Advanced PathophysiologyA 68-year-old obese male presents to the clinic with a 3-day history of fever with chills, and Lt. great toe pain that has gotten
... [Show More] progressively worse. Patient states this is the first time that this has happened, and nothing has made it better and walking on his right foot makes it worse. He has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which did give him a bit of relief.
HPI: hypertension treated with Lisinopril/HCTZ .
SH: Denies smoking. Drinking: “a fair amount of red wine” every week. General appearance: Ill appearing male who sits with his right foot elevated.
PE: remarkable for a temp of 100.2, pulse 106, respirations 20 and BP 158/92. Right great toe (first metatarsal phalangeal [MTP]) noticeably swollen and red. Unable to palpate to assess range of motion due to
extreme pain. CBC and Complete metabolic profile revealed WBC 15,000 mm3 and uric acid 9.0 mg/dl.
Diagnoses the patient with acute gout.
Question:
Explain the pathophysiology of gout.
• Undigested uric acid accumulates w/in lysosomes, damaging lysosomal membrane. Subsequent enzyme leakage results in cell death and tissue injury
• Disturbances in maintaining serum urate levels result in hyperuricemia and deposition of sodium urate crystals in the tissues, leading to painful disorders, known as gout
• Noninfectious inflammatory joint disease (gout); inflammation is caused by an immune response to the deposition of crystals of monosodium urate in and around the joint.
• Gout is an inflammatory response to excessive uric acid in the blood and other body fluids. Elevated levels lead to the formation of monosodium urate (MSU) crystals in and around the joins. When the uric acid concentration is high
enough, it crystallizes and forms insoluble precipitates of MSU that are deposited in connective tissues throughout the body. Crystallization in synovial fluid triggers the release of chemokines and interleukins. [Show Less]