Reply To Two Discussions

by


Reply to the following 2 Discussions

 

Requirement

 

APA format with intext citation

Word count minimum of 150 words per post, not including references

 

References at least one high-level scholarly reference per post within the last 5 years in APA format.

Plagiarism free.

Turn it in receipt.

 

DISCUSSION # 1Reply to Reesha Acute and Chronic Pancreatitis

 

Acute Pancreatitis

 

  • Acute condition of diffuse pancreatic inflammation & autodigestion, presents with abdominal pain, and is usually associated with raised pancreatic enzyme levels in the blood & urine.
  • Reversible inflammation of the pancreas
  • Ranges from mild to severe

 

Differentia Diagnosis:

  • Perforated bowel
  • Acute cholecystitis
  • Acute intestinal obstruction

 

  • Signs & Symptoms of Acute
  • Upper Abdominal pain, sudden onset, sharp, severe, continuous, radiates to the back, reduced by leaning forward.
    Generalized abdominal pain, radiates to the shoulder tips.
    Patient lies very still.
  • Nausea, non-projectile vomiting, retching
  • Anorexia
  • Fever, weakness
  • Distressed, moving continuously, or sitting still
  • Pale, diaphoretic. Confusion
  • Low grade fever
  • Tachycardia, Tachypnea
  • Shallow breathing
  • Hypotension
  • Mild icterus
  • Abdominal distension (Ileus, Ascites)
  • Grey Turner’s sign, Cullen’s sign, Fox’s sign
  • Rebound tenderness, Rigidity
  • Shifting dullness, reduced bowel sounds

 

  • Treatment Modalities
  • Aggressive supportive care
  • Decrease inflammation
  • Limit superinfection
  • Identify and treat complications (of pancreatitis & its treatment)
  • Treat cause if possible
  • Give analgesics (IM pethidine).
  • Give antiemetics.
  • Keep the patient NPO (until pain free/2-3 days).
  • NGT insertion to relieve vomiting

 

Patient and/or Family Teaching and Information

  • Explain what pancreatitis is and its causes
  • What are the signs and symptoms
  • Explain how acute pancreatitis is treated
  • Lifestyle modifications

 

  • Chronic pancreatitis is a progressive inflammatory disorder that leads to irreversible destruction of exocrine and endocrine pancreatic parenchyma caused by atrophy and/ or replacement with fibrotic tissue.
  • Alcohol consumption, nicotine habits, nutrition, hereditary, well characterized mutations, ductal obstruction and autoimmune factors can contribute to the diagnosis of CP (Brock, et, al., 2013).
  • Functional consequences include:
    • severe abdominal pain
    • diabetes mellitus
    • malabsorption

 

Chronic pancreatitis

 

  • Chronic pancreatitis is a progressive inflammatory disorder that leads to irreversible destruction of exocrine and endocrine pancreatic parenchyma caused by atrophy and/ or replacement with fibrotic tissue.
  • Alcohol consumption, nicotine habits, nutrition, hereditary, well characterized mutations, ductal obstruction and autoimmune factors can contribute to the diagnosis of CP (Brock, et, al., 2013).
  • Functional consequences include:
    • severe abdominal pain
    • diabetes mellitus
    • malabsorption
  • The pancreas is an accessory organ that functions in the endocrine and exocrine systems
  • Responsible for hydrolysis of proteins, carbohydrates, and fats
  • The pancreas has a main pancreatic duct running through the length of it, an accessory duct, and many various cell types.
    • The ducts can become blocked, or they can be genetically deformed
  • During constant inflammation, scarring and fibrosis of the ducts lead to permanent damage to many structures, impairing its secretory functions.

 

Treatment Methodologies

  • Goal of treatment is to decrease abdomen pain and malabsorption
  • Enzyme replacement treatment and dietary modification
  • Non-opioid regimens should be utilized (TCA, NSAIDs, pregabalin)
  • New studies show some benefit of using medium-chain triglycerides (Benjamin & Lappin, 2022).
  • During breakthrough uncontrollable pain hospitalization
    may be necessary
  • Decompression surgery can be considered in those with intractable pain who have failed medical therapy

Differential Diagnosis

. Pancreatic Cancer

  1. Cholelithiasis
  2. Peptic Ulcer Disease

 

Patient and Family Teaching

 

  • Eating small, frequent low-fat meals
  • A low-fat diet with high protein and carbohydrates is recommended for patients with steatorrhea
  • Fat intake should be less than 20g/day or less
  • Oral supplementation of fat-soluble vitamins
  • Replacement of fat-soluble vitamins and pancreatic enzymes
  • Cut out all consumption of alcohol and all forms of tobacco
  • Patients who continue to drink alcohol, have a death rate 3 times higher than those who do not drink alcohol

 

 

 

DISCUSSION # 2 Reply to Dianne.   Cirrhosis

 

  • Cirrhosis is a chronic liver disease characterized by progressive fibrosis and the destruction of liver tissue, leading to impaired liver function.
  • The etiology of cirrhosis is multifactorial, with various underlying causes.
  • The most common etiological factors include:
    • Chronic viral hepatitis (such as Hep B and C)
    • Excessive alcohol consumption, non-alcoholic fatty liver disease (NAFLD)
    • Autoimmune hepatitis

Other less common causes include inherited metabolic disorders and certain medications (Sharma &Nagalli, 2023

 

Anatomy and Physiology

 

The scarring of the liver that happens with cirrhosis disrupts the normal architecture of the liver and impairs its vital functions. The accumulation of scar tissue over time replaces healthy liver cells, creating nodules and structural abnormalities. This fibrotic process disrupts the normal flow of blood through the liver and affects its ability to perform essential functions like protein synthesis, detoxification, glycogen storage, bile production, and the metabolism of fats, carbs, and medications (Sharma &Nagalli, 2023). This leads to the accumulation of toxins and waste products in the blood stream along with the inability to synthesize proteins needed for clotting factors, albumen and other important molecules.

Additionally, the scar tissue restricts blood flow through the liver and leads to increased resistance in the portal vein, leading to portal hypertension. This causes blood to back up into other veins, resulting in the development of varices, particularly in the esophagus and stomach (Sharma &Nagalli, 2023). These varices are fragile and prone to bleeding, posing a significant risk for gastrointestinal hemorrhage. Increased pressure in the portal venous system also forms collateral vessels attempting to bypass the liver which may become engorged and contribute to further complications such as ascites (Sharma &Nagalli, 2023).

 

 

 

 

 

 

 

 

 

Treatment of alcoholic Cirrhosis

  • Alcoholic cessation​
  • Medication to treat hepatitis B or C​
  • Ursodiol to treat blocked bile duct​
  • When everything else fails, a liver transplant may be necessary

 

Non alcoholic Cirrhosis treatment

  • Weight loss​
  • Eating healthy diet​
  • Adequate physical activities​
  • Medication to treat hepatitis B or C​

Ursodiol to treat blocked bile duct

 

 

Cirrhosis: Patient and Family Education

  • Importance of AVOIDING alcohol.
    • May need referral for Alcoholic Anonymous or other counseling
  • Promote a balanced diet (lean protein, vegetables, frut)
    • Avoid processed food
    • Avoid raw seafood
  • Limit sodium consumption (2g per day)
  • Maintain good hand hygiene
  • Avoid being around people who are ill
  • Avoid certain medications that may cause further damage to liver
    • NSAIDs, pantoprazole, azithromycin, metformin, STATINs, ARBs, and ACE inhibitors
  • Education regarding symptoms of encephalopathy, infection, and bleeding tendencies