2 hours ago Lorie Valentin  Week 8 Initial Post Valentin, Lorie COLLAPSE Top of Form Initial Post Week 8 NURS 6501: Advanced Pathophysiology Gastrointestinal Disorders Lorie Valentin RN, BSN Gastrointestinal Disorders             Gastrointestinal symptoms such as pain, bloating, nausea, vomiting, and diarrhea, are a common manifestation of many different etiologies. Medication side effects, viral illness or stress are just a few. Sometimes though, these symptoms can indicate a bigger problem and a more chronic illness that needs to be addressed. Two of these chronic illnesses are inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). Because of the similarities in their presentation it can sometimes be hard to tell the difference between the two, but it is important to accurately identify which is the causative factor, because pathophysiology and treatment are very different (Huether & McCance, 2017). IBD IBD is one of several disease that cause inflammation of the mucosa of the intestines. Ulcerative colitis (UC) and Crohn disease are two of the inflammatory diseases. Both are autoimmune disease that cause ulceration of the mucosa, resulting in thickening in the lining causing narrowing of the lumen (Huether & McCance, 2017). Crohn’s additional can cause ulceration through the full thickness of the intestinal wall and often has additional inflammatory manifestation concurrently (Hammer & McPhee, 2019). Both have a high risk of infection and malignancy due to remodeling of the tissue. The most common symptoms are pain, bloating, diarrhea and blood in the stool ((Huether & McCance, 2017). IBS             IBS is similar in presentation to IBD, but lacks the autosomal component. IBS is thought to be the result of environmental factors (Huether & McCance, 2017). IBS is diagnosed based on symptom presentation without a detectable disease process (Huether & McCance, 2017). Symptoms of IBS are pain, bloating, diarrhea or constipation, or alternating diarrhea and constipation, nausea, and gas. Treatment is usually based on lifestyle changes and avoiding triggers (Huether & McCance, 2017). Treatments             The treatment for mild to moderate IBD is most often aminosalicylates, such as sulfasalazine or mesalamine (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). During acute exacerbations often corticosteroids are added, but if symptoms continue or for severe cases immunosuppressant medications might be needed to return to a remission state (Arcangelo et al., 2017). The treatment for IBS is behavioral changes to include reducing stress and dietary changes to reduce triggers and improve gut flora (Huether & McCance, 2017). Similar changes in diet are recommended for those with both IBD and IBS, reduction in inflammatory items such as gluten and increasing anti-inflammatory nutrients like omega 3 fatty acids and probiotics to improve gut flora (Arcangelo et al., 2017; Huether & McCance, 2017). Genetic Influences             Genetics is.

1. 2 hours ago
Lorie Valentin
Week 8 Initial Post Valentin, Lorie
COLLAPSE
Top of Form
Initial Post Week 8
NURS 6501: Advanced Pathophysiology
Gastrointestinal Disorders
Lorie Valentin RN, BSN
Gastrointestinal Disorders
Gastrointestinal symptoms such as pain, bloating,
nausea, vomiting, and diarrhea, are a common manifestation of
many different etiologies. Medication side effects, viral illness
or stress are just a few. Sometimes though, these symptoms can
indicate a bigger problem and a more chronic illness that needs
to be addressed. Two of these chronic illnesses are
inflammatory bowel disease (IBD) and irritable bowel syndrome
(IBS). Because of the similarities in their presentation it can
sometimes be hard to tell the difference between the two, but it
is important to accurately identify which is the causative factor,
because pathophysiology and treatment are very different
(Huether & McCance, 2017).
IBD
IBD is one of several disease that cause inflammation of the
mucosa of the intestines. Ulcerative colitis (UC) and Crohn
disease are two of the inflammatory diseases. Both are
autoimmune disease that cause ulceration of the mucosa,
resulting in thickening in the lining causing narrowing of the
lumen (Huether & McCance, 2017). Crohn’s additional can
cause ulceration through the full thickness of the intestinal wall
and often has additional inflammatory manifestation
concurrently (Hammer & McPhee, 2019). Both have a high risk

2. of infection and malignancy due to remodeling of the tissue.
The most common symptoms are pain, bloating, diarrhea and
blood in the stool ((Huether & McCance, 2017).
IBS
IBS is similar in presentation to IBD, but lacks the
autosomal component. IBS is thought to be the result of
environmental factors (Huether & McCance, 2017). IBS is
diagnosed based on symptom presentation without a detectable
disease process (Huether & McCance, 2017). Symptoms of IBS
are pain, bloating, diarrhea or constipation, or alternating
diarrhea and constipation, nausea, and gas. Treatment is usually
based on lifestyle changes and avoiding triggers (Huether &
McCance, 2017).
Treatments
The treatment for mild to moderate IBD is most often
aminosalicylates, such as sulfasalazine or mesalamine
(Arcangelo, Peterson, Wilbur, & Reinhold, 2017). During acute
exacerbations often corticosteroids are added, but if symptoms
continue or for severe cases immunosuppressant medications
might be needed to return to a remission state (Arcangelo et al.,
2017). The treatment for IBS is behavioral changes to include
reducing stress and dietary changes to reduce triggers and
improve gut flora (Huether & McCance, 2017). Similar changes
in diet are recommended for those with both IBD and IBS,
reduction in inflammatory items such as gluten and increasing
anti-inflammatory nutrients like omega 3 fatty acids and
probiotics to improve gut flora (Arcangelo et al., 2017; Huether
& McCance, 2017).
Genetic Influences
Genetics is considered one possible influencing factor
for an individual developing IBD, though this risk appears to be
relatively low at about 20-30 percent (Hammer & McPhee,
2019). Multiple genes have been recently identified that play a
role in the development of IBD (Hammer & McPhee, 2019).
However, like IBS, genetics is most certainly not the only factor
that contributes to the development of IBD. Environmental

3. causes such as stress, diet, behaviors, and infection are thought
to be triggers for developing either disorder (Hammer &
McPhee, 2019). Therefore, knowing that a close relative has
IBD or IBS is most significant in determining the type of testing
that might be considered.
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J.
A. (Eds.). (2017).
Pharmacotherapeutics for advanced practice: A practical
approach (4th ed.). Ambler, PA:
Lippincott Williams & Wilkins
Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of
disease: An introduction to clinical
medicine (8th ed.). New York, NY: McGraw-Hill Education
Huether, S. E., & McCance, K. L. (2017). Understanding
pathophysiology (6th ed.). St. Louis,
MO: Mosby
11 hours ago
Lauren Sanguinetti
Week 8 Main Discussion Post
COLLAPSE
Top of Form
Inflammatory bowel disease (IBD) is made up of two
chronic relapsing inflammatory disorders, Ulcerative colitis
(UC), and Crohn disease (CD). UC is inflammation that is found
in the colonic mucosa, whereas CD can affect any part of the
gastrointestinal tract (Huether & McCance, 2017). The exact
pathophysiology of UC is unknown, but the condition is
probably caused by an inappropriate immune response to an
unknown environmental stimulus within the colon (Ford,
Moayyedi, & Hanauer, 2013). Chronic inflammation from T-cell
activation leading to tissue injury is implicated in the

4. pathogenesis of Crohn disease (Ghazi, 2018). Patients with UC
and CD present with abdominal pain, diarrhea, rectal bleeding,
and weight loss. Additionally, patients with UC may also suffer
from urgency, fever, dehydration, and anemia (Huether &
McCance, 2017).
Irritable bowel syndrome (IBS) is a condition of
abdominal pain and altered bowel habits without any organic
pathological process or specific motility or structural
abnormalities (Hammer & McPhee, 2019). The pathophysiology
of IBS is unknown, but it is thought to be from altered
gastrointestinal motility, visceral hyperalgesia, and
psychopathology (Lehrer, 2018). Patients complain of
abdominal pain, bloating, constipation, and/or diarrhea.
Both of these conditions have very similar symptoms,
and their causes are speculated. Testing can be done to confirm
IBD, but IBS is diagnosed by excluding other conditions.
Treatments for IBD include 5-aminosalicylate therapy followed
by steroids if the condition is mild. For worsening disease, the
patient may require Thioprine and immunomodulatory agents. If
patients have severe disease, they may require surgery,
intravenous fluids (IV) or possibly total parenteral nutrition
(Huether & McCance, 2017). Patients with IBS may be treated
with laxatives, fiber, antidiarrheals, antidepressants,
prosecretory drugs, anti-spasmodic, visceral analgesics, and
serotonin agonists or antagonists (Huether & McCance, 2017).
Most of the medications are not used in both IBS and IBD, but
if the patient has continuous diarrhea, they may require IV
fluids and possibly electrolyte replacement.
Several of the genes that may be associated with ulcerative
colitis are involved in the protective function of the intestines.
Changes in the intestinal lining's protective function or an
abnormal immune response to the normal bacteria in the
digestive tract, both may be influenced by genetic variations.

5. Researchers have identified at least 200 genetic variations that
influence Crohn disease risk. The majority of these variations
are thought to act by subtly changing the amount, timing, and
location of gene activity (Genetics Home Reference, 2019).
Genetic changes are not well documented in IBS, but it runs in
families, so a genetic link is still being researched. When
patients are diagnosed with these disorders, they should be
educated there is a genetic link, and they may pass on the
disease if they procreate.
References
Ford, A. C., Moayyedi, P., & Hanauer, S. B. (2013). Ulcerative
colitis. BMJ,346, 29-36.
Genetics Home Reference. (2019). Crohn disease. Retrieved
from https://ghr.nlm.nih.gov/condition/crohn-disease#genes
Ghazi, L. J. (2018). Crohn Disease. Retrieved from
https://emedicine.medscape.com/article/172940-overview#a3
Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of
Disease: An Introduction to Clinical Medicine(8th ed.). New
York, NY: McGraw-Hill Education.
Huether, S. E., & McCance, K. L. (2017). Understanding
Pathophysiology(6th ed.). St. Louis, MO: Elsevier.
Lehrer, J. K. (2018). Irritable Bowel Syndrome. Retrieved from
https://emedicine.medscape.com/article/180389-overview#a3
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