Posted: September 16th, 2024

Gastrointestinal Function: Constipation and Heartburn in an Elderly Patient

Gastrointestinal Function: Constipation and Heartburn in an Elderly Patient – Case Study Discussion.

Constipation, a common gastrointestinal disorder, is characterized by infrequent bowel movements, difficulty passing stools, or both. Recent research indicates that constipation affects approximately 15% of the global population across all age groups (Aziz, 2024). Risk factors for developing constipation include advanced age, female gender, reduced physical activity, inadequate fiber intake, and certain medications (Mayo Clinic, 2023).

For patients suffering from constipation, several recommendations can be beneficial:

Increase dietary fiber intake gradually.
Stay adequately hydrated.
Engage in regular physical activity.
Establish a consistent bowel routine.
Consider over-the-counter laxatives or stool softeners under medical guidance.
In R.H.’s case study, several signs and symptoms are compatible with a constipation diagnosis:

Infrequent bowel movements (only one per week)
Straining during defecation
Extended time required to initiate bowel movements
Hard stools
Bloating sensation
Additional symptoms not mentioned in the case study but often associated with constipation include:

Abdominal pain or discomfort
Feeling of incomplete evacuation
Rectal bleeding due to straining
Nausea
Regarding the possibility of anemia as a complication of constipation, the information provided in the case study is insufficient to make this determination. Chronic constipation can potentially lead to anemia through various mechanisms, such as hemorrhoids or anal fissures causing blood loss. However, without specific data on R.H.’s blood parameters or reports of visible bleeding, it would be premature to consider anemia based solely on her constipation symptoms.

Endocrine Function: Type 2 Diabetes Mellitus in a Native American Woman

Diabetes Mellitus (DM) exhibits higher prevalence rates in certain racial and ethnic groups. Native Americans, including the Winnebago tribe to which C.B. belongs, are at significantly higher risk for developing Type 2 Diabetes Mellitus (T2DM) compared to the general population. Other high-risk groups include African Americans, Hispanic/Latino Americans, and some Asian American populations (Centers for Disease Control and Prevention, 2022).

Based on C.B.’s clinical manifestations, several signs and symptoms are compatible with a T2DM diagnosis:

Elevated fasting blood glucose (141 mg/dL)
Polydipsia (increased thirst)
Polyuria (frequent urination, especially at night)
Unexplained weight gain
Peripheral neuropathy symptoms (weakness and numbness in left foot)
History of recurrent infections (“female infections”)
If C.B. were to develop bacterial pneumonia in her right lower lobe, her glycemia values would likely increase significantly. This expectation is based on the body’s stress response to infection. During acute illnesses like pneumonia, stress hormones such as cortisol and epinephrine are released, which antagonize insulin action and promote gluconeogenesis. Consequently, blood glucose levels tend to rise, potentially leading to hyperglycemia in diabetic patients (American Diabetes Association, 2023).

The best initial therapy for C.B. should include both non-pharmacologic and pharmacologic approaches:

Non-pharmacologic interventions:

Structured diabetes education program
Dietary modifications focusing on portion control and balanced nutrition
Increased physical activity (aim for at least 150 minutes of moderate-intensity exercise per week)
Regular blood glucose monitoring
Weight management strategies
Pharmacologic interventions:

Metformin as first-line medication (unless contraindicated)
Consider adding a second-line agent based on individual factors (e.g., SGLT2 inhibitors or GLP-1 receptor agonists)
Initiate statin therapy for cardiovascular risk reduction
These recommendations align with the latest clinical practice guidelines for managing T2DM, emphasizing a patient-centered approach that considers individual factors such as comorbidities, patient preferences, and treatment goals (American Diabetes Association, 2024).

In conclusion, both case studies highlight the importance of comprehensive assessment and individualized management strategies in addressing complex health issues like constipation and T2DM. Early intervention, lifestyle modifications, and appropriate pharmacologic therapies play crucial roles in improving patient outcomes and quality of life.

References:

American Diabetes Association. (2023). Standards of medical care in diabetes—2023. Diabetes Care, 46(Supplement 1), S1-S270.

American Diabetes Association. (2024). Standards of medical care in diabetes—2024. Diabetes Care, 47(Supplement 1), S1-S285.

Aziz, A. (2024). Emerging treatments for chronic constipation and defecation disorders. Gastroenterology & Endoscopy News. Retrieved from https://www.gastroendonews.com/Review-Articles/Article/05-24/chronic-constipation-defecation-disorders-treatments-Satish-S-C-Rao-Abeer-Aziz/73666

Centers for Disease Control and Prevention. (2022). National diabetes statistics report. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services.

Mayo Clinic. (2023). Constipation – Symptoms and causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-20354253

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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?
Submission Instructions:

You must complete both case studies.
Your initial post should be at least 500 words per case study, formatted and cited in current APA style with support from at least 2 academic sources.
No websites can be cited. References must be no more than 5 years old.
Gastrointestinal Function: Constipation and Heartburn in an Elderly Patient.

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