Assignment 1: 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 this week’s Discussion: 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.
Resources
https://www.niddk.nih.gov/not-found?404url=digestive.niddk.nih.gov/index.aspx
Running Head: GASTRIC ACID 1
GASTRIC ACID 2
Gastric Acid
January 19, 2020
Gastric Acid
Gastric acid is a body stimulation in the stomach lining which enables the body to effectively digest proteins in consumed food. The process of stimulation and production of gastric acid in the body is basically a process which involves neural and hormonal mechanisms and epithelial cells. Gastric acid composes majorly of hydrochloric acid. It also comprises of potassium chloride and sodium chloride. Gastric acid is produced by the gastric glands in the lining of the stomach at normal conditions, a process which is stimulated once the digestion of proteins commences. The acid activates protein digesting enzymes. The lining of the stomach has to remain neutral and to avoid corrosion, a thin layer of mucous is found at the lining which prevents the stomach from getting corroded.
The stimulation and production of Gastric acid is crucial to the body. This process is however affected by several factors. Gastroesophageal Reflux Disease (GERD) is a condition that results into reflux or abnormal relaxation of the lower esophageal muscles which prevent the backflow of gastric acid into the esophagus. As a result, there is an accumulation of gastric acid in the esophagus. The acid doesn’t flow into the stomach for digestion in the right measures as a result of the backflow, hence, the production increases in order to satisfy the demand.
Gastritis
is disease that affects the lining of the stomach causing its inflammation. The mucus at the lining of the stomach is heavily affected and as a result, the acid gets to eat up the stomach walls. This results from increased acid production in the stomach which destroy mucus secreting cells in the body. Peptic Ulcer Disease (PUD) is a sore in the lining of the stomach or duodenum. Just as in the case of gastritis, PUD affects the stomach lining and reduces the thickness of the mucus hence, the stomach walls are exposed to the acid (American Liver Foundation, 2020). The process of secretion of gastric acid hence gets altered.
Age is one of the factors that affect PUD, GERD and gastritis. The three diseases result from secretion, stimulation and production of gastric acid which is directly affected by the age of the patient. The body system of a young child is very different from that of an adult. The stomach linings a child is not yet fully developed. When it comes to the issue of diseases, it is very easy to child affected by the stimulation compared to an adult. Additionally, the stomach lining of a child is quite weak. This means that the thickness of the mucus is small and therefore, this exposes the child to PUD and gastritis, which are major causes of irregularities in gastric acid stimulation and production in children. Eating of acidic foods regularly increase the acidity of the stomach hence resulting into damage of the mucus producing cells and in turn resulting into damage of the stomach lining (McCance, 2018), especially in children where the lining is still very weak. Additionally, a child’s muscles in the body are less developed and hence, they are very weak compared to the muscles of an adult. The delicacy of the lower esophageal muscles in children makes them subjective to any increase in pressure and they thus give in. as a result, it becomes very easy for a child to contract GERD compared to an adult. When pressure is applied on these muscles, they give in and the gastric acid starts moving in towards the esophagus. The child may thus start throwing up, a condition which if not well controlled, then it would have a serious impact on his or her health.
Diagnosis and Treatment
Diagnosis of GERD, PUD and Gastritis is almost done using the same mechanism. PUD is diagnosed by use of an endoscopy test.
Endoscopy
test checks for the presence of any sore on the lining of the stomach or on the stomach walls, which is basically a sign of ulcers. If ulcers are observed, then a small sample of the organ is removed for further test by biopsy to determine if it is PUD. The disease is also tested by use of an H. Pylori test, which tests the composition of acid in blood or stool. Treatment is done by the use of antibiotics, proton bump inhibitors to reduce the blocking production of acids as well as use of antacids. There are several ways by which GERD is diagnosed. Endoscopy is the most effective diagnostic method that can be employed. This involves the use of a hollow tube with a lens attached to it. This is used to diagnose the conditions of the digestive track. Regular burning sensation is a common sign if it goes for more than two days, then an investigation and treatment should be taught. The treatment of this disease is done by use of antibiotics and also avoiding the use of alcohol and smoking as well as observing proper diets. Gastritis can be diagnosed by the use of an x-ray where a patient swallow barium to help the doctors to check the details of the stomach. Tests can also be done by use of endoscopy and biopsy. Treatment of gastritis is through the use of antibiotics, use of H2 blockers which block acid producing cells and also the use of antacids.
Mind Map
Treatment
Antibiotics
H2 Blockers
Antacids
Diagnosis
X-Ray
Endoscopy
Biopsy
Epidemiology
Avoid Acidic Foods
Avoid excessive use of pain relievers
Clinical Presentation
Stomach pains
Burning Ache
Nausea
Vomiting Blood
Pathophysiology
Increased secretion of Gastric acid
Inflammation of stomach lining
Gastritis
References
McCance, K. L., & Huether, S. E. (2018). Pathophysiology-E-Book: The Biologic Basis for Disease in Adults and Children. Elsevier Health Sciences.
American Liver Foundation (2020). Retrieved From: https://liverfoundation.org/