At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.

Understanding of signals and symptoms of alterations in cellular processes is a critical step in diagnosis and treatment of many diseases. For the Advanced Practice Registered Nurse (APRN), this understanding can also help educate patients and guide them through their treatment plans.

For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts. 

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 a history of malabsorption syndrome and difficulty eating due to a 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?
• Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your peers’ posting: 

1st colleague to respond to

Explanation of Malabsorption Syndrome

Malabsorption syndrome is typically described as when a patient’s small intestines develop the inability to absorb certain vital nutrients and fluids

due to an immune response, inflammatory process, or physical alterations to the intestines from trauma or surgery (Clark & Regan, 2018). This can

occur from several common disorders and can be difficult to diagnose because symptoms are often subtle. This disorder can lead to nutrient

deficiencies, bloating, discomfort, diarrhea, and other unpleasant symptoms.

Role Genetics Plays in Malabsorption Syndrome

Genetics plays a significant role in Malabsorption Syndrome. Some common genetic related disorders include Cystic Fibrosis, Congenital Lactase

Deficiency, Celiac’s disease, and Nephrotic Syndrome (McCane & Huether, 2019). Cystic Fibrosis leads to thick mucus that can block digestive

enzymes. Congenital Lactase Deficiency can lead to impaired lactose digestion making the body unable to break down lactose so that it can be

absorbed. Celiac’s Disease causes an immune response that damages the intestines impairing absorption. Nephrotic Syndrome leads to leakage of

proteins into the urine and can be due to a genetic abnormality sometimes seen in family members (McCane & Huether, 2019). There are many other

genetic disorders that can also impair a person’s absorption and lead to symptoms.

Why Patient is Presenting with Specific Symptoms

This patient is presenting with generalized edema to the extremities and abdomen, malabsorption, and protein deficiency. These symptoms for an

83 year old patient could likely be indicative of Nephrotic Syndrome. Nephrotic Syndrome is caused by abnormalities to the filtration abilities of the

kidneys that lead to the loss of proteins in the urine. This loss of proteins allows fluids to leak into surrounding tissues which accounts for the patient

presenting with generalized edema (McCane & Huether, 2019). On top of this patient’s kidneys losing protein, the patient has difficulties eating foods

because of their lack of dentures which would result in further protein deficiency. Nephrotic Syndrome will typically also show hyperlipidemia nad

foamy urine from hypoproteinemia (Berkowitz, 2021).

Physiologic Response to Stimulus Presented and Why it Occurred

Malabsorption can occur from insufficiencies in pancreatic enzymes, bile salts and lactase. It can also be caused by inflammatory bowel diseases

(McCane & Huether, 2019). The physiologic response to the patient’s kidneys being unable to retain protein coupled with the patient’s inability to

easily chew food has resulted in a protein deficiency. This protein deficiency has caused the blood vessels to be less able to retain fluids which has

resulted in fluids leaking into the surrounding tissues. This can present as edema in the extremities and abdomen of the patient. A secondar

physiological response of Nephrotic Syndrome might show the liver trying to increase serum proteins which will in turn increase serum lipids resulting

in hyperlipidemia (Berkowitz, 2021).

Cells Involved in Process

The cells involved in malabsorption typically include, pancreatic acinar cells that produce digestive enzymes, intestinal lining enterocyte cells that

are responsible for absorbing nutrients, intestinal goblet cells that produce mucus to coat and preserve the intestinal lining, bile producing liver cells,

intestinal cell microvilli that improve the absorption and intestinal mucosal cells that line the intestines and provide a barrier

(McCane & Huether, 2019). The cells involved in Nephrotic Syndrome typically include injured glomerular kidneys cells including, endothelial cells that

facilitate passage of blood and preserve proteins, podocyte cells that assist in selecting the sizes of molecules to filter and mesangial cells that provide

structural support and aid in blood flow through the capillaries (McCane & Huether, 2019).

How Gender and Environmental Factors Change Response

While malabsorption is typically related to gastrointestinal health and diet, certain malabsorption diseases such as celiac disease, inflammatory

bowel disease, delayed stomach emptying, and hormonal changes related to pregnancy are more prevalent in women (Berkowitz, 2021). Nephrotic

syndrome is typically more common in male children but the prevalence in adults is relatively equal (Berkowitz, 2021). There are multiple environmental

factors that can lead to malabsorption such as allergies and food sensitivities. Autoimmune disorders such as lupus and diabetes mellitus can influence

the development of nephrotic syndrome (Berkowitz, 2021). The fact that the patient has trouble chewing and eating food also plays a large factor in

their protein deficiency. Alternative dieting methods should be considered to help this patient receive more nutrients.

References

Berkowitz, A. (2021). Clinical Pathophysiology made ridiculously simple. (2nd ed.). MedMaster Inc. Miami, FL. Chapter 3-4.

Clark, R. & Regan, J. (2018). Malabsorption Syndrome. Clinical Key for Nursing, 53(3), 361-374. Doi: 10.1016/j.cnur.2018.05.001.

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

Chapter 4-5. 

2nd Colleague

Week 1 Discussion Prompt:

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.

The role genetics plays in the disease.

Why the patient is presenting with the specific symptoms described.

The patient presented in this case study is in the Emergency Room for generalized edema. Malnutrition in elderly patients is often due to poor food intake, increased nutrient loss, poor nutrient absorption, or a combination of all. This resident had a known history of malabsorption most certainly from childhood, and has no dentures to help with the food intake. A physiologic decline in food intake has been seen in people as they age regardless of chronic illness and disease. Physiologic changes that decrease food intake—often referred to as the anorexia of aging—involve alterations in neurotransmitters and hormones that affect the central feeding drive and the peripheral satiation system (Evans, 2005). Depending on this patients other co-morbidities, medications and type of diet allotted may affect her nutritional status. As the body becomes more malnourished, changes at the cellular level start to occur. Likely this resident will have extremely abnormal electrolytes (low sodium, high potassium levels) which may explain the generalized edema. Management of malnutrition in the elderly population requires a multidisciplinary approach that treats pathology and uses both social and dietary forms of intervention. Nutritional deficiencies are more common among hospitalized patients and nursing home residents, depending on the this residents mental capabilities, management may become difficult and family discussions regarding end-of-life and nutritional interventions will need to occur.

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

As the body goes through deficits of nutrients, cell repair or injury can become irreversible. Injury to the cells and extracellular matrix (ECM) leads to injury in the tissues and organs. This can lead to ECM injury or cell death. Nutritional imbalances are a major factor in this. As cells are deprived nutrients, cellular structure and function will be compromised.

The cells that are involved in this process.

Extracellular vesicles (EVs) have been identified as active components in cellular communication, which are easily altered both morphologically and chemically by the cellular environment and metabolic state of the body (Mendivil-Alvardo et al. 2022). Although not studied in depth of malnourished adults, it is still noted the EVs play an important role in homeostasis and cell repair. Nutrient deprived cells can have altered cell transport mechanisms, chromosomes and DNA (Huether & McCance, 2019).

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

Gender and race would not likely have a role in my response. However, pertinent tests would, having the lab values, current mediations and more history. All the questions come to mind:

Has then been a history of long-standing diarrhea? What is the current diet? What medications are being taken?

References:

Evans C. Malnutrition in the elderly: a multifactorial failure to thrive. Perm J. 2005 Summer;9(3):38-41. doi: 10.7812/TPP/05-056. PMID: 22811627; PMCID: PMC3396084.

Mendivil-Alvarado, H., Sosa-León, L. A., Carvajal-Millan, E., & Astiazaran-Garcia, H. (2022). Malnutrition and Biomarkers: A Journey through Extracellular Vesicles. Nutrients, 14(5), 1002. MDPI AG. Retrieved from Links to an external site.“>http://dx.doi.org/10.3390/nu14051002Links to an external site.

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