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 5 points in your explanation, 3 references will support your points.
The role genetics plays in the disease. (May or may not be applicable to patient. For example, protein malabsorption in elders does not have a genetic basis in this case).
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, age) would change your response. i.e. What might be a characteristic influencing your response?
An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema
The disease highlighted in the scenario is protein malnutrition, characterized by insufficient intake or absorption of protein, leading to a deficiency of essential amino acids necessary for various physiological processes in the body.
**Role of Genetics:** While protein malnutrition itself may not have a direct genetic basis, genetic factors can influence an individual’s susceptibility to malabsorption syndromes or other conditions that impair protein digestion and absorption. For example, certain genetic mutations can predispose individuals to conditions like celiac disease or inflammatory bowel disease, which can lead to malabsorption of nutrients, including protein (Wapenaar et al., 2015).
**Symptoms Presentation:** The patient is presenting with generalized edema of extremities and abdomen due to protein malnutrition. Proteins play a crucial role in maintaining osmotic pressure in the blood vessels. In protein malnutrition, the decreased levels of serum proteins, particularly albumin and globulins, lead to a decrease in oncotic pressure, resulting in fluid accumulation in the interstitial spaces, causing edema (Silverthorn, 2013).
**Physiological Response:** In response to protein malnutrition, the body undergoes adaptive mechanisms to conserve protein and maintain essential bodily functions. One such response is the redistribution of available protein to support vital organs and functions, such as maintaining cardiac and respiratory function, at the expense of non-essential tissues. Additionally, the liver may increase the synthesis of acute-phase proteins, such as C-reactive protein, as part of the inflammatory response to tissue damage associated with malnutrition (Hui et al., 2015).
**Cells Involved:** The liver plays a central role in protein metabolism, including the synthesis of plasma proteins and the conversion of amino acids to glucose through gluconeogenesis. Hepatocytes are primarily responsible for these functions, synthesizing proteins such as albumin, which regulates osmotic pressure, and clotting factors involved in coagulation (Silverthorn, 2013).
**Influence of Age:** Advanced age can significantly impact the response to protein malnutrition. Elderly individuals may be more susceptible to malnutrition due to factors such as decreased appetite, impaired nutrient absorption, and age-related changes in metabolism. Additionally, age-related muscle loss, known as sarcopenia, can exacerbate the effects of protein malnutrition, leading to frailty and functional decline (Dorner et al., 2017). In this scenario, the patient’s age likely contributes to the severity of protein malnutrition and its associated symptoms.
In summary, protein malnutrition can lead to a range of adverse effects, including generalized edema, due to alterations in protein metabolism and physiological responses aimed at conserving essential nutrients. While genetics may not directly cause protein malnutrition, genetic factors can influence an individual’s susceptibility to conditions that impair protein absorption. Age-related changes can exacerbate the impact of protein malnutrition, highlighting the importance of early intervention and tailored nutritional support in elderly populations.
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