Assignment: Week 5 Knowledge Check Gastrointestinal and Hepatobiliary Disorders

Assignment: Week 5 Knowledge Check Gastrointestinal and Hepatobiliary Disorders

Assignment: Week 5 Knowledge Check Gastrointestinal and Hepatobiliary Disorders

QUESTION 1

1. Scenario 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

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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?

4 points   

QUESTION 2

1. Scenario 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? 

4 points   

QUESTION 3

1. Scenario 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? 

 

4 points   

QUESTION 4

1. 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? 

4 points   

QUESTION 5

1. 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 inthe lower GI tract?
   

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Episodic/Focused SOAP Note Template

 Patient Information:

Initials: Lily    Age: 20 years  Sex: Female    Race- African American

S.

CC (chief complaint): “Sore throat.”

HPI: Lily is a 20-year-old AA female patient who presented with complaints of a sore throat. The sore throat began three days, and she had ignored it until after she learned that a flu outbreak had occurred at her college two weeks ago. She expresses concerns that the flu outbreak may be connected with her symptoms. She also reports having a suppressed appetite, headache, and pain when swallowing. Some of Lily’s classmates have been treated in the clinic with similar symptoms.

Current Medications: OTC Tylenol for headache.

Allergies: Allergic to Septrin- causes a rash.

PMHx:  Immunization is current. Last Tdap- Sep, 2014; Last Flu- March 2022; COVID-19 vaccine- May 2021 & June 2021. No history of chronic illnesses or surgery.

Soc Hx: Lily is a student at a local community college pursuing Fashion and Design. She also works part-time in a clothing line as a seamstress. She lives at home with her parents and two younger siblings. Her hobbies include watching fashion shows and designing clothes. She takes vodka and smokes recreational marijuana occasionally but denies using other illicit substances.   

Fam Hx: The maternal grandmother had Stomach cancer and died at 83. The paternal grandfather died from Liver cirrhosis and had a history of alcoholism. Her parents and siblings are alive and well.

ROS:

GENERAL: Positive for decreased appetite. Denies fever, weight loss, chills, body weakness, or fatigue.

HEENT: Head: Positive for headache. Denies head trauma or injury. Eyes: Denies vision changes, double/blurry vision, lacrimation, or eye pain. Ears: Denies ear pain, discharge, or hearing loss. Nose: Positive for runny nose. Denies nasal congestion or sneezing. Throat: Positive for sore throat, slight voice hoarseness, and pain when swallowing.

SKIN: Negative for itchiness, bruises, or rashes.

CARDIOVASCULAR: Negative for chest pressure/pain, edema, dyspnea, or palpitations. 

RESPIRATORY: Negative for shortness of breath, cough, chest pain, or sputum.

GASTROINTESTINAL: Negative for nausea, vomiting, stomach pain, diarrhea, or constipation.

GENITOURINARY: Negative for dysuria, incontinence, urinary urgency, or urine color changes.

NEUROLOGICAL: Positive for headache. Negative for dizziness, tingling sensations, or muscle weakness.

MUSCULOSKELETAL: Denies muscle pain, joint pain, back pain, or joint stiffness.

HEMATOLOGIC: Denies bruises or bleeding.

LYMPHATICS: Denies lymph node swelling.

PSYCHIATRIC: Denies anxiety, depression, or suicidal symptoms.

ENDOCRINOLOGIC: Denies excessive sweating, heat/cold intolerance, polyuria, or polydipsia.

ALLERGIES: Positive for rashes with sulfur.

O.

Physical exam:

Vital Signs: BP- 110/72; HR- 78; Temp- 98.78; Resp- 20

GENERAL: The patient is well-groomed and appropriately dressed. She is alert, oriented, and maintains eye contact. She maintains a normal gait and posture.

HEENT: Head is atraumatic and symmetrical. Eyes:  Pink conjunctiva; White sclera; PERRLA. Ears: TMs are patent. Nose: Red nose with profuse, dripping nasal discharge; Mucous membranes have a glistening, glassy appearance. Throat: Voice hoarseness; Pharynx appears normal, without erythema, ulceration, or exudates. Mildly enlarged, non-tender cervical lymph nodes.

RESPIRATORY: Smooth respirations; Lungs are clear on auscultation.

CARDIOVASCULAR: Hear rate is regular with a normal rhythm. Si and S2 are present. No S gallop or systolic murmurs were heard.

Diagnostic results: CBC- Values WNL.

A.

Differential Diagnoses

The Common Cold: This is an acute and afebrile, self-limited viral infection of the upper respiratory system. The initial symptoms include a scratchy throat or sore throat. This is followed by rhinorrhea, sneezing, nasal obstruction, and malaise (DeGeorge et al., 2019). Temperature is usually within normal limits, especially when the causative pathogen is a rhinovirus. It also presents with watery and profuse nasal secretions on the first days, which later become more mucoid and purulent. Other symptoms include headache, facial and ear pressure, cough, loss of sense of smell and taste, and hoarseness (Pappas, 2018). Mildly enlarged, non-tender cervical lymph nodes are also present. The Common cold is the presumptive diagnosis based on positive findings of sore throat, pain when swallowing, headache, hoarseness, rhinorrhea, red nose with profuse dripping nasal discharge, glistening mucous membranes, and enlarged and non-tender cervical lymph nodes.

Influenza: Influenza is a viral respiratory infection that causes fever, cough, headache, and malaise. Typical clinical symptoms of Influenza in adults include a sudden onset of chills, fever, cough, prostration, and generalized aches and pains (Chow et al., 2019). Headache is prominent and is often accompanied by photophobia and retrobulbar aching. Respiratory symptoms initially include scratchy sore throat, nonproductive cough, nasal discharge, and coryza, and later progress to persistent and productive cough (Chow et al., 2019). Influenza is a differential based on symptoms of headache, sore throat, and runny nose. The patient could have become infected with Influenza during the Flu outbreak.

 Allergic Rhinitis: Allergic rhinitis is a seasonal or perennial upper respiratory condition attributed to exposure to pollens and other allergens. Clinical symptoms include itching in the eyes, nose, or mouth, rhinorrhea, sneezing, and nasal and sinus obstruction (Husna et al., 2022). Sinus obstruction can cause frontal headaches and sinusitis. Coughing and wheezing can also be present. The symptoms of sore throat, runny nose, dripping nasal discharge, and headache make Allergic rhinitis a differential diagnosis (Husna et al., 2022). However, the patient has no seasonal or environmental allergies making Allergic Rhinitis a less likely primary diagnosis.

This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

References

Chow, E. J., Doyle, J. D., & Uyeki, T. M. (2019). Influenza virus-related critical illness: prevention, diagnosis, treatment. Critical care, 23(1), 1–11. https://doi.org/10.1186/s13054-019-2491-9

DeGeorge, K. C., Ring, D. J., & Dalrymple, S. N. (2019). Treatment of the common cold. American family physician, 100(5), 281–289.

Husna, S. M. N., Tan, H. T. T., Shukri, N. M., Ashari, N. S. M., & Wong, K. K. (2022). Allergic rhinitis: a clinical and pathophysiological overview. Frontiers in Medicine, 9. https://doi.org/10.3389/fmed.2022.874114

Pappas, D. E. (2018). The Common Cold. Principles and Practice of Pediatric Infectious Diseases, 199–202.e1. https://doi.org/10.1016/B978-0-323-40181-4.00026-8