12/25/2019 0 Comments A & P Case Study on Addisons DiseaseUnit 1 Case Study Addison’s disease is from a result from damage to the adrenal cortex. These two adrenal glands are located on top of the kidneys, where they are enclosed in a fibrous capsule and a cushion of fat. . The have an outer portion, called the cortex, which is a glandular tissue derived from embryonic mesoderm. The inner portion called the medulla, which is more like a knot of nervous tissue than a gland and it is part of the sympathetic nervous system. The adrenal cortex synthesizes over two dozen steroid hormones called corticosteroids. The Adrenal medulla is part of the autonomic nervous system. They are often referred to as the suprarenal glands. That damage causes the cortex to produce less of their hormones (corticosteroids) The 3 types of hormone secreted are the glucocorticoid hormone (Cortisol) which maintain glucose control, decrease immune response and help the body respond to stress. The mineralocorticoid hormones (aldosterone) regulates sodium and potassium balance. The 3rd one is the sex hormones, androgen and estrogen, which affect sexual development and sex drive. There are a few things that may cause damage such as, the immune system mistakenly attacking the gland autoimmune disorder), infections such as tuberculosis, HIV or fungal infections. Hemorrhage’s, tumors and use of blood thinning drugs are some other causes. Risk factors for the autoimmune type of Addison’s disease include chronic thyroiditis, dermatis herpetiforms, Graves’ disease, hypoparathyroidism, hypopituitarism, myasthenia gravis, testicular dysfunction, type 1 diabetes and pernicious anemia. Usually the destruction of the adrenal gland cortex is often gradual and the symptoms are mild. Addison’s often goes undiagnosed until a sudden illness or accident occurs. The worsening of symptoms is called acute adrenal insufficiency and can be life threatening. Let’s go back to the start of symptoms with Addison’s disease. Here are a few, changes in heart rate and blood pressure, chronic diarrhea, darkening of the skin (it becomes patchy), irregular menstruation, irritability, paleness, extreme weakness, fatigue, loss of appetite, salt cravings, slow, sluggish movements, weight loss, lesions on the buccal mucosa, nausea and vomiting. Acute adrenal crisis have similar symptoms of course, however you will also see abdominal ain, confusion, dizziness, headaches, joint pain, rapid heart rate, rapid respirations, shaking chills, unusual and excessive sweating on face and/or palms. And in severe cases coma and/or death. The initial diagnosis and decision to treat are based on history, physical examination and lab findings. Lab tests such as ACTH stimulation test, cortisol level, fasting blood sugar, serum potassium and serum sodium. Tests may show an increase in potassium, low cortisol level, low serum sodium. The Adrenal medullae normally secrete 80% epinephrine and 20% norepinephrine. Sympathetic stimulation results in secretion. Epinephrine is the more potent stimulator of metabolic activities, but norepinephrine has the greater influence on peripheral vasoconstriction and blood pressure. The adrenal cortex produces the 3 hormones listed above. Cortisol is produced from 2 hydroxylations of 17 alpha-hydroxyprogesterone. Cortisol is 90-93% protein bound. Glucocorticoids are nonspecific cardiac stimulants that activate release of vasoactive substances. So in the absence of corticosteroids, stress results in hypotension, shock and even death. Glucocorticoids stimulate gluconeogenesis and decrease cellular glucose use, obilize amino acids and fatty acids, inhibit the effects of insulin, and give rise to ketone bodies in metabolism, elevate RBC and platelet levels and exhibit anti- inflammatory effects. Adrenal crisis occurs when the adrenal gland is damaged (primary adrenal insufficiency), the pituitary gland is injured (secondary adrenal insufficiency) or that adrenal insufficiency is not properly treated. Treatment with replacement corticosteroids will control the symptoms of this disease, and this usually will require the patient to take these drugs for life. It is receive a combination of glucocorticoids and mineralocorticoids. The provider may increase the dose in times of infection, injury and stress. With adrenal crisis patients will need an immediate injection of hydrocortisone, either IM, or IV. If the blood pressure is extreme low IV fluids will be helpful. Complications can occur if you take too much or not enough of the adrenal hormone supplement. This complications can arise due to related illnesses such as diabetes, chronic thyroiditis, hypoparathyroidsim, ovarian hypofunction or testicular failure, thyrotoxicosis and pernicious anemia. Low sodium with Addison’s should be carefully corrected, if one to quickly it can lead to brain damage, this is noted in a 2004 article in “American family Physician†they require immediate but slow administration of saline, which is basically salt water, composed of sodium chloride in water. They list a second step which then be finding the underlying cause. Primary adrenocortical insufficiency is not a common disorder. It’s incidence in western populations are near 50 cases per 1,000, 000. However with the widespread corticosteroid use secondary adrenocortical insufficiency due to steroid withdrawal has become much more common. Approximately 6,000,000 persons in the United States are considered to have undiagnosed adrenal insufficiency, which is significant only during times of physiologic stress. Primary adrenocortical insufficiency does have many etiologies. But it is noted that 70-80% of the cases in the United States are caused by autoimmune adrenal destruction. It is found that about 30% of the time the adrenal damage is due other causes such as TB. In children about 70% of the cases are caused by a congenital disease termed congenital adrenal hyperplasia. Primary adrenocortical insufficiency affects men and women equally, women are affected 2-3 imes more often by the idiopathic autoimmune form of adrenal insufficiency. In idiopathic autoimmune adrenal insufficiency, the diagnosis is most often found in the third to fourth decades of life. This disease however is not limited to any specific age group. “American Family Physicianâ€, Kian Peng:2004 “Robbins and Cotran Pathologic Basis of Diseaseâ€, Vinay Kumar 8th Ed 2009 http:/emedicine. medscape. com/article/765753-overview http:/labtestsonline. org/understanding/conditions/addisons-disease/ http:/www. nlm. nih. gov/medlineplus/ency/article/000378. htm
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12/12/2019 0 Comments Corporate Social Responsibility Essay Example | Topics and Well Written Essays - 1500 wordsCorporate Social Responsibility - Essay Example
These can include (but may not be limited to) employees, customers, suppliers, community oraganaizations, local neighborhood and shareholders.'-Wikipedia.CSR entails that corporations should contemplate the actual and impending effects of their decisions on other stakeholders as well. It is correlated with the principles of sustainable development, which propagate that social, environmental and other consequence of business decisions should be taken into consideration. These two aspects can be better understood by examining the shareholders and stakeholders theories. The main ideas of the two theories are juxtaposed under the following heads. Director's fiduciary duties: The Shareholder's theory advocates that value maximization should be the governing corporate objective. It makes a plea that the interest of the shareholders should precede over that of other constituents, based on the presumptions of capitalism. The supporting view is that, the directors fiduciary duty is to run the company in the interest of the shareholders.Tradional property rights are cited as a justification for this argument. The shareholders are the owners of the company, therefore they hold property rights. ... The chief proponents of the stakeholders' theory are Donaldson and Preston. According to this school of thought, directors should have multi fiduciary duties towards all the stakeholders. Stakeholders are the people who affect and are affected by the company. The stakeholders view of strategy is an instrumental theory of the corporatin, integrating both the resource based view and the market based view, it is opposed to the view where the company solely tries to increase the value for shareholding. The stakeholder group should not be treated as a mean to some end but must be participative in detreming the direction of the company in which they hold stake. Basis for determining business relationships: As per the shareholders' theory, business relationships are determined by legal contracts. Thus, it recognizes accountability towards those parties with whom explicit legal contacts have been signed. It follows Sternberg's argument that such contracts are made under 'libertarian free contracting". This vastly limits the scope of the corporation's obligations. On the other hand, the stakeholders' model advocates social and moral obligations towards all those who affect or get affected by the company, these obligations may be become binding on the company via legal or implied contracts. Both the theories accept that the firm is a nexus of contacts but differ about the basis for determing those contacts. Objective of wealth creation: The two theories take different stands about the nature of these contracts. Kay's work in strategic management (Kay1993), show that managing contracts on collaborative, 'relational' basis can lead to competitive advantages directly benefiting shareholders. Thus, shareholder's theory acknowledges that contacts should be |