Unit 4 Discussion Digestive Function. due 1-30-22. 1200w. 4 references.

Read the following case study and answer the posed questions.

Case #1:  A 64-year-old man presents to the emergency department with abdominal pain and distention, as well as constipation of 8 days’ duration. He denies vomiting, fever, diarrhea, or dysuria. Except for hypertension, he is otherwise healthy with no prior surgeries.

His vital signs are normal except for a borderline pulse of 99 bpm. His physical examination is unremarkable except for his abdomen, which is large, rotund, and tympanitic. There is diffuse tenderness everywhere in the abdomen.

1. What history would you want to obtain?

2. What differential diagnoses would you consider?

3. List and describe the specific diagnostic tests you might order to determine cause of his concern?

Case #2:

Kyle is a 58-year-old man who is experiencing lower abdominal discomfort nausea and diarrhea lasting 2 days. He thought he had eaten something that “disturbed his stomach” but since this has lasted so long, he is afraid it’s something serious.

1. As you obtain a history from this patient what differential diagnoses are you considering. Give rational for your choices.

2. Discuss the pathophysiologic relationship between nausea and vomiting?

Three days after Kyle’s initial visit his labs confirmed a diagnosis of cirrhosis.

3. Discuss the pathophysiologic relationship between cirrhosis and portal hypertension.

Cite current research findings, national guidelines, and expert opinions and controversies found in the medical and nursing literature to support your position and suggestions.

Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.

 

Answer & Explanation

 

 

Case #1

1. What history would you want to obtain?

-When was the last time he had flatus?

-History of alcohol intake

-characteristics of pain and if its radiating,relieves at rest or at motion

-past diagnostic exam for abdomen(ultrasound etc)

-eating habits

-medications taking

-LIFESTYLE

 

1 . I will ask details about the present symptoms, past health and medical history, current prescription or even any over the counter medications taken, injuries or even falls, recent change in diet plan, alteration of bowel habits, alteration of everyday routines which might contribute to the constipation of his. I’d also ask the patient in case he’s tried something, like over the counter or maybe liquid aids to alleviate the constipation of his. After the age of 65, you will find an increased number of risks a person will feel constipation due to various physiologic (normal) factors.

 

2 . Depending on the individuals clinical presentation, I’m suspecting a large or small bowel obstruction. At 64 years old, he’s in danger of developing cancer, severe blockages as a result of adhesions or maybe hernias thanks to bowel obstruction . To be able to distinguish between a large or small bowel obstruction KUB will be done.

2.What differential diagnoses would you consider?

-IMPAIRED BOWEL MOVEMENT RELATED TO SEDENTARY LIFESTYLE AS MANIFESTED BY CONSTIPATION

V IRREGULAR DEFECATION HABITS RELATED TO EATING HABITS AS MANIFESTED BY DISTENTION FOR MORE THAN A WEEK

 

 

3 . Confirmation of diagnosis might be done through the following tests:

 

• BMP or even CMP (Can find out whether WBC’s are elevated for infection that is possible taking place or even electrolyte imbalance)

• An abdominal X-ray

• CT scan

• KUB

• Abdominal ultrasound

• Barium X ray (Can identify tumors, ulcers, hernias and various other inflammatory conditions)

List and describe the specific diagnostic tests you might order to determine cause of his concern?

-ENDOSCOPY: TO RULE OUT BLOCKAGE AND OTHER PRECIPITATING FACTOR IN THE UPPER GI

-COLONOSCOPY- TO RULE OUT BLOCKAGE AND OTHER PRECIPITATING FACTOR IN THE LOWER GI

-ABDOMINAL MRI/ULTRASOUND: TO RULE OUT ANY FURTHER COMPLICATIONS OR MAY DETECT SOURCE OF ORIGIN OF THE MAIN PROBLEM

 

 

 

Case #2:

1 . One option is Kyle is affected by gastroenteritis. Lower abdominal pain/cramping along with his diarrhea and nausea and also the possibility of a minimal grade fever are classic symptoms and signs of gastroenteritis. Yet another option is this might be idiopathic inflammatory bowel disorders, like crohn’s, ulcerative colitis or maybe Budd Chiari syndrome, that provides with problems like abdominal discomfort, diarrhea, and also worsening ascites

 

2 . Nausea is a difficult and unpleasant to summarize psychic experience in people and probably animals. Physiologically, nausea is usually associated with reduced gastric motility and increased overall tone within the small intestine. Emesis or vomition happens when gastric and usually little intestinal contents are powered up to and from the jaws. Alkaline duodenal contents are refluxed easily into the distal belly and will develop vomiting due to localized irritation. The action itself of vomiting is because of the diaphragm relaxing abruptly and the abdominal pressure is rapidly transmitted to the chest area

 

1 .Discuss the pathophysiologic relationship between cirrhosis and portal hypertension.

 

Cirrhosis is a type of liver disease. It happens when cells inside your liver start to be broken and your body cannot restore them. As the liver cells expire, scar tissue forms. A build up of scar tissue stops the right blood circulation. A normal liver is able to filter wastes and harmful toxins to obtain them out of the body of yours. If scar tissue prevents blood from flowing through the liver of yours, it cannot get filtered. This leads to wastes and toxins to get in the body of yours.

 

Portal hypertension is a top complication of cirrhosis. Your entire body carries blood for your liver through a big blood vessel known as the portal vein. Cirrhosis slows the blood flow of yours and puts stress about the portal vein. This causes high blood pressure known as portal high blood pressure .

 

The pathophysiologic connection between cirrhosis as well as portal high blood pressure is that the portal vein transports bloodstream through the liver. One complication of cirrhosis is the fact that portal hypertension is a top complication of cirrhosis. Viral hepatitis as well as alcohol abuse were labeled as the chief reasons of cirrhosis. Since scar tissues can’t filter blood in the liver, the squander item builds up within the body and can result in waste and toxins to make up. A returned flow of blood increases pressure on the portal vein and leads to hypertension or Portal high blood pressure .

 

Step-by-step explanation

As you obtain a history from this patient what differential diagnoses are you considering. Give rational for your choices.

The history for this obtained for this patient must include diet and if he drinks alcohol. The next question is how often and how much he drinks. This patient complains of visceral pain, which can be a diseased or damaged organ (McCance et al., 2014). A complete review of additional possible symptoms is also necessary for fatigue, skin color (jaundice), bleeding, stool color, fluid retention, weight loss, mental condition, and nutrition status (Moctezuma-Valazquez, Garcia-Juarez, Soto-Solis, Hernandez-Cortez, & Torre, 2013).  The question of does he have any exposure to chemicals at work?

Discuss the pathophysiologic relationship between nausea and vomiting?

The leading causes of cirrhosis have been identified with viral hepatitis and alcohol abuse (McCance et al., 2014). The patients may notice a difference in food intake with increased abdominal distress leading to nausea. He has a greater chance of varices needing urgent evaluation. The damage from the tissue is causing liver damage causing inflammation. This process begins an activation of the stellate cells following fibrogenesis, angiogenesis, and parenchymal extension lesions (Tsochatzis, Bosch, & Burroughs, 2014).  Gastric sensitivity can have an effect on bacterial growth in the gut.

 

Three days after Kyle’s initial visit his labs confirmed a diagnosis of cirrhosis.

Discuss the pathophysiologic relationship between cirrhosis and portal hypertension.

Portal hypertension is usually caused by varices in the esophagus (McCance et al., 2014). The changes in portal hypertension are usually seen with endoscopy examination in the gastrointestinal tract and patients with cirrhosis (Kalaitzakis, 2014).  The mobility of the gut can have a delay in the small bowel and increased diarrhea (Kalaitzakis, 2014). The procedure can observe variceal bleeding and evaluate portal venous pressure (McCance et al., 2014). The blood flow is obstructed or limited, causing a vascular alteration in the hepatic system. It is most common in the lower esophagus (McCance et al., 2014). This may also be a cause for cirrhosis with gastrointestinal bleeding and anemia (Kalaitzakis, 2014). One of the major complications caused by cirrhosis after the development portal hypertension is ascites. Ascites have an increased rate of mortality after the diagnosis of approximately one year if the initial cause is from continual drinking of alcohol (McCance et al., 2014).

References

 

Kalaitzakis, E. (2014, October 28). Gastrointestinal dysfunction in liver cirrhosis. World Journal of Gastroenterology, 20(40), 14686-14695. https://doi.org/10.3748/wjg.v20.i40.14686

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2014). Pathophysiology: The Biologic Basis for Disease in Adults and Children (7th ed.). St. Louis, Missouri: Elsevier.

 

Tsochatzis, E. A., Bosch, J., & Burroughs, A. K. (2014, May 17). Liver cirrhosis. The Lancet, 383(9930), 1749-1761. https://doi.org/ DOI:10.1016/S0140-6736(14)60121-5

 

Moctezuma-Valazquez, C., Garcia-Juarez, I., Soto-Solis, R., Hernandez-Cortez, J., & Torre, A. (2013). Nutritional assessment and treatment of patients with liver cirrhosis. Nutrition, 29(11), 1279-1285. https://doi.org/DOI:10.1016/j.nut.2013.03.017