Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders – Advanced Pharmacology week 7 response 1
Type of document Essay
1 Page
Subject area
Pharmacology Academic Level Master
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Number of references 4
Order description:
Please respond to Barnabys post in one of the following ways and use the readings and resources as at least 2 resources
Post
Barnaby Urias
DQ 7- Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
COLLAPSE
Professor and Class,
The liver is a large, spongy organ that lies in the upper-right abdomen. Regarded as primarily part of the digestive system because it manufactures bile, the liver has many other functions, including the synthesis of blood-clotting factors and the detoxification of such harmful substances as alcohol. Cirrhosis describes the fibrous scar tissue (or nodules) that replaces the normally soft liver after repeated long-term injury by toxins such as alcohol or viruses. The liver may form small nodules (micronodular cirrhosis), large nodules (macronodular cirrhosis), or a combination of the two types (mixed nodular cirrhosis). Cirrhosis is a frequent cause of death among middle-aged men, and increasingly among women. While alcoholism is the most common cause, chronic hepatitis and other rarer diseases can also produce the irreversible liver damage that characterizes cirrhosis. The resulting organ is shrunken and hard, unable to perform its varied duties. Because of its altered structure, the cirrhotic liver causes serious problems for surrounding organs, as blood flow becomes difficult. The barrier to normal circulation leads to two serious complications: portal hypertension (the buildup of pressure in the internal veins) and ascites (fluid leakage from blood vessels into the abdominal cavity) (Rizzo, 2013).
Cirrhosis is the 12th leading cause of death in the United States. It accounted for 29,165 deaths in 2007, with a mortality rate of 9.7 per 100,000 persons. Alcohol abuse and viral hepatitis are the most common causes of cirrhosis, although nonalcoholic fatty liver disease is emerging as an increasingly important cause. Primary care physicians share responsibility with specialists in managing the most common complications of the disease, screening for hepatocellular carcinoma, and preparing patients for referral to a transplant center (Starr, 2011).
Pathophysiology
Histologically, the disease is reflected as a granulomatous lymphocytic cholangitis that consequently leads to small bile duct loss and cholestasis. Progressive disease is characterized by the development of a biliary cirrhosis, with end-stage features of liver disease ultimately impacting patient outcomes (Corrigan, 2015).
Causes
Causes of hepatic encephalopathy include constipation, infection, gastrointestinal bleeding, certain medications, electrolyte imbalances, and non-compliance with medical therapy (Starr, 2011).
Symptoms
Signs and symptoms of decompensated cirrhosis include abdominal swelling, jaundice, and gastrointestinal bleeding (Starr, 2011). In its early stages, cirrhosis often has no symptoms. But as liver cells die, the organ makes less of the proteins that regulate fluid retention and blood clotting and loses its ability to metabolize the pigment bilirubin. This causes symptoms and complications that include: fatigue, loss of appetite, nausea, weakness, weight loss, fluid accumulation in the legs (edema) and abdomen (ascites), Increased bleeding and bruising, jaundice, a yellowing of the skin and eyes, itching, and confusion. As damage increases, the liver fails to detoxify the blood and becomes less able to metabolize many medications, which magnifies their effects. Eventually, toxins build up in the brain. These changes can produce: increased sensitivity to drugs, personality and behavioral changes, including confusion, neglect of appearance, forgetfulness, trouble concentrating and changes in sleep habits, loss of consciousness, and coma. Scarring also impedes blood flow and increases pressure in the portal vein, which moves blood from the stomach to the liver. This condition is called portal hypertension. Blood vessels in the stomach and esophagus swell, and the body creates new ones in an attempt to bypass the liver. These vessels, called varices, have thin walls. If one bursts, the resulting hemorrhage (major bleeding) can cause death within hours if not treated (Drugs, 2012).
Diagnostics
Diagnosis is usually made from a history of alcoholism. A physical examination may reveal jaundice; a large nodular liver or a small shrunken one, depending upon the stage; or a fluid-filled abdomen (ascites). Laboratory studies may show elevated liver enzymes released from damaged cells and low levels of products that the liver normally produces (protein, clotting factors). A definitive diagnosis can be made only by biopsy, although radiographic methods such as computed tomography (CT) scanning and magnetic resonance imaging (MRI) can be quite conclusive (Rizzo, 2013).
Treatment
Specific medical therapies may be applied to many liver diseases in order to alleviate symptoms and primarily to avoid or delay the development of cirrhosis. Examples include prednisone and azathioprine for autoimmune hepatitis, interferon and other antiviral agents for hepatitis B and C, phlebotomy for hemochromatosis, ursodeoxycholic acid for primary biliary cirrhosis, and trientine and zinc for Wilson disease. These therapies become progressively less effective if chronic liver disease evolves into cirrhosis. Once cirrhosis develops, treatment is aimed at the management of complications as they arise. Certainly, variceal bleeding, ascites, and hepatic encephalopathy are among the most serious complications experienced by patients with cirrhosis. However, attention also must be paid to patients’ chronic constitutional complaints (Alaqaili, 2017).
Management
Screening for chronic liver disease is a key factor for early detection of signs for liver damage, which can be performed inexpensively and easily with clinical history-taking, measurement of transaminase concentrations, upper abdominal ultrasonography, and transient elastography (where available). Abnormal findings should prompt specific diagnostic testing to determine the etiology of the underlying disease. In most patients, the dynamic process of progressive fibrosis, which could ultimately lead to cirrhosis, can be interrupted by the timely recognition of the risk, followed by appropriate treatment (Alaqaili, 2017).
Case Study
In the case study, patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs: Synthroid 100 mcg daily, Nifedipine 30 mg daily, and Prednisone 10 mg daily. The current dosage for Nifedipine 30 mg daily would be discontinued and the current recommended dosage for Nifedipine is 30 mg PO TID. Prednisone should be used with caution; patients with cirrhosis may experience enhanced corticosteroids effects due to decreased metabolism and thereby may require lower doses (Drugs, 2012). Labs should be ordered routinely and patients with cirrhosis should be screened for hepatocellular carcinoma every six to 12 months using imaging, with or without serum α-fetoprotein measurement (Starr, 2011).
Reference
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins
Starr, S., & Raines, D. (2011). Cirrhosis: Diagnosis, management, and prevention. American Family Physician, 84(12), 1353–1359
Rizzo, C. P. (2013). Cirrhosis. Magill’S Medical Guide (Online Edition),
Corrigan, M., & Hirschfield, G. M. (2015). Aspects of the Pathophysiology of Primary Biliary Cirrhosis. Digestive Diseases (Basel, Switzerland), 33 Suppl 2102-108
Alaqaili, H. I., AlJuraysan, A. I., Hawsawi, R. A., Abuzaid, F. A., Alharbi, M. A., Mughallis, A. A., & … Al-Rajeh, H. I. (2017). Review on Liver Cirrhosis Complications and Treatment. Egyptian Journal Of Hospital Medicine, 69(8), 3092-3103
Drugs.com. (2012). Retrieved from http://www.drugs.com/
Use these resources
Learning Resources
This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. To access select media resources, please use the media player below.
Required Readings
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins. Chapter 28, “Nausea and Vomiting” (pp. 429-446)
This chapter focuses on the etiology of nausea and vomiting, as well as body systems that impact or trigger nausea and vomiting. It also covers various drugs used to treat nausea and vomiting including the process of selecting, administering, and managing drug therapy for patients.
Chapter 29, “Gastroesophageal Reflux Disease and Peptic Ulcer Disease” (pp. 447-462)
his chapter begins with an overview of risk factors, symptoms, and clinical stages of gastroesophageal reflux disease (GERD). It then examines drugs used to treat GERD and peptic ulcer disease (PUD), including proper dosages, possible adverse reactions, contraindications, and special considerations.
Chapter 30, “Constipation, Diarrhea, and Irritable Bowel Syndrome” (pp.465-494)
This chapter begins by exploring disorders associated with constipation and diarrhea, as well as drugs used in treatment. It also covers the pathophysiology of irritable bowel syndrome and related drug therapies.
Chapter 31, “Inflammatory Bowel Disease” (pp. 497-515)
This chapter examines the causes, pathophysiology, and diagnostic criteria of inflammatory bowel disease (IBD), Crohn’s disease, and ulcerative colitis. It also identifies drugs used to treat IBD, including proper dosage, adverse reactions, and special considerations.
Starr, S., & Raines, D. (2011). Cirrhosis: Diagnosis, management, and prevention. American Family Physician, 84(12), 1353–1359. Retrieved from the Walden Library databases.
This article examines the clinical presentation, pathophysiology, diagnosis, management, and prevention of cirrhosis. It also provides methods for managing complications of cirrhosis.
Drugs.com. (2012). Retrieved from http://www.drugs.com/
This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.
Required Media
Laureate Education, Inc. (Executive Producer). (2012). Pharmacology for the gastrointestinal system. Baltimore, MD: Author.
This media presentation outlines drug treatment options for disorders of the gastrointestinal system.
Note: The approximate length of this media piece is 2 minutes.
Optional Resources
Refer to the Optional Resources listed in Week 1.
