Case Study, Chapter 2, Cellular Responses to Stress, Injury, and Aging

Mr. A is a 68-year-old man who fell and sustained a compound fracture of his left leg. He has become very depressed over the past few weeks and refuses to get out of bed. He eats one meal a day of biscuits and grits and refuses any other food. He has recently noticed blisters and a foul odor from his leg. (Learning Objectives: 7, 9, and 10)

What will most likely occur with his muscle cells if he continues to remain in bed?

Continued bed rest without physical activity can lead to muscle disuse atrophy. Muscle cells may decrease in size and lose contractile proteins, resulting in weakness and reduced muscle mass

Discuss the pathophysiology associated with atrophy and identify potential causes.

Atrophy is a decrease in cell size or number, leading to a decrease in tissue or organ size.Causes of atrophy include disuse (lack of physical activity), denervation (loss of nerve stimulation), inadequate nutrition, reduced blood flow, and aging.

What are some possible causes of atrophy in Mr. A?

  • Prolonged bed rest and lack of physical activity contribute to disuse atrophy.
  • Poor nutrition, as indicated by his limited intake of one meal a day of biscuits and grits, can contribute to muscle wasting.
  • Depression and refusal to get out of bed may exacerbate disuse atrophy.

What could be causing the blisters and foul odor?

Blisters and foul odor may indicate infection and tissue necrosis.Lack of mobility, an open compound fracture, and poor nutrition may contribute to delayed wound healing and infection

He finally agrees to go to the emergency department, and he is diagnosed with gangrene.

  • What type of gangrene does he most likely have based on his symptoms?
  • Given the symptoms of blisters, foul odor, and compound fracture, Mr. A most likely has gas gangrene. Gas gangrene is caused by Clostridium bacteria, and it is associated with tissue necrosis, gas production, and foul-smelling discharge.
  • Identify and describe the manifestations associated with the three types of gangrene.
  • Dry Gangrene:
    • Caused by reduced blood flow without infection.
    • Tissue becomes dry, shrinks, and darkens.
    • Typically occurs in extremities.
  • Wet Gangrene:
    • Occurs with bacterial infection in moist tissue.
    • Tissue appears swollen, wet, and discolored.
    • Rapid progression and foul odor.
  • Gas Gangrene:
    • Caused by Clostridium bacteria.
    • Gas bubbles form in tissues, leading to crepitus.
    • Foul-smelling discharge, systemic toxicity, and rapid progression.

In summary, Mr. A is at risk of muscle disuse atrophy due to prolonged bed rest. His poor nutrition and the open compound fracture may contribute to delayed wound healing, infection, and the development of gas gangrene. Gas gangrene is characterized by gas production, foul odor, and tissue necrosis, requiring immediate medical attention.

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