Gastrointestinal Case Study
A 60-year old woman with a 10-year history of Type II diabetes presents with multiple complications including retinopathy, peripheral neuropathy and declining renal function.
She has not had the urge to eat as of recently she feels “full” after a few bites. The incidence of nausea and feeling bloated occurs at least twice a day and even after a glass of water she feels bloated. She also complains of fatigue and not been able to keep up with daily chores. A radiographic gastric emptying study shows a prolonged gastric emptying time.
Diagnosis and Pathophysiology
Gastroparesis slows motility in the stomach; which delays absorption of nutrients. When this occurs, the stomach muscles are not functioning properly and it affects gastric emptying (ADA, 2018). Gastroparesis delays digestion, which in turn, causes complications. Gastroparesis is common amongst Diabetics and can alter to blood glucose levels. Diabetes is the most common known underlying cause of gastroparesis (Drossman et al, 1993). In diabetics, the vagus nerve may be damaged due to neuropathy. Complications of gastroparesis may include: Dehydration due to repeated vomiting, malnutrition due to poor absorption of nutrients, blood glucose levels that are harder to control, which can worsen diabetes, low calorie intake, bezoars and lose weight without trying (Jung et al, 2009). This in turns leads to a lower quality of life.
Treatment and Diet
Treatment of gastroparesis depends on the cause, how severe your symptoms and complications are, and how well you respond to different treatments. Sometimes, treating the cause may stop gastroparesis. Since diabetes is causing this patient’s gastroparesis, a medication treatment regimen will be prescribed to assist with control blood glucose levels. The patient will be educated on changing eating habits to ensure the right amounts of nutrients , calories, and liquids are received. Getting the right amount of nutrients, calories, and liquids can treat the disorder’s two main complications: malnutrition and dehydration. Eating foods low in fat and fiber, eating five or six small, nutritious meals a day instead of two or three large meals, chewing food thoroughly, eating soft, well-cooked foods, avoiding carbonated, or fizzy beverages is also beneficial in controlling this condition. Avoiding alcohol, drinking plenty of water or liquids that contain glucose and electrolytes, such as low-fat broths or clear soups, naturally sweetened, low-fiber fruit and vegetable juices, sports drinks, oral rehydration solutions, gentle physical activity after a meal, such as taking a walk, to avoid lying down for 2 hours after a meal, and take a multivitamin each day is recommended (ADA, 2018). If symptoms are moderate to severe, the patient may be advised to drink only liquids or eat well-cooked solid foods that have been processed into very small pieces or paste in a blender.
There are several medications that assist with motility in the absorption of nutrients, control nausea and vomiting and reduce pain. For example, Metoclopramide (Reglan), Domperidone and Erythromycin (Lippincott Williams and Wilkins, 2018) are among a few. For this patient, Metoclopramide (Reglan) 5 mg will be prescribed to assist in gastric emptying. Metoclopramide also has an anti-emetic property that will assist with nausea and vomiting, if applicable (Lippincott Williams and Wilkins, 2018). The patient will be reassessed in a month for tolerance; and if effective, quarterly thereafter. The patient’s blood glucose levels will be monitored daily to ensure there is no hypo or hyperglycemic episodes that may place the patient in an emergent situation.
For patients with diabetes, following a healthy meal plan can help stabilize blood glucose levels. Dietary modifications can also assist the patient to ensure the right amount of nutrients, calories, and liquids if the patient is malnourished or dehydrated . Early diagnosis of this condition is vital in ensuring optimal health. There is no cure for gastroparesis. It’s a chronic condition. However, it can be successfully managed to lead a healthy and fulfilling life.
American Diabetes Association (ADA) (2018). Gastroparesis in diabetics. Retrieved June 2, 2018 from www.ada.org
Drossman, D., Li, Z., Andruzzi, E., et al. (1993). U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Digestive Diseases and Sciences;38(9):1569–1580.
Jung, H., Choung, R., Locke, G., III, et al. (2009). The incidence, prevalence, and outcomes of patients with gastroparesis in Olmsted County, Minnesota, from 1996 to 2006. Gastroenterology;136(4):1225–1233.
Lippincott Williams and Wilkins (2018). Metoclopramide. Retrieved June 2, 2018 from www.lww.com