NURS 350 PATHOPHYSIOLOGY EXAM ;The Gastrointestinal System [ ARIZONA COLLEGE OF NURSING]
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Course
PATHOPHYSIOLOGY
Institution
PATHOPHYSIOLOGY
Gastro-esophageal Reflux Disease (GERD)
Facts
Most common disease of the esophagus
i.
Caused by the rise of stomach acid into the esophagus
ii.
a.
Pathophysiology (two types)
Malfunctioning relaxation of the sphincter between the esophagus and stomach (LES)
i.
Rise in pressure within the ...
The Gastrointestinal System
Wednesday, 6 November, 2019 12:08
1. Gastro-esophageal Reflux Disease (GERD)
a. Facts
i. Most common disease of the esophagus
ii. Caused by the rise of stomach acid into the esophagus
b. Pathophysiology (two types)
i. Malfunctioning relaxation of the sphincter between the esophagus and stomach
(LES)
ii. Rise in pressure within the stomach which overwhelms a properly functioning
sphincter
c. Risk factors
i. First type
1) Diet: food with high fat content, chocolate, acidic food, alcohol
2) Smoking
3) Excessive secretion of stomach acid
4) Certain medications, especially NSAIDs
5) Neurological and mechanical diseases of the esophagus
ii. Second type
1) Pregnancy
2) Obesity
d. Outcome
i. The rise of acid from the stomach to the esophagus causes heartburn
ii. Repetitive chemical burns of the esophagus could cause a chronic chemical
inflammation, eventually causing esophageal cancer
iii. Harms quality of life
e. Heartburn
i. Singeing, burning, or pain around the superior stomach region or chest cavity
(behind sternum)
ii. Worse with
1) Change in position (from laying to standing)
2) After meals (especially fatty, spicy, acidic foods and coffee)
3) Due to smoking
4) With weight gain
5) Stress/anxiety
iii. Not made worse with exertion and generally is not accompanied by shortness of
breath
iv. Sometimes comes with regurgitation
f. Red flags (raise suspicion of life threatening condition like bleeding ulcers or cancer)
i. Pain or difficulty swallowing
ii. Weight loss
iii. Dizziness
iv. Fatigue
v. Anemia
g. Diagnosis
i. Physical: checking for sensitivity by touch of the epigastrium
ii. If there are no red flags, there is no need for more tests
iii. Gastroscopy if there is suspicion for ulcer or cancer. Checks for the presence of
Helicobacter pylori
h. Treatment
i. Teach patient about changing lifestyle
1) Quit smoking
2) No alcohol
3) Weight loss
Pathophysiology Page 1
, 3) Weight loss
4) Appropriate nutrition
5) Elevating pillow while sleeping
ii. In more severe cases, medications are prescribed to reduce amounts of acid in the
stomach
iii. If nothing helps, more tests are performed
i. Medications
i. Antacids like magnesium hydroxide or carbonate, or calcium carbonate
ii. Antihistamine H2 receptor blockers which activate hydrogen channels and
secretion of acid into the stomach
iii. PPI hydrogen channel blockers
2. Gastritis/Duodenum (including ulcers)
a. Pathophysiology
i. Two main factors
1) Presence of Helicobacter pylori bacteria in stomach
2) Use of NSAIDs
ii. Other factors
1) Other medications like biphosphonates for osteoporosis
2) Other diseases
b. Helicobacter pylori
i. Responsible for all ulcers of the stomach and duodenum in those not taking
NSAIDs
ii. Most people are only carriers of the bacteria and will not develop an ulcer
iii. Some breeds of the bacteria produce a toxin which is a protein that penetrates
epithelial cells of the stomach and changes them, increasing the chance of
developing gastritis or an ulcer
iv. The host's genotype also holds importance in the chance for the disease to
develop
c. Diagnosis
i. Urea Breath Test: use of urea marked with C13. If the bacteria exists it secretes
urease which breaks down the urea and then the C13 is absorbed in exhalation
(CO2 is marked)
ii. Biopsy from ulcer/inflammation region during gastroscopy
iii. Identification of the bacteria's antigens from fecal sample
d. Treatment
i. The bacteria is very resistant so it requires treatment via two antibiotics and
medication that block hydrogen channels and significantly lowers stomach acidity
levels. Treatment lasts 10-14 days
ii. After a month the patient does another urea breath test to check that eradication
of the bacteria has indeed occurred
3. Irritable Bowel Syndrome (IBS)
a. Facts
i. Very common. 25% of the population suffers from it
ii. 70% of sufferers are women
iii. Typically starts in teenage years but can appear at any age
b. Pathophysiology
i. The mechanism is unknown but studies have shown a disruption of neurological
monitoring of the intestines from the cerebral level to the intestines themselves
ii. There is evidence of intestinal flora changes among sufferers
c. Risk factors
i. Following infections of the GI tract
ii. Emotional stress and depression
iii. Following an antibiotic regimen
d. Criteria (according to Rome III)
i. Stomach aches or upset stomach lasting at least three days in a month for at least
three month, beginning in the last half a year (does not have to be continuous)
ii. The stomach ache or upset stomach are accompanied by at least two of three of
the following:
Pathophysiology Page 2
, the following:
1) Better after defecating
2) Change in bowel movement frequencies (diarrhea or constipation)
3) Change in bowel movement appearance
e. Accompanying symptoms which verify the diagnosis
i. Disturbance in "emptying out"; not feeling fully emptied out after going to the
bathroom
ii. Bowel movement with mucus
iii. Stomach bloating
f. Red flags
i. Disease appears over 60 years old
ii. Fresh blood in feces
iii. Unplanned weight loss
iv. Fever
v. Loss of appetite
vi. Vomiting
vii. Pain or diarrhea that wake the patient at night
viii. Family history of colon cancer
ix. Use of medications that affect the digestive system (antibiotics)
x. Depression
xi. Panic attacks
xii. Anemia
xiii. Possible lactose sensitivity
xiv. Another known disease of the digestive system like inflammatory disorders, Celiac
g. Treatment
i. Primarily explanation, guidance, comfort, and support
ii. Part of the patients will enjoy a fiber-rich diet
iii. No specific medication; some are relieved by diarrhea or constipation medicine
iv. Some are relieved by antidepressants, especially those affecting the nervous
system (serotonin)
4. Inflammatory Bowel Disease (IBD)
a. Ulcerative Colitis
i. Facts
1) Attack on the colon's mucosa (exclusively), although there are cases where
the small intestine (where it meets the large intestine) is also affected
2) Typically shows up around 20-50 years old, primarily among Jews
3) Chronic inflammation of the mucosa
4) Has remissions and episodes
ii. Signs
1) Fresh blood from passing of food and rectal exams
2) Chronic diarrhea (bloody and covered in mucus)
3) Sensitivity to touch of stomach region, especially upper and left side
4) Signs of malnutrition
5) Fever
6) Tachycardia
iii. Helpful tests
1) Blood count: anemia, leukocytes
2) Inflammation values: ESR, CRP
3) Fecal sample: blood, mucus, and sometimes infectious bacterial growth
4) Autoimmune serology: to find antigen against the cell components like P-
ANCA (antigen against cytoplasm components)
5) Fecal sample test for the presence of immune system components like
Lactoferrin and Calprotectin, which come from the neutrophils. Can
differentiated between inflammatory conditions of the digestive system and
IBS but its main use is to track the biological treatment administered to
these patients
iv. Imaging
1) Test of choice: colonoscopy
Pathophysiology Page 3
, 1) Test of choice: colonoscopy
2) CT of the stomach can show thickening of the intestinal walls in the inflamed
regions. Essential for verifying/ruling out involvement of other digestive
organs other than the colon
v. Clinical expression and treatment
1) Mild: all symptoms are mild; very few episodes. Can be treated with
appropriate diet which supplements any deficits, and anti-inflammatory
medications
2) Intermediate: frequent diarrhea, sometimes bleeding, low fever; more
severe episodes. Treated with medications (steroids, anti-inflammatories,
medications which inhibit the immune system)
3) Severe: blood diarrhea, stomach aches, low appetite, weight loss,, high
fever, malnutrition, death, common intestinal blockages. Treated with
removing the colon.
4) In cases where only the rectal area is involved, the sole expression is
constipation and rectal bleeding
vi. Maintenance
1) Biological medication designed to prevent episodes
2) Genetically engineered antigens against components of the immune system
responsible for the disease. Blocking these components helps keep the
disease "on a low flame", reducing and even preventing flare ups. Response
to this treatment is tracked by immune system components secreted in the
feces: Lactoferrin and Calprotectin
vii. Secondary complications
1) Higher risk for colon cancer. Important to constantly check
2) Osteoporosis due to the disruption of essential vitamins and minerals
caused by long term consumption of steroids
3) Skin rash
4) Arthritis/joint pain
5) Higher chance of other cancers (skin, gall bladder, etc.)
b. Crohn's Disease
i. Facts
1) Attack on all layers of the intestines; can affect all lengths of the tract
2) Starts around 15-30 years old
3) 3-8 times more common among Jews
4) 50% of cases involve both the small and large intestine
5) The first characteristic sign is pain in the lower right abdomen, diarrhea, and
low fever (in youth)
6) Many are misdiagnosed with appendicitis at first
ii. Signs and symptoms
1) Stomach aches
2) Diarrhea (not necessarily bloody)
3) Fever
4) Weight loss
5) Fistulas
6) In some patients, oral cavity is also involved
7) Sensitivity in the lower right abdomen
8) Sometimes a bulge can be felt in the stomach
9) Cachexia (skinniness)
10) Muscle dystrophy (due to malnutrition)
iii. Diagnostic tests
1) Blood work: anemia, leukocytosis
2) Increased inflammatory factors: ESR, CRP
3) Fecal sample. Presence of fat could mean a disruption in absorption;
presence of leukocytes mean inflammation; presence of Lactoferrin and
Calprotectin can be used to track the immune system and treatment
iv. Imagining tests
1) Colonoscopy: test of choice
Pathophysiology Page 4
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