Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the
GI tract. Many of these disorders often have similar symptoms such as abdominal pain,
cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied
to the same symptoms, it is important for advanced practice nurses to carefully evaluate
patients and prescribe treatment that targets the cause rather than the symptom. Once the
underlying cause is identified, an appropriate drug therapy plan can be recommended
based on medical history and individual patient factors. In this Discussion, you examine a
case study of a patient who presents with symptoms of a possible GI/hepatobiliary
disorder, and you design an appropriate drug therapy plan.
Consider the following 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
Prednisone 10 mg daily
� Review the provided case study. Reflect on the patient’s symptoms, medical history, and
drugs currently prescribed.
� Think about a possible diagnosis for the patient. Consider whether the patient has a
disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms
are the result of a disorder from another system or other factors such as pregnancy, drugs,
or a psychological disorder.
� Consider an appropriate drug therapy plan based on the patient’s history, diagnosis,
and drugs currently prescribed.
An explanation of your diagnosis for the patient including your rationale for the diagnosis.
Then, describe an appropriate drug therapy plan based on the patient’s history, diagnosis,
and drugs currently prescribed.
Gastrointestinal (GI) and hepatobiliary disorders
The signs of the patients in the case are nausea, vomiting and diarrhea. The patient has a
history of drug abuse and possible hepatitis c. infection of the GI is very common and the
symptoms range from mild to acute (Diehl, 1999). The patient exhibits mild symptoms that could
indicate the presence of a gastrointestinal and hepatobiliary disorders. The infection of the
gastrointestinal tract can be caused by different organisms including bacteria, viruses, fungi and
parasites. The presence of symptoms like diarrhea are ignored and not taken to a physician and
this may complicate the infection without the knowledge of the patient. However, the symptoms
can also be as a result of other infections but the possibility of hepatitis c makes the case more
GASTROINTESTINAL (GI) AND HEPATOBILIARY DISORDERS 2
sensitive. The symptoms indicate that there is an infection in the stomach because of the
vomiting, and the abdominal pains. There are also possibilities of infection in the large and small
intestines because of the diarrhea. The possibilities of hepatitis c indicate infection in the liver
The diagnosis of the disease could be done through laboratory examination. This could be
done through gross examination, microscopic examination, and blood cultures for septicemia,
serological tests, toxin essays, ELISA tests, endoscopy and radiology studies and pathological
examination (Takahashi, 2006). There is need for careful diagnosis of the disease in order to rule
out other infections and know the extent of the infection in the body. The hepatobiliary disease is
a liver infection. It is a benign and malignant lever disease and the extrahepatic bilary tract that
can be seen and evaluated.
There are other diseases that could have these signs but the diagnosis gives results about
the presence of the disease. The drugs that the patient is using are showing possible presence of
gastrointestinal and hepatobiliary disorders (Takahashi, 2006). The examination needs to be
carried out carefully so that if the hepatitis is still present in the body then it can be treated and
the combination of drugs for treatment can be chosen correctly. In case of psychological
disorders in addition to the presence of the disease, then therapy should be done so as to facilitate
the treatment process (Takahashi, 2006).
Drug therapy plan
Diarrhea causes dehydration and therefore rehydration is necessary. A balanced oral
rehydration solution is administered. The patient should be instructed on the proper
administration of the oral rehydration therapy so that it can work to replace the lost minerals and
GASTROINTESTINAL (GI) AND HEPATOBILIARY DISORDERS 3
act as a preventive measure. Corticosteroids, either alone or in combination with azathioprime,
are use in the drugs therapy for patients with hepatitis (Shaheen, et al, 2006). A recommended
combined therapy for hepatitis is using the corticosteroid prednisone with azathioprine. If the
medical therapy fails, then liver transplantation is done. This procedure is recommended and
effective only if other therapy procedures have failed or for those with decompensated cirrhosis
caused by autoimmune hepatitis. Transplant can also be done as a rescue procedure where the
hepatitis has caused so much damage to the liver (Shaheen, et al, 2006).
Vomiting and abdominal pains should be stabilized. The need to stabilize the vomiting is
to control the electrolyte abnormalities that may have occurred as a result (Feldman, Friedman,
& Brandt, 2010). The high rate of dehydration necessitates support with intravenous dextrose-
containing solutions and antiemetics. Sedative induced sleep is helpful to relieve the persistent
nausea. For abdominal pains, it must be determined that the pain is genuine by carrying out a
diagnosis of functional abdominal pain. Drugs to relief the abdominal pains is administered as
treatment for any organic disease is done (Feldman, Friedman, & Brandt, 2010).
Diehl, D. L. (1999). Acupuncture for gastrointestinal and hepatobiliary disorders. The Journal of
Alternative and Complementary Medicine, 5(1), 27-45.
Feldman, M., Friedman, L. S., & Brandt, L. J. (2010). Sleisenger and Fordtran’s Gastrointestinal
and Liver Disease-2 Volume Set: Pathophysiology, Diagnosis, Management, Expert
Consult Premium Edition-Enhanced Online Features and Print E-Book (Vol. 1). Elsevier
GASTROINTESTINAL (GI) AND HEPATOBILIARY DISORDERS 4
Shaheen, N. J., Hansen, R. A., Morgan, D. R., Gangarosa, L. M., Ringel, Y., Thiny, M. T., … &
Sandler, R. S. (2006). The burden of gastrointestinal and liver diseases, 2006. The
American journal of gastroenterology, 101(9), 2128-2138.
Takahashi, T. (2006). Acupuncture for functional gastrointestinal disorders. Journal of
gastroenterology, 41(5), 408-417.