Gastrointestinal Tract: Disorders of Motility.

Posted: December 28th, 2022

Gastrointestinal Tract: Disorders of Motility.

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.Gastrointestinal Tract: Disorders of Motility.

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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.Gastrointestinal Tract: Disorders of Motility.Gastrointestinal Tract: Disorders of Motility.

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.Gastrointestinal Tract: Disorders of Motility.

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.Gastrointestinal Tract: Disorders of Motility.
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.Gastrointestinal Tract: Disorders of Motility.
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.Gastrointestinal Tract: Disorders of Motility.
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.

RUBRIC:
Quality of Work Submitted:
The extent of which work meets the assigned criteria and work reflects graduate level critical and analytic thinking.–

Excellent 27 (27%) – 30 (30%)
Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics.Gastrointestinal Tract: Disorders of Motility.

Quality of Work Submitted:
The purpose of the paper is clear.–

Excellent 5 (5%) – 5 (5%)
A clear and comprehensive purpose statement is provided which delineates all required criteria.

Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student’s ability to:

Understand and interpret the assignment’s key concepts.–

Excellent 9 (9%) – 10 (10%)
Demonstrates the ability to critically appraise and intellectually explore key concepts.

Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student’s ability to:

Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources.–

Excellent 18 (18%) – 20 (20%)
Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 2-3 course resources to support point of view.Gastrointestinal Tract: Disorders of Motility.

Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student’s ability to:

Synthesize (combines various components or different ideas into a new whole) material in course resources (i.e. video, required readings, textbook) and outside, credible resources by comparing different points of view and highlighting similarities, differences, and connections.–

Excellent 18 (18%) – 20 (20%)
Synthesizes and justifies (defends, explains, validates, confirms) information gleaned from sources to support major points presented. Applies meaning to the field of advanced nursing practice.

Written Expression and Formatting

Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused–neither long and rambling nor short and lacking substance.–Gastrointestinal Tract: Disorders of Motility.

Excellent 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity

Written Expression and Formatting

English writing standards: Correct grammar, mechanics, and proper punctuation–

Excellent 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.

Written Expression and Formatting

The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.–Gastrointestinal Tract: Disorders of Motility.

Excellent 5 (5%) – 5 (5%)
Uses correct APA format with no errors.
Total Points: 100

Gastro-Esophageal Reflux Disease (GERD), Peptic Ulcer Disease (PUD), and Gastritis: An Understanding of the Pathophysiology, Diagnosis, and Treatment
Physiology of Gastric Acid Stimulation and Production
Gastric acid is concentrated hydrochloric acid (HCl). Gastric juice is this acid mixed together with the other digestive enzymes secreted in the stomach. There are several specialised cells in the epithelial lining of the stomach that secrete each of these components of gastric juice. However, gastric acid is specifically produced by the parietal cells situated in the fundus and antrum of the stomach. Secretion of gastric acid is under neurologic control through the parasympathetic division of the autonomic nervous system. The preganglionic nerve fibres are carried to the parietal cells by the tenth cranial nerve, the vagus nerve (Hammer and McPhee, 2014; Huether and McCance, 2017; Barrett, Barman, Brooks, and Yuan, 2019). Production of gastric acid occurs in phases named cephalic phase, gastric phase, and intestinal phase. Before eating (cephalic phase), the thought of imminent food causes the vagus nerve to stimulate the G cells in the stomach by releasing the chemical Gastrin-releasing Peptide (GRP) and the neurotransmitter acetylcholine (ACh). This chemical causes the G cells to release the hormone gastrin that in turn activates receptors on the parietal cells in the fundus of the stomach. Histamine is then released. Histamine being an H2 receptor agonist is the final chemical messenger that activates the parietal H2 receptors and HCl is produced.ACh produces a similar effect. During the gastric phase food stretches the stomach and activates stretch receptors that then continue the production. Histamine production is continued in the intestinal phase. Parietal cells secret HCl through an energy-intensive process that uses the proton pump (H+, K+- ATPase) to release H+ (hydrogen cations) against a concentration gradient. K+ (potassium cations) are exchanged for the released H+. Furthermore, accompanying chloride anions (Cl-) are released together with the H+. Equal amounts of bicarbonate (HCO-) are also released at the same time, to later neutralise the produced acid after digestion. This maintains the internal acid-base balance.Mucus, too, is produced by mucus secreting epithelial cells of the stomach. Together with the bicarbonate (HCO-), they protect the lining of the stomach from corrosion by its own acid. The alteration or derangement of any of these normal processes in the production of gastric acid is what results in disease. Three of these disease conditions are peptic ulcer disease (PUD), gastro-esophageal reflux disease (GERD), and gastritis.Gastrointestinal Tract: Disorders of Motility.
Pathophysiology of PUD, GERD, and Gastritis
GERD will occur if the lower esophageal sphincter is weak; peristaltic contractions of the stomach are weak, there is delayed emptying of the stomach contents into the duodenum, esophageal peristaltic contractions are weak, there is a hiatus hernia, there are scars formed by duodenal ulcers causing narrowing of the pyloric sphincter, the patient is obese, coughing or vomiting. All of these result in the acidic stomach contents being pushed into the esophagus. This causes corrosion, irritation and inflammation of the esophageal lining (Hammer and McPhee, 2014).Gastrointestinal Tract: Disorders of Motility.
On the other hand, PUD occurswhen there’s ulceration of the stomach lining, duodenum, or esophagus (Hammer & McPhee, 2014). The ulceration occurs due to an imbalance in the protective functions of the mucus and bicarbonate (HCO-), vis-à-vis the production of gastric acid. The latter outpaces the former due to stress, the effect of drugs like non-steroidal anti-inflammatory agents (NSAIAs),or a particular lifestyle (alcoholism and smoking). Chronic alcohol irritates the stomach lining, while nicotine mimics the actions of acetylcholine.
Gastritis, on its part, occurs when the protective gastric mucus lining is inflamed. This inflammation results from an interference with the protective functions of bicarbonate and mucus. The interference is caused by drugs like NSAIAs, chemicals, or infection with the bacterium H. Pylori.
Effect of Behavior or Lifestyle on GERD, PUD, and Gastritis
A sedentary lifestyle leading to obesity will result in GERD due to pressure on the stomach by the omentum. Smoking will release nicotine to act on the gastric nicotinic receptors, just like ACh, causing increased acidity. Chronic alcohol consumption will result in mucosal irritation. Lastly, psychological stress will also increase acidity in the stomach through vagal stimulation. These last three will combine to result in either gastritis or PUD. The diagnosis will be based on history of any or all of these lifestyle indicators (smoking, etc.), presenting complaints (epigastric pain/ tenderness, abdominal discomfort, bleeding); and endoscopic imaging. The treatment will involve counselling for lifestyle change and avoidance of stress, proton-pump inhibitors (lower acid production), antibiotics (for H. Pylori), and H2 blockers (lower acid secretion); vitamin B12 for pernicious anaemia, and finally surgery as a last resort (Jameson et al., 2018).Gastrointestinal Tract: Disorders of Motility.
Gastritis Mind Map

Gastrointestinal Tract: Disorders of Motility.