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1 — Case Study #19 – Colon Cancer
What is the probability the patient will still be alive in 5 years?
According to the American Cancer Society, the 5-year relative survival rate for this patient is 73%. His cancer is staged as IIB due to perforating though the ascending colon’s outermost layers. (American Cancer Society, 2022)
What is the probability the patient will still be alive in 5 years?
Now that the cancer has recurred and spread to distant organs, his 5-year survival rate unfortunately drops dramatically to 13%.
Why is the patient taking budesonide?
Budesonide is a steroidal medication used to treat inflammatory bowel diseases. This patient has an eight-year history of Crohn Disease (Kalola & Ambati, 2024).
Provide a reasonable explanation for the rather comprehensive neurologic exam performed by the oncologist?
A neurologic exam is warranted in this case due to his cancer spreading to other organs of the body. A comprehensive neuro exam may assist in detecting cranial nerve involvement before lab tests or scans show a problem is present.
Identify the single major risk factor associated with the patient’s first occurrence with colon cancer:
According to the center for Disease Control, his greatest risk factor for colon cancer is his eight-year history of inflammatory bowel disease (CDC, 2024).
Identify four more risk factors that may have contributed to the patient’s first occurrence of colon cancer:
Other risk factors present in this patient are: sedentary lifestyle, frequent alcohol use, being a regular heavy smoker, and a history of type II diabetes.
Identify the single major risk factor associated with the patient’s recurrence of colon cancer:
His single greatest risk factor for his recurrence of cancer was his previous battle with cancer.
Identify seven abnormal lab tests that are consistent with a diagnosis of colon cancer.
1.Elevated CEA levels (Carcinoembryonic antigen) may indicate a cancer presence
2 – 4. Elevated AST and ALT and Bilirubin may indicate liver involvement
5. Elevated LDH may indicate tissue damage or disease
6. Decreased Albumin may indicate GI disease or cancer
7. Decreased Protein may indicate worsening absorption
Why might liver function tests be abnormal?
There is evidence the cancer has spread to his liver. Hepatomegaly is present along with abdominal tenderness on the costal margins. CT scan showed multiple possible lesions indicating metastasis. These abnormal lab value may indicate the liver is not operating as it needs to and may be damaged.
Can you find any explanation among laboratory data for the development of ascites in this patient?
There is clear liver involvement in this patient’s cancer. Tumor formation in the abdomen and liver damage can cause fluid to build up in this area causing ascites. Looking at his lab data, aside from the liver values, his albumin and protein are low which can also result in ascites.
Based on laboratory data, should chronic bleeding be a concern in this patient?
Chronic bleeding does not appear to be a problem with regard to his hemoglobin and hematocrit value, but must be monitored closely with evidenced of blood in his stool. These values may have more of a late change related to a large GI bleed.
2–
Gastroesophageal Reflux Disease
1. Which clinical information suggests worsening symptoms of GERD in this patient?
Clinical manifestations indicating the patient’s symptoms of GERD are worsening would be increased frequency of heartburn after meals with regurgitation and difficulty swallowing. Other manifestations of worsening GERD would include waking in the middle of the night with regurgitation and heartburn and the use of antacids with histamine-2-receptor blocker.
2. Which symptom(s) indicates the possible severity of the patient’s GERD?
Symptoms that indicate the severity of the patient’s GERD would be dysphagia, regurgitation at nighttime, and increased frequency of heartburn after meals.
3. Are the patient’s symptoms classic or atypical?
The symptoms for the patient are considered classic symptoms. According to Antunes et al.,, classic symptoms presented in GERD include regurgitation, dysphagia, heartburn, chest pain, back pain, and belching (2024). Atypical symptoms include hoarseness, coughing, and dental erosions (Antunes et al., 2024).
4. Identify all those factors that may be contributing to the patient’s symptoms.
Symptoms that would be contributing to the patient’s symptoms would include history of heavy alcohol usage, current alcohol usage of 6 drinks per week, current smoker, and daily caffeine consumption. According to Antunes et al.,, alcohol and caffeine usage can relax the lower esophageal sphincter and stimulate acid production while smoking weakens the lower esophageal sphincter over time (2024). The patient also has a hiatal hernia that could be contributing to the worsening of his GERD symptoms by allowing stomach acid to more easily flow back into the esophagus (Antunes et al., 2024).
5. Why is the drug verapamil a potential contributing factor to the patient’s symptoms?
Verapamil is a calcium channel blocker that can exacerbate GERD symptoms due to its effect of relaxing smooth muscles such as the lower esophageal sphincter, when the sphincter is weakened, it allows stomach acid to reflux into the esophagus (Fahie & Cassagnol, 2023).
6. What non-pharmacologic therapies or lifestyle modifications might be beneficial in the management of this patient’s acid reflux disease?
Non-pharmacologic therapies or lifestyle modifications that could benefit the patient’s acid reflux would include weight loss, daily exercise, smoking cessation and elevation of the head of the bed. The patient could also make dietary changes such as avoiding alcohol, citrus, caffeine, spicy or greasy foods, and consuming smaller meals.
7. What pharmacotherapeutic alternatives are available for the treatment of this patient’s GERD?
Pharmacotherapeutic alternatives for treatment of the patient’s GERD would include proton-pump inhibitors such as Nexium or Prilosec, H2-receptor antagonists such as Pepcid or Tagamet, prokinetic agents such as metoclopramide, and antacids such as Tums (Antunes et al., 2024).
8. What therapeutic options are now available for this patient?
The patient’s current therapy does not seem to alleviate his symptoms, the patient’s current GERD medication should be increased or consider the possibility of trialing another GERD medication. The patient may need to be referred to a gastrointestinal specialist or surgeon for further evaluation.
9. Based on upper endoscopy test results, what grade of esophagitis can be assigned to this patient’s condition?
Based on the upper endoscopy results showing multiple, circular, and confluent erosions in the distal esophagus, the patient’s condition is classified as Grade C esophagitis according to the Los Angeles Classification. The grade is characterized by erosions that affect more than 75% of the esophageal circumference but do not result in strictures (Antunes et al., 2024).
Gastroesophageal Reflux Disease
Lisa Jenner posted Sep 3, 2024 11:02 AM
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1. Which clinical information suggests worsening symptoms of GERD in this patient?
Clinical manifestations indicating the patient’s symptoms of GERD are worsening would be increased frequency of heartburn after meals with regurgitation and difficulty swallowing. Other manifestations of worsening GERD would include waking in the middle of the night with regurgitation and heartburn and the use of antacids with histamine-2-receptor blocker.
2. Which symptom(s) indicates the possible severity of the patient’s GERD?
Symptoms that indicate the severity of the patient’s GERD would be dysphagia, regurgitation at nighttime, and increased frequency of heartburn after meals.
3. Are the patient’s symptoms classic or atypical?
The symptoms for the patient are considered classic symptoms. According to Antunes et al.,, classic symptoms presented in GERD include regurgitation, dysphagia, heartburn, chest pain, back pain, and belching (2024). Atypical symptoms include hoarseness, coughing, and dental erosions (Antunes et al., 2024).
4. Identify all those factors that may be contributing to the patient’s symptoms.
Symptoms that would be contributing to the patient’s symptoms would include history of heavy alcohol usage, current alcohol usage of 6 drinks per week, current smoker, and daily caffeine consumption. According to Antunes et al.,, alcohol and caffeine usage can relax the lower esophageal sphincter and stimulate acid production while smoking weakens the lower esophageal sphincter over time (2024). The patient also has a hiatal hernia that could be contributing to the worsening of his GERD symptoms by allowing stomach acid to more easily flow back into the esophagus (Antunes et al., 2024).
5. Why is the drug verapamil a potential contributing factor to the patient’s symptoms?
Verapamil is a calcium channel blocker that can exacerbate GERD symptoms due to its effect of relaxing smooth muscles such as the lower esophageal sphincter, when the sphincter is weakened, it allows stomach acid to reflux into the esophagus (Fahie & Cassagnol, 2023).
6. What non-pharmacologic therapies or lifestyle modifications might be beneficial in the management of this patient’s acid reflux disease?
Non-pharmacologic therapies or lifestyle modifications that could benefit the patient’s acid reflux would include weight loss, daily exercise, smoking cessation and elevation of the head of the bed. The patient could also make dietary changes such as avoiding alcohol, citrus, caffeine, spicy or greasy foods, and consuming smaller meals.
7. What pharmacotherapeutic alternatives are available for the treatment of this patient’s GERD?
Pharmacotherapeutic alternatives for treatment of the patient’s GERD would include proton-pump inhibitors such as Nexium or Prilosec, H2-receptor antagonists such as Pepcid or Tagamet, prokinetic agents such as metoclopramide, and antacids such as Tums (Antunes et al., 2024).
8. What therapeutic options are now available for this patient?
The patient’s current therapy does not seem to alleviate his symptoms, the patient’s current GERD medication should be increased or consider the possibility of trialing another GERD medication. The patient may need to be referred to a gastrointestinal specialist or surgeon for further evaluation.
9. Based on upper endoscopy test results, what grade of esophagitis can be assigned to this patient’s condition?
Based on the upper endoscopy results showing multiple, circular, and confluent erosions in the distal esophagus, the patient’s condition is classified as Grade C esophagitis according to the Los Angeles Classification. The grade is characterized by erosions that affect more than 75% of the esophageal circumference but do not result in strictures (Antunes et al., 2024).
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