UNIT 12 Alterations in Gastrointestinal Function Originally developed by: Anne Mueller RN, MN Revised (1993) by: Dot Hughes RN, MSc, PhD Revised (2000) by: May Chow RN, MN Rankin, Reimer & Then. © 2000 revised edition. NURS 461 Pathophysiology, University of Calgary Unit 14 Alterations in Gastrointestinal Function 1 Unit 14 Table of Contents Overview....................................................................................................3 Aim ....................................................................................................... 3 Objectives ................................................................................................ 3 Resources................................................................................................. 3 Web Links................................................................................................ 4 Section 1: Inflammatory Bowel Disease ..............................................................5 Introduction ............................................................................................. 5 Pathophysiology ........................................................................................ 6 Clinical Manifestations................................................................................. 9 Evaluation and Treatment........................................................................... 11 Learning Activity #1 ................................................................................. 15 Section 2: Peptic Ulcer Disease .......................................................................19 Introduction ........................................................................................... 19 Pathophysiology ...................................................................................... 21 Clinical Manifestations............................................................................... 24 Evaluation and Management ....................................................................... 25 Learning Activity #2 ................................................................................. 31 Final Thoughts...........................................................................................33 References ................................................................................................34 Acronym List .............................................................................................36 Checklist of Requirements ............................................................................36 Readings ............................................................................................... 36 Learning Activities ................................................................................... 36 Answers to Learning Activities.......................................................................37 Clinical Manifestations of Ulcerative Colitis...................................................... 37 Effect of Prolonged Bleeding and Diarrhea....................................................... 37 Clinical Manifestations of Crohn’s Disease ....................................................... 37 Mechanisms Underlying Differences Between Diseases........................................ 37 Outcome Differences of IBD Surgery .............................................................. 38 Answers to Learning Activity #1................................................................... 39 Student Assessment Answers: Peptic Ulcer Disease ............................................ 40 Answers to Learning Activity #2................................................................... 40 Rankin, Reimer & Then. © 2000 revised edition. NURS 461 Pathophysiology, University of Calgary 2 Unit 14 Alterations in Gastrointestinal Function UNIT 14 Alterations in Gastrointestinal Function Disorders of the gastrointestinal tract represent some of the most challenging health care problems for both health care workers and their clients. Despite extensive research and the development of numerous theories, the etiology of many of these disorders remains unknown. Patients and their families are faced with diseases whose course and response to therapy is unpredictable, the severity may range from mild to life threatening, impacting every facet of life. A sound understanding of the underlying pathophysiology of these disease conditions greatly enhances the nurse’s ability to plan comprehensive patient care. The knowledge gained in this unit will build upon knowledge you have acquired in earlier units, specifically wound healing and the inflammatory process, and the mechanism of immunity. There are two main sections to this unit: 1. Inflammatory Bowel Disease 2. Peptic Ulcer Disease Rankin, Reimer & Then. © 2000 revised edition. NURS 461 Pathophysiology, University of Calgary Unit 14 Alterations in Gastrointestinal Function 3 Overview Aim The general aim of this unit is to facilitate your understanding of the pathophysiology underlying common gastrointestinal disorders such as Inflammatory Bowel Disease (IBD) and specific types of ulcers. Upon completing this unit you will be familiar with the development, manifestations, therapeutic interventions, and terminology of inflammatory bowel disease and peptic ulcer disease. Objectives Upon completing this unit you will be able to: 1. Describe the pathogenesis, clinical manifestations, and principles of management of Inflammatory Bowel Disease (IBD). 2. Compare the etiology, pathogenesis, and clinical features of gastric and duodenal ulcers. 3. Discuss the surgical and medical management of peptic ulcer disease. Resources Required In completing this unit you will be required to do the following readings: Print Companion: Alterations in Gastrointestinal Function Pardi, D.J., & Tremaine, W.J. (1998). Inflammatory bowel disease: Keys to diagnosis and treatment. Consultant, 38(1), 87-92, 96-98. McCance, K. L., & Huether, S. E. (2001). Pathophysiology: The biologic basis for disease in adults and children (4th ed.) (pp. 1261-1281). St. Louis: Mosby. Before commencing work on this unit, it is recommended that you review the anatomy and physiology of the gastrointestinal system in a current anatomy and physiology text. Supplemental Materials Brozenec, J.A. (1996), Ulcer therapy update, RN, 59 (9), 48-50, 52-54. Cumbic, B. (1996). Bowel obstruction, Nursing 96, 26 (1), 33. Heslin, J.M. (1997). Peptic ulcer disease. Nursing 97, 27(1), 34-40. Pullen, M. (1999). Nutrition in Crohn’s disease. Nursing Standard, 13(27), 48-52. Rankin, Reimer & Then. © 2000 revised edition. NURS 461 Pathophysiology, University of Calgary 4 Unit 14 Alterations in Gastrointestinal Function Web Links All web links in this unit can be accessed through the Web CT system. Rankin, Reimer & Then. © 2000 revised edition. NURS 461 Pathophysiology, University of Calgary Unit 14 Alterations in Gastrointestinal Function 5 Section 1: Inflammatory Bowel Disease Introduction A disorder of inflammation occurs when defence mechanisms are inappropriate or when they become chronic as in Inflammatory Bowel Disease. Definition Inflammatory Bowel Disease (IBD) is a term used to describe disorders of chronic inflammation, primarily ulcerative colitis and Crohn’s disease (Cooke, 1991; Katz, 1994; Ogorek & Fisher, 1994). The term, IBD, is currently used due to the overlapping of clinical manifestations and therapeutic interventions in these diseases (Katz, 1994; McCance & Huether, 2001; Ogorek & Fisher, 1994). Prevalence The development of an epidemiologic profile for IBD is difficult due to problems associated with accurate diagnosing and delayed reporting of the disease. In many countries, medical attention may not be sought or when sought, vague and overlapping signs and symptoms may not be easily recognized. Even in more advanced centres definitive diagnoses may take many months. Despite these uncertainties, statistical estimates and trends have been determined. Worldwide, the highest prevalence of IBD occurs in Northern Europe and the United States, with low incidence in South Africa and Australia, and a relative rarity in South America, South African blacks, and Asia (Whelan, 1990). In the United States, there is an estimated 200,000 to 500,000 persons with IBD, and an estimated 20,000 to 25,000 new cases diagnosed annually. Worldwide statistics suggest that the prevalence of ulcerative colitis has stabilized over the past two decades and that following a dramatic rise in the occurrence of Crohn’s disease, it may also be reaching a plateau (Whelan, 1990). Population at Risk Inflammatory bowel disease can effect any age group, but occurrence rates tend to peak in the third and sixth decade of life. IBD is evident in both sexes however, incidence rates of Crohn's disease are 20% higher and incidence rates for men are 20% higher in ulcerative colitis. These factors suggest a possible hormonal, occupational or dietary influence (Lashner, 1995). Both ulcerative colitis and Crohn's disease seem to be more common in descendants of Northern Europeans and less common among African- American and Orientals (Cooke, 1991). Studies suggest that migration from a location of low prevalence to one of high prevalence does not change the prevalence rates. This suggests that developing IBD may be related to Rankin, Reimer & Then. © 2000 revised edition. NURS 461 Pathophysiology, University of Calgary 6 Unit 14 Alterations in Gastrointestinal Function genetics and early exposure to environmental factors (Lashner,