NURS 6501 Week 5 Knowledge Check: Gastrointestinal and Hepatobiliary Disorders Example Approach Explain what contributed to the development of this patient’s history of PUD.
PUD is distinguished by a breach in the mucosa that extends to the submucosa or deeper layers. PUD primarily affects gastric and duodenal mucosa. Peptic ulcer disease originates from an array of etiologies. However, the most common etiologies include NSAID use, alcohol, and H. pylori (McCance & Huether, 2019). In the case scenario, the patient apparently has all these predominant etiologies. For instance, her urease test is positive, which points to H. pylori, and she uses ibuprofen, an NSAID. She also takes wine. Additional risk factors for her PUD development include smoking and emotional stress following a pending divorce.
What is the pathophysiology of PUD/ formation of peptic ulcers?
Peptic ulcer disease stems from an imbalance between gastric mucosa’s destructive and protective factors. Protective factors include GI mucus, bicarbonate, mucosal blood flow, tight intercellular junctions, cell renewal and restitution, and prostaglandins E, F, and I (McCance & Huether, 2019). Gastrointestinal mucosa, for instance, protects against mucosal damage, lubricates against friction, and controls the diffusion of hydrogen ions.
On the other hand, aggressive factors include acid, pepsin, bile, pancreatic enzymes, and H. pylori. With the destruction of the mucosal layer, the bicarbonate production is decreased, resulting in enhanced susceptibility of the deep layers to acidity (McCance & Huether, 2019). Several factors alter this balance, including NSAIDs, H. pylori, alcohol, steroids, psychological stress, and genetic factors.
If the client asks what causes GERD, how would you explain this as a provider?
GERD is a condition that develops following the backflow of stomach contents into the esophagus. The exact cause related to the development of GERD is unknown. However, it is stipulated that GERD stems from a multifactorial etiology. For instance, motor abnormalities, esophageal dysmotility, impaired tone of the lower esophageal sphincter, delayed gastric emptying, and transient lower esophageal sphincter relaxation have been identified (Clarrett & Hachem, 2018).
Additionally, anatomical factors such as hiatal hernia and an increase in intraabdominal pressure, as in the case of obesity, predispose to GERD. Other risk factors correlated with GERD symptoms include smoking, alcohol consumption, pregnancy, age greater than 50 years, connective tissue disorders, low socioeconomic status, and drugs such as anticholinergics, benzodiazepines, and calcium channel blockers (Clarrett & Hachem, 2018).
What are the variables here that contribute to an upper GI bleed?
Upper GI bleeding implies gastrointestinal bleeding that originates proximal to the ligament of Treitz. According to McCance and Huether (2019), upper GI bleeding accounts for 70 to 80% of all gastrointestinal bleeding. In the scenario presented, variables that contribute to the diagnosis of an upper GI bleed include age, passing dark tarry stools, history of antiacids, and mid-epigastric pain for several weeks. An age greater than 60 years increases the risk of gastrointestinal bleeding, while the passage of black tarry stool predominantly originates from upper GI bleeding. Finally, antiacid use and mid-epigastric pain are associated with peptic ulcer disease, the most common cause of upper GI bleeding.
What can cause diverticulitis in the lower GI tract?
Diverticula refer to sac-like protrusions in the colonic wall (Strate & Morris, 2019). These outpouchings are a consequence of the weakness of the outer muscle layer of the colonic wall. Diverticulitis refers to the inflammation or infection of these sac-like protrusions. The distinct cause of diverticulitis is unclear. However, several factors contribute to the risk of diverticulitis, including increased pressure from constipation, abdominal obesity, and smoking (Strate & Morris, 2019). Similarly, diet plays a significant role in the development of diverticulitis, particularly high-fat, red meat, and low-fiber diets (Strate & Morris, 2019). Finally, exposure to drugs such as opioids, steroids, and NSAIDs increases the risk of diverticulitis.
References
Clarrett, D. M., & Hachem, C. (2018). Gastroesophageal reflux disease (GERD). Missouri Medicine, 115(3), 214–218. https://www.ncbi.nlm.nih.gov/pubmed/30228725
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby.
Strate, L. L., & Morris, A. M. (2019). Epidemiology, pathophysiology, and treatment of diverticulitis.