Discussion 1
________________________________________
J.C is an 82-year-old white man who was evaluated by GI specialist due to abdominal discomfort, loss of appetite, weight lost, weakness and occasional nausea.
Past Medical History (PMH):
Patient is Diabetic, controlled with Metformin 500 mg by mouth twice a day, Lantus 15 units SC bedtime. Hypertensive, controlled with Olmesartan 20 mg by mouth once a day. Atrial Fibrillation, controlled with Rivaroxaban 15 mg by mouth once a day and bisoprolol 10 mg by mouth once a day.
Labs:
Hb 12.7 g/dl; Hct 38.8% WBC 8.2; Glycemia 74mg/dl; Creatinine 0.8 mg/dl; BUN 9.8 mg/dl; AST 21 U/L ALT 17 U/L; Bil T 1.90 mg/dl; Ind 0.69 mg/dl; Dir 1.21 mg/dl.
Diagnostic test:
Endoscopic Ultrasound of the Pancreas. Solid mass in the head of pancreas 4 cms, infiltrating Wirsung duct. The solid mass impress to infiltrate the superior mesenteric vein. Perilesional node is detected, 1.5 cms, metastatic aspect. Fine needle aspiration (FNA) biopsy: Ductal adenocarcinoma.
Case study questions:
1. Please name the potential most common sites for metastasis on J.C and why?
2. What are tumor cell markers and why tumor cell markers are ordered for a patient with pancreatic cancer?
3. Based on the case study described, proceed to classify the tumor based on the TNM Stage classification. Why this classification important?
4. Discussed characteristic of malignant tumors regarding it cells, growth and ability to spread.
5. Describe the carcinogenesis phase when a tumor metastasizes.
6. Choose the tissue level that is affected on the patient discussed above: Epithelial, Connective, Muscle or Neural. Support your answer.
Submission Instructions:
• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
Grading Rubric
________________________________________
Your assignment will be graded according to the grading rubric.
Discussion Rubric
Criteria Ratings Points
Identification of Main Issues, Problems, and Concepts Distinguished – 5 points
Identify and demonstrate a sophisticated understanding of the issues, problems, and concepts. 5 points
Use of Citations, Writing Mechanics and APA Formatting Guidelines Distinguished – 3 points
Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing. High level of APA precision and free of grammar and spelling errors. 3 points
Discussion/APA sample
How to Post
Discussion post should follow American Psychological Association (APA) guidelines. Use the appropriate level headings, citations and your reference list to reflect the areas that were cited. First line of the paragraph must be indented. A references list main purpose is to show the sources of your intext citations. Sources that have three or more authors can be shortened, and et al be used following the first author’s name. The word references must be centered and bold without a period at the end. The second line of the reference list must be indented. Canvas alters your post, so please center your headings and indent your second line on the reference list before posting. Finally, do not upload your discussion post as an attachment. Cut and paste it into the discussion board. When you upload, it takes the reader out of Canvas to read it and its difficult to remember all areas you want to respond to. Students who uploaded in the past did not get any response to their post. Read, interpret and analyze discussion questions before answering them. Answer what is asked and stick to the questions. If the case study has five parts, please complete all areas. Do not shortchange yourself. Please participate and follow these instructions to make these discussions enjoyable.
Bilirubin Function
Bilirubin is the main pigment in bile. Bile is formed in the liver and stored in the gallbladder where it is secreted into the gut via the common bile duct (Brandon & Ting, 2018). The main purpose of bile is to emulsifies lipids. Bilirubin metabolism begins with breakdown of Red Blood Cells (RBC) which forms unconjugated indirect bilirubin (Brandon & Ting, 2018). Shah and Ciciliano (2016) noted that in the liver, bilirubin is conjugated with glucuronide to form conjugated direct bilirubin.
Liver and Bilirubin
Rhim et al. (2017) explained that the liver excretes direct bilirubin via the hepatic bile duct and common bile duct and into the gut. Bilirubin is excreted in stool which gives it a brown color; normal levels of direct bilirubin ranges from 0.1-0.3mg/dL and elevated bilirubin results in jaundice (Rhim et al., 2017). Jaundice occurs when direct bilirubin exceeds 2.5mg/dL (Rhim et al., 2017). To determine if jaundice is caused by direct or indirect bilirubin, the source must be identified. Rhim et al. (2017) noted that hepatocellular dysfunction such hepatitis will result in elevated unconjugated indirect bilirubin. Extrahepatic obstruction of the bile duct by tumors or gallstones will result in elevated conjugated direct bilirubin (Rhim et al., 2017).
References
Brandon, Y.M. & Ting, D.T. (2018). RNA sequencing of pancreatic circulating tumor cells implicates WNT signaling in metastasis. Nature, 48(7), 510–513.
Rhim, A.D., Thege, F.I. & Santana, S.M. (2017). Detection of circulating pancreas epithelial cells in patients with pancreatic cystic lesions. Gastroenterology, 14(16), 647–651.
Shah, A.M. & Ciciliano, J.C. (2016). Tumor cells. Science Translation Medicine, 20(13), 5-17.