Gastrointestinal Function

R.H. is a 74-year-old black woman, who presents to the family practice clinic for a scheduled appointment. She complains of feeling bloated and constipated for the past month, some-times going an entire week with only one bowel movement. Until this episode, she has been very regular all of her life, having a bowel movement every day or every other day. She reports straining most of the time and it often takes her 10 minutes at a minimum to initiate a bowel movement. Stools have been extremely hard. She denies pain during straining. A recent colonoscopy was negative for tumors or other lesions. She has not yet taken any medications to provide relief for her constipation. Furthermore, she reports frequent heartburn (3–4 times each week), most often occur-ring soon after retiring to bed. She uses three pillows to keep herself in a more upright position during sleep. On a friend’s advice, she purchased a package of over-the-counter aluminum hydroxide tablets to help relieve the heartburn. She has had some improvement since she began taking the medicine. She reports using naproxen as needed for arthritic pain her hands and knees. She states that her hands and knees are extremely stiff when she rises in the morning. Because her arthritis has been getting worse, she has stopped taking her daily walks and now gets very little exercise.
Case Study Questions

In your own words define constipation and name the risk factors that might lead to develop constipation. List recommendations you would give to a patient who is suffering from constipation. You might use a previous experience you might have.
Based on the clinical manifestations on R.H. case study, name and explain signs and symptoms presented that are compatible with the constipation diagnosis. Complement your list with signs and symptoms not present on the case study.
Sometimes as an associate diagnosis and a complication, patients with constipation could have anemia. Would you consider that possibility based on the information provided on the case study?
Endocrine Function:
C.B. is a significantly overweight, 48-year-old woman from the Winnebago Indian tribe who had high blood sugar and cholesterol levels three years ago but did not follow up with a clinical diagnostic work-up. She had participated in the state’s annual health screening program and noticed that her fasting blood sugar was 141 and her cholesterol was 225. However, she felt “perfectly fine at the time” and could not afford any more medications. Except for a number of “female infections,” she has felt fine until recently. Today, she presents to the Indian Hospital general practitioner complaining that her left foot has been weak and numb for nearly three weeks and that the foot is difficult to flex. She denies any other weakness or numbness at this time. However, she reports that she has been very thirsty lately and gets up more often at night to urinate. She has attributed these symptoms to the extremely warm weather and drinking more water to keep hydrated. She has gained a total of 65 pounds since her last pregnancy 14 years ago, 15 pounds in the last 6 months alone.
Case Study Questions

In which race and ethnic groups is DM more prevalent? Based on C.B. clinical manifestations, please compile the signs and symptoms that she is exhibiting that are compatible with the Diabetes Mellitus Type 2 diagnosis.
If C.B. develop a bacterial pneumonia on her right lower lobe, how would you expect her Glycemia values to be? Explain and support your answer.
What would be the best initial therapy non-pharmacologic and pharmacologic to be recommended to C.B?

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Sample Answer

 

 

 

Constipation

Definition: Constipation is a condition characterized by infrequent bowel movements, hard stools, difficulty passing stools, or a feeling of incomplete evacuation.

Risk Factors for Constipation:

  • Diet: Low fiber intake, dehydration, excessive intake of processed foods.
  • Lack of Exercise: Physical inactivity can slow down digestion and make it harder to have a bowel movement.
  • Medications: Certain medications, such as opioids, antidepressants, and diuretics, can contribute to constipation.

Full Answer Section

 

 

 

  • Medical Conditions: Diabetes, thyroid disorders, neurological conditions, and irritable bowel syndrome (IBS) can all increase the risk of constipation.
  • Pelvic floor dysfunction: Weak or tight pelvic floor muscles can make it difficult to have a bowel movement.
  • Ignoring the urge to go: Regularly putting off the urge to have a bowel movement can lead to constipation over time.

Recommendations for Constipation:

  • Increase fiber intake: Aim for 25-35 grams of fiber per day through fruits, vegetables, and whole grains.
  • Hydrate: Drink plenty of water throughout the day to soften stools.
  • Exercise regularly: Physical activity helps stimulate the digestive system.
  • Establish a regular bathroom routine: Try to have a bowel movement at the same time each day, even if you don’t feel the urge.
  • Respond to the urge to go: Don’t ignore the urge to have a bowel movement.
  • Consider over-the-counter laxatives: If lifestyle changes don’t help, consider using over-the-counter laxatives occasionally. However, it’s important to consult with a doctor before using laxatives for an extended period.

R.H.’s Constipation Signs and Symptoms:

  • Bloating: Feeling of abdominal fullness and distention.
  • Infrequent bowel movements: Going a week with only one bowel movement.
  • Straining: Having to exert extra effort to pass stool.
  • Hard stools: Difficulty passing stools due to their consistency.

Additional Signs and Symptoms of Constipation:

  • Abdominal pain
  • Rectal bleeding
  • Feeling of incomplete evacuation

Anemia and R.H.’s Case:

Based solely on the information provided, it’s difficult to determine if R.H. might have anemia. While chronic constipation can sometimes lead to iron deficiency anemia, other symptoms like fatigue, pale skin, and weakness would be more indicative. Anemia is best diagnosed through blood tests.

Diabetes Mellitus Type 2 (C.B.’s Case)

DM Prevalence: Diabetes Mellitus (DM) is more prevalent in certain racial and ethnic groups, including Hispanic/Latino, African American, Native American, Asian American, and Pacific Islander populations (according to the National Institute of Diabetes and Digestive and Kidney Diseases).

C.B.’s Signs and Symptoms of DM:

  • Increased thirst: This can be a sign of the body trying to expel excess sugar through urination.
  • Frequent urination: The body tries to get rid of excess sugar in the blood through urine.
  • Urinary tract infections (UTIs): Frequent urination can increase the risk of UTIs.
  • Weight gain: C.B. reports gaining a significant amount of weight in recent years, which can be a symptom of uncontrolled DM.
  • Numbness and weakness: These can be signs of nerve damage caused by high blood sugar levels. (This symptom appeared in her left foot recently).

Impact of Pneumonia on Blood Sugar:

If C.B. develops bacterial pneumonia, her blood sugar levels (glycemia) are likely to be elevated. Stress hormones released during illness can cause the body to resist insulin, leading to higher blood sugar levels. This can further complicate her diabetes management.

Initial Therapy for C.B.:

Non-pharmacologic:

  • Diet: A diabetic diet that focuses on whole foods, portion control, and limited sugar intake is crucial.
  • Exercise: Regular physical activity helps manage blood sugar levels.
  • Weight management: Losing weight can improve insulin sensitivity.

Pharmacologic:

The specific medication will depend on the severity of C.B.’s condition. Options could include oral medications like metformin or injectable medications like insulin. A doctor will determine the most appropriate course of treatment.

Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult a healthcare professional for diagnosis and treatment of any medical condition.

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