Gastrointestinal Case Study

diverticulitis. The patient has no diet regimen, which may be the likely cause of his

B.S. is an 81 year old Caucasian female presenting with abdominal pain, diarrhea, nausea and vomiting in the emergency room on February 3, 2013. B.S. has a history of glaucoma, hypothyroidism, degenerative arthritis and diverticulosis. She has allergies to iodine and vicodin. B.S. is admitted for diverticulitis with possible partial bowel obstruction and hydronephrosis. B.S. was admitted on February 3, 2013 here at Verdugo Hills Hospital.

Patient might experience mild or sever pain, crampy, and aching that is similar to appendicitis. Passing of gas or stool elimination may reduce the adverse effect of pain. According to spivak & deSouza (2008), patient that are of high risk are those with the history of low-fiber diet, constipation, high intake of red meat, severe dehydration, and aging. The diagnostic tests are barium enema which determines number of diverticula, CBC indicates present of anemia, colonoscopy exposes present of diverticula, CT scan reveals changes in the colon wall, GI bleeding scan that identifies active bleeding, and CBC with differential reveals leukocytosis.

"Ulcerative colitis is a chronic disease of the large intestine, also known as the colon, in which the lining of the colon becomes inflamed and develops tiny open sores, or ulcers, that produce pus and mucus. The combination of inflammation and ulceration can cause abdominal discomfort and frequent emptying of the colon.

which the lining of the colon becomes inflamed and develops tiny open sores, or ulcers, that

Inflammatory bowel diseases or IBDs affect “as many as 1.4 million Americans”. Crohn’s disease and ulcerative colitis inflame certain areas of the intestines that result into chronic and long-term complications in peoples’ lives. Even though these diseases are not known to be lethal to humans, they are unbearable to its victim. Both ailments can cause patients to “experience abdominal symptoms, including diarrhea, abdominal pain, bloody stools, and vomits” 8. Both diseases result in painful

Ulcerative colitis is an inflammation of the digestive tract. There are four types of ulcerative colitis. Ranging from most severe to least severe Pan-ulcerative colitis, left sided colitis, Proctosigmoiditis, and ulcerative proctitis. Though the causes are unknown there are possibly three factors which may play a part in the disease. The immune system, basically the immune system is fighting itself and inflaming the GI tract, environmental triggers such as certain bacteria’s, viruses, and genetic predisposition. (CrohnsandColitis) Also a lot of theories have been thrown out there, things like salmonella poisoning, and different strands of anti-biotics. (TheMedicalAdvisor)

It is 12:15 in the morning and it is time for me to take my lunch break. As I was heading to the break room, I was paged to rush to the ER. When I got to the ER, there was a group of adult that had the same symptom. At first I thought it was food poisoning by the way they were vomiting and tearing up. My first patient Jerry was in his late 30s, weight 260, and his height was 5’10. I asked jerry a couple of question before diagnosing and treating him. I asked him what did he eat and has he been having many bile movement throughout the day. He replied and said yes and he told me that he ate fresh raw vegetable but they were freshly washed.

Ulcerative Colitis (UC) is a disease/disorder of the Large intestine. It occurs in the colon and rectum areas only. When food passes through the Large Intestine, the body’s immune system may mistake the food materials, bacteria, etc as foreign invading agents and sends White blood cells (WBC) to defend the body.

Health care providers use the Rome Criteria, which is a group of the most common symptoms that characterize IBS. The Rome Criteria includes abdominal discomfort during the span of several months or longer that is associated with at least two of the following: “the pain or discomfort is relieved by defecation, the pain or discomfort is associated with an increase or decrease in stool frequency, and/or the pain or discomfort is associated with the stools becoming harder or softer in consistency” (International). After the Rome Criteria is concluded, the provider must look for signs and symptoms that are suggestive of a condition other than IBS, such as inflammatory bowel disease or celiac disease. These signs and symptoms have been referred to as “red flags”, which include: rectal bleeding, iron-deficiency anemia (IDA), weight loss, family history of colon cancer, fever, and age of onset after age

Please review the information available in DocuCare patient chart, including demographics, notes, diagnostics, assessments and flow sheet. Included in the "notes" section is a history and physical (H & P) which includes a review of systems (ROS), past history and family history as well as the physical exam (PE).

Crohn’s disease (CD) is a life-long, chronic, idiopathic inflammatory condition of the intestines that is characterized by frequent symptomatic relapse and remission. It involves inflammation and ulceration of various regions of the gastrointestinal tract (GI tract) lining, which often extends deep into the layers of the affected areas. The associated inflammation and ulceration of the disease affects various segments of the intestines with unaffected bowel occuring between the diseased areas. CD can involve any area of the GI tract, ranging from the mouth to the anus. However, it frequently affects the jejunum, terminal ileum (regional enteritis), and proximal colon (granulomatous colitis) (Schub, 2016).

Irritable bowel syndrome is described as a chronic illness that affects about one out of every five Americans. It is characterized as an ailment of the large intestine that causes cramping, abdominal pain, bloating, gas, and diarrhea, or constipation; sometimes both. There are different types of IBS, however, both affect the abdominal area. However, only a small number of people have extremely severe symptoms. Many people are able to manage/ control their symptoms through changes in diet, stress, and lifestyle. In more extreme cases, medication as well as counseling is used. .

In the digestive system, SGLT1(sodium-glucose transporter type 1), GLUT2 (glucose transporter type 2), GLUT4 (glucose transporter type 4) are transporters involved in the absorption of glucose.

In a retrospective study in Detroit USA, analysis of 1100 patients with acute LGIB was done, all of whom were admitted to the surgical service of a single urban emergency hospital, Gayer et al determined that the most common etiologies for bleeding in these patients were diverticulosis (33.5%), hemorrhoids (22.5%), and carcinoma (12.7%). The investigators also found that most patients in the study (55.5%) presented with hematochezia, with the next most frequent presentations being maroon stools (16.7%) and melena (11%) 8. In another study that was done at National University Hospital of Iceland during 2010. In this study all patient who underwent colonoscopy were included, 1134 patients underwent 1275 colonoscopies. Overall, 163 patients had ALGIB. The crude incidence for ALGIB was 87/100 000 inhabitants/year. The most common findings were diverticulosis (23%) and ischemic colitis (16%) 3. A difference has been noticed between the West and the subcontinent in the frequency of different findings in patients with rectal bleeding. In Pakistan, lot of studies were done on aetiology and treatment of upper gastrointestinal bleeding but little work is done on the lower gastrointestinal tract. In a study carried out in 1990 in Pakistan, colonoscopy was performed in patients with lower gastrointestinal tract pathologies. The most common pathologies diagnosed were ulcerative colitis and malignancy, followed by amoebic colitis, while percentage of Crohn’s colitis, polyps and diverticuli were less9. In another study conducted it was determined that the most common cause of rectal bleeding is proctosigmoiditis10. Yet in another study carried out in Karachi using flexible sigmoidoscopy to determine the cause of lower GI bleeding revealed most common findings were hemorrhoids in