gastrointestinal or genitourinary systems

Topic 6 DQ 1

Choose a medical condition from the gastrointestinal or genitourinary systems and explain the pathophysiology changes that may occur. What patient education would need to be included related to this disorder? Make sure that you select a different medical condition than your peers. Include the name of the medical condition in the subject line so that the medical condition can be followed. Include your references in APA style.

Sample student response 1

Peptic Ulcer Disease

Peptic ulcer disease (PUD) is one of the most common gastrointestinal diseases, which occurs when a sore forms in the lining of the stomach or the duodenum. Some of the associated risk factors that could lead to PUD include NSAID use, H-pylori infection, genetic association, and those from the African American and Hispanic communities (Malik et al., 2020).

The pathophysiology of PUD involves a defect in gastric mucosa due to the damage in the inner gastric layers becoming susceptible to corrosion by the gastric juices, mainly hydrochloric acid. Similarly, the defective mucosa and exposure to acidity affect the ability of the mucosal cells to secrete bicarbonate which is responsible for neutralizing the high levels of acidity within the stomach or duodenal lining.

In addition, colonization of h-pylori, a gram-negative bacterium in the gastric mucosa further impairs the proper functioning of the mucosal membrane with regard to regulation of pH, Which further exacerbates the condition by promoting the development of acidity and gastric metaplasia (Malik et al., 2020).

Some of the considerations that should be taken by patients with PUD include, eating a healthy balanced diet, preferable with foods that don’t elevate gastric acidity. The patient should also be educated, not to skip meals, eat small frequent meals instead of heavy ones, and reduce dairy products.

Interestingly, fermented products such as yogurt have a positive effect in the management of PUD, specifically, they provide an anti-h-pylori effect and should be considered as a healthy option to deal with the condition (Nair et al., 2016). Patients should also be advised to avoid carbonated drinks, and food with saturated fats since they tend to elevate gastric pH. (Vomero & Colpo, 2014). Patients should also be advised to complete the treatment therapy prescribed and by all means to avoid self-medicating.

References

Malik, T. F., Gnanapandithan, K., & Singh, K. (2020). Peptic Ulcer Disease.. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.

Nair, M. R., Chouhan, D., Sen Gupta, S., & Chattopadhyay, S. (2016). Fermented Foods Are They Tasty Medicines for Helicobacter pylori Associated Peptic Ulcer and Gastric Cancer?. Frontiers in microbiology, 7, 1148. https://doi.org/10.3389/fmicb.2016.01148

Vomero, N. D., & Colpo, E. (2014). Nutritional care in peptic ulcer. Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery, 27(4), 298–302. https://doi.org/10.1590/S0102-67202014000400017

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Sample student response 2

The gastrointestinal system condition that I have chosen to address is esophageal varices resulting from cirrhotic portal hypertension. According to Gunarathne et al., esophageal varices is the most clinically significant of the many complications related to liver cirrhosis because of its high mortality rate of 25-50% (2020). Portal hypertension results from increased hepatic vascular resistance (scar tissue, increased Angiotensin II vasoconstrictor levels) and increased portal blood flow (Gunarathne et al., 2020).

“Collaterals slowly enlarge and connect the systemic circulation to the portal venous system. Over time, this leads to a congested submucosal venous plexus with tortuous dilated veins in the distal esophagus” (Meseeha, 2021). As the veins enlarge with time, the risk for rupture and hemorrhage increases. The gold standard for varices diagnosis is endoscopy (EGD). Abdominal CT and right upper quadrant ultrasound can also diagnose. Once esophageal varices have developed and bled a first time there is a 70% chance of rebleed (Meseeha, 2021).

Patient education should emphasize the importance of abstaining from alcohol if the patient has alcoholic liver cirrhosis, or complying with treatment of the underlying cause of the patient’s portal hypertension. Patients should be taught to seek medical attention immediately for any signs of bleeding: vomiting red, maroon, blood-tinged, or coffee-ground emesis, or red or dark tarry stools. Additionally, patients must avoid any medications that are toxic to the liver, including Acetaminophen.

References:

Gunarathne, L.S., Rajapaksha, H., Shackel, N., Angus, P.W., & Herath, C.B. (2020). Cirrhotic portal hypertension: From pathophysiology to novel therapeutics. World Journal of Gastroenterology, 26(40), 6111–6140. https://doi.org/10.3748/wjg.v26.i40.6111

Meseeha M, A.M. Esophageal Varices. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448078/

Topic 6 DQ 2

Select a medication used in evidence-based treatment guidelines for the condition chosen in the first discussion question. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions of which one should be aware. Make sure that you select a different medication than your peers. Include the name of the medication in the subject line so that the medications can be followed. Include your references in APA style.

Sample student response 1

Omeprazole

Usually, triple therapy is recommended for persons with peptic ulcer disease (PUD). However, proton pump inhibitors (PPI) are usually part of the standard regimen. These are a class of medications that reduce the production of stomach acid (Forgerini et al., 2018). An example of PPI is omeprazole.

Omeprazole is a PPI that acts by inhibiting the secretion of gastric acid by irreversibly blocking the enzyme system of hydrogen/potassium adenosine triphosphatase (ATP), the “proton pump” of the gastric parietal cell (Forgerini et al., 2018). The antisecretory effect of omeprazole is dose-related and leads to the inhibition of both basal and stimulated acid secretion, regardless of the stimulus. Omeprazole, by inhibiting the secretion of gastric acid raises the pH level in the stomach, which discourages the growth of H.pylori that thrives best in a neutral environment.

The action occurs rapidly, within an hour after administration, and reaches the maximum level of efficacy after 2 hours, with the inhibitory effect lasting for as long as 72 hours after drug administration (Shah & Gossman, 2020). This makes it one of the most effective drugs in managing gastric acidity.

Omeprazole is usually well tolerated by most patients, however, some of the side effects noted include abdominal pain, nausea, vomiting, headache, diarrhea, and flatulence in adults (Shah & Gossman, 2020). Omeprazole has been associated with an increased risk of Clostridioides difficile (C. diff) associated diarrhea. Rare events of hypomagnesia have been reported among patients under omeprazole and could be an aspect to monitor. One of the drug interactions involving omeprazole is warfarin where patients under both medications could experience increased INR resulting in bleeding (Shah& Gossman, 2020).

Reference

Forgerini, M., Mieli, S., & Mastroianni, P. D. C. (2018). Safety assessment of omeprazole use: a review. Sao Paulo Medical Journal, 136, 557-570.

Shah, N., & Gossman, W. (2020). Omeprazole. In StatPearls [Internet]. StatPearls Publishing.

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Sample student response 2

Botox for Neurogenic Bladder 

Although many look at botox as a cosmetic procedure only, the botulinum neurotoxin is an extremely effective medical treatment when injected into the bladder wall by decreasing the muscular contractions of the bladder that may be causing spasms. A study in 2013 found that “Botulinum neurotoxin (BoNT) injection into the bladder wall has been shown to be an effective alternative to anticholinergic (antimuscarinic) medications and more invasive surgery in those with multiple sclerosis and spinal cord injury with neurogenic detrusor overactivity (NDO) and urinary incontinence who are not tolerating anticholinergic medications” (Linsenmeyer, 2013).  

The mechanism of action is best defined by Orasanu & Mahajan, as follows:  

“All serotypes of botulinum toxin act by inhibiting calcium- mediated release of acetylcholine vesicles at the pre-synaptic neuromuscular junction in peripheral nerve endings, resulting in temporary flaccid muscle paralysis.[11] Binding of toxin to both peripheral and central nerve ending is highly selective and saturable.[10] The toxin’s specificity for cholinergic nerve endings is determined by the heavy chain component and the mechanism of action is a two-step process.

First the molecule binds to the neuronal cell membrane with the heavy chain and the molecule is internalized.[12] A disulfide reaction then separates the heavy chain from the light chain. The light chain binds to the acetylcholine vesicles and acts as a zinc-dependent endopeptidase splitting several proteins needed for the fusion of neurotransmitter vesicles with the cell surface, thereby preventing acetylcholine exocytosis and blocking the neuromuscular end-plate” (Orasanu & Mahajan, 2013). 

Monitoring includes watching for potential of infection, often patients will begin prophylactic antibiotics to prevent infection. Patients may need to go home with a foley catheter, but that is uncommon. Side effects of Botox are generally uncommon and is a drug that is relatively well tolerated. The most common side effects include UTI, painful urination, or retention. Drug interactions include some antibiotics such as aminoglycosides, Alzheimer’s drugs, myasthenia gravis dugs, and quinidine (WebMD, n.d.) 

Reference 

Linsenmeyer T. A. (2013). Use of botulinum toxin in individuals with neurogenic detrusor overactivity: state of the art review. The journal of spinal cord medicine, 36(5), 402–419. https://doi.org/10.1179/2045772313Y.0000000116 

Orasanu, B., & Mahajan, S. T. (2013). The use of botulinum toxin for the treatment of overactive bladder syndrome. Indian journal of urology : IJU : journal of the Urological Society of India, 29(1), 2–11. https://doi.org/10.4103/0970-1591.109975 

Web MD. (n.d.). Botox injection: Uses, side effects, interactions, pictures, warnings & dosing. https://www.webmd.com/drugs/2/drug-153465/botox-injection/details