PATHOPHYSI NR 507 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) Discussion Discussion Part Three (graded) Responses Lorna Durfee 6/1/2016 8:24:18 AM Discussion Part Three 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). What are the risks for this patient if this condition continues? There can be dehydration and weight loss, anemia, and fever as a result of fluid loss, bleeding, and inflammation (McCance, Huether, Brashers, & Rote, 2014, p. 1442). If a patient has been suffering from this condition for over 10 years, this increases the risk of developing colon cancer by 30-fold. Ulcerative colitis has inflammation as a known symptom (McCance, Huether, Brashers, Rote, & Virshup, 2014, p. 384). The authors also tell us that cancer and its cause is more than just inherited of acquired gene mutations but also involves epigenetic changes that precede and cause cancer-causing genetic mutations (McCance, Huether, Brashers, Rote, & Virshup, 2014, p. 409). This condition can lead to colorectal carcinoma. What is the etiology of this disease? Inflammation ay be caused by pathogenic organisms with increased mucosal adherence and invasion and constant activation of T cells (McCance, Huether, Brashers, & Rote, 2014, p. 1441). What tests do we use to diagnose? Ulcerative colitis can cause folate malabsorption, and thus, folate deficiency can suppress the proliferation of intestinal mucosa, and this leads to gastrointestinal damage (McCance, Huether, Brashers, & Rote, 2014, p. 989). Testing for folate level would be a consideration. Risk factors and genetic component? The cause of ulcerative colitis is not known. However, dietary, infections, genetic and immunologic factors are possible causes (McCance, Huether, Brashers, & Rote, 2014, p. 1441). Lesions of ulcerative colitis can be found in individuals between 20 and 40. Other risk factors include a family history of the disease, Jewish ancestry. The disease found more often in white populations. It is found less commonly in smokers (McCance, Huether, Brashers, & Rote, 2014, p. 1440). The familial tendency to develop ulcerative colitis in identical twins supports a genetic cause or theory (McCance, Huether, Brashers, & Rote, 2014, p. 1442). How to we diagnose this patient? We must first do a physical assessment and do a review of systems on the patient. We must pay particular attention to the abdomen and the location of pain and tenderness in the left lower abdominal quadrant. A complete history and physical exam is vital. We must also consider the symptoms and signs currently and if there has been weight loss or fever. Adams and Bornemann (2013) inform us that ulcerative colitis presents with bleeding, diarrhea and pain in the abdomen. The author states that endoscopic biopsy is the best way to confirm the diagnosis (Adams & Bornemann, 2013, p. 700). They state that anemia and thrombocytosis, as well as hypoalbuminemia, may suggest inflammatory bowel disease, but most patients with ulcerative colitis do not have these abnormalities (Adams & Bornemann, 2013, p. 700). Testing for perinuclear antineutrophil cytoplasmic antibodies and anti-Saccharomyces antibodies are often positive with patients who have ulcerative colitis (Adams & Bornemann, 2013, p. 700). PLAN/TREATMENT: Peppercorn and Farrell (2016) (Evaluation should begin with laboratory tests including blood counts, liver test and C-reactive protein and erythrocyte sedimentation rate, stool studies to rule out infection and flexible sigmoidoscopy. Peppercorn and Farrell (2016) This is to rule out any other infection (Pepperco