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- QUESTION
: Gastrointestinal Tract: Disorders of Motility ( The running head)
Jamie is a 3-month-old female who presents with her mother for evaluation of “throwing up.” Mom reports that Jamie has been throwing up pretty much all the time since she was born. Jamie does not seem to be sick. In fact, she drinks her formula vigorously and often acts hungry. Jamie has normal soft brown bowel movements every day and, overall, seems like a happy and contented baby. She smiles readily and does not cry often. Other than the fact that she often throws up after drinking a bottle, she seems to be a very healthy, happy infant. A more precise history suggests that Jamie does not exactly throw up—she does not heave or act unwell—but rather it just seems that almost every time she drinks a bottle she regurgitates a milky substance. Mom thought that she might be allergic to her formula and switched her to a hypoallergenic formula. It didn’t appear to help at all, and now Mom is very concerned.
Cases like these are not uncommon. The mother was concerned and thinking her daughter may have an allergy; she changed to a different formula. However, sometimes babies have immature GI tracts that can lead to physiology reflux as they adapt to normal life outside the uterus. Parents often do not consider this possibility, prompting them to change formulas rather than seeking medical care. As in the case study above, GI alterations can often be difficult to identify because many cause similar symptoms. This same issue also arises with adults—adults may present with symptoms that have various potential causes. When evaluating patients, it is important for the advanced practice nurse to know the types of questions he or she needs to ask to obtain the appropriate information for diagnosis. For this reason, you must have an understanding of common GI disorders such as gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis.
To prepare:
- Review this week’s media presentation on the gastrointestinal system.
- Review Chapter 33 in the Huether and McCance text. Identify the normal pathophysiology of gastric acid stimulation and production.( course text book)
- Review Chapter 35 in the Huether and McCance text. Consider the pathophysiology of gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis. Think about how these disorders are similar and different. (course text book)
- Select a patient factor different from the one you selected in this week’s Discussion: genetics gender, ethnicity, age, or behavior ( my selected factor). Consider how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on this factor. (
- Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct a mind map for gastritis. Consider the epidemiology and clinical presentation of gastritis.
To complete
Write a 2- to 3-page paper that addresses the following:
- Describe the normal pathophysiology of gastric acid stimulation and production. Explain the changes that occur to gastric acid stimulation and production with GERD, PUD, and gastritis disorders.
- Explain how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Describe how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
- Construct a mind map for gastritis. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper.
Resources
- Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby. ◦Chapter 33, “Structure and Function of the Digestive System”
This chapter provides information relating to the structure and function of the digestive system. It covers the gastrointestinal tract and accessory organs of digestion.
◦Chapter 34, “Alterations of Digestive Function”
This chapter presents information relating to disorders of the gastrointestinal tract and accessory organs of digestion. It also covers the pathogenesis, clinical manifestations, evaluation, and treatment of gastroesophageal reflux disease, gastritis, peptic ulcer disease, inflammatory bowel disease, and irritable bowel syndrome.
◦Chapter 35, “Alterations of Digestive Function in Children”
This chapter presents information relating to disorders of the gastrointestinal tract and liver that affect children. It focuses on congenital impairment, inflammatory disorders, metabolic disorders, as well as the impairment of digestion, absorption, and nutrition.
- McPhee, S. J., & Hammer, G. D. (2010). Pathophysiology of disease: An introduction to clinical medicine (Laureate Education, Inc., custom ed.). New York, NY: McGraw-Hill Medical. ◦Chapter 13, “Gastrointestinal Disease”
This chapter provides a foundation for exploring gastrointestinal disorders by reviewing the structure and function of the GI tract. It also describes mechanisms of regulation of GI tract disorders such as acid-peptic disease, inflammatory bowel disease, and irritable bowel syndrome.
◦Chapter 14, “Liver Disease”
This chapter reviews the structure and function of the liver. It then explores the clinical presentation, etiology, pathogenesis, pathology, and clinical manifestations of three liver disorders: acute hepatitis, chronic hepatitis, and cirrhosis.
◦Chapter 15, “Disorders of the Exocrine Pancreas”
This chapter begins by reviewing the anatomy, histology, and physiology of the exocrine pancreas. It then examines the clinical presentation, etiology, pathology, pathogenesis, and clinical manifestations of acute and chronic pancreatitis, pancreatic insufficiency, and pancreatic cancer.
- Gasiorowska, A., Poh, C. H., & Fass, R. (2009). Gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS)—Is it one disease or an overlap of two disorders? Digestive Diseases and Sciences, 54(9), 1829–1834.
Retrieved from the Walden Library databases.
This article examines the similarities between gastroesophageal reflux disease and irritable bowel syndrome. It focuses on symptoms presented in patients with the disorders, as well as management and treatment options.
Media
- Laureate Education, Inc. (Executive Producer). (2012c). The gastrointestinal system. Baltimore, MD: Author.
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| Subject | Nursing | Pages | 9 | Style | APA |
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Answer
Gastrointestinal Tract: Disorders of Motility
The Standard Pathophysiology of Gastric Acid Stimulation and Production
Gastric acid is defined as a digestive juice that is released by the gastric glands and deposited on the walls of the stomach. This secretion is mostly initiated by the presence of some amounts of food in the stomach hence starting the digestion process (Di Lorenzo & Youssef, 2010). As such, the gastric digestive secretions can digest the stomach walls through two processes; the hydrolysis of proteins, and the destruction of cells. However, to stop the self-digestion of the stomach, the gastric mucosal barriers provide a protective impediment to the stomach luminal surface. Notably, in some situations, the gastric mucosal barriers are overpowered which in turn leads to the disease condition resulting from the inflammation of the gastric (Lingappa & Ganong, 2010). Specifically, the products of the gastric secretion namely the gastric acids and enzymes can be the potential cause of gastric glands ulceration which is a degenerative condition.
Changes That Occur To Gastric Acid Stimulation and Production with GERD, PUD, and Gastritis Disorders
During the disorders of GERD, PUD, and gastritis, the process of gastric acid stimulation and production undergoes some notable changes. Gastroesophageal reflux disease (GERD) emanates from the reflux of the existing gastric material up through the lower esophageal sphincter (LES) and proceeds into the esophagus (Gasiorowska, Poh, & Fass, 2009). This reflux results to the injury of the esophageal tissue. As such, it is justified to state that Gastric acid stimulation and production is responsible for the increment of the volume of refluxing gastric acid into the esophagus. Gastritis, on the other hand, is a condition characterized by the inflammation of the stomach mucosa resulting in the erosion of the secretory glands. In this case, therefore, the absence of the gastric glands leads to a reduced production and stimulation of gastric acid.
Impact of Behavior the Pathophysiology of GERD, PUD, and Gastritis
Any changes in the gastric acid stimulation and production during the GERD, PUD and gastritis conditions are more often than not likely to affect pathophysiology and severity negatively. The rise of the gastric levels discussed above in GERD, PUD condition favors the pathologic reflux by subduing the ability of the esophageal mucosa to maintain any tolerance of the acid. Further, the subduing of the esophageal protective mechanisms such as mucosal resistance and esophageal acid clearance leads to the severity of the disease. Helicobacter pylori are the cause of the gastritis condition as it infects and digests the lining of the stomach. Therefore, the stimulation and production of gastric acid lead to an increment in the density of the Helicobacter pylori colony in the stomach as well as the distribution and the seriousness of the mucosal erosion. This might eventually lead to gastric cancer.
The factor I selected and which is Gastrointestinal intestinal motility behavior is characterized by the loss of the gut’s ability to coordinate any muscular activity resulting from the endogenous or exogenous causes. This condition is the one that orchestrates the signs that are described in Jamie’s case. Specifically, the signs and symptoms of the condition include irritable bowel syndrome (IBS), Intractable, recurrent vomiting, Gastroesophageal reflux disease, Abdominal distention, etc.
Diagnose and Prescribe Treatment of These Disorders for a Patient
The diagnosis of the GI disorders is varied. However, one of the most commonly used diagnosis mechanism is the use of conventional therapeutic tools such as the standard medical evaluations of upper and lower endoscopy, CT scanning and ultrasound. Although these diagnosis procedures are used, they have the disadvantage of failing to establish the precise causes of the treatment and hence fail to provide the rationale for treatment. In this method, patients are commonly offered the symptomatic therapies such as steroids, antidepressants, and sedatives. However, these only serve to alleviate the symptoms without providing any cure. As such, patients will go for long periods without experiencing any significant relief.
The method mentioned above is used by health practitioners who do not have the proper knowledge of the current approaches. However, those acquainted with the current methods deploy a functional approach in the diagnosis and treatment of the gastrointestinal disorder. Specifically, they start by enquiring about the following from the patient or his/her care; the food choices and eating habits, the omission of any meals, whether the patient takes his/her meals standing up, sitting down, when talking a cell phone, etc., whether the food(in this case the formula) is well-blended or has some particles. Additionally, it is also critical to test for any abnormal gut bacteria, food allergies, parasites, abnormal digestion and absorption, Candida, and markers of gut inflammation. Moreover, the medical practitioners will assess whether the patient has cases of tissue transglutaminase, liver detoxification, and other antibody tests for gluten intolerance. Notably, it is critical that the levels of Heavy metals, trace minerals, red cell fatty acids, urine organic acids, vitamin and mineral levels.
After using the functional perspective to diagnose the patient, the health practitioners will then recommend nutritional supplements such as Special probiotic and beneficial bacteria and their supports prebiotic formulas, which are the mainstays of treatment. These supplements help in providing improvement especially when the prescription drugs are not of help. Additionally, it is also possible that antibiotics will offer more help when especially combined with the dosages. The elimination of any dairy, glutton and soy is also of utmost significance. The treatment of GI disorders can also be using maintenance drugs such as aspirin, steroids NSAIDS, statins, and antidepressants. These drugs are critical especially when the gastrointestinal ailments are unresolved.
Sometimes, there exists a possibility that the potent immunosuppressive agents can be avoided or eliminated. At such times, any recommended surgeries are ruled out. Notably, the operations are performed with an aim of removing the gallstones. As such, the recommendation of certain diets can lead to the elimination of gallstones. However, in the present case involving a child, a good digestive system rehabilitation program is imperative. This will include activities such as heavy metal removal, Detoxification, and liver rejuvenation. This rational and systematic approach ensures that gastrointestinal illnesses are cured even when they are recurrent. This leads the improvement of other aspects of the child.
Mind Map for Gastritis
In conclusion, gastrointestinal motility disorders include gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis. These are caused by the disposition of gastric acid in the walls of the stomach. This leads to the self-digestion of the stomach walls. The signs of this disorder include vomiting, severe abdominal pain, as well as constipation. The clinical presentation of the disorders is in the form of irritable bowels and vomiting. The diagnosis of GI disorders is performed by endoscopy or C-T scan. However, the treatment can be in the form of maintenance foods, nutritional supplements, and symptomatic therapies and in extreme cases, surgeries.
References
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Chaidez, V., Hansen, R. L., & Hertz-Picciotto, I. (2014). Gastrointestinal problems in children with autism, developmental delays or typical development. Journal of autism and developmental disorders, 44(5), 1117-1127. Di Lorenzo, C., & Youssef, N. N. (2010, February). Diagnosis and management of intestinal motility disorders. In Seminars in pediatric surgery (Vol. 19, No. 1, pp. 50-58). WB Saunders. Gasiorowska, A., Poh, C. H., & Fass, R. (2009). Gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS)—is it one disease or an overlap of two disorders?. Digestive diseases and sciences, 54(9), 1829-1834. Huether, S. E., & McCance, K. L. (2013). Understanding pathophysiology. Elsevier Health Sciences. Lingappa, V. R., & Ganong, W. F. (2010). Pathophysiology of disease: an introduction to clinical medicine. J. D. Lange (Ed.). Lange Medical Books/McGraw-Hill.
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