Discussion 1 (Luna)
Gastrointestinal and Endocrine Function
In your own words define constipation and name the risk factors that might lead to developing constipation.
Constipation is a prevalent condition that affects people of all ages. A gastrointestinal disorder in which a person has severe difficulty accomplishing egestion or expelling a Packed rectum is known as this ailment. Different people experience a variety of presentations classifiable as constipation including reduced bowel movements to fewer than 3 in a week, hard stool, distension, painful stool passing, abdominal discomfort, and nausea (Sen et al., 2019). Dietary fiber and female sex are two factors that increase sensitivity to these symptoms. Insoluble fiber bulks up food, aiding peristalsis and preventing constipation. The qualities of soluble fiber improve stool water retention, which enlarges and softens stools and improves peristalsis. As a result, a lack of dietary fiber might cause constipation by impairing peristalsis.
Constipation is more common in women than men. About 80% of women experience constipation during their reproductive years, which may persist after menopause (Ozturk & Kılıc, 2019). Ovulation-related hormonal changes particularly an increase in progesterone levels are thought to be the cause of this high incidence. Furthermore, due to weakening pelvic floor muscles and hormonal degradation as people age, postmenopausal women are more susceptible to this disorder. Peristalsis, gastrointestinal secretion patterns, and water absorption in the duodenum are all affected by these two factors, resulting in bowel movement alterations.
List recommendations you would give to a patient who is suffering from constipation.
The majority of constipation situations are non-indicative of serious underlying conditions, and self-care solutions provide relief in a reasonable amount of time. The following is a list of suggestions that a patient could use: a) Drink two glasses of water per day instead of one. More water softens feces and makes them easier to pass. b) Stay away from caffeinated beverages, which might dehydrate you. c) Limit your alcohol intake due to drying qualities. d) To get rid of active constipation, take docusate. e) Consume more veggies, fruits, and whole meals to increase dietary fiber. Fiber bulks up the stool and improves peristalsis. f) Keep a food journal and note which one produces constipation (Sen et al., 2019).
Based on the clinical manifestations in R.H.’s 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 in the case study.
R.H. presented several constipation symptoms, including feeling bloated and reduced defecation. The patient complained of delayed bowel movement, which could have resulted from hormonal changes and reflex spasms of the anal sphincter. R.H. reported heartburn as well. This condition occurs in constipation when stool builds up in the rectum and causes prolonged food stay in the stomach resulting in heartburn. Other symptoms presented by other patients might include nausea, abdominal pain, and distension (Ozturk & Kılıc, 2019).
Sometimes as an associate diagnosis and a complication, patients with constipation could have anemia. Would you consider that possibility based on the information provided in the case study?
R.H.’s symptoms are insufficient to rule out anemia as a diagnosis. A diagnosis of constipation with anemia requires evidence of blood loss or iron deficiency which is absent in the patient’s symptomatic profile. Constipation can occur as a symptom of an underlying condition associated with hemorrhage, such as inflammatory bowel disease (IBD). Other conditions like proctitis can cause massive iron loss and anemia-specific symptoms such as blood in stool, fatigue, confusion, and general malaise. H.R. presents none of these symptoms. Similarly, anemia in constipation can result from persistent rectal injury and hemorrhage as a result of hard stool and a strained stool passing experience. Such an experience leaves lesions or bruises in the rectal region observable in a colonoscopy. The absence of these marks in the patient’s colonoscopy and denial of pain during egestion disqualify anemia or rectal injury as its source. Therefore, a lack of these symptoms eliminates the possibility of diagnosing constipation with anemia (Ozturk & Kılıc, 2019).
In which race and ethnic groups is DM more prevalent? Based on C.B.’s clinical manifestations, please compile the signs and symptoms that she is exhibiting that are compatible with the Diabetes Mellitus Type 2 diagnosis.
Diabetes Mellitus (DM) is a major public health concern, with more diagnoses being recorded each year. The most affected ethnic groups in the country are American Indians and non-Hispanic black communities. American Indians account for 14.7% of diagnosed cases, while the African American community accounts for about 12%. Asians and Hispanics follow in DM prevalence. These populations present a variety of symptoms depending on genetic predisposition, environmental factors, and co-morbidities. Some of the symptoms C.B. presents include high blood sugar levels and elevated cholesterol levels. Her fasting blood sugar level was 141 mg/dL, which was above the health maximum of 125 mg/dL (Lester, 2019). The patient registered 25 mg/dL of cholesterol above the accepted threshold as well. She also presented increased thirst and polyuria depicted in frequent nighttime urination. The patient’s rapid weight gain and numbness in the foot support a diabetes mellitus diagnosis too.
If C.B. develop bacterial pneumonia on her right lower lobe, how would you expect her Glycemia values to be? Explain and support your answer.
With the onset of bacterial pneumonia, C.B.’s blood glucose levels will rise. Toxins and cellular damage caused by bacterial colonization of the lower right lobe will stimulate an immunological response. In addition to the release of inflammatory substances like antibodies and leucocytes, the immune response causes an increase in blood glucose to provide respiratory energy for immune response processes like active transport in phagocytosis. Therefore, the patient will experience hyperglycemia in pneumonia (Lester, 2019).
What would be the best initial therapy non-pharmacologic and pharmacologic to be recommended to C.B?
C.B. has been diagnosed with diabetes and will need to take some steps to maintain a healthy blood glucose level. Healthy eating is one of the criteria. Because of the patient’s condition, a shift in diet toward whole foods, fruits, and vegetables is required. Sweetened beverages, white bread and rice, and dried fruit must be avoided since they contain high amounts of chemicals such as fructose corn syrup, which raise blood glucose to harmful levels. Furthermore, the diet contains a low intake of red meat and dried fruits, both of which induce insulin resistance in cells (Lester, 2019).
An increase in physical exercise is another strategy. Physical activity helps to maintain a healthy glucose level by enhancing insulin sensitivity and stimulating cellular glucose use. Insulin sensitivity in the skeletal muscles is reduced in type 2 diabetes patients, resulting in lower blood glucose uptake. Exercise improves this condition by translocating the glucose transporter 4 in skeletal cells from intracellular position to within extracellular access (Lester, 2019). This change results in improved kidney function, weight loss, and better blood glucose levels.
Physical activity and diet play an important role in the management of diabetes mellitus. These measures, however, may be insufficient to provide instant relief. One of the pharmacological interventions C.B. may apply to attain quick results is the use of metformin. This drug, administered at 1,000 g/day, achieves weight loss by lowering gastrointestinal glucose uptake (Veni & Gupta, 2019). Metformin’s glucose control derives from its ability to alter cellular insulin sensitivity as well. Patients under this therapy experience about a 28% increase in glucose uptake in skeletal muscles and a reduction in blood glucose (Veni & Gupta, 2019). The drug also improves hepatic insulin production, which slows down gluconeogenesis.
Another pharmacological intervention is thiazolidinediones (TZDs). TZDs regulate blood glucose by improving hepatic and muscular sensitivity to insulin. This treatment activates intracellular nuclear receptors responsible for insulin-mediated glucose assimilation and its conversion into adipose tissue which lowers blood glucose (Carrasco-Sánchez et al., 2021). While TZDs fail to impact insulin secretion rates, the drug maintains low blood glucose by inhibiting the oxidation of fats, hence decreasing gluconeogenesis.
Carrasco-Sánchez, F. J., Fernández-Rodríguez, J. M., Ena, J., Gómez-Huelgas, R., & Carretero-Gómez, J. (2021). Medical treatment of type 2 diabetes mellitus: Recommendations of the Diabetes, Obesity and Nutrition Group of the Spanish Society of Internal Medicine. Revista Clinica Espanola, 221(2). https://doi.org/10.1016/j.rce.2020.06.005
Discussion 2 ( George)
Constipation is the discomfort one feels when passing small amounts of dry and hard stool infrequently. The common risk factors for constipation include dehydration, consumption of a low fiber diet, lack of physical activity, depression, and taking opioid pain medications. (Diaz, Bittar and Mendez, 2022). For a patient suffering from constipation, major recommendation include, adequate hydration and regular physical activity. Also, consumption of a high fiber diet and fresh green vegetables alleviates constipation. Those who use opioid medications for pain relief should minimize the duration of their use or consume a lot of fiber rich diets an