Nursing: Case Study Analysis

Part 1: Identification of Chronic Disease

This section analyzes the symptoms, medical history and other relevant information with respect to the case of Bob Jackson who was admitted into the emergency department with presenting complaints of nausea, diarrhea and malaise and identifies the most probable chronic illness that he was suffering from. Though there are many possibilities following the myriad of symptoms and predisposing factors listed in the case, the most probable chronic condition in the scenario was colorectal cancer. This refers to the presence to cancerous tumors in both the large intestines and its final inches towards the rectum. This condition often starts with no presenting symptoms as benign adenomatous polyps but later becomes malign with numerous presenting symptoms that mirror Jackson’s case (Johnson et al., 2013). There are a number of risk factors associated with it though causes are not clearly known.

One of the compelling reasons why the Bob case is likely to be colorectal cancer is due to the risk factors he had been exposed to. Indeed many chronic illnesses share the symptoms listed but few other than colorectal cancer are highly reported in individuals with a history of abusing alcohol and smoking (Siegel, DeSantis & Jemal, 2014). Colorectal cancer is prevalent in individuals who have a smoking history, with Bob having a lengthy one in that regard dating back to 35 years. Other predisposing factors associated with the chronic disease include heavy drinking where his review records six stubbies of the same every week. Elsewhere, several studies have identified obesity and old age as some of the risk factors for the chronic condition, both of which are evident in the case study. Bob was 55 years old and though this does not qualify per se as old age in global standards, it was largely beyond the life expectancy of a rural Australian and therefore could be interpreted as such. Most of the communities living in rural Melbourne are the Aboriginal and Strait Islander people who are disproportionately affected by chronic disease due to health inequities and risk exposure which has rendered their life expectancy way below 55 years (Phillips et al., 2014).  Also important, cases of colorectal cancer are prevalent in individuals above the age of 50 and such symptoms at such a juncture warrant a screening. There was also an issue of diet as a risk factor. A diet rich in fat and meat and poor in fiber, folate and calcium has been also identified as a risk factor for colorectal cancer. This can be related to the fact that Jackson was a sheep farmer and therefore may have been accustomed to large amounts of fatty mutton. Bob’s BP reading was also telling with 165/110 indicating hypertension that also relates to colorectal cancer (Beaugerie & Itzkowitz, 2015).  Therefore, a large number of risk factors pointed towards colorectal cancer as the most probable chronic illness in Bob’s case.

More importantly, the presenting symptoms and review of symptoms suggests a case of colorectal cancer. Diarrhea, nausea and malaise were all symptoms that have been associated with an established case of colorectal cancer. There is general body fatigue that is unexplained, while the nausea may develop into frequent vomiting. Elsewhere, change in bowel behavior has been widely reported in many cases which was also highlighted in Bob’s case as occasional loose stools and diarrhea (Siegel, DeSantis & Jemal, 2014). The most significant factor was however rectal bleeding, which was reported as frank blood in the patient’s stool. Colorectal cancer is also a rare but possible gastrointestinal cause of pain the lower left quarter of the abdomen that had been reported in Bob’s case study(Johnson et al., 2013). As was identified priory, the underlisted symptoms and pathophysiology can be related with many other conditions such as irritable bowel syndrome, but when considered alongside the risk factors, colorectal cancer comes on top as the most probable health problem in context. 

Part 2: Possible Alternative Scenario

The other possibility in Bob’s case was Crohn’s disease. This is an inflammatory bowel disease (IBD) characterized by an inflammation of the digestive tract leading to abdominal pain, a severe case of diarrhea, fatigue, weight loss and many other symptoms that closely relate to colorectal cancer. It is also a chronic illness with no known cure and though is less threatening than colorectal cancer; it can equally lead to life threatening complications if not well managed (Siegel, DeSantis & Jemal, 2014). The inflammation caused by Crohn’s disease may affect different parts of the digestive tract in different cases and also causes severe pain as reported in Bob’s case.

In differentiating the two illnesses, there are various tests in which a credible determination can be made. The most ideal procedure is colonoscopy, which entails the doctor examining the entire digestive tract using a thin, flexible tube that is connected to a camera. The procedure also permits the collection of a tissue sample that can be analyzed in the laboratory. The presence of granulomas, which are essentially clusters of inflammatory cells proves the presence of Crohn’s disease (Sebastian et al., 2014). On the other hand, the biopsy conducted during colonoscopy can also detect colorectal cancer through the same laboratory procedure. The presence of malignant cells will suggest a typical colorectal cancer case. The method is highly reliable as it allows for the analysis of the digestive tract to prove or disapprove both scenarios given that the pathophysiology of both illnesses entails different digestive tract issues. In the same way, imaging techniques such as an X-ray or CT scan can come in handy (Sebastian et al., 2014). These allow for the medical examiner to identify the nature of the abnormalities in the digestive tract. The images can differentiate a tumor from inflammation caused by Crohn’s disease.

In the end, differentiating Crohn’s disease from colorectal cancer can be quite complicated looking at the similarity in the manner in which the main symptoms present themselves. Apart from carrying out colonoscopy and imaging tests, blood tests can also give a definitive difference between the two. One should particularly examine the carcinoembryonic antigen (CEA) levels to distinguish colorectal cancer from Crohn’s disease (Sebastian et al., 2014). For Crohn’s disease, anemia would be a more appropriate investigation. Notably, the genetic history of Mr. Bob may come in handy in both cases. Both colorectal cancer and Crohn’s disease have been associated with genetic inheritance. The condition that will be found to run through their family will be the most probable scenario in context. 

References

Beaugerie, L., & Itzkowitz, S. H. (2015). Cancers complicating inflammatory bowel disease. New England Journal of Medicine, 372(15), 1441-1452.

Johnson, C. M., Wei, C., Ensor, J. E., Smolenski, D. J., Amos, C. I., Levin, B., & Berry, D. A. (2013). Meta-analyses of colorectal cancer risk factors. Cancer causes & control, 24(6), 1207-1222.

Phillips, B., Morrell, S., Taylor, R., & Daniels, J. (2014). A review of life expectancy and infant mortality estimations for Australian Aboriginal people. BMC Public Health, 14(1), 1.

Sebastian, S., Hernández, H. V., Myrelid, P., Kariv, R., Tsianos, E., Toruner, M., … & Gasche, C. (2014). Colorectal cancer in inflammatory bowel disease: results of the 3rd ECCO pathogenesis scientific workshop (I). Journal of Crohn’s and Colitis, 8(1), 5-18.

Siegel, R., DeSantis, C., & Jemal, A. (2014). Colorectal cancer statistics, 2014. CA: a cancer journal for clinicians, 64(2), 104-117.