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Introduction: A case study topic representing pathology will be chosen and approved by the instructor

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Introduction: A case study topic representing pathology will be chosen and approved by the instructor. The students will develop an in-depth paper and poster presentation revolving around the case stud Objective: The purpose of this capstone project is to allow the student an opportunity to demonstrate proficiency and knowledge in their chosen specialty as well as in general education. As a resu The paper will be read and evaluated by at least two persons other than the course instructor. These persons could include other faculty within the College, the Dean of Health of Profession the Dean of General Education and/or the Medical Director. The specialty instructor is the only one who will assign a numerical/letter grade to the paper. The poster will be viewed by a varie of interested constituents. Focus: The focus of this capstone project is to research a SPECIFIC pathology or disease process rel to the student’s field of specialty. The options for the case selection could be from the following a patient scanned by the student, a patient that the student assisted in the scanning, or a patie scanned by a sonographer at the student’s clinical site and the student interviews that sonographer about the patient’s study that was completed. Cardiac Case Studies: Must be from an adult patient (non-pediatric patients). This capstone project will be an in-depth analysis and correlation as to the cause of the specific pathology, the effect of the pathology on the patient, social/economical/genetic/gender relations, as well as micro/macro structural changes associa with this pathology. The student will be expected to include images from any of the following sources: the actual case study, the Internet, textbooks or articles. See attached example of documentation and inserting the image within the text. Paper Requirements: This paper is expected to be an in-depth analysis of the specialty specific examination and the pathology. The following are the specific requirements: 1. Title Page 2. Abstract including keywords 3. Introduction to overall paper/topic (1-3 paragraphs) 4. Patient Review a. Explain the significance of choosing the case study b. Describe the patient’s signs and symptoms, pertinent medical history, risk factors, age, and any other relevant patient information c. Discuss the type of specialty specific examination (and any other diagnostic tests performed) d. Discuss the equipment and technique used e. Describe the specialty specific examination findings (sonographers/technologists/radiologist/vascular surgeon report) f. Describe the patient outcome (treatment ordered and/or any follow-up the patient may have received) 2. Pathogenesis a. Etiology (Viral, bacterial, genetic...and what type: virus, bacteria, genome specificity [dominant vs. recessive...etc.]) b. Conditional requirements c. Communicability d. Social/economical/cultural/racial/gender prevalence of the pathology 3. Effects a. Micro effect (cellular changes) b. Macro effect (tissue/organ changes) c. Physiological/Systemic effect (how did it change the organ it affected...how did that change affect other organs and vessels) 4. Pathological progression a. Progression and cycles of the disease process b. How the disease “progresses” in the patient scenario 5. Diagnostic procedures that were (or may be) used to help differentiate or diagnose the pathology: a. Clinical findings b. Ancillary procedures (other specialty specific examinations, CT/MRI scan, lab tests, biopsy results, surgical reports...etc) 6. Treatments/Outcome a. List and discuss the available treatment options b. Expected outcome with and without Treatment c. Long-term effects 8. Conclusion/Correlation a. Correlate the specialty procedure findings with the patient’s symptoms, ancillary reports, physician’s diagnosis, treatment/outcome, and pathology. b. Final remarks 9. Images of Pathology a. Five to eight pictures/images that are embedded into the body/content of the paper that represent the pathology. The student is expected to provide images of the patholog illustrative images should be included; they should be labeled to direct the reader to structures of interest. Images/pictures should be cited in using the latest APA edition. Images must follow the latest APA edition and will need to be placed within the body of the paper (not at the beginning or end of the paper). Please see image examples below. Examples for Citing & Referencing Images within Text *Images utilized from your clinical site do not need to be listed on the Reference Page, but nee to be cited within the paper. *Images utilized from additional resources do need to be listed on the Reference Page. Image Example – Clinical Site The systemic effect of abdominal aortic aneurysms occurs when mural thrombus develops in the AAA. The mural thrombus may take up a lot of space in the affected vessel; thu creating a residual lumen (see Figure 2) (Rumwell & McPharlin, 2017). The lower extremity vessels may have diminished flow, depending on how small the residual lumen is. Another systemic effect that may occur is blue toe syndrome or “trash foot” (Rumwell & McPharlin, 2017). With this syndrome, a piece of the mural thrombus breaks off, travels down to the arcua artery, and gets stuck. The arcuate artery perfuses the toes. If the arcuate artery becomes occluded by the emboli, the toe(s) will not receive oxygenate-rich blood. The affected toe(s) wi then become ischemic (Rumwell & McPharlin, 2017). Figure 2 A sonographic image of a residual lumen created by the mural thrombus located in the AAA (Regional Medical Facility, 2020). **Special Note – This citation example, listed above, does not need to be included on the reference page** Grading: The paper and concept map is to be completed in the current APA format. NO OTHER FORMAT WILL BE ACCEPTED. Failure to complete this paper in this format will result in failure of the paper according to the grading criteria listed below. The paper must include a title page, abstract, text, illustrations (images) and references. THE PAPER MUST BE 9-11 PAGES, plus title page, abstract, and reference page. The body of the paper will be 6-8 pages excluding images. References No less than five references are to be used. FIVE of these references MUST be from peer-reviewed sources, such as, peer-reviewed textbooks and journal articles as well. Interviews with physicians and sonographers are also acceptable references. Abdominal Aortic Aneurysms and an Associated Case Study Student Name Bryan College of Health Sciences assssdsssssssssssssssssstgffg CVTD415: Clinical Practicum III: Cardiac & Vascular Sonography – Section 1 xdfxfdfdxfdxdfxfxfxf Dr. Renee Hathaway March 15, 2021 2 Abstract An abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta (Joviliano et al., 2017). The dilatation occurs due to the weakening of the three layers of the aortic vessel wall (Rumwell & McPharlin, 2017). An abdominal aortic aneurysm is a true aneurysm because all three layers of the vessel wall are involved in weakening and bulging out (Rumwell & McPharlin, 2017). These aneurysms can form anywhere on the abdominal aorta; however, the most common location for an abdominal aortic aneurysm is in the distal aorta. It is usually found on the infrarenal aorta near the aorto-iliac bifurcation (Joviliano et al., 2017). Keywords: abdominal aortic aneurysm, AAA, dilatation, weakening, bulge, distal, and aorta 3 Abdominal Aortic Aneurysms The mortality rate of abdominal aortic aneurysms (AAA) that rupture each year is 15,000 (Daigle, 2017). It is important to educate the public of abdominal aortic aneurysms and the risks that accompany them, so that the public is aware and may take action to get an abdominal aortic aneurysm screening if they meet the criteria. This research paper will include the pathogenesis, effects, pathological progression, diagnostic procedures, and treatments for abdominal aortic aneurysms. A clinical case study is also included in this research paper. The patient provided informed consent to use his medical information as necessary. The significance of choosing this specific case study is that the author, student name, was able to scan and find the patient’s abdominal aortic aneurysm as an incidental finding during an aorto-iliac duplex examination. Correlations will be made between the case study and the research obtained for this paper. Patient Review The patient in the case study was first referred to for an outpatient abdominal aorto-iliac ultrasound examination by his physician (Regional Medical Facility, 2020). The patient did not have any symptoms. He denied having any abdominal, back, or flank pain or experiencing blue toe syndrome. He also denied any pain or heaviness of his buttocks or lower extremities when walking, which is commonly seen with arterial disease (Regional Medical Facility, 2020). Although, he presented with multiple risk factors for developing an AAA. The patient was male and Caucasian. He was also elderly, as he was 88 years old. The patient was a former smoker. He smoked cigarettes for 30 years and quit in 1985. He also had a history of hypertension (Regional Medical Facility, 2020). 4 An abdominal aorto-iliac ultrasound examination was performed on the patient. A large, infrarenal abdominal aortic aneurysm was found. The AAA was located in the distal abdominal aorta. The aneurysm measured 5.57cm x 4.77cm. The residual lumen measured 1.66cm x 2.71cm (Regional Medical Facility, 2020). Mural thrombus was noted in the AAA. The right and left common iliac arteries measured normal. The right and left popliteal arteries were also examined, as popliteal aneurysms have been known to coincide with abdominal aortic aneurysms (Regional Medical Facility, 2020). The right and left popliteal arteries measured within normal limits. The patient’s physician was notified of the results. However, they mentioned that they already knew that the patient had an AAA that was found in 2016. It had not been followed throughout the years. Also, the patient was not aware of his condition (Regional Medical Facility, 2020). The patient had a consult with the vascular clinic. An abdominal/pelvis non-contrast computed tomography (CT) examination was performed on the patient. The exam was performed without contrast due to the patient’s allergy to contrast (Regional Medical Facility, 2020). The results showed a distal AAA. It measured to be 6.2cm in maximum diameter. Endovascular aortic repair surgery was recommended due to the size and risk of rupture of the AAA (Regional Medical Facility, 2020). The patient underwent an endovascular aortic repair surgery. Intravascular ultrasound and CO2 angiography were performed to provide direction and anatomical information during the procedure (Regional Medical Facility, 2020). A 31mm x 14mm x 13cm Gore Excluder endograft was utilized with the main body positioned in the abdominal aorta at the level of the renal arteries. The limbs of the graft were deployed into the right and left common iliac arteries (Regional Medical Facility, 2020). A completion angiogram was implemented at the end of the procedure. The results indicated adequate positioning of the endograft and limbs, complete 5 exclusion of the aneurysm, and no evidence of an endoleak. The surgery was a success. The patient was sent back to his hospital room for observation. No complications have been noted at this time (Regional Medical Facility, 2020). Pathogenesis Joviliano et al. (2017), state that abdominal aortic aneurysms are caused by genetic and environmental factors. These aneurysms are not caused by a specific gene mutation, but are found with susceptible genes that contribute to inflammatory mediators, cellular biology of smooth muscle cells, and tissue proteases (Joviliano et al., 2017). Familial factors are also to be taken into consideration. If a male develops an AAA, the risk of their first-degree relatives developing this disease is four times higher than the general populations’ risk. Conditional requirements for developing an AAA are smoking habits, chronic obstructive pulmonary disease (COPD), obesity, and hypertension (Joviliano et al., 2017). Smoking is a prominent risk factor for abdominal aortic aneurysms. In 75% of AAA cases where the aneurysm is 4.0 centimeters or larger, smoking is the main culprit. Individuals with COPD are found to develop an AAA in 7% to 11% of cases. Abdominal aortic aneurysms and obesity are found to be independently related (Joviliano et al., 2017). Hypertension, or high blood pressure, is a common risk factor; however, it is a weak relation in that it is only a risk factor due to the constant hemodynamic load on the aortic wall, as the hemodynamics are found with any disease associated with hypertension (Joviliano et al., 2017). The communicability of abdominal aortic aneurysms is not due to the disease being contagious. However, Tuveson et al. (2016), indicates that there is a prevalence of developing popliteal artery aneurysms associated with abdominal aortic aneurysms. Popliteal artery 6 aneurysms coexist with abdominal aortic aneurysms in 20% to 35% of cases (Tuveson et al., 2016). Gender plays a big role in the development of abdominal aortic aneurysms. Males are five times more likely to develop this pathology than females (Daigle, 2017). This is most likely due to hormonal factors, genetic susceptibility, and vulnerability to environmental factors (Joviliano et al., 2017). Also, age is a prominent risk factor for developing an AAA. The elderly are at a greater risk for this pathology, specifically males of advanced age. Males, ranging in age from 65-80, were reported to have AAA’s in 4% to 8% of cases. The racial prevalence should also be addressed. The Caucasian race is the most likely to develop an AAA. The western population has an average annual incidence of abdominal aortic aneurysm diagnoses of 0.4% to 0.67%. The Asian populations have an incidence of ten times less than the western populations. The African-American population has the lowest risk of developing abdominal aortic aneurysms (Joviliano et al., 2017). Effects Araujo et al., (2019) explains that abdominal aortic aneurysms and their associated effects are not fully understood yet. However, their research exposes collagen turnover, T-cell proliferation, and smooth muscle cell apoptosis as cellular changes that are involved in the formation of abdominal aortic aneurysms. These changes occur due to the result of the gene ALOX5 contributing to the cathespin K modulation. In developing AAA’s, the ALOX5 gene is increased; thus, resulting in an escalation of leukotriene production. The leukotriene production causes aortic wall inflammation and injury (Araujo et al., 2019). To find the cellular changes, the ALOX5 arrangements are noted on the microRNA-29 (Araujo et al., 2019). The dysregulation of 7 microRNA-29 is associated with the development of abdominal aortic aneurysms (Joviliano et al., 2017). The abdominal aortic aneurysm originally starts to develop as a result of injury to the aortic wall due to the associated risk factors. Leukocytes are then brought to the tunica media of the affected area (Joviliano et a., 2017). Macrophages are stimulated. As a result, proinflammatory molecules and proenzyme forms of matrix metalloproteinases are produced. Neutralizing the matrix metalloproteinases may occur due to tissue inhibitors; however, the neutralization does not stop the decline of elastin and interstitial collagens (Joviliano et al., 2017). The deterioration of elastin, cyclin strain, and increased wall tension cause progressive dilatation of the aorta. This progression occurs over a duration of many years (Joviliano et al., 2017). The aortic wall is weakened even more by collagen degeneration. The media smooth muscle cells and fibroblasts may attempt to repair the structure; however, apoptosis and cellular senescence cause the amount of smooth muscle cells to decrease (Joviliano et al., 2017). In accordance, the interstitial collagen may become chaotic. Then, the infiltration of T cells, B lymphocytes, plasma cells, dendritic cells, and immunoglobulins make up the aneurysmal tissue that develops (Joviliano et al., 2017). This results in a cellular and humoral immune response. The promotion of microRNA-29 activates the deterioration of the extracellular matrix and generates the formation of aneurysms (Joviliano et al., 2017). Abdominal aortic aneurysms are a type of true aneurysm. The layers of the vessel wall include the tunica adventitia (outermost layer), tunica media (middle layer), and the tunica intima (innermost layer). Rumwell & McPharlin (2017) state that with true aneurysms, all three layers of the vessel will stay intact and bulge outwardly (see figure 1). 8 Figure 1 Normal Aorta vs. True Aortic Aneurysm Note. An example of the difference between a normal aorta and a true aneurysm of the abdominal aorta (Vascular Institute of the Rockies (n.d.). [Photograph of a normal aorta and an abdominal aortic aneurysm]. https://vascularinstitute.com/Abdominal-Aortic-Aneurysms). The systemic effect of abdominal aortic aneurysms occurs when mural thrombus develops in the AAA. The mural thrombus may take up a lot of space in the affected vessel; thus, creating a residual lumen (see figure 2) (Rumwell & McPharlin, 2017). The lower extremity vessels may have diminished flow, depending on how small the residual lumen is. Another systemic effect that may occur is blue toe syndrome or “trash foot” (Rumwell & McPharlin, 2017). With this syndrome, a piece of the mural thrombus breaks off, travels down to the arcuate artery, and gets stuck. The arcuate artery perfuses the toes. If the arcuate artery becomes occluded by the emboli, the toe(s) will not receive oxygenate-rich blood. The affected toe(s) will then become ischemic (Rumwell & McPharlin, 2017). 9 Figure 2 Residual Lumen Note. A sonographic image of a residual lumen created by the mural thrombus located in the AAA (Regional Medical Facility (2020). [Photograph of the residual lumen of an abdominal aortic aneurysm]). Pathological Progression As the individual who has an AAA ages, the aneurysm gets larger. The abdominal aorta is said to become aneurysmal when it reaches 3 centimeters or has a diameter that exceeds one and one-half times the expected diameter of that location, dependent upon the body size and gender of the individual (Daigle, 2017). Abdominal aortic aneurysms are usually asymptomatic. However, upon physical examination, a pulsatile mass may be palpated in the abdomen (Daigle, 2017). Also, with the progression of the disease, back pain and abdominal pain may occur. The pathological progression for this disease can include mural or intraluminal thrombus, dissection, and/or rupture. Mural thrombus develops in the aneurysmal area because the original vessel injury initiates coagulation and thrombosis in that location (see figure 3). Over time, the thrombus can 10 weaken the aortic walls due to the thrombus inhibiting proper nutrient distribution and oxygenation from the free-flowing blood to the vessel wall, according to Lukasiewicz et al. (2016). Small vessel development in the mural thrombus and aneurysm wall can cause the integrity and stability of the abdominal aortic aneurysm wall to decrease. This leads to further progression of the aneurysm. It can also increase the risk of rupture (Lukasiewicz et al., 2016). Figure 3 Mural Thrombus Note. A sonographic image portraying mural thrombus located in an abdominal aortic aneurysm (Regional Medical Facility (2020). [Photograph of mural thrombus located in an abdominal aortic aneurysm]). Aortic dissections occur when the tunica intima gets pulled away from the tunica media due to the extravasation of blood that separates the two layers. This creates a true lumen and a false lumen, ac...
 

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