Gastrointestinal System

During examinations, patients often present with various symptoms. Often, these symptoms overlap multiple disorders within body systems—especially gastrointestinal (GI) disorders—further increasing the difficulty in diagnosing and treating patients. Consider a patient who presents with severe abdominal pain that has persisted for months. At first review, it might be inflammatory bowel disease or irritable bowel syndrome, but upon closer inspection and testing, gastric cancer is found. As this case outlines, it is important that you, as an advanced practice nurse, are able to identify alterations of GI disorders in order to properly diagnose patients or refer them for specialized care when necessary.

This week you examine the pathophysiology of gastrointestinal disorders. You also explore common treatments and the impact of patient factors on these disorders.

Learning Objectives

Students will:

Compare the pathophysiology of inflammatory bowel disorder and irritable bowel syndrome

Analyze treatments for digestive disorders

Evaluate the impact of patient factors on digestive disorders

Analyze the pathophysiology of gastric acid stimulation and production

Evaluate the impact of patient factors on gastrointestinal disorders

Evaluate clinical considerations of gastrointestinal disorders

Understand and apply key terms, concepts, and principles related to alterations of the gastrointestinal system

Photo Credit: Keith Brofsky/Photodisc/Getty Images

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Chapter 35, “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 36, “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 37, “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.
Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education.

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.
de Bortoli, N., Martinucci, I., Bellini, M., Savarino, E., Savarino, V., Blandizzi, C., & Marchi, S. (2013). Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome. World Journal of Gastroenterology, 19(35), 5787-5797. doi:10.3748/wjg.v19.i35.5787

Required Media

Laureate Education, Inc. (Executive Producer). (2012c). The gastrointestinal system. Baltimore, MD: Author.

This media presentation outlines the pathophysiology of the gastrointestinal system and associated alterations.

Optional Resources

American Liver Foundation (2016). Retrieved from http://www.liverfoundation.org/

National Digestive Diseases Information Clearinghouse. (2016). Retrieved from http://digestive.niddk.nih.gov/index.aspx

Discussion: Digestive Disorders

Many patient symptoms can be tied to multiple disorders, which may lead to misdiagnoses. For instance, consider two digestive disorders of the gastrointestinal tract—inflammatory bowel disease and irritable bowel syndrome. These two disorders are commonly confused because they present similar symptoms. As an advanced practice nurse, you must know the differences to properly diagnose and treat the disorders. How does the pathophysiology of inflammatory bowel disease compare to the pathophysiology of irritable bowel syndrome? How do treatments for the two disorders compare?

To Prepare

Review Chapter 36 in the Huether and McCance text and Chapter 13 in the Hammer and McPhee text.

Identify the pathophysiological mechanisms of inflammatory bowel disease and irritable bowel syndrome. Think about similarities and differences between the disorders.

Consider common treatments for inflammatory bowel disease and irritable bowel syndrome. Reflect on whether treatments for one disorder would work for the other disorder.

Select one of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factor you selected might impact the pathophysiology of and treatments for each disorder.

ASSIGNMENT 1a

WRITE an explanation of the pathophysiological mechanisms of inflammatory bowel disorder and irritable bowel syndrome, including similarities and differences. Then describe common treatments, addressing whether treatments for one disorder would work for the other disorder. Finally, explain how the patient factor you selected might impact the pathophysiology of and treatments for each disorder.

Assignment 1B:

Gastrointestinal Tract: Disorders of Motility

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 35 in the Huether and McCance text. Identify the normal pathophysiology of gastric acid stimulation and production.

Review Chapter 37 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.

Select a patient factor different from the one you selected in ASSIGNMENT 1a: genetics, gender, ethnicity, age, or behavior. 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.

ASSIGNMENT 2: The Pathophysiology of Disorders

During the last 5 weeks, you have explored various body systems: neurological, cardiovascular, respiratory, and hematological. These four systems work together along with other body systems to complete a myriad of functions. For this reason, when disorders occur within one body system, it can create potentially devastating effects throughout the entire body. For instance, Parkinson’s disease is a disorder of the central nervous system, yet its alterations actually affect multiple body systems from the cardiovascular system to the gastrointestinal system. In this Assignment, you examine alterations associated with disorders, as well as the impact of the alterations on multiple body systems.

To Prepare

From the list below, select a disorder of interest to you:

Alzheimer’s disease

Asthma in children

Chronic obstructive pulmonary disease (COPD)

Congestive heart failure

Hepatic disease (liver disease)

Hypertension

Hyperthyroidism and hypothyroidism

Seizures

Sepsis

Identify alterations associated with your selected disorder. Consider the pathophysiology of the alterations. Think about how these alterations produce pathophysiological changes in at least two body systems.

Reflect on how patient factors such as genetics, gender, ethnicity, age, and behavior might impact the pathophysiology of the alterations you identified, as well as the diagnosis and treatment of your selected disorder.

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 the disorder you selected. Consider the epidemiology and clinical presentation of your selected disorder.

To Complete

Develop a 5- to 10-slide PowerPoint presentation that addresses the following:

Describe your selected disorder, as well as associated alterations. Explain the pathophysiology of the alterations, including changes that occur in at least two body systems.

Explain how genetics, gender, ethnicity, age, and behavior might impact the pathophysiology of the alterations you identified, as well as diagnosis and treatment of your selected disorder.

Construct a mind map for the disorder you selected. Include the epidemiology, pathophysiology of alterations, risk factors, and clinical presentation, as well as the diagnosis and treatment of the disorder.

 

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