MN551 Unit 6 Assignment Case Study 2

MN 551 Advanced Physiology and Pathophysiology across the Life Span – Unit 6 Case Study 5: Gastrointestinal Disorders

Case Study 5: Gastrointestinal Disorders

There are many disorders that affect the gastrointestinal system and the lives of many people; some examples of these diseases are irritable bowel syndrome, colitis, diverticular disease, constipation, hemorrhoids, cancer, colon polyps and many others (Bevan & Rutter, 2018). Many of these life changing conditions can be well managed and prevented by maintaining a healthy lifestyle, eating a balanced diet, getting regular annual cancer screenings, and practicing good bowel habits (Bevan & Rutter, 2018).

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In this case study we discuss a 52- year old female named Marcee. She was a receptionist at a company head office, however, she had to take some time off when she was treated for colorectal cancer. Her diagnosis of colorectal cancer was stage I on the Dukes classification system; which involved surgery and radiation therapy. Marcee denies having a family history of colorectal cancer. Marcee also denies drinking alcohol or smoking tobacco, she also denies paying attention to her diet. In fact she admits that while she was working as a receptionist most of her meals were foods she found in the vending machine in the cafeteria, and her meals at home were mainly frozen dinner and prepackages foods.

Marcee’s diet and what factors it might play to the contribution to the development of colorectal cancer?

Marcee’s diet is full of over-processed foods and increased fats. Unfortunately, this type of diet will lead to an increased bile acids synthesis in the liver. This increased synthesis of bile acids is then converted to possible carcinogens as they come in contact with the colon’s bacterial flora. The bacterial flora are then capable of converting the bile acid, which will then cause the carcinogen consequence (Politis et al., 2019). Diets that are high in sugar, especially refined sugars, are shown to have increased proliferation of bacteria. In the case of Marcee, she also had a diet that was mainly processed foods which are low in nutrients including Vita A, C, and E. These nutrients are important as they act as a free radical which prevents conversion and proliferation of potential carcinogens (Politis et al., 2019). Also, most processed foods are low in fiber, which dietary fiber helps increase stool bulk, which will decrease constipation and help with the removal of potential carcinogens (Politis et al., 2019). Foods that can help increase dietary fibers include fruits, vegetables, and foods with less animal and dairy fat. It is recommended by the American Cancer Society that individuals consume at minimum five fruits and vegetables a day (Politis et al., 2019)

CRC arises from adenomatous What are the development and histological features of these polyps?

Colorectal Cancer (CRC) sometimes arises from adenomatous polyps in the mucosal epithelium of the intestinal wall which results from neoplastic cell proliferation occurring over those needed to replace cells which are normally shed from the mucosal surface epithelium (Politis et al., 2019). Three dominant forms of adenomas include tubulovillus adenomas, tubular adenomas, and villous adenomas; when can range in size from barely visible to quite large (Politis et al., 2019). Tubulovillus adenomas are characterized as posing an intermediate cancer risk (Politis et al., 2019). Tubular adenomas are made up of cells that are shaped as smooth spheres in the mucosal wall that is attached by a stalk. Villous adenomas are broad based cells that are shaped similar to a cauliflower-like surface (Politis et al., 2017). Tubular adenomas and villous adenomas are more likely to contain malignant cells and stalks of tubular adenomas which destroy the malignant cells within the mucosal wall. Studies have shown that if polyps in the colon or rectum become cancerous that overtime it can spread or metastasize to the blood vessels or lymph nodes near the colon and then eventually to other parts of the body (Politis et al., 2017).

CRC complications in individuals with ulcerative Pseudo polyps and how they differ from other polys discussed previously.

Those individuals that are suffering from ulcerative colitis also have an increased risk of developing CRC due to damage in the DNA and the instability of mucosal cells, this increases the risk of developing CRC to a person with ulcerative colitis (Pickhardt et al., 2018). Studies have shown that there is an increased amount of CRC in patients who also suffer from an increased inflammation of the colon and rectum. Ulcerative colitis’ inflammatory process can lead to the formation of small mucosal hemorrhages that will eventually lead to crypt abscesses that can develop into necrotic bowl or ulcerate (Pickhardt et al., 2018). This can lead to the development of pseudo polyps as the mucosal layer folds and develops tongue-like protrusions that look very similar to polyps (Pickhardt et al., 2018). Pseudo polyps are proof of severe inflammation and can be seen in endoscopy in individuals that have ulcerative colitis (Pickhardt et al., 2018). These pseudo polyps can develop when those suffering from ulcerative colitis that have undergone rapid treatment, surgery, bowel stenosis, or biological agents (Pickhardt et al., 2018).

Why is fecal occult blood test used to screen for CRC? How do you administer this test?

The first line of CRC diagnostic tools are fecal occult blood tests, as it helps identify blood in the stool, as a marker signifying polyps in the colon (Kościelniak-Merak et al., 2018). When a fecal occult blood test is positive it indicates that there is some sort of blood in the gastrointestinal tract but not the location (Kościelniak-Merak et al., 2018). The fecal occult blood test is accomplished by obtaining a small sample or samples of stool from the patient’s feces and placing it on the card or brush. There are two types of fecal occult blood test that are used one is a guaiac smear test (gFOBT) and the other is a fecal immunochemical test (FIT); both require collecting stool samples and taking smaller samples from that. The fecal occult blood test can detect such small amounts of blood that is beneficial to detecting disorder such as ulcers, polyps, hemorrhoids, colitis, and diverticulitis. As useful as the fecal occult test are they are only able to detect the absence or presence of blood and not the source (Kościelniak-Merak et al., 2018). It is important to educate all individuals that if they notice blood coming from their anus or they are experiencing abdominal pain that doesn’t go away with a change in bowel habits they should consult their clinician. It is recommended by the United States Preventative Services Task Force that individuals aged 50 to 75 years undergo screening for CRC (Kościelniak-Merak et al., 2018). For individuals that are at a greater risk of developing CRC they should speak to their clinicians on when they should start screening for CRC (Kościelniak-Merak et al., 2018).

References

Bevan, R., & Rutter, M. D. (2018). Colorectal cancer screening-who, how, and when?. Clinical Endoscopy, 51(1), 37–49. https://doi.org/10.5946/ce.2017.141

Kościelniak-Merak, B., Radosavljević, B., Zając, A., & Tomasik, P. J. (2018). Faecal occult blood point-of- care tests. Journal of Gastrointestinal Cancer, 49(4), 402–405. https://doi.org/10.1007/s12029-018-0169-1

Pickhardt, P. J., Pooler, B. D., Kim, D. H., Hassan, C., Matkowskyj, K. A., & Halberg, R. B. (2018). The natural history of colorectal Polyps: Overview of predictive static and dynamic features. Gastroenterology Clinics of North America, 47(3), 515–536. https://doi.org/10.1016/j.gtc.2018.04.004

Politis, D. S., Katsanos, K. H., Tsianos, E. V., & Christodoulou, D. K. (2017). Pseudopolyps in inflammatory bowel diseases: Have we learned enough?. World Journal of Gastroenterology, 23(9), 1541– 1551. https://doi.org/10.3748/wjg.v23.i9.1541

Politis, D. S., Papamichael, K., Katsanos, K. H., Koulouridis, I., Mavromati, D., Tsianos, E. V., & Christodoulou, D. K. (2019). Presence of pseudopolyps in ulcerative colitis is associated with a higher risk for treatment escalation. Annals of Gastroenterology, 32(2), 168–173. https://doi.org/10.20524/aog.2019.0357