Case Study exploring content from Weeks 1-3 of HLT100.

Q1.  Aging has a significant effect on the skin, therefore changes in the skin are the most significant sign of aging such as sagging skin, wrinkles, etc. as we know that Skin contains nerve receptors that permit us to feel pain, touch, pressure, etc. also help control fluid balance in the body which help in controlling the temperature of the body, and control and protect the body from the environment (Wu et al. 2017), as the skin has many layers but generally divided into three main parts which is epidermis an outer part of the skin include skin cells, proteins and pigment, the dermis the middle part and second layer of the skin comprising nerves, blood vessels, oil glands, and hair follicles. The subcutaneous layer which is the inner layer under the dermis is accountable for fat, blood vessels, sweat glands, and hair follicles. As we know that in Human thermoregulatory response is accountable for controlling heat loss, as a person gets older its harder for the body to control its temperature, in consideration to Katherine case study are age is the reason why she gets the cold easily as with aging person loss it ability to sweat. In general a human maintain 37 C body temperature despite living in different environment.  When human being are exposed to heat stress the thermoregulatory system of the body became active and help body to maintain the heat balance.  Metabolic production of heat balance the rate of lost heat from surface of skin to the environment through a dry combination and exchange of evaporative heat, rise in metabolic and muscular activity increase temperature and for that reason inefficiency of metabolic need metabolic reaction to give energy to working muscles.  Almost 80% of the   energy produced as heat is through muscular contraction, as person became age they lost the ability to sweat and finding has shown the elderly show a delayed core temperature onset threshold for sweating and decrease heat loss (Weber et al. 2018). This happen due to decrease in amount of sweat generated per gland.  As we know that temperature regulation is type of homeostasis.

Changes in body temperature occur daily and as age aged people are unable to control their body temperature different pathologies might happen, as human body has about four methods to keep the core temperature, which are vaporization, radiation, convection and conduction, and for it physical factor are enough, as intravascular volume and cardiovascular function must able to function internal heat to surface, the older people are at higher risk due to poor thermoregulation due to poor cardiovascular and intravascular function. 

Q2.  Humerus and Femur neck fracture is very common hip fracture in elderly, however, the healing process may take time as clinical experience has shown evidence that healing process is different in different age group. Spatial, temporal and cellular relation of signalling molecules and extracellular matrix has not adequately proved that fracture healing in geriatric skeleton, therefore elderly has delayed healing fracture compare to young ones and fracture healing is actually a traumatic bony disruption occurring naturally, and there are three stages that are inflammatory, reparative, and remodelling, though these option are supported by various treatment option however immobilization is key treatment option, to avoid different complication considering the Katherine age.  Usually a fracture take 12 weeks healing process but considering Katherine age it may take little longer, however, it cannot be shown exactly,  healing process require number of requirement to be met, for instance,   blood supply should be intact ( viability of fragment), immobilization, and avoid infection through proper hygiene and medication (Harvey et al. 2017). Though healing process depend on configuration of fracture fragments that are spontaneous, gap healing, contact healing.  The fracture healing process divided in different stages and it’s a biological continuum, the endosteum, and Haversian and periosteum canals are foundations of pluripotent mesenchymal stem cells to initiate the building of tissue that support healing. Femur fracture start the process of healing within 2-3 week and it might take time upto12-18 week and humerus take time up to 6-10 week commonly, surgery is most suitable option in the cases of extreme fracture with prescribed medication. Internal fixation through metal pins to fix the bone, by ensure that bone hold together so that fracture can heal, or hip replacement and later the patient need physical therapy to retain the energy and strength to walk.

Elderly people bone loss calcium and it became weak that the reason they are at high risk of fracture in case of falling, Katherine suffer humerus and femur neck fracture due weak bone. The reason why fracture occur in elder is supported by three common factor:

Skeletal fragility: Appendicular fracture are generally happen after falling and are the main reason for hip fracture and the risk of the fracture increase with age, especially for people who are over 65 year old (Verde et al. 2019). Impact of fall and strength of bone depend is vital as bone strength is associated with mineral and densitometry, as mineral bone density decrease the trauma associated with increases.

Calcium: as calcium- vitamin d decreases with ageing therefore casualties related to falling increase, similar in Katherine case, due to weak bone. 

Less body control: as elderly people loss their strength and ability to control the body decreases with aging the risk of elderly people falling increase the risk of fracture, the hip fracture is most common fracture in elderly after falling, due to low muscle strength the bone break easily in the elderly.

Q3.  Bile is a multifaceted fluid that contain water, batter of organic molecules that has acid, phospholipids, cholesterol, etc. and electrolyte, this fluid flow through biliary tract into small intestine. The two main function of bile are:

• The bile include acid that are very significant in the process of digestion and fats absorption as well in absorption of vitamin that are fat soluble in small intestine.
• The second function it to eliminate the waste such as bilirubin though secretion into bile and reduction in feces.

It is been said that human body produce 400 to 800 bile on daily bases, it is said the secretion of bile occur in two stage where initially, secrete hepatocyte bile into canaliculi (Ovadia et al. 2019) from there it transport into bile duct, the hepatic bile include the good amount of bile acids, and other molecules that are organic in nature.  The flow of bile through duct it altered by water addition, secretion rich in bicarbonate from epithelial cells, other alteration occur in gallbladder that stores the bile concentrates. Discharge into bile is a significant course for dispensing with cholesterol. Free cholesterol is for all intents and purposes insoluble in fluid arrangements, however in bile, it is made dissolvable by bile acids and lipids like lecithin. Gallstones, a large portion of which are made dominatingly out of cholesterol, result from forms that permit cholesterol to hasten from arrangement in bile. Bile has significant role in fat digestion and absorption. Bile acids are subordinates of cholesterol integrated in the hepatocyte. Cholesterol, ingested as a feature of the eating routine or got from hepatic amalgamation is changed over into the bile acids cholic and chenodeoxycholic acids, which are then conjugated to an amino corrosive (glycine or taurine) to yield the conjugated structure that is effectively emitted into cannaliculi. Bile acids are facial amphipathic, that is, they contain both hydrophobic (lipid dissolvable) and polar (hydrophilic) faces. The cholesterol-inferred bit of a bile corrosive has one face that is hydrophobic (that with methyl gatherings) and one that is hydrophilic (that with the hydroxyl gatherings); the amino corrosive conjugate is polar and hydrophilic. Their amphipathic nature empowers bile acids to complete two significant capacities:

Emulsification of lipid totals: Bile acids have cleanser activity on particles of dietary fat which makes fat globules separate or be emulsified into minute, tiny beads. Emulsification isn't processing in essence, yet is of significance since it enormously expands the surface region of fat, making it accessible for assimilation by lipases, which can't get to within lipid beads. Solubilization and transport of lipids in a watery domain: Bile acids are lipid transporters and can solubilize numerous lipids by shaping micelles - totals of lipids, for example, unsaturated fats, cholesterol and monoglycerides - that stay suspended in water. Bile acids are additionally basic for transport and assimilation of the fat-solvent nutrients (Sanchez-Cabus et al. 2017).

Due to inhibited bile production Katherine can face following difficulty, diarrhea, weightloss, pale-colored stool, blood pressure, stomach cramps, etc. therefore the medication to treat bile to help Katherine in releasing bile.

Q4. Combination of vitamin D and calcium is best for treatment for osteoporosis (Hill & Aspray 2017), in consideration to Katherine case this will help in improving the bone strength and help in recovering the fracture and help in decreasing the risk of fracture as in shown by different study 800 IU of vitamin d given to people aged over 65 for 12 week help in strengthening the muscle and decreasing the risk of fall (Zhao et al. 2017). Therefore in consideration to Katherine study I think combination of calcium and vitamin will help her in improving muscle strength.

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Reference:

Harvey, N. C, Biver, E, Kaufman, J. M, Bauer, J, Branco, J, Brandi, M. L & Dimai, H 2017, The role of calcium supplementation in healthy musculoskeletal aging. Osteoporosis International, 28(2), 447-462.

Hill, T. R & Aspray, T. J 2017, The role of vitamin D in maintaining bone health in older people. Therapeutic advances in musculoskeletal disease, 9(4), 89-95.

Ovadia, C, Perdones?Montero, A, Spago, K, Smith, A, Sarafian, M. H, Gomez?Romero, M & Mitchell, 2019, Enhanced microbial bile acid deconjugation and impaired ileal uptake in pregnancy repress intestinal regulation of bile acid synthesis. Hepatology, 70(1), 276-293.

Sanchez-Cabus, S, Pittau, G, Sebagh, M & Cherqui, D 2017, Primary non-functioning neuroendocrine tumor of the extrahepatic bile duct. Revista Espanola de Enfermadades Digestivas (REED), 109(3), 228-230.

Verde, Z., Giaquinta, A., Moreno Sainz, C., Díaz Ondina, M., & Fernández Araque, A. (2019). Bone Mineral Metabolism Status, Quality of Life, and Muscle Strength in Older People. Nutrients, 11(11), 2748.

Weber, P, Meluzínová, H, Prudius, D & Bielaková, K 2018, Thermoregulatory disorders and their significance in the elderly. Vnitrni lekarstvi, 64(11), 1091-1097.

Wu, Y, Nieuwenhoff, M. D, Huygen, F. J, van der Helm, F. C, Niehof, S & Schouten, A. C 2017, Characterizing human skin blood flow regulation in response to different local skin temperature perturbations. Microvascular research, 111, 96-102.

Zhao, J. G, Zeng, X. T, Wang, J & Liu, L 2017, Association between calcium or vitamin D supplementation and fracture incidence in community-dwelling older adults: a systematic review and meta-analysis. Jama, 318(24), 2466-2482.