Week 5: Alterations in Endocrine Function - Discussion Part Three
This week's graded topics relate to the following Course Outcomes (COs).
1 Analyze pathophysiologic mechanisms associated with selected disease states
...
Week 5: Alterations in Endocrine Function - Discussion Part Three
This week's graded topics relate to the following Course Outcomes (COs).
1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)
2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)
3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)
4 Distinguish risk factors associated with selected disease states. (PO 1)
5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)
6 Distinguish risk factors associated with selected disease states. (PO 1)
7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)
Case Study
Sierra is a 16-year-old female who comes to your office today with complaints of severe abdominal pain and frequent bloody diarrhea. She has had a history of urgent bowel movements, diarrhea
a few times a week with no blood present, chronic fatigue, and recent weight loss. Her mother has a history of irritable bowel disease and her maternal grandfather has had colon cancer. Her physical
exam reveals hyperactive bowel sounds in all four abdominal quadrants, abdominal distention, and right lower quadrant tenderness. Her vital signs are within normal limits. Labs are obtained and reveal
the following:
Hg: 9.1 (anemia)
CRP: 117 mg/L (inflammation)
Stool sample: White blood cells present (stool result)
(National Institute of Diabetes and Digestive and Kidney Disease [NIDDK], 2014).
As her health care provider you suspect Ulcerative Colitis as your primary diagnosis with a differential diagnosis of Crohn’s Disease and Irritable Bowel Syndrome. Ulcerative Colitis is a chronic
disease that causes inflammation, irritation, swelling, or sores deemed ulcers on the inner lining of the large intestine. The exact cause of ulcerative colitis is unknown but several factors are believed to
play a part in the development of ulcerative colitis (NIDDK, 2014). Cope (2014) found a functional disorganization of the innate and adaptive immune responses occurs against materials in the gut,
usually intestinal microbiota or gut flora. According to NIDDK (2014), ulcerative colitis has been known to be recurrent within families. Abnormal genes may appear in people with ulcerative colitis,
however a clear clink has not been determined. Ulcerative colitis usually begins gradually and becomes worse over time with symptoms that range from mild to severe. Most people experience periods
of remissions with no symptoms present. Complications of ulcerative colitis include rectal bleeding, dehydration, malabsorption, and changes in the bones. Inflammation can also occur in other areas of
the body including the joints, eyes, skin, and liver (NIDDK, 2014).
To diagnose ulcerative colitis an endoscopy can be done to visualize the large intestine. A colonoscopy or flexible sigmoidoscopy can be done to visualize the rectum and colon. In ulcerative
colitis they will reveal irritated and swollen tissue, ulcers, polyps, or abnormal tissue. Biopsy of the patient’s colon and rectum may also be obtained to assess for ulcerative colitis in the tissue (NIDDK,
2014).
The goal of ulcerative colitis treatment is to achieve long-term remission. This can be done with medications or surgery. The treatment depends on the severity of the disease. Medications
typically used to treat symptoms include aminosalicylates for inflammation, corticosteroids (short-term use) to reduce over activity of the immune system and decrease inflammation, immunomodulators
to reduce immune system activity, which causes decreased inflammation, and anti-TNF therapies to decrease inflammation in the large intestine by neutralizing TNF. Acetaminophen is prescribed for
pain because NSAIDS are contraindicated, antibiotics are given if an infection is present, and loperamide is used to stop diarrhea. Surgery is indicated if symptoms do not improve with medication, lifethreatening complications occur, or signs of colon cancer occur. If the entire colon including the rectum is removed ulcerative colitis is essentially cured. Good nutrition is important in the managementof ulcerative colitis and reducing symptoms. Dietary changes include avoiding carbonated beverages, popcorn, vegetable skin, nuts, and high fiber foods during the occurrence of symptoms. Drinking
more liquids, smaller portions, and a food diary are also recommended (NIDDK, 2014). According to Cope (2014), a low-residue or fiber diet is often recommended to a patient with ulcerative colitis
with severe inflammation.
Ref
Write a one (1) paragraph case study of your own for a patient with Ulcerative Colitis.
PATIENT/CLIENT: 35-year old female patient presents today to the clinic for a complaint of bloody diarrhea that is accompanied by mucus.
SYMPTOMS/OBJECTIVE: She has had abdominal cramping. The diarrhea is becoming worse, and she is beginning to feel very tired.
DIAGNOSIS/ASSESSMENT: Ulcerative Colitis
What is Ulcerative Colitis: Ulcerative colitis is an ulcerated and inflamed mucosal and submucosal lining of the large intestine. The result is
abdominal pain, diarrhea, and rectal bleeding. It is a chronic inflammatory disease that causes ulceration of the colon mucosal surfaces and extends
from the rectum to the colon (McCance, Huether, Brashers, & Rote, 2014, p. 1440).
What are the signs and symptoms of ulcerative colitis? Loss of the absorptive mucosa leads to decreased time for waste in the colon, and this leads
to watery diarrhea. The destroyed mucosa will cause bleeding, cramping and urge to defecate. There is purulent mucus and bloody diarrhea. The
symptoms depend on the severity of the form of ulcerative colitis (McCance, Huether, Brashers, & Rote, 2014, p. 1442).
Epidemiology: Both ulcerative colitis and Crohn disease are chronic diseases involving the bowel. It is important to note that the incidence of
Inflammatory Bowel Diseases are on the rise and increasing around the world. The rate varies from 3 to 300 per 100,000 persons (McCance, Huether,
Brashers, & Rote, 2014, p. 1440).
What is the pathophysiology?. There are genetic factors associated with both ulcerative colitis and Crohn disease. There are alterations in epithelial
cells and barrier function. Immunopathology is related to abnormal T-cell reactions to microflora and other luminal antigens (McCance, Huether,
Brashers, & Rote, 2014, p. 1440). The humoral and cellular immunologic factors are the most significant factors associated with the disease (McCance,
Huether, Brashers, & Rote, 2014, p. 1441). Colonic antibodies of IgG have been identified in the sera of patients with UC and plasma cells are found in
the inflamed colon. T-cells in patients with UC may have cytotoxic effects on the epithelial cells, and there is damage caused by inflammatory
cytokines, tumor necrosis factor-alpha, free radicals that are toxic, and interferon-gamma. Autoimmune disorders can all accompany this condition.
They are systemic lupus erythematosus and erythema nodosum (McCance, Huether, Brashers, & Rote, 2014, p. 1441). The lesions of UC are limited to
the mucosa. There is a thin mucosal layer which impairs the epithelial barrier. It always involves the rectum. The disease is most severe in the rectum
and sigmoid colon (McCance, Huether, Brashers, & Rote, 2014, p. 1441)
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