Disorders of the Gastrointestinal System, 2nd Edition
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allows biopsy to rule out cancer and H. pylori infection. ● Barium swallow, upper GI series, and small bowel serie s: Verify the presence of an ulcer. These are likely to be the first tests performed if signs and symptoms are not severe, but they are unreliable for small ulcers and do not provide the opportunity for biopsies. ● H. pylori t esting : Blood tests for H. pylori are less reliable than other available tests; therefore, they are used less frequently. Other more reliable tests include stool test, breath test, and gastric tissue biopsy. ● Lab work : Although not exclusively diagnostic, some lab tests can indicate that bleeding is occurring. Generally, lab work includes blood counts, electrolytes, liver enzymes, bleeding times, and H. pylori testing. Treatment focuses on eliminating H. pylori and protecting the lining of the stomach. Experts in the treatment of PUD recommend the following treatments and most often use more than one concur- rently (Anand, 2021): ● Administration of PPI to decrease secretion of gastric acid. ● Antibiotics: Often, more than one antibiotic is used concomitantly. ● Administration of histamine-2 blockers to reduce gastric acid secretion. ● Administration of cytoprotective agents that prevent mucosal damage (Pepto-Bismol, Carafate). ● Administration of blood products if extensive GI bleeding occurs. ● Avoidance of caffeine, alcohol, nicotine products, and other items that encourage gastric acid secretion and irritate the stomach lining. ● Avoidance of NSAIDs.
CASE STUDY 7 Tim is a 66-year-old retired teacher. He enjoys drinking beer in his garden and watching the birds. Yesterday, he woke up with a dull pain in his abdomen that seemed to get better when he sat in a forward-leaning position. Today, he can- not get rid of the pain, which has started radiating toward his back. Tim decided to go to the nearby emergency department when he began to vomit and developed a fever. After some lab work, the hospital diagnoses acute pancreatitis and begins IV fluids. Question Which of the following lab values would be most helpful in diagnosing pancreatitis? a. Platelet count. b. Urinalysis. c. Amylase and lipase. d. Total protein. Answer/Rationale: The pancreas is a gland just behind the stomach responsible for making insulin and digestive enzymes critical for diges- tion and converting food to energy (Tang, 2021). When these enzymes damage the pancreas, often in the presence of envi- ronmental factors, the subsequent inflam - mation is called pancreatitis , which can be acute or chronic (Tang, 2021). In the U.S., the rate of hospitalizations related to pancreatitis has been increasing since the late 1990s, and the U.S. has one of the highest rates of the disorder internation- ally (Tang, 2021). The risk of developing acute pancreatitis is up to 10 times higher in African Americans than in Whites, who The correct answer is c. Amylase and lipase are useful in diagnosing pancreatitis. Pancreatitis
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