection, and the presence of a sexually transmitted disease (STD) (Paulis, 2018). A healthcare provider should educate the patient on ways to decrease the risks of prostatitis. Preventative measures include remaining hydrated by drinking water, practicing good perineal hygiene to reduce infection, reducing caffeine intake to avoid irritating the prostate, practicing safe sex, proper dieting, and maintaining a healthy weight. Adequate knowledge of prostatitis, including the causes and preventative factors can help decrease the chances of the patient having a recurrent infection.

How does prostatitis affect fertility?

The relationship between chronic prostatitis and fertility has been controversial for many years. Yet, prostatitis is one of the most prevalent healthcare problems in urology practice in adult males younger than 50 years old and the third most frequent urologic diagnosis in men more aged than 50 years old (Paulis, 2018). Prostatitis is considered among the most poorly understood medical problems but has been linked with male infertility. The volume of prostatic secretions is known to diminish during male sex gland infections (Alshahrani, McGill, & Agarwal, 2015). Prostatitis has been linked with decreased prostatic excretory function, including decreases in citric acid, alpha-glucosidase, fructose, and zinc secretions (Alshahrani, McGill, & Agarwal, 2015). These factors play significant roles in prostate function, from enzyme activity to sperm motility (Alshahrani, McGill, & Agarwal, 2015). Although decreased semen volume can negatively affect male infertility, the mechanism of glandular secretory dysfunction in prostatitis and the effects of lower concentrations of prostatic enzymes and trace elements remain unclear (Alshahrani, McGill, & Agarwal, 2015).

Another factor that plays a role in prostatitis and infertility is oxidative stress. Oxidative stress is an excess of reactive oxygen species (ROS) coupled with decreased total antioxidant capacity (Biotech Week, 2018). Seminal ROS are thought to originate predominantly from leukocytes and partially from sperm themselves (Biotech Week, 2018). ROS is produced by leukocytes in response to stimuli such as infection or inflammation (Biotech Week, 2018). High levels of ROS can lead to damage of cell membranes, intracellular proteins, organelles, and sperm DNA (Biotech Week, 2018). ROS produced by activated seminal leukocytes during genitourinary inflammation has been correlated with impairment of sperm motility and metabolism (Biotech Week, 2018). Also, increased oxidative stress affects the sperm chromatin integrity and may lead to sperm DNA damage (Paulis, 2018). Furthermore, increased ROS levels are associated with leukocytospermia (Paulis, 2018).

Summary

Prostatitis is an infection that can affect men of all ages. Not only can prostatitis affect a man’s daily life but also fertility. Prevention of prostatitis involves making a number of lifestyle and dietary changes towards maintaining a healthy prostate. The prostate plays a crucial role in the male reproductive system. As healthcare providers, it is important to assess patients thoroughly and educate them on modifiable risk factors to decrease the risk of prostatitis, which can play a negative role in procreation.

References

Alshahrani, S., McGill, J., & Agarwal, A. (2015). Prostatitis and male infertility. Journal of Reproductive Immunology, 100(1), 30-36. Retrieved from http://www.clevelandclinic.org/reproductiveresearchcenter/docs/agradoc474

Biotech Week. (2018, September 19). Reproductive medicine – male infertility; recent findings from southeast university provides new insights into male infertility (role of oxidative stress in pathology of chronic prostatitis/chronic pelvic pain syndrome and male infertility and antioxidants function in ameliorating …). Retrieved from https://ezp.waldenulibrary.org/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F2103189625%3Facco

McCance, K. L., & Huether, S. E. (2019). Pathophysiology: the biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier

Paulis, G. (2018). Inflammatory mechanisms and oxidative stress in prostatitis: The possible role of antioxidant therapy. Research and Reports in Urology, 10, 75-87. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.2147/RRU.S170400