Gastrointestinal and Hepatobiliary Disorders Paper
Gastrointestinal and Hepatobiliary Disorders
Scenario 1: Peptic Ulcer Disease
Question: What is the pathophysiology of PUD/ formation of peptic ulcers?
The 65-year-old patient potential has peptic ulcer disease. Peptic ulcer disease is attributed to any factor that breaks the mucosal barrier in the stomach. Several factors might have contributed to the development of the peptic ulcer disease by the patient. One of them is the use of non-steroidal anti-inflammatory drugs. The patient currently uses ibuprofen as needed for pain. Prolonged use of NSAIDs increases the risk of peptic ulcer disease since they inhibit the production of prostaglandins(Sverdén et al., 2019). The inhibition lowers the release of bicarbonates and mucus production, hence, increased susceptibility to the effect of NSAIDs.
The patient also has risk factors associated with the development of peptic ulcer disease. One of them is smoking. Smokers have an elevated risk of developing peptic ulcers and gastroesophageal reflux disease as compared to the non-smokers. Evidence shows that smoking weakens the esophageal sphincter that prevents the backward movement of hydrochloric acid to the esophagus, hence, causing GERD. Smoking also affects the secretion of gastric acid. It also interferes with the action of crucial histamine-2 antagonists, which protect the mucosal layer. It also increases the emptying of gastric liquids and duodenal reflex(Dunlap & Patterson, 2019). Lastly, smoking reduces mucosal blood flow, production of prostaglandins and bicarbonate secretion in the stomach.
The other risk factor for peptic ulcer disease the patient has is stress. Stress increases the production of gastric acid, as a physiological response. Stress also predisposes patients to engage in risky lifestyles and behaviors such as alcohol abuse and smoking. The patient also drinks alcohol and 6-7 cups of coffee in a day. Alcohol and chronic drinking of alcohol act as irritants of the stomach mucosa, hence, the risk of developing peptic ulcer disease (Sverdén et al., 2019).
Scenario 2: Gastroesophageal Reflex Disease (GERD)
Question: If the client asks what causes GERD how would you explain this as a provider?
The patient in the case study has GERD. I would inform her that several factors cause GERD. One of the aspects that I will educate her is that GERD is a condition that develops following the ulceration of the mucosal lining that protects the esophagus. One of the causes of the disorder is Zollinger-Ellison syndrome, which increases the release of gastric acid. Zollinger-Ellison syndrome is characterized by the presence of multiple duodenal or pancreatic tumors that increase gastric acid secretion (Maret-Ouda et al., 2020).
The other cause of GERD that the patient should be aware is the prolonged use of NSAIDs. NSAIDs inhibit the synthesis of protective prostaglandins. They also lower the production of bicarbonates and mucus while increasing the secretion of hydrochloric acid. The other factor is smoking. Smoking suppresses the production of prostaglandins, mucus for protection, and weakens the esophageal sphincter. Increased use of irritants such as coffee and alcohol also play a crucial role(Katz et al., 2022). The irritation acts as a source of stress that degrade the protective mucosa and increase the production of destructive gastric acid.
The other cause is any form of stress. Stressors such as hospitalization and life experiences also act as a source of GERD. Any stressors increase the production of gastric acid. The risk of GERD increases if the patient already has other risk factors for GERD and or peptic ulcer disease. The additional risk factors that should be addressed to prevent GERD include obesity, hiatal hernia, esophageal contractions, prolonged or reduced stomach emptying, and abnormalities of esophageal sphincter (Maret-Ouda et al., 2020).
Scenario 3: Upper GI Bleed
- What are the variables here that contribute to an upper GI bleed?
The patient in the case study has a potential diagnosis of upper GI bleed. Several variables contribute to the development of the upper GI bleed. One of the variables is peptic ulcer bleeding. Patients with chronic ulcers are increasingly at a risk of developing upper GI bleed. The bleed arises from severe destruction of the protecting mucosal layer by gastric secretions. The other variable is gastritis. The irritation and inflammation of the gastric mucosa increase the risk of its destruction by gastric acid(Graham & Carlberg, 2019). Over time, gastritis causes upper GI bleed due to the destruction of the mucosal barrier in esophagus and stomach.
The other variable associated with upper GI bleed is esophagitis. Esophagitis refers to the inflammation of the esophagus. The inflammation occurs from the different irritants to the esophageal mucosa. Chronic inflammation may cause altered mucosa integrity and damage from gastric reflux, hence, the development of upper GI bleed. The other variable is esophageal varices. Esophageal varices are inflamed veins within the esophagus. The varices are highly prone to rupture when exposed to stressors such as straining or irritants(Leebeek& Muslem, 2019). Rupture of the veins cause upper GI bleeding, hence, a potential cause of the client’s problem in this case study.
The other variable contributing to upper GI bleed that should be considered in the client is Mallory-Weiss syndrome. Mallory-Weiss syndrome causes tears and bleeding from the stomach or esophageal lining. Cancer of the upper GI also may contribute to upper GI bleed. For example, cancers of the stomach or esophagus may cause rupture of the blood vessels, resulting in the upper GI bleed(Graham & Carlberg, 2019). Consequently, these potential causes should be ruled out through comprehensive diagnostics in the patient’s care.
Scenario 4: Diverticulitis
Question: What can cause diverticulitis in the lower GI tract?
The patient in the case study has diverticulitis. Diverticulitisdevelopswhen a part of the colon weakens leading to pouches and protrusion in the wall of the colon. Several factors can cause diverticulitis. One of them is aging. The risk of a patient developing diverticulitis increase significantly as one ages. The other cause of obesity. The risks of diverticulitis increase significantly with excessive weight gain. An imbalance between the bacterial flora in the colon has also been attributed to diverticulitis (Peery et al., 2021). For example, an imbalance between Clostridium coccoides and Escherichia have been identified to cause diverticulitis in most of the patients.
Diet also plays a role in the development of diverticulitis. Patients with a history of low fiber diet have an elevated risk of developing the disorder as compared to those who take fiber rich diet. Low fiber diet results in too much volume within the colon, hence, increasing the risk of diverticulitis. The other cause is physical inactivity. Physical inactivity affects intestinal microbiome as well as increases the risk of diverticulitis-associated risk factors such as obesity. Genetics also contributes to diverticulitis. Accordingly, people born to families with a history of diverticulitis are increasingly at a risk of developing the disorder. However, the direct link between the exposure and development of diverticulitis is inconclusive. The use of certain medications has also been shown to increase the risk of diverticulitis. For example, NSAIDs and steroids have been shown to increase the risk of diverticulitis due to their effect on gastrointestinal physiology. Lifestyles such as smoking also increases the risk(Peery et al., 2021). This can be seen from the evidence that most of the smokers have a high rate of diverticulitis as compared to non-smokers.
References
Dunlap, J. J., & Patterson, S. (2019). PEPTIC ULCER DISEASE. Gastroenterology Nursing, 42(5), 451. https://doi.org/10.1097/SGA.0000000000000478
Graham, A., & Carlberg, D. J. (2019). Gastrointestinal Emergencies: Evidence-Based Answers to Key Clinical Questions. Springer.
Katz, P. O., Dunbar, K. B., Schnoll-Sussman, F. H., Greer, K. B., Yadlapati, R., &Spechler, S. J. (2022). ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. The American Journal of Gastroenterology, 117(1), 27–56. https://doi.org/10.14309/ajg.0000000000001538
Leebeek, F. W. G., & Muslem, R. (2019). Bleeding in critical care associated with left ventricular assist devices: Pathophysiology, symptoms, and management. Hematology, 2019(1), 88–96. https://doi.org/10.1182/hematology.2019000067
Maret-Ouda, J., Markar, S. R., & Lagergren, J. (2020). Gastroesophageal Reflux Disease: A Review. JAMA, 324(24), 2536–2547. https://doi.org/10.1001/jama.2020.21360
Peery, A. F., Shaukat, A., & Strate, L. L. (2021). AGA Clinical Practice Update on Medical Management of Colonic Diverticulitis: Expert Review. Gastroenterology, 160(3), 906-911.e1. https://doi.org/10.1053/j.gastro.2020.09.059
Sverdén, E., Agréus, L., Dunn, J. M., & Lagergren, J. (2019). Peptic ulcer disease. BMJ, 367, l5495. https://doi.org/10.1136/bmj.l5495
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Gastrointestinal and Hepatobiliary Disorders
In this exercise, you will complete a 5-essay type question Knowledge Check to gauge your understanding of this module’s content.
Possible topics covered in this Knowledge Check include:
- Ulcers
- Hepatitis markers
- After HP shots
- Gastroesophageal Reflux Disease
- Pancreatitis
- Liver failure—acute and chronic
- Gall bladder disease
- Inflammatory bowel disease
- Diverticulitis
- Jaundice
- Bilirubin
- Gastrointestinal bleed – upper and lower
- Hepatic encephalopathy
- Intra-abdominal infections (e.g., appendicitis)
- Renal blood flow
- Glomerular filtration rate
- Kidney stones
- Infections – urinary tract infections, pyelonephritis
- Acute kidney injury
- Renal failure – acute and chronic
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
By Day 7 of Week 5
Complete the Knowledge Check By Day 7 of Week 5.
Question 1 4 pts
Scenario 1: Peptic Ulcer
A 65-year-old female comes to the clinic with a complaint of abdominal pain in the epigastric area. The pain has been persistent for two weeks. The pain described as burning, non-radiating and worse after meals. Denies N&V, weight loss or obvious bleeding. She admits to frequent belching with bloating.
PMH: seasonal allergies with Chronic Sinusitis, positive for osteoarthritis,
Meds: Claritin 10 mg po daily, ibuprofen 400-600 mg po prn pain
Family Hx-non contributary
Social history: Separated recently pending divorce; stressful situation with trying to manage two homes. Works as a Legal Assistant at a local law firm. She has 35 PPY of smoking, drinks 1-2 glasses of wine a day, and 6-7 cups of coffee per day. She denies illicit drug use, vaping or unprotected sexual encounters.
Breath test in the office revealed + urease.
The healthcare provider suspects the client has peptic ulcer disease.
Questions:
1. Explain what contributed to the development from this patient’s history of PUD?
Question 2 4 pts
Scenario 1: Peptic Ulcer
A 65-year-old female comes to the clinic with a complaint of abdominal pain in the epigastric area. The pain has been persistent for two weeks. The pain described as burning, non-radiating and worse after meals. Denies N&V, weight loss or obvious bleeding. She admits to frequent belching with bloating.
PMH: seasonal allergies with Chronic Sinusitis, positive for osteoarthritis,
Meds: Claritin 10 mg po daily, ibuprofen 400-600 mg po prn pain
Family Hx-non contributary
Social history: Separated recently pending divorce; stressful situation with trying to manage two homes. Works as a Legal Assistant at a local law firm. She has 35 PPY of smoking, drinks 1-2 glasses of wine a day, and 6-7 cups of coffee per day. She denies illicit drug use, vaping or unprotected sexual encounters.
Breath test in the office revealed + urease.
The healthcare provider suspects the client has peptic ulcer disease.
Question:
1. What is the pathophysiology of PUD/ formation of peptic ulcers?
Question 3 4 pts
Scenario 2: Gastroesophageal Reflux Disease (GERD)
A 44-year-old morbidly obese female comes to the clinic complaining of “burning in my chest and a funny taste in my mouth”. The symptoms have been present for years but patient states she had been treating the symptoms with antacid tablets which helped until the last 4 or 5 weeks. She never saw a healthcare provider for that. She says the symptoms get worse at night when she is lying down and has had to sleep with 2 pillows. She says she has started coughing at night which has been interfering with her sleep. She denies palpitations, shortness of breath, or nausea.
PMH-HTN, venous stasis ulcers, irritable bowel syndrome, osteoarthritis of knees, morbid obesity (BMI 48 kg/m2)
FH:non contributary
Medications: Lisinopril 10 mg po qd, Bentyl 10 mg po, ibuprofen 800 mg po q 6 hr prn
SH: 20 PPY of smoking, ETOH rarely, denies vaping
Diagnoses: Gastroesophageal reflux disease (GERD).
Question:
1. If the client asks what causes GERD how would you explain this as a provider?
Question 4 4 pts
Scenario 3: Upper GI Bleed
A 64-year-old male presents the clinic with complaints of passing dark, tarry, stools. He stated the first episode occurred last week, but it was only a small amount after he had eaten a dinner of beets and beef. The episode today was accompanied by nausea, sweating, and weakness. He states he has had some mid epigastric pain for several weeks and has been taking OTC antacids. The most likely diagnosis is upper GI bleed which won’t be confirmed until further endoscopic procedures are performed.
Question:
1. What are the variables here that contribute to an upper GI bleed?
Question 5 4 pts
Scenario 4: Diverticulitis
A 54-year-old schoolteacher is seeing your today for complaints of passing bright red blood when she had a bowel movement this morning. She stated the first episode occurred last week. The episode today was accompanied by nausea, sweating, and weakness. She states she has had some LLQ pain for several weeks but described it as “coming and going”. She says she has had a fever and abdominal cramps that have worsened this morning.
Diagnosis is lower GI bleed secondary to diverticulitis.
Question:
1. What can cause diverticulitis in the lower GI tract?