N5315 Advanced Pathophysiology Gastrointestinal Core Knowledge Objectives with Advanced Organizers

N5315 Advanced Pathophysiology Gastrointestinal Core Knowledge Objectives with Advanced Organizers Gastrointestinal Bleeds 1. Analyze the etiology, clinical manifestations, and pathophysiology of the upper and lower GI bleed and describe the implications this has for your clinical practice as a nurse practitioner. Disease Etiology Clinical Manifestations Pathophysiology Implications for Practice Upper GI Bleed Bleeding varices (varicose veins) in the esophagus or stomach, peptic ulcers, gastritis, or a Mallory-Weiss tear (tearing of esophagus from stomach) Frank, bright red or “coffee ground” (affected by stomach) emesis Hematemesis = bright red, bloody emesis= requires emergent intervention. Melena = black tarry. Shock symptoms if untreated: decreased CO, hypotension, ARF, tachycardia, and anemia. Any source of bleeding which occurs in the esophagus, stomach, or duodenum. If left untreated or if severe, can result in shock. Lower GI Bleed Inflammatory bowel disease, cancer, diverticula, or hemorrhoids Hematochezia: bright red blood in stools and the presence suggest bleed in lower track usually rectum, sigmoid colon, or descending colon. Any source of bleeding in the jejunum, ileum, colon, or rectum. Occult GI bleed is one that is not visible and results in iron deficiency. Type of bleed associated with colon cancer. = testing stools for occult blood Peptic Ulcer Disease 2. Analyze the etiology, clinical manifestations, and pathophysiology of gastric and duodenal ulcers and describe the implications for clinical practice. Disease Etiology Clinical Manifestations Pathophysiology Clinical Implications Gastric Ulcer s Ages 55-65, typically caused by NSAIDs. Chronic use of NSAIDs suppresses mucosal prostaglandin synthesis, resulting in decreased bicarbonate secretion and mucin production Epigastric pain which worsens when eating, melena, hematemesis or coffee ground emesis. Decreased mucosal protection or increased acid production. Infection with H. pylori. Complications include bleeding or perforation. If a perforation occurs, luminal contents can escape into the peritoneum and cause peritonitis. Treatment is similar to duodenal ulcer treatment. See p. 1437