Who can assist with responses to two of the questions on the following discussion post, APA format, including a reference?
Treatment for Gastrointestinal and Endocrine Disorders
- Describe diagnostic criteria for nausea and vomiting and treatment recommendations.
The three identified phases of emesis are nausea, retching, vomiting. Nausea is the unpleasant physical sensation of impending retching or vomiting. Common symptoms associated with nausea are flushing, pallor, tachycardia, and hypersalivation. Retching is the second base of emesis and is an involuntary synchronized labor movement of the abdominal and thoracic muscles before vomiting. Vomiting is the coordinated contractions of the abdominal and thoracic muscles to expel gastric contents. The esophageal sphincter contracts, allowing G.I. retroperistalsis. The actual exposure of gastric contents differentiates vomiting from retching. (Arcangelo et al., 2021)
A health history needs to be conducted to determine the cause of the nausea and vomiting. Some issues may include mechanical obstruction, perforation, peritonitis, viral gastroenteritis, or possibly certain medications. The goal is to determine the best treatment of choice for the patient. This may include an antiemetic, a gastric acid suppressor, a prokinetic agent, IV fluids, or electrolyte replacement. Sometimes nausea and vomiting may be caused by drug toxicity which can be treated by antidotes. Changes in a patient’s diet may affect the frequency and severity of nausea and vomiting. Professional counseling or group therapy may help patients with psychogenic nausea and vomiting. (Arcangelo et al., 2021)
The goal of drug therapy is to alleviate nausea and vomiting and its associated complications. The goal is also to minimize drug toxicity, adverse effects and containment cost. Some of the medications used to treat nausea and vomiting include phenothiazines, antihistamines – anticholinergics, benzodiazepines, serotonin antagonists, metoclopramide and other anti-emetics, cannabinoids, corticosteroids and antacids. (Arcangelo et al., 2021)
- Discuss symptoms of GERD, complications, and drug management.
GERD results from the abnormal reflux of gastric contents into the esophagus or beyond including the oral cavity or lungs. Symptoms associated with GERD are caused by the exposure of the esophagus to gastric contents. This happens because of the relaxation of the lower esophageal sphincter which can be the result of intraabdominal pressure, delayed gastric emptying, hiatal hernia, or certain medications or food. Some symptoms include acid regurgitation, heartburn, epigastric fullness, epigastric pressure, nausea, bloating, belching, chronic cough, bronchospasm, and dental erosions. (Arcangelo et al., 2021)
Complications of GERD result from a repeated exposure to reflux gastric contents for prolonged periods. Barrett’s esophagus is a complication of GERD which causes the stratified squamous cells to change and become simpler cells like those that line the intestines. Esophageal carcinoma is more common in older white males with an elevated BMI. (Arcangelo et al., 2021)
Drug classes used to treat GERD and substance include antacids, histamine-2 receptor antagonist, and proton pump inhibitors. Histamine-2 receptor antagonist and proton pump inhibitors are used for two weeks to confirm GERD until symptoms improve. In some instances, it may take up to 4 to 16 weeks. The goal of drug therapy is to improve symptoms, decrease the frequency and duration of reflux, heal the esophageal mucosa, and prevent complications. (Arcangelo et al., 2021)
- Compare and contrast Crohn’s disease and Ulcerative Colitis
Inflammatory bowel disease describes chronic inflammation of the G.I. tract that usually affects the intestines. This disease is usually seen in women, Whites, people of Jewish descent (Ashkenazi Jews) and smokers. The most common forms of inflammatory bowel disease are Crohn’s disease and ulcerative colitis. They are characterized by periods of exacerbations and remissions that can vary in severity. Inflammatory bowel disease is thought to be caused by a genetically associated autoimmune state that occurs as a result of a dysregulated response by the mucosal immune system to intestinal microbiota. The G.I. immune system either reacts excessively or inadequately to intestinal microbiota resulting in an imbalance in their immune response which lead to inflammatory disease. Complications of inflammatory bowel disease include anemia, malnutrition, and fluid and electrolyte imbalances. Diagnosis of Crohn’s and Ulcerative Colitis include a health history, physical examination, stool analysis, blood chemistry, CBC, C-reactive protein levels, colonoscopy, endoscopy, and serologic markers. Treatment includes anti-diarrheal agents, corticosteroids, antibiotics, and surgical interventions. (Dlugasch & Story, 2024)
Crohn’s disease is an insidious, slow developing progressive condition that often emerges in adolescence. T-cell activation leading to tissue damage has been implicated in the disease however the exact cause is unknown. This condition usually affects the distal ileum, ileum and cecum, or the ileum and entire colon. It is characterized by patchy areas of inflammation involving the full thickness of the intestinal wall and ulcerations. These patchy areas of ulceration are separated by areas of normal tissue that form fissures divided by nodules giving the intestinal wall of cobblestone appearance. Eventually, the entire wall becomes thick and rigid. The intestinal lumen becomes narrowed and potentially obstructed. Overtime, the damaged intestine loses its ability to process and absorb food. It also decreases digestion and absorption. Eventually, there is the development of obstructions, adhesions, fistulas and perforations. Intestinal manifestations include abdominal cramping, steatorrhea, constipation, palpable abdominal mass, and anorexia. (Dlugasch & Story, 2024)
Ulcerative colitis is a progressive condition of the rectum and colon mucosa that usually develops in the second or third decade of life. Inflammation is triggered by T cell accumulation of the colon mucosa which causes epithelium loss, surface erosion, and ulceration. The ulceration begins in the rectum and extends in a continuous segment involving the entire colon. Necrosis of epithelial can result in abscesses known as crypt abscesses. Ulcers emerge, creating large areas of stripped mucosa. Nutritional, fluid, electrolyte, and PH imbalance develop due to the lack of adequate surface area for absorption. (Dlugasch & Story, 2024)
- Discuss Diabetes, its causes, symptoms, and treatment.
Diabetes refers to a group of conditions characterized by hyperglycemia resulting from defects in insulin production, insulin action or both. Impaired insulin production or action results in abnormal carbohydrate, protein, and fat metabolism because of the glucose transportation issue. The forms of diabetes include type 1, type 2, gestational diabetes and monogenic diabetes syndrome. An estimated 422 million people have diabetes worldwide and it is very common in the US. (Dlugasch & Story, 2024)
Hyperglycemia can cause glucose, polyuria, polydipsia, polyphagia, weight loss, blurred vision, fatigue, nausea, vomiting, and abdominal pain. Hypoglycemia can cause low glucose, tremors, palpitations, anxiety, sweating, hunger, paresthesia, drowsiness, confusion, delirium, seizure and even coma. (Dlugasch & Story, 2024)
Diagnosis is usually made with laboratory evaluation of glucose. Treatment for diabetes include dietary changes, exercise management, glucose monitoring, weight loss, insulin, and complication management. Bariatric and metabolic surgeries have also shown promise as potential cures for diabetes. (Dlugasch & Story, 2024)
