Walden – NURS 6501 – Concepts of Gastrointestinal and Hepatobiliary Disorders – Week 5

Module 3: Gastrointestinal and Hepatobiliary Disorders

What’s Happening This Module?

Module 3: Gastrointestinal and Hepatobiliary Disorders is a 1-week module, Week 5 of the course. In this module, you will examine fundamental concepts of diseases and disorders that impact gastrointestinal and hepatobiliary systems. You will also evaluate the impact of patient characteristics, including racial and ethnic variables, on physiological functioning within these systems.

Go to the Week’s Content

Week 5

Week 5: Concepts of Gastrointestinal and Hepatobiliary Disorders

Patients of gastrointestinal and hepatobiliary disorders often face life-altering changes, including changes to diet, new treatment regimens, and more. For some disorders, treatments can include surgery.

Gastrointestinal conditions, such as ulcers, diverticulitis, and pancreatitis, often cause varying levels of pain and discomfort. Hepatobiliary conditions can also bring significant changes to patient routines and well-being.

This week, you examine fundamental concepts of gastrointestinal and hepatobiliary disorders. You explore common disorders in these categories, and you apply the key terms and concepts that help communicate the pathophysiological nature of these issues to patients.

Learning Objectives

Students will:

• Analyze concepts and principles of pathophysiology across the life span

Learning Resources

Required Readings

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

• Chapter 38: Structure and Function of the Renal and Urological Systems including Summary Review
• Chapter 39: Alteration of Renal and Urinary Function (stop at Fluids and electrolytes); Summary Review
• Chapter 41: Structure and Function of the Digestive System (stop at Tests of digestive function); Summary Review
• Chapter 42: Alterations of Digestive Function (stop at Cancer of the digestive track); Summary Review

Osna, N. A., Donohue, T. M., Jr., & Kharbanda, K. K. (2017). Alcoholic liver disease: Pathogenesis and current management. Alcohol Research: Current Reviews, 38(2), 7–21

Document: NURS 6501 Midterm Exam Review (PDF document)

Note: Use this document to help you as you review for your Midterm Exam in Week 6.

Required Media

Module 3 Overview with Dr. Tara Harris

Dr. Tara Harris reviews the structure of Module 3 as well as the expectations for the module. Consider how you will manage your time as you review your media and Learning Resources throughout the module to prepare for your Knowledge Check. (2m)

Liver Function Tests

MedCram. (2013, April 14). Liver function tests LFTs explained clearly by MedCram.com [Video file]. Retrieved from https://www.youtube.com/watch?v=bFdTgty0T0I

Note: The approximate length of the media program is 11 minutes.

Liver Diseases

MedCram. (2019, May 15). Diagnosis of key liver diseases: Hepatitis A, B C vs. alcoholic vs. ischemic (AST vs ALT labs) [Video file]. Retrieved from https://www.youtube.com/watch?v=ZZRHA2JvCGA

Note: The approximate length of the media program is 13 minutes.

Liver Pathophysiology

MedCram. (2013, April 9). Liver explained clearly: Pathophysiology, LFTs, hepatic diseases  [Video file]. Retrieved from https://www.youtube.com/watch?v=BTGkB8nOu7g

Note: The approximate length of the media program is 14 minutes.

Online Media from Pathophysiology: The Biologic Basis for Disease in Adults and Children

In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 41 and 42 that relate to the hepatobiliary system. Refer to the Learning Resources in Week 1 for registration instructions. If you have already registered, you may access the resources at https://evolve.elsevier.com/

Knowledge Check: Gastrointestinal and Hepatobiliary Disorders

In this exercise, you will complete a 10- to 20-essay type question Knowledge Check to gauge your understanding of this module’s content.

Possible topics covered in this Knowledge Check include:

• • Ulcers
  • Hepatitis markers
  • After HP shots
  • Gastroesophageal Reflux Disease
  • Pancreatitis
  • Liver failure—acute and chronic
  • Gall bladder disease
  • Inflammatory bowel disease
  • Diverticulitis
  • Jaundice
  • Bilirubin
  • Gastrointestinal bleed – upper and lower
  • Hepatic encephalopathy
  • Intra-abdominal infections (e.g., appendicitis)
  • Renal blood flow
  • Glomerular filtration rate
  • Kidney stones
  • Infections – urinary tract infections, pyelonephritis
  • Acute kidney injury
  • Renal failure – acute and chronic

Complete the Knowledge Check By Day 7 of Week 5

To complete this Knowledge Check:

Module 3 Knowledge Check

Sample Paper – Week 5 Knowledge Check

NURS 6501 – Knowledge Check

Check Knowledge Scenarios

Student Name:

Institutional Affiliation:

Check Knowledge Scenarios

Scenario 1 Peptic Ulcer Disease

Question 1

The patients have been using ibuprofen, which is categorized as inflammatory drugs. This drug is the most cause of peptic ulcers. The patient was also reported to have been smoking tobacco, excessive caffeine, drinking alcohol, and psychological stress on managing his families. All these factors may have led to the development of peptic ulcer disease.

Question 2

Ibuprofen drugs contribute to peptic ulcer development by interfering with the patient’s stomach ability to protect itself from gastric acid corrosion. Tobacco smoking destroys gastroduodenal mucosa risking the stomach to PUD, while ethanol in alcohol led to gastric irritation, which may risk the patient to get ulcers (Lanas & Chan, 2019). Caffeine also causes the production of acid in the body, which is a direct cause of PUD.

Scenario 2 Gastroesophageal Reflux Disease (GERD)

GERD is mainly caused by frequent acid reflux. This involves the backwash of stomach acids to the esophageal, causing burning pain (Clarret & Hachem, 2018). His action, such as smoking, can aggravate this problem of frequent acid reflux acid. It can also be facilitated by excessive drinking of certain beverages such as alcohol and coffee. Other factors that risk the people getting GERD is obesity, problem or disorder of connective tissues, etc.

Scenario 3 Upper GI Bleed

GI is a problem that occurs in the digestive tract. Upper GI happens in the esophagus, stomach, or beginning of small interest (Steele, 2020). This problem can range from excessive bleeding, which is life-threatening, to a minor, which can only be identified through conducting the patient stool test. The main cause associated with this disease is peptic ulcers; these are open sores in the intestine lining. It can also be caused by the tearing of veins located in the esophagus, which can result in bleeding. Another factor that can contribute to this problem is the enlargement of veins in the esophagus abnormally, but this is common for liver disease people. Esophagitis is another factor that involves inflammation of the esophagus, and it is the most contributors to this problem.

Scenario 4 Diverticulitis

This problem results from pressure build-up due to a lack of enough fiber diet, which finally leads to constipation. The process repeats continuously while the patient develops pressure and staining, which finally causes diverticulosis (Young-Fadok, 2018). Due to this pressure, the colon gives up the weak pint and gives way causing a protruding marble size pouches in the colon, resulting in diverticula. Finally, this diverticula tend to break, leading to inflammation (diverticulitis) or in some worse case to other infections.

Scenario 5 Portal Hypertension

Cirrhosis is a liver disease that results from excessive drinking of alcohol. The patient has developed portal hypertension, which is associated with cirrhosis. This occurs because, in the body, there is a large vessel that transports blood to the liver, knows as portal vein (Arab, Barrera & Arrese, 2017). When a person develops cirrhosis, it slows the blood flow and subjects the portal vein to stress. Because the heart continues pumping blood, this slow movement of blood in the liver causes high blood pressure, resulting in portal hypertension.

Scenario 5 part 2: Ascites

Ascites is the abnormal accumulation of fluid within the peritoneal cavity. This is caused by conditions such as portal hypotension. This problem involves enlarging the blood vessels to create room for the high blood pressure resulting from liver cirrhosis (Arab, Barrera & Arrese, 2017). The high pressure in the portal veins causes leakage of protein fluid to the surface of various organs such as the liver, intestine, and this protein-containing fluid tends to accumulate within the patient’s abdomen. This creates the problem of Ascites, which is presented by the described symptoms.

Scenario 6: Hepatic Encephalopathy (HE)

Hepatic encephalopathy can be referred to as reduced brain function, which the main cause is liver disease. In this case of a patient having liver cirrhosis, it will reduce or stop the liver’s functioning, leading to a build-up of toxins in the patient’s bloodstream (Ferenci, 2017). In this condition, the liver is not able to filter toxins from the body so that it can be removed. When the liver is damaged, it cannot perform its function properly, making the toxin to be circulated throughout the body. Continuous build-up of these toxins in the patient’s disease tends to damage the brain, and this is reflected by the patient been confused due to brain disorientation and flapping his hand. 

Scenario 7: Sudden onset of Abdominal Pain

The most likely problem associated with these symptoms may be gastrointestinal or stomach ulcers. This may lead to the abdominal sudden onset of pain. If this problem is not treated earlier, it can bring other problems such as heart attacks, patient vomiting bloody due to internal bleed from the stomach sores. It can disrupt heart operation as blood pressure is affected. The continuous manifestation of these symptoms may lead to deadly stages, such as when a patient starts experiencing a heart attack or abnormal heartbeat.

Scenario 8: Acute Cholecystitis

Question 1

Gallstones are a hard deposit of bile, which are formed in the gallbladder. They can be referred to as parts of a solid component forming in the gallbladder. Gallstones are formed if the bile contains too much bilirubin, excessive cholesterol, or inadequate bile salt (Ibrahim et al.,2018). It develops when there is too much cholesterol or bilirubin, which tends to crystalize and finally form gallstones. The result can also be seen when the gallbladder cannot perform its function properly, making it unable to empty well. Bile can solidify and form a solid substance that can block the bile passage from the liver.

Because of these gallstones’ formation, the patient gall bladder enlarged to create room for the new substances formed; stones are seen in the patient bile duct was resulted from solidified excessive cholesterol or hardened bile forming stones which disruption the bile transportation (Ibrahim et al., 2018). Theses gallstone’s presence was the main reason for dilated common duct as it tries to be more elastic to house the bile produced and the blocking stones formed.

Question 2

The patient becomes jaundiced when there was excess production of bilirubin in his body. The bilirubin is located in the red blood cells, and when its cells die, they are filtered from the body by the liver. Because the patient developed jaundice, this means her life stop carrying its function well, leading to the accumulation of bilirubin in the patient’s body, which made her skin look yellow—therefore making the patient jaundiced.

Scenario 9: Pancreatitis

Pancreatitis is a condition that develops when the patient’s digestive enzymes become functional or activated before leaving the pancreas. This will, in turn, result in irritating the pancreas cells and finally make it enlarge because of inflammation (Kleeff et al., 2017). Therefore, the activated digestive enzyme creates an unconducive environment for the pancreas cell to function, making them swell, leading to this condition of pancreatitis. When this process continues, it can go further and lead to chronic pancreatitis. In this scenario, because the patient has a history of alcoholism for a long time, it could have played a big role in her problem. This is because the pancreas’ acinar cell metabolizes ethanol into harmful byproducts, which damages bile ducts. After this, the bile can no longer transport enzymes anymore, and they tend to build up in the digestive tract, and if this continues, it starts digesting the pancreas. The damaged tissue led to inflammation of the entire pancreas, resulting in further damage leading to pancreatitis. Therefore, Ruth’s drinking behavior leads to her development of this pancreas problem.

Scenario 10: Hepatitis B

The symptoms given by the patient are a clear indicator of hepatitis B.  These symptoms include; nausea and vomiting, abdominal pain, loss of appetite, fatigue, and dark urine. Following the patient history and combining with the symptoms he is reporting automatically show he has hepatitis B. This is because of his history behavior, such as engaging in sexual activities and sharing needles, are the main cause of this disease (Terrault et al., 2018).

Scenario 11: Ulcerative Colitis (UC)

The problem of ulcerative colitis is commonly associated with the malfunction of the immune system. This happens when the body’s immune system tries to defend the body from a certain virus or disease (Xu et al., 2019). The body responds by producing an abnormal response that attacks the digestive tract cells instead of fighting the virus or other problem. This, in turn, results in inflammation and ulcers in the patient digestive tract, which affects the inner part of the colon and rectum.

Scenario 12: Acute Kidney Injury

The patient is suffering from a postrenal type of acute kidney injury. This type involves nephropathy obstruction, which is causing the patient urine flow restriction (Mehran, Dangas & Weisbrod, 2019). It is diagnosed following the symptoms and cause given by the patient and the lab result. For example, it is associated with other diseases such as congenital defects and other swelling symptoms in the lower extremities. These symptoms were the main factor that leads the CXR to diagnose the patient for this kind of kidney injury.

Scenario 13: Glomerular filtration rate (GFR)

The most important concept which the APRN should address when dealing with the student about the glomerular filtration rate is the function of each part of the component involved. This is because it will help stress how this rate is checked and how any disruption from normal can be detected (Bersie et al., 2020). The APRN should also stress on how the students can estimate the amount of blood passing at glomeruli at a given time. The normal GFR should be communication and all the problem or disorder which may be associated with GFR. By doing so, the students will understand how this rate is achieved and know the factor that can affect the normalcy.

Scenario 14: Autoregulation

APRN should start by giving the student the overall meaning concept of autoregulation. Another concept would involve how the body can regulate local blood. The factors and hormones involved. The relationship between blood flow and blood flow regulation and how blood pressure can cater to body function (Wang, Ortega-Gutierrez & Peterson, 2018). The concept of how various blood pressures may make the blood run fast and how one can deal with to ensure blood flow in the body is stable and effective.

Scenario 15: Hormonal Regulation

The APRN should address how hormones regulations take place in the body. He should bring out the concept of how this process occurs and all the components required (Bersie et al., 2020). This will involve addressing both the negative and positive feedback mechanisms used by the body to achieve this regulation. In this concept, he will also mention how the thyroid system contributes to promoting hormone regulations. Organs that are responsible for producing these hormones should be covered in this concept.

Scenario 16: Pyelonephritis

Pyelonephritis can be referred to as the inflammation of the kidney because of infection from bacteria. Urinal calculi calculus may lead to urine obstruction, and this can result in acute pyelonephritis (Johnson & Russo, 2018). When urinal calculi occur, the urine accumulates, leading to the multiplication of bacteria as the body cannot flash all the urine out. These bacteria may attack the kidney, and the damaged part may lead to inflammation of the whole kidney. Whenever the kidney stone is formed in the urinary tract, the outflow of urine is not possible, and the bacteria collected in other body parts may be accumulated here, and upon their accumulation, they lead to pyelonephritis.

Scenario 17: Chronic Renal Failure

Diabetes and hypertension are among the primary cause of chronic renal failure. When a person is suffering from hypertension or diabetes, high blood sugar, or high pressure resulting from hypertension, they can damage the kidney’s blood vessels, hence interfering with its function (Mehran, Dangas & Weisbrod, 2019. When this damage occurs, the kidney may fail to perform its function leading to kidney failure. If such damage kidney continues for a long time, it tends to impair it, leading to the development of chronic renal failure.

References

Arab, J. P., Barrera, F., & Arrese, M. (2017). Bile acids and portal hypertension. Annals of hepatology, 16, Ferenci, P. (2017). Hepatic encephalopathy. Gastroenterology report, 5(2), 138-147.S83-S86

Bersie‑Larson, L. M., Gyoneva, L., Goodman, D. J., Dorfman, K. D., Segal, Y., & Barocas, V. H. (2020). Glomerular filtration and podocyte tensional homeostasis: importance of the minor type IV collagen network. Biomechanics and Modeling in Mechanobiology.

Clarrett, D. M., & Hachem, C. (2018). Gastroesophageal Reflux Disease (GERD). Missouri medicine, 115(3), 214.

Ibrahim, M., Sarvepalli, S., Morris-Stiff, G., Rizk, M., Bhatt, A., Walsh, R. M., … & Burke, C. A. (2018). Gallstones: Watch and wait or intervene. Cleve Clin J Med, 85(4), 323-331.

Johnson, J. R., & Russo, T. A. (2018). Acute pyelonephritis in adults. New England Journal of Medicine, 378(1), 48-59.

Kleeff, J., Whitcomb, D. C., Shimosegawa, T., Esposito, I., Lerch, M. M., Gress, T., … & Muñoz, J. E. D. (2017). Chronic pancreatitis. Nature reviews Disease primers, 3(1), 1-18.

Lanas, A., & Chan, F. K. (2017). Peptic ulcer disease. The Lancet, 390(10094), 613-624.

Mehran, R., Dangas, G. D., & Weisbord, S. D. (2019). Contrast-associated acute kidney injury. New England Journal of Medicine, 380(22), 2146-2155.

Steele, C. (2020). Upper GI Bleed. In Resources for Optimal Care of Emergency Surgery (pp. 137-137). Springer, Cham.

Terrault, N. A., Lok, A. S., McMahon, B. J., Chang, K. M., Hwang, J. P., Jonas, M. M., … & Wong, J. B. (2018). Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology, 67(4), 1560-1599.

Wang, A., Ortega-Gutierrez, S., & Petersen, N. H. (2018). Autoregulation in the Neuro ICU. Current treatment options in neurology, 20(6), 20.

Xu, X., Yang, W., Liang, Q., Shi, Y., Zhang, W., Wang, X., … & Yin, L. (2019). Efficient and targeted drug/siRNA co-delivery mediated by reversibly crosslinked polymersomes toward the anti-inflammatory treatment of ulcerative colitis (UC). Nano Research, 12(3), 659-667.

Young-Fadok, T. M. (2018). Diverticulitis. New England Journal of Medicine, 379(17), 1635-1642.

What’s Coming Up in Module 4?

In Module 4, you will analyze processes related to endocrine disorders. To do this, you will analyze alterations in the relevant systems and the resultant disease processes. You will also consider patient characteristics, including racial and ethnic variables, that may impact physiological functioning and altered physiology.

Week 6 Knowledge Check: Endocrine Disorders

In the Week 6 Knowledge Check, you will demonstrate your understanding of the topics covered during Module 4. This Knowledge Check will be composed of a series of questions related to specific scenarios provided. It is highly recommended that you review the Learning Resources in their entirety prior to taking the Knowledge Check, since the resources cover the topics addressed. Plan your time accordingly.

Also, during this week you will take your Midterm Exam. Please make sure to finalize and complete your Knowledge Check prior to completing your exam.

Next Module

To go to the next Module:

Module 4

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