NURS 6501 Knowledge Check Gastrointestinal and Hepatobiliary Disorders

Sample Answer for NURS 6501 Knowledge Check Gastrointestinal and Hepatobiliary Disorders Included After Question

In this exercise, you will complete a 5-essay type question Knowledge Check to gauge your understanding of this module’s content.  

Possible topics covered in this Knowledge Check include:

  • Ulcers
  • Hepatitis markers
  • After HP shots
  • Gastroesophageal Reflux Disease
  • Pancreatitis
  • Liver failure—acute and chronic
  • Gall bladder disease
  • Inflammatory bowel disease
  • Diverticulitis
  • Jaundice
  • Bilirubin
  • Gastrointestinal bleed – upper and lower
  • Hepatic encephalopathy
  • Intra-abdominal infections (e.g., appendicitis)
  • Renal blood flow
  • Glomerular filtration rate
  • Kidney stones
  • Infections – urinary tract infections, pyelonephritis
  • Acute kidney injury
  • Renal failure – acute and chronic

A Sample Answer For the Assignment: NURS 6501 Knowledge Check Gastrointestinal and Hepatobiliary Disorders

Title: NURS 6501 Knowledge Check Gastrointestinal and Hepatobiliary Disorders

Question 1

4 out of 4 points

CorrectScenario 1: Peptic Ulcer A 65-year-old female comes to the clinic with a complaint of abdominal pain in the epigastric area. The pain has been persistent for two weeks.  The pain described as burning, non-radiating and worse after meals. Denies N&V, weight loss or obvious bleeding. She admits to frequent belching with bloating.   PMH:  seasonal allergies with Chronic Sinusitis, positive for osteoarthritis,  Meds: Claritin 10 mg po daily, ibuprofen 400-600 mg po prn pain  Family Hx-non contributary   Social history: Separated recently pending divorce; stressful situation with trying to manage two homes. Works as a Legal Assistant at a local law firm. She has 35 PPY of smoking, drinks 1-2 glasses of wine a day, and 6-7 cups of coffee per day. She denies illicit drug use, vaping or unprotected sexual encounters.   Breath test in the office revealed + urease.  The healthcare provider suspects the client has peptic ulcer disease. Questions: 1.     Explain what contributed to the development from this patient’s history of PUD?
Selected Answer: PUD is ulceration in the mucosal lining of the lower esophagus, stomach, and or duodenum. This patient has several risk factors contributing to the development of peptic ulcer disease. including, Patient’s age of 65, Daily use of NSAIDs for osteoarthritis pain, High stress due to a pending divorce, working, and managing 2 homes.                                                       The patient smokes and drinks  Alcohol daily. Coffee consumption may be another causative factor for PUD. Also, her positive breath test for urease indicates the presence of H. pylori infection.  Chronic use of ibuprofen suppresses mucosal prostaglandin synthesis which in turn results in decreased bicarbonate secretion and mucin production. The bicarbonate is a buffer against HCl, and mucin is a component of the gut barrier. Subsequently, the secretion of HCl is increased. The interaction of NSAIDS and H. Pylori can contribute to the pathogenesis of peptic ulcers as both disrupt the integrity of the mucosa. This exposes submucosal areas to gastric secretions and autodigestion, causing erosion and ulceration Correct Answer: Correct  Stress secondary to divorce and financial situation, cigarette smoking, alcohol consumption, use of NSAIDS, excess coffee consumption, +H Pylori test Response Feedback: [None Given]
NURS 6501 Knowledge Check Gastrointestinal and Hepatobiliary Disorders
NURS 6501 Knowledge Check Gastrointestinal and Hepatobiliary Disorders

Question 2

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CorrectScenario 1: Peptic Ulcer A 65-year-old female comes to the clinic with a complaint of abdominal pain in the epigastric area. The pain has been persistent for two weeks.  The pain described as burning, non-radiating and worse after meals. Denies N&V, weight loss or obvious bleeding. She admits to frequent belching with bloating.   PMH:  seasonal allergies with Chronic Sinusitis, positive for osteoarthritis,  Meds: Claritin 10 mg po daily, ibuprofen 400-600 mg po prn pain  Family Hx-non contributary   Social history: Separated recently pending divorce; stressful situation with trying to manage two homes. Works as a Legal Assistant at a local law firm. She has 35 PPY of smoking, drinks 1-2 glasses of wine a day, and 6-7 cups of coffee per day. She denies illicit drug use, vaping or unprotected sexual encounters.   Breath test in the office revealed + urease.  The healthcare provider suspects the client has peptic ulcer disease. Question: 1.     What is the pathophysiology of PUD/ formation of peptic ulcers? 
Selected Answer: The two major types of peptic ulcers are duodenal ulcers and gastric ulcers. Both are predominately caused by H. pylori and NSAID usage. The pathophysiology of both is similar, however, in duodenal ulcers, acid and pepsin concentrations in the duodenum penetrate the mucosal barrier and lead to ulceration. In the case of gastric ulcers, duodenal reflux of bile precipitates ulcer formation by limiting the mucosa’s ability to secrete a protective layer of mucus. The pyloric sphincter may fail to respond properly allowing reflux of bile and pancreatic enzymes to damage the gastric mucosa. The damaged mucosal barrier permits hydrogen ions to diffuse into the mucosa. Here they disrupt permeability and cellular structure. A vicious cycle is then established as the damaged mucosa liberates histamine. This stimulates the increase of acid and pepsinogen production, blood flow, and capillary permeability. The disrupted mucosa becomes edematous and loses plasma proteins. The destruction of small vessels causes bleeding.                                                                                         Thus, the pathophysiology of the various peptic ulcer formation has similar beginnings and can diverge from there to follow a couple of different pathways.                                                      Initially: 1. Causative factors: H. pylori, bile salts, NSAIDS, alcohol, ischemia                                                                                                                                                                                              2. Damaged mucosal barrier                                                                                                                                                                                                                                                                                   3. Decreased function of mucosal cells, decreased quality of mucus, loss of tight junctions between cells                                                                                                                                           4. Back-diffusion of acid into gastric mucosa which leads to A. Conversion of pepsinogen to pepsin. This leads to further mucosal erosion, destruction of blood vessels, and bleeding. Resulting in ulceration.                                                                                                                                                                                                                                                                                            B. Formation and liberation of histamine. This leads to local vasodilation and results in increased capillary permeability, loss of plasma proteins, mucosal edema, and loss of plasma into the gastric lumen. This formation and liberation of histamine also increase acid secretion leading to both ulceration and muscle spasms. it should be also be noted that  H. pylori which thrive in the presence of increased acidity also leads to mucosal injury, and thereby, ulceration. High-risk for  PUD include alcoholics, patients on extensive NSAIDs, and those with chronic renal failure. PUD has been strongly linked to infection with Helicobacter pylori. This bacterium is responsible for the destruction of protective mechanisms in the stomach and duodenum leading to damage by stomach acid that would otherwise not be a problem. These ulcers are found more commonly in the duodenum than in the stomach, although both locations present equal incidences of bleeding. Correct Answer: Correct  Chronic use of NSAIDS causes suppresses of mucosal prostaglandin and direct irritative topical effect. High gastrin level and excessive gastric acid production often seen in Zollinger-Ellison syndrome which can caused by gastrinoma. Smoking impairs healing by vasoconstriction. H Pylori causes gastritis and interferes with mucosa Response Feedback: [None Given]

Question 3

4 out of 4 points

CorrectScenario 2: Gastroesophageal Reflux Disease (GERD) A 44-year-old morbidly obese female comes to the clinic complaining of  “burning in my chest and a funny taste in my mouth”. The symptoms have been present for years but patient states she had been treating the symptoms with antacid tablets which helped until the last 4 or 5 weeks. She never saw a healthcare provider for that. She says the symptoms get worse at night when she is lying down and has had to sleep with 2 pillows. She says she has started coughing at night which has been interfering with her sleep. She denies palpitations, shortness of breath, or nausea.  PMH-HTN, venous stasis ulcers, irritable bowel syndrome, osteoarthritis of knees, morbid obesity (BMI 48 kg/m2)  FH:non contributary    Medications: Lisinopril 10 mg po qd, Bentyl 10 mg po, ibuprofen 800 mg po q 6 hr prn  SH: 20 PPY of smoking, ETOH rarely, denies vaping     Diagnoses: Gastroesophageal reflux disease (GERD).    Question: 1.     If the client asks what causes GERD how would you explain this as a provider? 
Selected Answer: GERD is caused by frequent acid reflux; the reflux of acid and pepsin or bile salts from the stomach to the esophagus. This, in turn, causes esophagitis, or inflammation and irritation of the esophagus. To break it down even more, when you swallow, a circular band of muscle around the bottom of your esophagus (lower esophageal sphincter or LES) relaxes to allow food and liquid to flow into your stomach. Then the sphincter closes again. If the sphincter relaxes abnormally or weakens, stomach acid can flow back up into your esophagus. This constant backwash of acid irritates the lining of your esophagus, often causing it to become inflamed.                                                                                                                                                  I would then explain to the patient the risk factors that increase a person’s susceptibility to developing GERD, as well as factors that can aggravate acid reflux as follows: Conditions that can increase your risk of GERD include Obesity, Bulging of the top of the stomach up into the diaphragm (hiatal hernia), Drugs or chemicals that relax the lower esophageal sphincter, (such as anti-cholinergic, nitrates, calcium channel blockers, nicotine), Pregnancy, and Connective tissue disorders, such as scleroderma, Delayed stomach emptying. Factors that can aggravate acid reflux include Smoking, Eating large meals, eating late at night, Eating certain foods (triggers) such as fatty or fried foods, drinking certain beverages, such as alcohol or coffee, and Taking certain medications, such as NSAIDs or aspirins. Correct Answer: Correct  GERD manifestations result directly from gastric acid reflux into the esophagus. Pyrosis, the classic symptom, is a substernal burning sensation typically described as heartburn. It may be accompanied by regurgitation, particularly in someone who has recently eaten. The lower esophageal sphincter (LES) relaxes due to certain medications (calcium channel blockers), hiatal hernia, and obesity allows stomach contents to enter the lower esophagus causing inflammation and possibly erosion of the esophagus. Response Feedback: [None Given]

Question 4

4 out of 4 points

CorrectScenario 3: Upper GI Bleed A 64-year-old male presents the clinic with complaints of passing dark, tarry, stools. He stated the first episode occurred last week, but it was only a small amount after he had eaten a dinner of beets and beef. The episode today was accompanied by nausea, sweating, and weakness. He states he has had some mid epigastric pain for several weeks and has been taking OTC antacids. The most likely diagnosis is upper GI bleed which won’t be confirmed until further endoscopic procedures are performed. Question: 1.     What are the variables here that contribute to an upper GI bleed? 
Selected Answer: Bleeding within the GI tract itself is not a disease, but rather a symptom of a disease. This bleeding may be divided into upper and lower GI bleeding The gastrointestinal (GI) tract begins in the mouth and works its way down the esophagus, through the stomach, small and large intestines, and rectum, before terminating at the anus. Bleeding anywhere along this pathway may be acute or chronic and can be due to a host of factors.                                                                                                                                                                                          Bleeds from the upper GI tract are significant causes of morbidity and mortality and are much more common than lower GI bleeds. Important to note that mortality associated with upper GI bleeds is often because of comorbidities rather than the actual bleeding itself. signs of upper GI bleed include Melena or dark, tarry stool that is almost black in color, pale skin, Nausea, vomiting blood, shortness of breath, sweating, alterations of consciousness, and epigastric and diffuse abdominal pain. The major causes of upper GI bleeding include: peptic ulcer bleeding,  erosive esophagitis and erosive gastritis, esophageal inflammation due to acid reflux, esophageal varicies, or abnormally dilated vessels; typically seen in patients with portal hypertension and chronic liver disease and these patients are at an increased risk for hemorrhage. also, Mallory-Weiss syndrome (caused by violent coughing or vomiting; results in a tear of mucous membrane most commonly were stomach and esophagus meet).                                                                    Patients in shock due to trauma, sepsis, or organ failure can also have upper GI bleeds as a result of erosions occurring in the presence of decreased blood flow and altered acidity of the gastric lumen, and cancer. Common risk factors for upper GI bleeding include:  prior upper GI bleeding, anticoagulant use, high-dose nonsteroidal anti-inflammatory drug use, and older age. The most common conditions associated with lower GI bleeding include diverticulitis, infections, polyps, inflammatory bowel disease, hemorrhoids, anal fissures, and cancer. Correct Answer: Correct  UGI bleeds can be caused by Peptic ulcer disease (PUD) which remains the most common cause of UGIB. Esophageal bleeding from a Mallory-Weiss tear (caused by repeated vomiting, retching, erosions of the mucosa), gastric carcinomas. Response Feedback: [None Given]

Question 5

4 out of 4 points

CorrectScenario 4: Diverticulitis A 54-year-old schoolteacher is seeing your today for complaints of passing bright red blood when she had a bowel movement this morning. She stated the first episode occurred last week. The episode today was accompanied by nausea, sweating, and weakness. She states she has had some LLQ pain for several weeks but described it as “coming and going”. She says she has had a fever and abdominal cramps that have worsened this morning. Diagnosis is lower GI bleed secondary to diverticulitis. Question: 1.     What can cause diverticulitis in the lower GI tract? 
Selected Answer: Diverticula are small, bulging pouches that can form in the lining of your digestive system. They are found most often in the lower part of the large intestine (colon).                                   Diverticula are common, especially after age 40, and seldom cause problems. The presence of diverticula is known as diverticulosis. When one or more of the pouches become inflamed, and in some cases infected, that condition is known as diverticulitis. Diverticulitis can cause severe abdominal pain, fever, nausea, and a marked change in your bowel habits. Mild diverticulitis can be treated with rest, changes in your diet, and antibiotics. The signs and symptoms of diverticulitis include pain, which may be constant and persist for several days.  The lower left side of the abdomen is the usual site of the pain. Sometimes, however, the right side of the abdomen is more painful, especially in people of Asian descent.                                                                                                                                                         Other symptoms include nausea and vomiting, Fever, Abdominal tenderness, Constipation, or diarrhea. Correct Answer: Correct  Diverticulitis is defined as an inflammation of one or more diverticula. Fecal material or undigested food particles may collect in a diverticula causing obstruction. The obstruction can cause vascular compromise. Increased intraluminal pressure or food particles cause erosion of the diverticular wall, resulting in inflammation, localized necrosis, and perforation. Response Feedback: [None Given]

Scenario 4: Diverticulitis

A 54-year-old schoolteacher is seeing your today for complaints of passing bright red blood when she had a bowel movement this morning. She stated the first episode occurred last week. The episode today was accompanied by nausea, sweating, and weakness. She states she has had some LLQ pain for several weeks but described it as “coming and going”. She says she has had a fever and abdominal cramps that have worsened this morning.

Diagnosis is lower GI bleed secondary to diverticulitis.

Question:

1.     What can cause diverticulitis in the lower GI tract? 

Your Answer:

Diverticulitis in the lower GI tract is caused by inflamed or infected diverticula, which are small pouches that form in the colon. Factors include the presence of diverticula, a low-fiber diet, age (typically over 50), lifestyle factors (obesity, sedentary lifestyle), and potential genetic factors. Prompt medical attention is crucial for evaluation and treatment.

Scenario 3: Upper GI Bleed

A 64-year-old male presents the clinic with complaints of passing dark, tarry, stools. He stated the first episode occurred last week, but it was only a small amount after he had eaten a dinner of beets and beef. The episode today was accompanied by nausea, sweating, and weakness. He states he has had some mid epigastric pain for several weeks and has been taking OTC antacids. The most likely diagnosis is upper GI bleed which won’t be confirmed until further endoscopic procedures are performed.

Question:

1.     What are the variables here that contribute to an upper GI bleed? 

Your Answer:

The variables that contribute to an upper gastrointestinal (GI) bleed in this scenario include peptic ulcer disease (PUD), diet (beets and beef), and the presence of symptoms such as nausea, sweating, weakness, and passing dark, tarry stools (melena). Medications and underlying conditions are also potential factors.