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Constantina Case Study: Adult Female Marathon Runner Assignment Sample



Question 1 (8 marks total)

A. Endometrial tissue contains glandular structures relevant to Constantina’s reproductive function. Note the role of this glandular tissue in reproductive function, including any likely changes from normal in the secretion and resultant effects for Constantina.

B. Considering Constantina and her current circumstances describe the role of oestrogen and discuss how the levels of this hormone may vary from normal.

Question 2 (8 marks total)

A. Describe the role of the kidneys in maintaining fluid balance with reference to the role of antidiuretic hormone (ADH). Is Constantina at risk of not maintaining homeostatic fluid mechanisms? Why/why not?

B. What is a urinalysis and what is its significance for this case? With respect to the specific gravity (SG) component of Constantina’s urinalysis result, and using your knowledge of normal kidney function, would you expect this result? Why /why not?

Question 3 (8 marks total)

A. What is gut motility? Is it likely that Constantina’s gut motility has increased or decreased from normal? Discuss EITHER peristalsis OR segmentation in your response.

B. Why is it important for Constantina to maintain adequate protein intake? Discuss its importance in cellular recovery in your response.

Question 4 (8 marks total)

A. Constantina has used Voltaren Emugel (containing a NSAID) to ease her aching muscles. Identify the route of administration and discuss how the drug is likely to be absorbed after administration and its likely bioavailability. Justify your answer by discussing whether the drug would be subjected to hepatic first pass.

B. What is the importance of the half-life of a drug? Assuming 100% absorption and the half-life of an NSAID is 8 hours; calculate the % amount of drug that is likely to be present in the blood after 24hours.

Question 5 (8 marks total)

A. Consider Constantina’s blood pressure result and discuss whether the mean arterial pressure is likely to be varied from normal. In your answer you must include reference to a possible change in blood viscosity and briefly mention the consequences of any change in BP upon kidney function B. Discuss the role of the renin-angiotensin-aldosterone system in the maintenance of blood pressure in Constantina’s circumstance.


The Constantina biology assignment case study seeks to critically examine the clinical data provided by Constantina, a 38-year-old adult female marathon runner who visited a GP office in post-training run state.

Constantina's reproductive function may be considered in the context of endometrial tissue, which has glandular structures important for the release of glycogen, which enhances blood flow in the spiral arteries and raises progesterone levels (Lessey & Young, 2019). According to study by Brame, Macedo, and Klein (2017), high-intensity exercise in women lowers progesterone levels, which in turn lowers glycogen release from the glandular structure of endometrial tissue and may lead to poor endometrium tissue maintenance and monthly imbalance. Regarding the Constantina case study, Constantina engages in vigorous exercise, which has reduced progesterone production and caused glandular tissue to perform poorly in the release of glycogen, adversely impacting the reproductive system and menstrual cycle.

The release of oestrogen, which is crucial for maintaining reproductive health, raising cholesterol levels, and strengthening bones, is connected to the reproductive process (Vellanki, K., & Kramer, 2019). The secretion of luteinizing hormone and follicle-stimulating hormone is stimulated by an increase in oestrogen during the follicular phase of the menstrual cycle, which also maintains the growth of the endometrium. However, Nagai et al. (2016) suggested that excessive exercise may result in an abnormal variation in oestrogen secretion and a decrease in oestrogen secretion. Thus, it may be claimed that Constantina's three days of intense exercise each week decreased the oestrogen hormone's release from the usual level, which led to amenorrhea and impaired reproductive function.

Focusing on the Constantina case study once again, it is found that Constantina exhibits lethargy and a reduction in fluid consumption, both of which may be connected to renal function. In relation to the antidiuretic hormone, it is essential for maintaining fluid balance by controlling the concentration of urine and its excretion by reabsorption of bodily fluids. The anti-diuretic hormone operates on the late distal tubules of the kidneys and the collecting duct to stimulate re-absorption of water, which helps the body retain water (Cuzzo & Lappin, 2019). Aquaporin-2, which tends to increase water transport over the osmotic gradient and preserve hemostasis, is phosphorylated by it. In the provided case study with Constantina, Constantina is at risk of not maintaining fluid balance since her water consumption has apparently been lower than normal, which increases the likelihood that she may get dehydrated. It is also clear from her physical exam, which is depicted in the Constantina case study, that she is dehydrated, as evidenced by her dry lips, dark circles under her eyes, poor skin turgor, and high urine specific gravity. As a result, the fluid imbalance that results from Constantina's dehydration is not corrected.

A urinalysis was performed on Constantina in order to examine the urine sample, which is important for diagnosis. Urinalysis is the process of examining the colour, consistency, and concentration of urine. It is used to diagnose and treat a variety of illnesses, including kidney problems, UTIs, and diabetes (Free, 2018). The specific gravity (SG) of the urine in the Constantina case study is stated to be 1.035, indicating a value in the upper range. Due to the malfunction of the renal tubules and the production of the ADH hormone, it is thus suggestive of impaired kidney functioning. Due to an increase in urine output and a rise in solute concentration brought on by the inhibition of water reabsorption, there is an excessive loss of water and dehydration (Perrier et al., 2017). Therefore, a high SG is anticipated in the urinalysis because Constantina runs the risk of not maintaining a fluid mechanism.

Another element essential to preserving a person's health is their gastrointestinal motility. Simply put, peristalsis, or the movement of the contents inside the digestive system, is a result of the contractions and relaxations of the muscles of the gastrointestinal (GI) tract, which are referred to as gut motility (Beckett et al., 2017). According to Wood (2019), dehydration causes the gut to absorb a lot of water from food being digested, making it harder to excrete the food and obstructing peristalsis movement, which may be helped by a high water volume. Since dehydration is a problem in Constantina, it may be assumed that peristalsis movement will be less than usual.

Maintaining daily calorie intake, repairing cells and tissues, and promoting muscle and body development are the three major purposes of protein in the diet. Constantina competes in marathons, which are basically endurance sports that may cause discomfort and tissue damage. According to Eddens et al. (2017), eating a diet high in protein is necessary to promote cellular recovery, repair damaged tissue, and preserve the integrity of cells. As a result, she must maintain her protein consumption to satisfy her daily calorie demands. Protein also promotes muscle repair, which assists in cellular healing and facilitates the process of restoring strength (Cintineo et al., 2018).

Constantina was found to have severe muscular discomfort and soreness, according to the Constantina case study. Constantina turned to the NSAID-containing Voltaren Emulgel to soothe her sore muscles. Diclofenac is the NSAID component and the active ingredient in this emulgel, and it works by lowering inflammation and alleviating pain. Topical application through the skin is more likely to be absorbed systemically from the GI tract and first pass via the liver. Diclofenac sodium's relative bioavailability is thus related to the size of the region treated, dependent on the total applied dosage as well as the degree of skin moisture, and was 6% of the systematic exposure, indicating 94% lower than oral diclofenac (Gopalasatheeskumar et al., 2017).

It would be appropriate to discuss the significance of a drug's half-life in this situation. According to the definition, it refers to the length of time needed for a drug's plasma concentration to reach 50% of its whole body concentration (Binder & Skerra, 2017). This drug's half-life, which is important in addition to the two other critical parameters of strength and length, is intended to show if drug buildup may arise as a result of numerous dosage practise. Assuming complete absorption and an NSAID's 8-hour half-life, 50% of the medication will be absorbed in the first 8 hours, and the remaining 50%, or 25%, will be absorbed in the following 8 hours (16th hours). Additionally, half of 25%, or 12.5%, will still be present in the blood after 24 hours.

Constantina's blood pressure was again examined and determined to be 87/58 mm of Hg. Typically, the normal blood pressure ranges from 110/70 mm Hg to 120/80 mm Hg. As a result, it was anomalous in the case study situation for Constantina. Mean arterial blood pressure (MABP), which should typically range from 70 to 110 mm Hg, deviated in this situation and showed a lower result. According to study by Zimmerman et al. (2017), a condition where blood viscosity increases results in an increase in total peripheral resistance (TPR), which obstructs blood flow. The relationship between MABP and cardiac output and TPR shows that raising systolic blood pressure is necessary to maintain blood volume. As a result, low BP in the Constantina case study causes the TPR to drop, which in turn causes the blood viscosity to decrease. It results in a rise in blood flow and a decrease in MABP. According to Larsson et al. (2018), a drop in MABP will also result in a drop in blood volume, which will impede blood flow to the glomerulus. As a result, it affects how well the kidneys reabsorb substances.

For Constantina, a quick decrease in blood pressure triggers the renin-angiotensin-aldosterone pathway, which releases renin from the kidney (RAAS). Through activation of the angiotensinogen, which then transforms into angiotensin II, it causes the synthesis of angiotensin I. Aldosterone hormones are released, and they directly affect the kidney (Ghazi & Drawz, 2017). It works by enhancing salt absorption and releasing it into the bloodstream. Therefore, the conclusions drawn from the examination of the Constantina case study make it clear that in Constantina's circumstance, the production of the hormone aldosterone raises the salt level and blood volume, which ultimately raises the blood pressure.

The medical history, physical examination, and pathological tests, including a urinalysis, performed on Constantina provided crucial information concerning the problem of dehydration and hypotension, it can be inferred from the discussion above based on the case study of Constantina. The execution of these basic pathological tests may help to simplify the treatment plans in a manner that will effectively promote her health and wellness.


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