Case Study Hypoproteinemia

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Nov 24, 2024

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1. Describe all the constituents contained in plasma and their concentrations. Plasma, constituting 55% of the total blood volume, serves as the cell-free liquid component with distinct characteristics. It is a pale straw-colored fluid with a specific gravity around 1.022, amounting to approximately 3.5 liters in an average person. The diverse constituents of plasma can be broadly categorized into water, gases, electrolytes, low molecular weight nonelectrolytes, and high molecular weight molecules (Mathew et al., 2023). Water is the predominant component, comprising 90% of plasma volume. Gases found in plasma include nitrogen, carbon dioxide, oxygen, as well as traces of nitric oxide and hydrogen sulfide. Essential electrolytes such as sodium, chloride, bicarbonate, potassium, magnesium, and calcium contribute to the ionic balance of plasma (Mathew et al., 2023). Low molecular weight nonelectrolytes encompass glucose, fatty acids, amino acids, vitamins, hormones, and urea. Meanwhile, high molecular weight molecules, particularly plasma proteins, play crucial roles. The total plasma protein concentration ranges from 70-90g/L, with 80% attributed to albumin (Mathew et al., 2023). Among plasma proteins, globulins form a significant portion, subdivided into α-1, α-2, β, and γ globulins. These include diverse proteins such as α1-foetoprotein, α1-antitrypsin, ceruloplasmin, haptoglobin, and immunoglobulins. Fibrinogen, a glycoprotein, contributes to blood clotting. Collectively, these constituents ensure plasma's multifaceted functions, including nutrient and hormone transport, immune response, and maintenance of osmotic pressure in the circulatory system (Mathew et al., 2023). 2. Explain the liver's role in production of proteins. The liver assumes vital metabolic functions in the human body, particularly in protein synthesis and metabolism. It produces a diverse array of proteins, including several with endocrine roles such as angiotensinogen, thrombopoietin, and insulin-like growth factor I. While the liver is the primary site for heme synthesis in children, adults experience a shift with bone marrow taking over this function, although the liver remains responsible for approximately 20% of heme synthesis in adulthood. Significantly, the liver is integral to the synthesis of nearly all plasma proteins, encompassing albumin, alpha-1-acid glycoprotein, and a majority of the coagulation cascade and fibrinolytic pathways. Notable exceptions to this involvement include gamma globulins, factor III, IV, and VIII. Among the proteins synthesized by the liver are protein S, protein C, protein Z, and plasminogen activator inhibitor, along with antithrombin III. Additionally, the liver synthesizes vitamin K- dependent proteins, including Factors II, VII, IX, and X (Trefts et al., 2017). 3. Why would albumin be important in regulating pressure at the capillaries? Albumin, a soluble protein coagulable by heat and synthesized mainly in the liver, constitutes a significant portion of plasma proteins, comprising up to two-thirds of the plasma's protein concentration. Its primary functions include regulating colloidal osmotic pressure in blood, influencing water exchange between plasma and interstitial spaces. Reduced albumin levels lead to increased water flow, causing tissue fluid accumulation or edema. Additionally, albumin serves as a transport protein for various substances such as fatty acids, hormones, bilirubin, and drugs. Its three main functions involve metabolite transport, maintenance of oncotic pressure for fluid distribution, and provision of amino acids for the body's use (Moman et al., 2020).
4. Explain the process of fluid movement at both the arterial and venous side of the capillary. The cardiovascular system serves the fundamental purpose of circulating gases, nutrients, wastes, and various substances to and from the body's cells. Small molecules can diffuse through capillary walls, while glucose, amino acids, and ions utilize transporters for facilitated diffusion. Larger molecules may exit the blood through intercellular clefts or fenestrated capillary pores. The liver synthesizes most plasma proteins, contributing to crucial physiological processes. Bulk flow, a pressure-driven mechanism, facilitates mass fluid movement between capillary beds and tissues. Hydrostatic pressure, exerted by blood, drives fluid from capillaries to tissues (filtration), while osmotic pressure draws fluid back into capillaries (reabsorption). The net filtration pressure (NFP), the difference between capillary hydrostatic pressure (CHP) and blood colloidal osmotic pressure (BCOP), determines fluid movement. The interplay of these pressures varies along the capillary bed, with NFP being positive at the arterial end, zero in the middle, and negative at the venous end, indicating filtration, equilibrium, and reabsorption, respectively. Blood colloidal osmotic pressure, largely influenced by plasma proteins, accounts for reabsorption by drawing water back into the capillary. The osmotic pressure gradient is a crucial factor in this process, with solute concentrations impacting the movement of water across semipermeable membranes (Scallan et al., 2010). 5. What can Betty do to improve her situation? Betty, a previously active 24-year-old with a job at a local university, developed symptoms including fatigue, fever, stomach pain, joint and muscle soreness, and noticeable changes in hair and swelling. After consulting her physician, she was diagnosed with hepatitis C and hypoproteinemia, specifically low albumin levels. To improve her situation, Betty should adhere to her prescribed hepatitis C treatment, focusing on antiviral medications. Additionally, she can enhance her diet by incorporating high-quality proteins and nutrient-rich foods. Staying well-hydrated, limiting alcohol intake, and engaging in approved physical activity are also crucial. Regular communication with her healthcare team and addressing both physical and emotional aspects of her health will contribute to Betty's overall well-being. References Mathew, J., Sankar, P., & Varacallo, M. (2023). Physiology, Blood Plasma . PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK531504/#article-27296.s3 Moman, R. N., Gupta, N., & Varacallo, M. (2020). Physiology, Albumin . PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459198/#:~:text=Human%20albumin%20acts %20as%20the Scallan, J., Huxley, V. H., & Korthuis, R. J. (2010). Fluid Movement Across the Endothelial Barrier. Nih.gov; Morgan & Claypool Life Sciences. https://www.ncbi.nlm.nih.gov/books/NBK53443/ Trefts, E., Gannon, M., & Wasserman, D. H. (2017). The liver. Current biology : CB , 27 (21), R1147– R1151. https://doi.org/10.1016/j.cub.2017.09.019
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