Gastrointestinal Tract: Disorders of Motility Essay example
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. 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.
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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 Gastrointestinal Tract: Disorders of Motility Essay example. 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.
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.
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.
To Complete
Write a 2- to 3-page Gastrointestinal Tract: Disorders of Motility Essay example 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.
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.
Notes
Please include a purpose statement
References must be 5 years or less
Please follow the rubric that will be uploaded.
Gastro-Intestinal Motility Disorders
Gastric acid is one of the common hormones that aid digestion and is produced in the stomach. Alteration in the stimulation and the production of gastric acid initiate a cascade of event that finally leads to disorders of gastro-intestinal motility. Notably, some of the common disorders related to alteration in the production of gastric acid are: “gastro esophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis” (Zatorski, 2017). The following paper will present a discussion of the normal physiology of gastric acid production, development of the mentioned diseases based on gastric acid stimulation and production and impact of genetics on the development of the above three specified disorders. Finally, the paper will present a mind map of gastritis based on the epidemiological features, pathophysiological development, presentation, and management Gastrointestinal Tract: Disorders of Motility Essay example.
Gastric Acid Stimulation and Production
Gastric acid production is stimulated by endocrine and the nervous inputs. Gastric acid production is initiated in response to the presence of food in the stomach. When food enters the stomach, the G cells of pyloric mucosa produce gastrin hormone and is released into the stomach. Subsequently, through the process of churning in the stomach, the gastrin hormone comes into contact with the enterochromaffin-like cells of the gastric gland. Upon activation by the hormone gastrin, enterochromaffin-like cells secrete histamine which, in turn, prompts the secretion of the acid by parietal cells. In addition to the hormonal stimulation, nervous stimulation leads to the production of gastric acid. The smell, taste or the sight of food causes the release of nerve impulses from the hypothalamus, the amygdala, and the cerebral cortex through the vagus nerve to the enterochromaffin-like cells in the stomach, causing the release of histamine which subsequently stimulates the secretion of gastric acid (Waldum, Kleveland, & Fossmark, 2015).
The histamine binds to H2 receptors on the enterochromaffin-like cells, activating the H+/ K+ ATPase proton pump. Chloride ions are actively transported from the cell’s cytoplasm into the canaliculi whereas sodium ions are pumped into the cell. As a result, the positively charged sodium and potassium ions bind to the negatively charged chloride ions, forming sodium chloride and potassium chloride in the cell’s canaliculi. In addition, within the cell’s cytoplasm, water is broken down into hydrogen and hydroxyl ions. The H+/ K+ ATPase proton pump transports the hydrogen ions from the cytoplasm of the parietal cells into the canaliculi of the cells by active transport. In turn, the negatively charged chloride ions bind with the positively charged chloride ions, forming gastric acid. Thereafter, the gastric acid flows into the lumen of the stomach, to aid in the activation of other digestive hormones (Schubert, 2017). Gastrointestinal Tract: Disorders of Motility Essay example.
Pathophysiology of GERD, Gastritis and PUD.
Notably, the level of gastric acid production is inhibited by several nervous and hormonal mechanisms. Therefore, the failure of the control mechanism initiates a cascade of events that lead to the development disorders such as GERD, PUD, and gastritis. Overproduction of gastric acid leads to the erosion of the mucosa of the lower end of that small intestine, a condition referred to as peptic ulcer disease. Additionally, in the event of the dysfunction of the pyrolic sphincter or a hiatal hernia, the reflux of gastric contents occurs. Particularly, in cases of overproduction of gastric acid, stomach contents with high levels of gastric acid flow to the esophagus, in a condition called gastro esophageal reflux disease. The high acidic contents cause irritation of the gastric and esophageal mucosa, causing gastritis and its complications (Schubert, 2017).
Genetics and Pathophysiology of GERD, PUD, and Gastritis
The genetic makeup of an individual determines the integrity of the pyloric sphincter and therefore plays a role in the development of gastro esophageal reflux disease. Subsequently, genetics play a role in the irritation of the mucosa of the stomach and esophagus. The presence of human leucocyte antigen (HLA) is genetically associated with the occurrence of peptic ulcer disease. In general, genetics play a role in the occurrence and the prevalence of peptic ulcer disease, gastritis, and gastro-esophageal reflux disease Gastrointestinal Tract: Disorders of Motility Essay example. The association of genetics to the development of disorders of gastric motility, therefore, dictates on the treatment of the disorders. Particularly, during clinical management, it is imperative to take detailed family history concerning the occurrence of such conditions affecting family members so as to determine the causative factor and therefore the treatment. In addition, screening through genetic mapping to identify genetic markers associated with the development of any of the three disorders of gastric motility (Rugge, Fassan, & Graham, 2015).
In conclusion, the physiology of the stimulation and production of gastric acid is multifactorial and takes place through several stages. The alteration of the physiology of gastric acid initiates the pathophysiology of PUD, GERD and gastritis. Genetics play an important role in the development of gastritis and therefore the epidemiology, diagnosis, and treatment is significantly affected by the influence of genetics on gastritis. Gastrointestinal Tract: Disorders of Motility Essay example.
References
Rugge, M., Fassan, M., & Graham, D. Y. (2015). Epidemiology of gastric cancer. In Gastric Cancer Springer, Cham.
Schubert, M. L. (2017). Physiologic, pathophysiologic, and pharmacologic regulation of gastric acid secretion. Current opinion in gastroenterology, 33(6), 430-438.
Waldum, H. L., Kleveland, P. M., & Fossmark, R. (2015). Upper gastrointestinal physiology and diseases. Scandinavian journal of gastroenterology, 50(6), 649-656.
Zatorski, H. (2017). Pathophysiology and Risk Factors in Peptic Ulcer Disease. In Introduction to Gastrointestinal Diseases Vol. 2 (pp. 7-20). Springer, Cham. Gastrointestinal Tract: Disorders of Motility Essay example.