Posted: August 30th, 2023

Scenario: An 83-year-old resident of a skilled nursing facility

Scenario: An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema of extremities and abdomen. History obtained from staff reveals the patient has history of malabsorption syndrome and difficulty eating due to lack of dentures. The patient has been diagnosed with protein malnutrition.

Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:

· The role genetics plays in the disease.

· Why the patient is presenting with the specific symptoms described.

· The physiologic response to the stimulus presented in the scenario and why you think this response occurred.

· The cells that are involved in this process.

· How another characteristic (e.g., gender, genetics) would change your response.

The disease highlighted in the scenario is protein malnutrition, also known as kwashiorkor. This condition occurs when there is a severe deficiency of protein in the diet, leading to a negative nitrogen balance and impaired growth and development. Genetics may play a role in the susceptibility to protein malnutrition, as some genetic variants may affect the metabolism of amino acids, the building blocks of proteins. For example, a mutation in the gene that encodes phenylalanine hydroxylase, an enzyme that converts the amino acid phenylalanine to tyrosine, can cause phenylketonuria, a disorder that prevents the body from using phenylalanine and leads to its accumulation in the blood and urine. This can result in intellectual disability, seizures, and other neurological problems if left untreated. Therefore, people with this mutation need to follow a low-protein diet to avoid these complications.

The patient is presenting with generalized edema of extremities and abdomen because of the low levels of protein in the blood. Protein plays an important role in maintaining the osmotic pressure of the blood, which is the force that keeps fluid inside the blood vessels. When protein levels are low, fluid leaks out of the blood vessels and accumulates in the interstitial spaces, causing swelling and distension. This can also affect the function of other organs, such as the kidneys, liver, and heart. The patient also has difficulty eating due to lack of dentures, which may worsen the malnutrition and lead to weight loss, muscle wasting, and weakness.

The physiologic response to protein malnutrition is a complex and multifactorial process that involves hormonal, metabolic, and immunologic changes. One of the main responses is the activation of the stress response system, which includes the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system. These systems release hormones such as cortisol and adrenaline, which increase blood glucose levels and suppress immune function. This may help the body cope with acute stress, but chronic activation can have detrimental effects on health and well-being. Another response is the alteration of metabolic pathways to conserve energy and protein. For example, the body may reduce protein synthesis and increase protein breakdown, leading to muscle loss and reduced organ function. The body may also switch from using glucose to using fatty acids and ketones as fuel sources, resulting in ketosis and acidosis.

The cells that are involved in this process are mainly those of the endocrine system, such as the hypothalamus, pituitary gland, adrenal glands, pancreas, and thyroid gland. These cells secrete hormones that regulate various aspects of metabolism, growth, development, and stress response. Other cells that are involved are those of the immune system, such as lymphocytes, macrophages, neutrophils, and eosinophils. These cells are responsible for defending the body against infections and foreign substances. However, protein malnutrition can impair their function and increase the risk of infections and inflammation.

Another characteristic that would change my response is gender. Studies have shown that there are gender differences in the prevalence, severity, and outcomes of protein malnutrition. For example, females tend to have higher rates of protein malnutrition than males in some regions of the world, such as sub-Saharan Africa and South Asia. This may be due to socio-cultural factors that affect access to food, health care, education, and empowerment. Females also tend to have more severe edema than males with protein malnutrition, which may be related to hormonal differences that affect fluid balance. Furthermore, females may have worse outcomes than males with protein malnutrition, such as higher mortality rates and lower recovery rates.

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