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?

Sample Solution

R.H. Case Study: Constipation

Constipation Definition and Risk Factors:

Constipation is characterized by infrequent bowel movements (less than three per week) and difficulty passing stool. Here are some risk factors that can contribute to constipation:

Dietary factors: Low fiber intake, dehydration, and excessive intake of processed foods.
Lack of physical activity: A sedentary lifestyle can slow down digestion.
Medications: Certain medications like opioids, antidepressants, and diuretics can cause constipation as a side effect.
Medical conditions: Hypothyroidism, diabetes, and certain neurological disorders can also contribute to constipation.
Age: As we age, colonic muscle function can weaken, leading to constipation.

Recommendations for Constipation Relief:

Increase fiber intake: Aim for 25-35 grams of fiber daily through fruits, vegetables, and whole grains.
Stay hydrated: Drink plenty of water throughout the day to soften stool.
Exercise regularly: Physical activity helps stimulate bowel movements.
Establish a regular bathroom routine: Try to go to the bathroom at the same time each day, even if you don't feel the urge.
Over-the-counter laxatives: Use them only occasionally and follow dosage instructions carefully.

R.H.'s Constipation Signs and Symptoms:

Feeling bloated
Straining during bowel movements
Hard stools
Infrequent bowel movements (only once a week)

Additional Constipation Signs and Symptoms (not present in R.H.'s case):

Abdominal pain
Rectal bleeding
Feeling incomplete evacuation

Anemia and R.H.'s Case:

Based on the information provided, it's unlikely that R.H. has anemia solely due to constipation. However, chronic straining and bleeding from hemorrhoids (a possible complication of constipation) can contribute to iron-deficiency anemia. Further investigation would be needed to rule out anemia.

C.B. Case Study: Diabetes Mellitus Type 2

Prevalence of Diabetes:

Diabetes Mellitus (DM) is more prevalent in certain racial and ethnic groups, including African Americans, Hispanic/Latino Americans, Native Americans, and Asian Americans/Pacific Islanders according to the National Institute of Diabetes and Digestive and Kidney Diseases (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3830901/).

C.B.'s Signs and Symptoms of Diabetes:

History of high blood sugar: Identified in a previous screening (though not diagnostic)
Recent weight gain: Can be a sign of insulin resistance
Increased thirst: A classic symptom of uncontrolled blood sugar
Frequent urination: Another classic symptom of uncontrolled blood sugar
Weakness and numbness in the foot (potential complication): These can be neuropathy symptoms, a complication of chronic high blood sugar.

Impact of Pneumonia on Glycemia:

If C.B. develops bacterial pneumonia, her blood sugar levels (glycemia) would likely be elevated. During infection, the body releases stress hormones like cortisol, which can impair insulin action and cause hyperglycemia (high blood sugar).

Initial Therapy Recommendations for C.B.:

Non-pharmacologic:

Diet modification: Implement a balanced diet low in sugar and refined carbohydrates.
Weight management: Aim for healthy weight loss through diet and exercise (as tolerated).
Exercise regularly: Physical activity improves insulin sensitivity.
Blood sugar monitoring: Regularly monitor blood sugar levels at home.

Pharmacologic:

Medications for type 2 diabetes may be prescribed by the doctor depending on the severity of her condition. These might include oral medications like metformin or injectable medications. It's important to note that medications should only be initiated under the supervision of a qualified healthcare professional.

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Gastrointestinal Function

Sample Solution

R.H. Case Study: Constipation

C.B. Case Study: Diabetes Mellitus Type 2

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