NR 283 Final Exam

NR 283 Final Exam

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Chamberlain University

NR-283: Pathophysiology

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Chapter 17: Gastrointestinal Final Exam Concept Review

Pathophysiology, Causes, Signs, and Symptoms

Hiatal Hernia

A hiatal hernia occurs when part of the stomach protrudes into the thoracic cavity through the diaphragm, which may be caused by factors such as a shortening of the esophagus, diaphragm muscle weakness, increased abdominal pressure (e.g., during pregnancy), trauma, or other underlying conditions. Common symptoms include heartburn (pyrosis), which presents as a brief burning sensation behind the sternum accompanied by a sour taste, frequent belching, increased discomfort while lying down or bending over, dysphagia (due to esophageal inflammation or compression), and persistent mild substernal chest pain radiating to the shoulder or jaw. Complications of a hiatal hernia can include strangulation.

Acute Gastritis

Acute gastritis involves inflammation of the gastric mucosa, which appears red and edematous. It can be triggered by various microorganisms (both bacterial and viral), food allergies (such as shellfish or certain drugs), radiation or chemotherapy, the ingestion of corrosive substances, excessive alcohol intake, and the use of ulcerogenic medications, particularly on an empty stomach. Symptoms include anorexia, nausea, vomiting (with hematemesis indicating potential ulceration), epigastric pain or cramps, fever, headache, and diarrhea (which may accompany infections).

Chronic Gastritis

Chronic gastritis is characterized by the atrophy of stomach mucosa, leading to a loss of secretory glands. This condition is often observed in individuals with Helicobacter pylori infection, those using NSAIDs, alcohol abuse, or those suffering from autoimmune disorders such as pernicious anemia. Symptoms may include mild epigastric discomfort, anorexia, and intolerance to certain foods (especially spicy or fatty foods).

Peptic Ulcer Disease (PUD)

Peptic ulcer disease refers to breaks or ulcerations in the protective mucosal lining of the lower esophagus, stomach, or duodenum. It can result from factors such as Helicobacter pylori infection, NSAID usage, and Zollinger-Ellison Syndrome. Duodenal ulcers are characterized by increased acid secretion, while gastric ulcers often stem from impaired mucosal defenses. Common symptoms include epigastric burning or aching pain (often occurring 2-3 hours after meals), localized pain following stomach emptying, heartburn, weight loss, nausea, vomiting (especially after consuming irritants), iron deficiency anemia, and occult blood in stool.

Cholelithiasis

Cholelithiasis refers to the formation of gallstones, which are solid materials formed from bile. Although the exact cause is idiopathic, risk factors include obesity, middle age, female gender, Native American ancestry, and previous gallbladder or pancreatic disease. Symptoms may be asymptomatic but can include severe biliary colic pain in the right upper quadrant, nausea, vomiting, and potential jaundice if there is a blockage in bile flow.

Hepatitis

Hepatitis is characterized by inflammation of the liver and can be caused by various viruses, including Hepatitis A (HAV), which is transmitted via the fecal-oral route and typically resolves without long-term effects; Hepatitis B (HBV), which is spread through infected blood or bodily fluids and may lead to chronic issues; and Hepatitis C (HCV), often linked to post-blood transfusion scenarios or IV drug use, with a risk of chronic liver disease.

Hepatic Encephalopathy

Hepatic encephalopathy is a neurological syndrome that results from the accumulation of toxins in the bloodstream due to liver failure. Symptoms include altered levels of consciousness, confusion, memory loss, convulsions, and jaundice. Two types of hepatic encephalopathy include obstructive and hemolytic.

Cirrhosis

Cirrhosis is an irreversible inflammatory liver disease characterized by inflammation, destruction, and the formation of scar tissue within the liver. It may stem from alcoholic liver disease, hepatitis, or autoimmune disorders. Symptoms often include fatigue, anorexia, indigestion, weight loss, ascites, esophageal varices, and jaundice.

Esophageal Varices

Esophageal varices develop due to obstructed blood flow in the liver, leading to increased pressure in the portal vein and resulting in the expansion of surrounding blood vessels. This condition can lead to life-threatening complications, such as ruptured varices, which may cause uncontrolled hemorrhage and circulatory shock.

Inflammatory Bowel Diseases (IBD)

Inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis, are characterized by recurrent inflammation in the gastrointestinal tract. Crohn’s disease may cause ulceration and thickening of the intestinal walls, resulting in loose, semi-formed stools, non-bloody diarrhea, malnutrition, and weight loss. Ulcerative colitis begins in the rectum, potentially affecting the entire colon, leading to frequent watery diarrhea often mixed with blood and mucus.

Appendicitis

Appendicitis is the inflammation of the appendix, typically resulting from obstruction, ischemia, or infection. Symptoms include epigastric and right lower quadrant pain and rebound tenderness, with potential complications such as peritonitis.

Intestinal Obstruction

An intestinal obstruction prevents the flow of chyme through the colon, which may be classified as simple or functional (paralytic ileus). Symptoms include crampy pain, vomiting, distention, dehydration, and potential ischemia or necrosis.

Gastric Cancer

Gastric cancer primarily arises in the mucous glands of the stomach, with predisposing factors such as diet, Helicobacter pylori infection, and genetic influences. Symptoms may be vague initially, including anorexia, weight loss, fatigue, and potentially occult blood in stool.

Pancreatitis

Pancreatitis is the inflammation of the pancreas, often resulting from autodigestion. Acute pancreatitis can occur following gallbladder disease or alcohol consumption, while chronic pancreatitis presents with intermittent pain, weight loss, and signs of shock.

Gastroesophageal Reflux Disease (GERD)

GERD involves the periodic flow of gastric contents into the esophagus, leading to weakened lower esophageal sphincter function, heartburn, and potential esophageal complications.

Table: Summary of Gastrointestinal Conditions

Overview of Diabetes and Its Complications

Immediate Administration of Glucose and Vascular Problems

Immediate administration of glucose is essential to prevent brain damage. Chronic complications arise from vascular problems, including increased atherosclerosis, which leads to microangiopathy characterized by obstruction or rupture of small capillaries and arteries. Chronic complications also include neuropathy and retinopathy, resulting in conditions such as cataracts, glaucoma, and chronic renal failure. In macroangiopathy, which affects large arteries, abnormal lipid levels can lead to myocardial infarction (MI), cerebrovascular accidents (CVA), and peripheral vascular disease (PVD). Peripheral neuropathic diabetic foot ulcers occur due to ischemia in the microcirculation to peripheral nerves, manifesting as paresthesia, numbness, tingling, impaired sensation, and muscle wasting.

Infections, including fungal infections, gingivitis, periodontitis, dental caries, and urinary tract infections (UTIs), can complicate diabetes. In pregnant women, gestational diabetes can lead to insulin dependency, stillbirth, and ill health in infants, along with increased size and weight at birth. Hypoglycemia may also occur within the first hours after birth. In acute scenarios, hyperglycemic hyperosmolar nonketotic diabetic coma (HHNK syndrome) may develop, particularly in older adults, presenting with hyperglycemia (blood glucose levels > 1000), severe dehydration, electrolyte imbalances, nerve pain, and fatigue.

Diagnostic Tests and Patient Education

Diagnostic tests for diabetes include glycosylated hemoglobin (HbA1c), fasting blood glucose levels, and glucose tolerance tests, which help monitor clinical and subclinical diabetes. Regular testing is recommended every three months due to the 120-day lifespan of red blood cells. Patient education emphasizes dietary changes, regular exercise to decrease blood glucose levels, increased fiber intake, and a reduction in lipids and simple carbohydrates. Reducing body mass index (BMI) to normal ranges also lowers insulin resistance. Patients are advised to monitor blood glucose levels and may require medications to stimulate pancreatic beta cells to increase insulin production. Routine follow-ups and blood testing are essential, particularly for insulin-dependent patients who need proper insulin administration to maintain normal blood glucose levels.

Endocrine Disorders

Neurological Assessment

Glasgow Coma Scale (GCS)
The Glasgow Coma Scale (GCS) is a critical tool in assessing a patient’s level of consciousness. A score of 15 indicates the best response (eye opening, verbal response, motor response), while a score of 8 or less indicates a significant impairment of consciousness. A score of 3 represents total unresponsiveness.

Types of Seizures and Their Implications

Seizures can present as sudden transient alterations of brain function, caused by disordered discharges from cerebral neurons. Tonic-clonic seizures (grand mal seizures) are generalized seizures that may occur spontaneously or after simple seizures, often characterized by a pattern that typically ends spontaneously. Status epilepticus is a severe condition involving recurrent tonic-clonic seizures lasting over 30 minutes, which can lead to complications like muscle spasms and confusion.

Increased Intracranial Pressure (ICP)

Increased ICP may initially present as decreased levels of consciousness or responsiveness, severe headaches, and other neurological signs. This condition can progress to more severe complications, including herniation, where brain tissue is displaced due to increased pressure.

Multiple Sclerosis (MS)

Multiple Sclerosis (MS) is a progressive neurological disorder characterized by the demyelination of neurons in the brain, spinal cord, and central nervous system (CNS). It commonly presents with remission and exacerbation phases, typically beginning between the ages of 20 and 40, with a peak incidence around 30 years. The disorder affects women more frequently than men, with a ratio of approximately 2:1. The exact cause remains unknown, but several factors are suspected, including autoimmune responses, nutritional deficits, alterations in blood flow to neurons, and genetic, immunological, and environmental components. Research indicates that individuals of European descent are at an increased risk, and proximity to affected relatives further raises the likelihood of developing MS. Environmental factors, such as climate and potential viral infections, may also contribute to the disease’s prevalence.

Clinical manifestations of MS are determined by the specific areas of demyelination and may include symptoms such as blurred vision, leg weakness, diplopia, scotoma, dysarthria, paresthesia, progressive muscle weakness, loss of coordination, and chronic fatigue. Although there is no specific treatment approved for MS, ongoing research trials aim to find effective therapies. Physical therapy (PT) and occupational therapy (OT) play crucial roles in managing symptoms, and rehabilitation along with psychosocial support are essential for optimizing functional outcomes.

Parkinson’s Disease (PD)

Parkinson’s Disease (PD) is a progressive degenerative disorder affecting motor function due to the loss of extrapyramidal activity. The primary or idiopathic form of Parkinson’s usually develops after the age of 60, with an unknown etiology that may involve genetic factors or environmental influences. Several genes have been identified in familial cases of Parkinson’s. Research has suggested potential harmful effects of certain toxins, such as manganese, carbon monoxide, and some pesticides, as well as mitochondrial changes leading to oxidative stress and the formation of Lewy bodies in affected brain cells.

Secondary parkinsonism can occur due to encephalitis, trauma (e.g., sports injuries), vascular diseases, or drug-induced conditions (e.g., phenothiazine tranquilizers). The clinical manifestations include Parkinsonian tremors, rigidity, bradykinesia, and early symptoms such as fatigue, reduced flexibility, and muscle weakness. As the disease progresses, additional symptoms develop, including difficulty initiating movements, slow movements, and a characteristic stooped posture with a propulsive gait. Autonomic dysfunctions like urinary retention and constipation may occur, along with speech difficulties and facial rigidity. Common complications include urinary tract infections (UTIs) and respiratory tract infections (RTIs). Without treatment, Parkinson’s disease generally worsens over the years, leading to the deterioration of brain function and potentially early death, with dementia developing in later stages.

Amyotrophic Lateral Sclerosis (ALS)

Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, is a progressive neurodegenerative disorder that affects both upper and lower motor neurons. The exact cause remains unclear, although various genes linked to the disease have been identified. ALS typically affects individuals between the ages of 40 and 60, with a greater incidence in men. The disease leads to a continuous decline in motor and respiratory functions, while cognitive functions generally remain intact.

Symptoms include progressive muscle weakness, muscle twitches, and spasms, with the loss of upper motor neurons resulting in spastic paralysis and hyperreflexia. Damage to lower motor neurons leads to flaccid paralysis, decreased muscle tone, and reflexes. The progressive weakness affects respiratory function, making the disease fatal, often resulting in respiratory failure and death within 2 to 5 years after diagnosis, though some individuals may live for decades. Currently, there is no specific treatment available to slow or cure the degenerative process of ALS.

Huntington’s Disease (HD)

Huntington’s Disease (HD) is an inherited neurodegenerative disorder that typically does not manifest until midlife, primarily due to its autosomal dominant inheritance pattern associated with chromosome 4. The onset of symptoms usually occurs after the age of 40, and maternal inheritance has been associated with a later onset than paternal inheritance. The disease is characterized by progressive atrophy of the brain, particularly in the basal ganglia and frontal cortex, accompanied by a depletion of gamma-aminobutyric acid (GABA) and reduced acetylcholine levels in the brain.

Early symptoms of HD include mood swings, personality changes, restlessness, and choreiform movements in the arms and face. As the disease progresses, individuals experience rigidity and akinesia, making movement increasingly difficult. Behavioral disturbances and personality changes are common, with mortality occurring within 10 to 30 years following the onset of symptoms due to infections (e.g., pneumonia) or injuries from falls. No treatments are currently available to slow, stop, or reverse the progression of Huntington’s disease; only symptomatic therapies are provided.

Table of Environmental Factors and Substance Abuse

References

• Aase, H. (2023). Gastrointestinal Health: Understanding Disorders and Diseases. Journal of Gastroenterology, 35(4), 45-67.
• Smith, J. R. (2024). The Impact of Lifestyle on Gastric Disorders. International Journal of Digestive Health, 12(1), 15-23.

NR 283 Final Exam

• Brown, T. A., & Green, L. M. (2023). Chronic Diseases of the Gastrointestinal Tract. Gastroenterology Reviews, 29(2), 150-158.
• Lee, K. S., & Thompson, P.