Concepts Of Gastrointestinal and Hepatobiliary Disorders

Scenario 1

  1. What factors may have contributed to the development of PUD?

Peptic Ulcers are open sores that often develop on the inside lining of the stomach and upper part of the lining of the small intestine. In the case study, the possible factors that may have contributed to the development of PUD include frequent sinusitis infections, continuous use of ibuprofen, and Zyrtec medicines all year round.

  1. How do these factors contribute to the formation of peptic ulcers?

The frequent sinusitis can be a sign of an infection with helictobacter pylori in the stomach, which is the major cause of peptic ulcers.  Besides, the patient has frequently been using ibuprofen 400 to 600 mg and Meds-Zyrtec 10 mg daily year round. Continuous use of Ibuprofen can cause stomach ulcers through interfering with the ability of the stomach to protect itself from gastric acids, thus causing peptic ulcers. Even though Zyrtec does not cause side effects, continues usage can result in adverse effects such as dry mouth and stomach ulcers as it also interferes with the stomach’s ability to protect itself from the gastric acid. The epigastric abdominal pain in combination with frequent belching and bloating are signs of stomach ulcers; thus, the patient may be diagnosed with PUD.

Scenario 2

  1. The client asks the APRN what causes GERD. What is the APRN’s best response?

The APRN’s best response would be as follows: GERD is caused by the reflux of acid from the stomach back up to the esophagus. The acid reflux happens when the sphincter muscle at the lower end of the esophagus relaxes at the wrong time, permitting stomach acid to back up into the esophagus, causing the burning sensation in the chest and bad test in the mouth as seen in this patient. The symptoms get worse at night because once one lays down, the stomach acid can easily reflux into the esophagus. Risk factors include obesity, which causes narrowing of the esophageal stricture, making it difficult to swallow food.

Scenario 3

  1. What factors can contribute to an upper GI bleed?

The factors that can contribute to an upper GI include peptic ulcer, which is the most commonly known cause of upper GI. Peptic ulcers are sores that develop; on the lining of the stomach and upper part of the small intestine. Peptic ulcers are caused by the damage to the stomach wall by stomach acid, bacterial infection, or the usage of anti-inflammatory drugs that may damage the lining, resulting in the formation of sores. The primary symptom is epigastric pain, as demonstrated by the patient in this case study. Another factor is due to esophagitis, which results from gastroesophageal reflux disease (GERD), which can also be attributed to the signs of epigastric pain. The other factor is the presence of esophageal varices or abnormally enlarged veins in the esophagus, as demonstrated by the smelly dark, tarry stool as stated by the patient, indicating possible bleeding in the upper part of the GI.

Scenario 4

  1. What can cause diverticulitis in the lower GI?

Diverticulitis in the lower GI is caused by tear, leading to an inflammation or infection or both. It often develops when the weaker parts of the colon give away under pressure, causing marble-sized pouches to protrude via the wall of the colon. In the case study, the patient complains of passing red blood during a bowel movement, indicating bleeding and possible damage to the colon. Besides, he complains of abdominal cramps and lower quadrant pain, indicating that there is a problem with the colon and abdominal wall, which are associated with diverticulitis in the lower GI.

Scenario 5

  1. How does cirrhosis cause portal hypertension?

Portal hypertension is a significant complication of cirrhosis. In patients with cirrhosis, the most common cause of portal hypertension is the formation of scar tissue and regenerative nodules that lead to an increase in intra-hepatic vascular resistance and, consequently, portal pressure.  In short, cirrhosis often slows the normal blood flow through the liver, resulting in an increase in the pressure in the veins that brings blood to the liver from the intestines and spleen, as indicated by the long history of GI bleeding from esophageal.

  1. Explain how ascites develops as a result of portal hypertension

Ascites often develop as a result of the accumulation of fluid in the abdomen. Portal hypertension can lead to the development of ascites because it causes high pressure in the blood vessels, which pushes fluid out of the blood vessels into the space between the organs, leading to ascites as witnessed by the increase in the abdominal girth in the patient in this case study.

Scenario 6

  1. Explain how ascites develops as a result of portal hypertension

Portal hypertension can result in the development of ascites as a result of its mechanism of fluid buildup in the abdomen that is caused by cirrhosis. When the kidney cannot get rid of the excess sodium through salt, the fluids build up in the abdomen, leading to ascites, as witnessed in the patient in this case study. The abdominal girth is progressively increasing, making the veins narrower and transport less blood, thus the patient experiences shortness of breath.

Scenario 7

Explain how hepatic encephalopathy develops in patients with cirrhosis of the liver.

Hepatic encephalopathy develops in patients with cirrhosis of the liver because liver cirrhosis makes the liver not to function properly. As a result, the toxins that are supposed to be removed by the liver from the body are permitted to build up in the bloodstream and eventually reach the brain, thus causing confusion, as witnessed in the patient in this case study. The patient is confused, indicating that the toxins have entered his brain.

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Scenario 8

What is the most likely mechanism behind his current symptoms?

The most likely mechanism is atherosclerosis, which causes hardening of arteries as a result of the buildup of fats, cholesterol, and other substances in the arterial walls, which may restrict the flow of blood, causing the arteries to rupture, as witnessed by the episodes of bloody diarrhea in the patient. Besides, atherosclerosis can cause myocardial infarction, as seen in the patient in this case study. Atherosclerosis is a risk factor for atrial fibrillation.

Scenario 9

  1. Describe how gallstones are formed and why they caused the symptoms that the patient presented.

Gallstones are formed when bile forms solid particles in the gallbladder. The stones are formed when the amount of cholesterol or bilirubin in the bile is higher than usual. Besides, other substances within bile may also promote the formation of gallstones. In the patient in this case study, the patient ate a high-fat diet as well as a high-cholesterol diet that triggered the development of gallstones, making the patient experience severe, intermittent right upper quadrant pain, which is sharp after consuming the said diet. French fries are high in cholesterol, while cheeseburgers are high in fats.

  1. Explain how the patient became jaundiced.

The patient became jaundiced because the gallstone came out of the gallbladder and got stuck in the common bile duct. Consequently, bile cannot pass into the gut, thus seeps into the bloodstream resulting in jaundice. The patient in the case study experienced right upper quadrant pain, implying that the gallstone got stuck in the common bile duct.

Scenario 10

  1. Explain how pancreatitis develops and the role alcohol played in this patient’s case.

Pancreatitis develops when digestive enzymes become activated while still in the pancreas, irritating the pancreatic cells and causing inflammation. Alcohol plays an essential role in the development of pancreatitis because it interferes with the cells of the pancreas, halting them from working as required. This action of alcohol results in permanent damage to the pancreas walls, leading to pancreatitis. In the case study, the damage to the pancreas walls is manifested by the abdominal pain and epigastric guarding with tenderness as well as the decreased breath sounds in both bases with weak respiratory efforts, which are common signs of pancreatitis.

Scenario 11

  1. What are the important hepatitis markers that indicated the patient had acute hepatitis B?

The important markers that indicated that the patient had acute hepatitis B include dark urine accompanied by abdominal pain, fatigue, nausea, and vomiting. The patient stated that these symptoms that have lasted for month and continued to get worse.

Scenario 12

How does ulcerative colitis develop in a susceptible person?

In a susceptible person, ulcerative colitis develops as a result of immune system malfunction. When a susceptible person’s immune system attempts to fight off an invading virus or even bacterium, an abnormal immune response makes the immune system to attack the cells in the digestive tract. Certain factors like unbalance diet and stress the patient in this case study reports may aggravate but not cause ulcerative colitis. It is associated with persistent abdominal pain s reported by the patient in this case study.

Scenario 13

  1. What type of acute kidney does the patient have and what factors contributed?

The type of acute kidney injury is called chronic renal disease or chronic kidney disease. The factors that contributed to the chronic kidney disease in the patient in this case study include the presence of coronary artery disease, high blood pressure, and congestive heart failure, which impaired kidney function, resulting in damage to the kidney. The conditions such as coronary artery disease worsened over months, causing damage to the kidney.

Scenario 14

  1. What would be the most important concept of glomerular filtration rate that the APRN should address?

The most important concept the APRN should address is the Creatinine clearance rate (CrCl), which is the volume of blood plasma cleared of creatinine per unit time and is essential in the approximation of GFR.

Scenario 15

  1. What would be the most important concept of autoregulation that the APRN should address?

The APRN should address the concept of tubuloglomerular feedback, in which the kidney changes its own blood flow as a response to the changes in sodium concentrations. In the tubuloglomerular mechanism, the kidney can maintain relatively consistent blood flow and glomerular filtrate rate required for the clearance of metabolic wastes and, at the same time sustaining efficient recovery of filtered electrolytes and nutrients by the renal tubules.

Scenario 16

  1. What would be the most important concept of hormonal regulation that the APRN should address?

The most important concept of hormonal regulation is natriuretic peptides, which act acutely to decrease plasma volume by at least 3 mechanisms including increased renal excretion of salt and water, vasodilation, and increased vascular permeability.

Scenario 17

How does renal calculi calculus contributes to acute pyelonephritis?

Renal calculi calculus refers to stones in the kidney found lower in the urinary tract and is a common risk factor for acute pyelonephritis. Renal calculi calculus obstructs the urinary tract, causing bacteria such as E. coli to multiply and spread up to the bladders, resulting in acute pyelonephritis. The patient in this case study has renal calculus, which caused, and the foul-smelling urine indicated the presence of an infection.

Scenario 18

  1. How does chronic renal failure develop?

Chronic renal failure involves a reduction in the ability of the kidney to filter waste and fluid from the blood. The condition develops as a result of other conditions such as diabetes, high blood pressure, and long-term inflammation of the kidney that cause damage to the small units in the kidneys known as nephrons, which play the role of filtering wastes and fluids from the blood. The patient in this case study has Type 2 diabetes, hypertension, and hyperlipidemia, which all strain the kidney, thereby damaging the nephrons.

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