An acute Exacerbation of panacinar emphysema

Mrs. Georgia Anastasis, a 75-year-old retired cook, is admitted to the ward with an acute exacerbation of panacinar emphysema and a chronic wound on her right foot. Georgia’s chart indicates a past medical history of dyslipidaemia, hypertension, and type-2 diabetes mellitus. Her current medications are as follows: glibenclamide (5 mg BD), atorvastatin (80 mg once daily), salmeterol (50 mcg/dose) inhaled twice daily, tiotropium (18 mcg/dose) inhaled once daily and diltiazem (240 mg, controlled release) once daily.

a) Describe two characteristics of panacinar emphysema, providing rationale for its location and aetiology. (300 words)

b) Discuss two pathophysiological changes that are present in patients with emphysema like Georgia. (300 words)

c) Discuss two factors for Georgia that could trigger hyperglycemic hyperosmolar syndrome (HHS) and two pathophysiological changes present in patients with HHS. (300 words)