Alterations in Digestive Function Q & A

Q: Discuss why females who drink alcohol are more susceptible to liver damage than males who drink the same quantity of alcohol. What are the implications?

A: Research shows that women develop alcohol-related problems and medical conditions at lower drinking levels than do men. On average, women weigh less than men and have less water in their bodies pound for pound. A man and woman of the same weight, however, can drink the same amount of alcohol and the woman’s blood alcohol concentration will be higher than the man’s. This all puts women at a greater risk for alcohol-related issues (National Institute of Health, 2013). The USDA defines ‘moderate drinking’ as up to 1 drink a day for women, and 2 for men (National Institute of Health). It is important for women to watch their alcohol intake because of their increased risk to develop alcohol-related diseases and minor issues such as sleep complications.

Q: Crohn’s disease and ulcerative colitis are both inflammatory bowel diseases. Develop two case scenarios that include the clinical presentation of each of these diseases. What would the patient "look" like? What clinical findings would you expect (or not expect) with each disorder?

A: Ulcerative colitis and Crohn’s disease are inflammatory bowel disorders. These conditions will cause chronic inflammation in the patient’s digestive system. “Ulcerative colitis occurs in the inner lining of the large intestine, and Crohn’s disease extends into the deeper areas of the intestinal wall, and can affect the gastrointestinal tract (the digestive system)” (American Accreditation HealthCare Commission, 2011). As well, inflammatory bowel disorders present themselves in different ways to different patients. Genetics plays a role, so age may vary between 15 and 35 for patients with some type of inflammatory bowel disorder (American Accreditation HealthCare Commission, 2011). Two examples of the clinical presentation of Crohn’s are in the development of complications include toxic megacolon (severe inflammation of the colon) and malnutrition, due to the intestines’ inability to process nutrients. Symptoms and complications tend to appear first in young people; those most at risk for Crohn’s are people of Eastern European Jewish descent, and whites are more likely to develop Crohn’s disease than non-whites (American Accreditation HealthCare Commission, 2011).

Q; Your friend confides in you that he is worried about his father's health. According to your friend, his father has been a heavy alcohol drinker for many years and has just been informed by his physician that he has alcohol-related hepatitis. Discuss how you would explain alcohol-related liver damage to your friend so that he can better understand his father's condition.

A: It is right for your friend to be concerned about his father’s health, and alcohol-related conditions can be very serious. The liver is a very important organ in the body. It has many important jobs. It processes food and drink, and turns it into nutrients and energy that your body can use. It also works to remove harmful substances from the blood. Alcohol damages liver cells, and even destroys them. Another job of the liver is to break down the alcohol so it can be removed from the body, and the liver can be damaged if the alcohol is not processed quickly enough (American Liver Foundation, 2011). Although there are some health benefits from drinking wine, one potential condition that comes from a lifetime of heavy drinking is alcohol hepatitis.

Alcohol hepatitis makes the liver swell and become seriously damaged. Alcohol hepatitis includes loss of appetite, vomiting, nausea, fever, jaundice, and abdominal. It is developed by up to 35 percent of heavy alcohol drinkers. It ranges from mild to severe and can cause liver failure or death (American Liver Foundation, 2011). Treatment for alcohol-related liver diseases is to maintain a healthy diet, completely avoid alcohol. Medications can be necessary to manage the complications that are caused by liver damage. In severe cases of alcoholic cirrhosis, a liver transplant could be necessary. Patients with alcohol-related liver disease are advised to stop drinking alcohol to be allowed consideration for a liver transplant (American Liver Foundation, 2011). It is important to let the friend know that, despite his father’s current condition, there are treatment options so as long as his father stops drinking alcohol.

Q: You are visiting relatives and your aunt develops sharp, severe right upper quadrant abdominal pain. You suspect that she may be having an attack of cholelithiasis or cholecystitis. What kinds of questions can you ask her that could help determine whether she is having either of these problems? If she were to go to an emergency department, what laboratory tests might be ordered? What would be the test results if she has either one of these disorders? How might these lab tests differ based on which disease she has?

A: The symptoms of cholecystitis can be one or more of the following: severe, steady pain in the upper right part of the abdomen, tenderness of the abdomen, sweating, fever, chills, bloating, vomiting, and/or nausea (Mayo Clinic, 2014). A key symptom is sharp, severe right upper quadrant abdominal pain, which is already clear in the aunt. It would be an important next step to see if she has any of these additional symptoms. It is also important to know when these symptoms occur because “Cholecystitis signs and symptoms usually occur after a meal, particularly a large meal or a meal high in fat” (Mayo Clinic, 2014). If she matches any of these symptoms, it would be pertinent if she would go see a doctor. Cholelithiasis has much the same list of symptoms and is noted as the presence of one or more gallstones that are in the gallbladder (Siddiqui, 2013). The key differences are in that cholelithiasis there are gallstones involved in the bile tract and these are what causes the condition.

There are tests that a doctor would do to diagnose cholecystitis. They include blood tests (to look for signs of gallbladder issues or other infections), testing images of the gallbladder (these tests include abdominal ultrasound or computerized tomography scans that reveal signs of cholecystitis in the gallbladder), and a hepatobiliary iminodiacetic acid scan. The last tracks the movement of bile through to the gallbladder and involves the injection of a radioactive chemical into your body (Mayo Clinic, 2014). As well, for cholelithiasis, a test for diagnosis would be an ultrasonograph, and no lab tests are typically necessary.

References

American Accreditation HealthCare Commission (2011). Ulcerative colitis. Carolinas HealthCare System. Retrieved from http://www.carolinashealthcare.org/body.cfm?id=5128&action=detail&AEArticleID=000069&AEProductID=Adam2004_10&AEProjectTypeIDURL=APT_10

American Liver Foundation. (2011). Alcohol-related liver disease. Retrieved from http://www.liverfoundation.org/abouttheliver/info/alcohol/

Mayo Clinic. (2014). Diseases and conditions: Cholecystitis. Retrieved from http://www.mayoclinic.org/diseases-conditions/cholecystitis/basics/symptoms/CON-20034277

National Institute of Health. (2013). Women and alcohol. National Institute on Alcohol Abuse and Alcoholism. Retrieved from http://pubs.niaaa.nih.gov/publications/womensfact/womensfact.htm

Siddiqui, A. A. (2013). Cholelithiasis. The Merck Manual. Retrieved from http://www.merckmanuals.com