NU 621 Unit 4 Discussion - Digestive Function

Case #1

What history would you want to obtain?

The patient has a history consistent with being an older adult. An accurate assessment of symptoms is essential. The guy has been experiencing constipation for eight days. He hasn't had anything to eat or drink in a long time. The drug list must be reviewed. Only hypertension-related symptoms have been brought up, and he hasn't had anything else. Throughout, he's complained of a sore stomach or colicky discomfort. What if there is anything that alleviates the pain? Diagnoses, such as diabetes or stomach discomfort, need further information. Palpation and palpation may diagnose discomfort or soreness with pulse and look for hernia or intestinal torsion (McCance et al., 2014).

What differential diagnoses would you consider?

Additional testing is needed to confirm this patient's diagnosis of intestinal blockage. Is it a minor or significant blockage in the bowels? As we become older, our chance of acquiring cancer from a large intestinal blockage increase. With no history of surgery, an abrupt obstruction of the intestines from adhesions or hernia might occur. For a minor blockage of the big or small intestine, I need a kidney, urinary, and bladder (KUB). In order to rule out the possibility of a major intestinal blockage, I believe more testing is necessary. Patients with substantial intestinal blockage are more likely to have emesis, although the patient has not expressed this concern (Yeo & Lee, 2013).

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

Rectal lump or bleeding should be examined during a physical examination. Additionally, a complete blood count (CBC) would be performed to determine whether anemia or white blood cell abnormalities are present. If you suspect ischemia, have a basic metabolic panel to check for abnormalities in electrolytes or acid-base balance. KUB starts with an ultrasound and then goes on to a CT scan, making certain that labs are obtained for contrast prior to the CT scan. A laparoscopic treatment or a surgical operation may be required to decompress the colon if strangulation or total blockage is diagnosed (McCance et al., 2014).

Case #2

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

Any information acquired about this patient's past medical history should include his diet and whether or not he engages in any alcohol use. Inquire about how often and how much he drinks next. Visceral pain, which a sick or injured organ might cause, is reported by this patient (McCance et al., 2014). Additional probable symptoms, such as exhaustion, skin color (jaundice), bleeding, stool color, fluid retention, weight loss, mental state, and dietary status, must also be examined (Moctezuma-Valazquez et al., 2013). Does he work in an environment where chemicals are present?

Discuss the pathophysiologic relationship between nausea and vomiting?

Viral hepatitis and alcohol addiction are the most common causes of cirrhosis (McCance et al., 2014). Abdominal discomfort may lead to nausea in the patients, who may notice a change in their food consumption. Varices are more likely to develop in him, necessitating immediate medical attention. Inflammation in the liver is caused by tissue injury. Following fibrogenesis, angiogenesis, and parenchymal expansion lesions, this mechanism initiates the activation of stellate cells (Tsochatzis, Bosch, & Burroughs, 2014). Bacterial growth in the intestines might be affected by changes in gastric sensitivity.

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

Discuss the pathophysiologic relationship between cirrhosis and portal hypertension.

The most common cause of portal hypertension is varices in the esophagus (McCance et al., 2014). Endoscopy examinations of the gastrointestinal tract and individuals with cirrhosis are often used to detect changes in portal hypertension (Kalaitzakis, 2014). Short intestine transit time may be slowed down if the gut is less mobile, leading to more diarrhea. Valve hemorrhage and portal venous pressure may be monitored throughout this surgery (McCance et al., 2014). The hepatic system's vascular system is altered due to the obstruction or limitation of blood flow. The lower esophagus is the most often affected area (McCance et al., 2014). Anemia and gastrointestinal bleeding are symptoms of cirrhosis, which might be caused by this (Kalaitzakis, 2014). Ascites is a serious consequence of cirrhosis that may arise following the onset of portal hypertension. If the original etiology of ascites is alcohol abuse, there is a higher death risk after one year of diagnosis.

 

 

 

 

 

References

Jackson, P. G., & Raiji, M. (2011, January 15). Evaluation and management of intestinal obstruction. American Family Physician, 83(2), 159-165. Retrieved from https://www.aafp.org/afp/2011/0115/p159.html

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.

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

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

Yeo, H. L., & Lee, S. W. (2013). Colorectal emergencies: Review and controversies in the management of large bowel obstruction. Journal of Gastrointestinal Surgery, 17(11), 2007-2012. https://doi.org/10.1007/s11605-013-2343-x