Describe Larry’s current state of health and justify what advice would have been given to him during his recent health check

 

          

Case Study: part 1

Larry is a 55 year old bank manager. He has recently experienced breathlessness climbing one flight of stairs to his flat. He doesn’t smoke but takes very little exercise and his weight is stable at 95kg. Both Larry’s father and uncle died of a heart attack before the age of 60. At a recent health check, Larry’s blood results were as follows

Height: 1.65 m                     Fasting Blood glucose: 8.5 mmol/l

BP: 165/93 mmHg   Total cholesterol: 8.1 mmol/l

Question 1

Describe Larry’s current state of health and justify what advice would have been given to him during his recent health check (20 marks)

Case study: part 2

Larry has started to notice that his trousers no longer fit and he has started to feel very tired. He has also started to notice pain in his lower abdomen and has been suffering severe constipation. He goes to see his local GP who takes some blood tests. The results are as follows:

White cell count 12,000/mm3         Haemoglobin 7.1 g/dl

Se Ferritin 4 ng/ml            Iron 5 μg/dl

Se Albumin 20 g/l                          CRP 11mg/dl

Question 2

Discuss the pathophysiological mechanisms responsible for his presenting symptoms (20 marks)

Case study part 3

Following referral to the Oncologist, Larry undergoes a colonoscopy which shows a cancerous lesion in his descending colon. He is scheduled for a colectomy. Following the surgery, Larry develops pyrexia and an abscess appears at his stoma. A swab confirms the presence of Escherichia coli he treated with antibiotics. For a week post-surgery, Larry remains in intensive care, unable to tolerate oral nutrition. His anaemia persists, despite a blood transfusion, and his albumin also remains low. There is evidence of muscle wasting.

Question 3

  1. Which antibiotic(s) would be used to inhibit the coli associated with the abscess and what is the mode(s) of action of your chosen antibiotic(s)? (5 marks)
  2. Why and how do proliferating pathogenic bacteria contribute to anaemia ? Also, what is the source of proliferating bacteria in this case? (5 marks)
  3. Name the gut friendly bacterium which is thought to have a protective role in preventing the development of colonic cancer and explain how this is achieved by colonic fermentation of dietary products (10 marks)

Question 4

Discuss the impact of his cancer and the subsequent events post-surgery on Larry’s energy metabolism and substrate utilisation (20 marks)

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