Gastro-esophageal reflux is a common problem, creating damage and inflammation from acid in the esophagus for both infants and adults.
What is the goal of treatment of GERD in an adult?
The goals of treatment of Gastro-esophageal reflux disease in an adult include the prevention of relapse of esophagitis or mucosal lesions, healing of the esophageal lining, and prevention of strictures ulcerations that may cause bleeding. An adult may experience long-term complications of gastroesophageal reflux disease that must be treated with a full-dose proton pump inhibitor to effectively achieve the treatment of the oesophageal injury and the severity of symptoms (Banasik, 2021).
How does that differ for GERD in an infant?
The recurrent goal of treatment of GERD in an infant is to heal the oesophagitis and relief the symptoms as an infant has minimal lesions and mild symptoms as compared to an adult (Banasik, 2021). Thus, in an adult with gastroesophageal reflux disease (GERD) the treatment goals are the maintenance of oesophageal healing and symptom control.
Why might a newborn have an elevated bilirubin value? When and how should it be treated?
During pregnancy, bilirubin is removed from the blood of a newborn baby when the placenta is removed that causing a condition called newborn jaundice in a neonatal hyperbilirubinemia a few days after birth. A variety of reasons why a newborn baby might have an elevated bilirubin value are incompatibility of a blood group with the mother, significant bruising at the time of birth, and premature birth. Treatment of high bilirubin in the blood depends on the newborn’s general health condition, age, and symptoms. A newborn baby must be put under special blue spectrum lights to decrease the bilirubin level in the blood after a few days of birth because bilirubin absorbs light (Banasik, 2021). Therefore, phototherapy is the best treatment to lower and stop the bilirubin levels in the blood from rising to dangerous levels.
A very common cause of altered bile flow in adults is cholelithiasis.
Explain the pathophysiology that causes those stones.
The pathophysiology of cholelithiasis is an inflammatory disorder that leads to the development of gallstone formation that involves the retention of cholesterol crystals and nucleation of supersaturated bile. This inflammatory disease eventually leads to stone growth. The precursor of gallstones manifestation is due to a polymer of bilirubin, mixed stones, pigment-calcium bilirubin, cholesterol precipitate, and micro-crystals in the pancreatic bile duct (Banasik, 2021).
When is treatment required?
People with cholelithiasis symptoms mostly develop gallstone formation in ten years as the formation of stones is a slow process but when they are formed they can result in inflammation of the gallbladder, and cholelithiasis (Banasik, 2021). Treatment of cholelithiasis depends on the health condition of the patient and the quantity, size, or number of stones. If there are large gallstones, urgent removal of the gallbladder is the necessary treatment through an operation called a cholecystectomy.
What would the treatments include?
In some patients with asymptomatic cholelithiasis condition, the inflammation is treated with some medications such as ursodiol to dissolve stones in the gallbladder but this involves a lengthy treatment period. To pulverize gallstones, another method named Extracorporeal Shockwave Lithotripsy is used for improving the subsequent flow through the bile ducts and to increase the width of the bile ducts if stones are not inside the gallbladder. The increased width of the duct allows the stones to pass into the intestine and then be excreted through urine. However, if the gallstones are large and are inside the gallbladder, a gallbladder removal surgery commonly called cholecystectomy is performed through a narrow tube with a camera in the abdomen to visualize the gallbladder and remove the stones (Banasik, 2021).
If the pancreatic or common bile duct is compromised by surgery or a stone, what pathophysiologic response will follow? How is that treated?
In case a bile duct or pancreas is compromised by stone or during the surgery, the goal of the treatment should be the management of blockage, infection, or leakage to reconstruct the bile duct. If the injury is mild due to surgery or stone, the doctor must repair it at that time but if the injury is complex, the patient may require another operation by a specially trained doctor so that a patient can go on to have a good quality of life.
There are many causes of acute and chronic hepatitis, the cumulative effects being further compounded by other systemic diseases. Explain the impact of age, diet, and social situations on the diagnosis and care of elderly patients with liver disease.
Elderly patients may develop acute and chronic hepatitis and other liver diseases due to dietary changes, age, and social situations. People as they get older make different dietary choices that are associated with a lower intake of Vitamin B and E, zinc, calcium, iron, etc. In various situations, hepatitis in elderly patients is often caused by chronic alcoholism and exposure to environmental hepatotoxins that are associated with aging (Banasik, 2021).
Banasik, J. L. (2021). Pathophysiology. (7th ed.). Elsevier Health Sciences. US.