This chapter discusses the assessment and laboratory findings, imaging, diagnosis and management of ascites. A common complication of cirrhosis is ascites, or the accumulation of fluid in the abdominal cavity. Ascites that develops from cirrhosis is associated with portal hypertension. The patient with cirrhosis and ascites may complain of increased weight gain, lower extremity edema, and abdominal bloating or distension. Physical examination findings may reveal a distended or even tense abdomen, positive fluid wave, dullness to abdominal percussion, and peripheral edema. Routine laboratory testing, such as complete blood count, complete metabolic panel, and liver function testing, should be performed with new-onset ascites and at routine return visits. Patients with cirrhosis and ascites can develop electrolyte imbalances and renal failure. Ultrasound is helpful to determine whether ascites is present if there is any uncertainty upon physical examination. Patients should abstain from alcohol consumption and avoid using nonsteroidal anti-inflammatory drugs.
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Concurrent with the release of Education and Identity in 1969, the United States was at the nexus of social unrest and expanding funding and support for educational initiatives. The decades of the 1950s and 1960s saw a great increase in research and practice focused on developmental theorists working in the area of higher education. At the forefront of this work was theorist Arthur Chickering. The primary construct of Chickering’s (1969) work is the Seven Vectors of Development. The vectors are: (a) developing competence, (b) managing emotions, (c) moving through autonomy toward interdependence, (d) developing mature interpersonal relationships, (e) establishing identity, (f) developing purpose, and (g) developing integrity. This vector addresses competence across three domains: intellectual, physical and manual, and interpersonal. This chapter briefly outlines Chickering’s life work, and ways in which practitioners can apply his theory to their daily interactions with college students.
Traditionally, there has been a division of labor in higher education between academics and student affairs. This chapter is designed to focus on the plausibility of using theory to facilitate communication across the many departments and divisions of higher education. It is important to remember that the student affairs profession “grew from the campus up, not from theory down”. Early institutions of higher education followed the Oxbridge model with historically based residential living systems in which educators resided in residence halls with the students. This concept of faculty–student integration remains a valuable component in student success today, and is discussed in greater detail in this chapter. One useful “language” for student affairs practitioners is found in Erikson’s stages of psychosocial development. Erik Erikson pioneered a theoretical framework and proposes an eight-staged life-span model through which developing individuals permeate starting at birth and eventually ending with death.
Inflammatory bowel disease (IBD) is a broad diagnosis that includes two major chronic diseases: ulcerative colitis (UC) and Crohn’s disease (CD). IBD is typically diagnosed in young adulthood. Smoking has been associated with a higher risk of developing CD. UC is an inflammatory disease of the mucosa of the colon and rectum. Typical symptoms include bowel movement urgency, tenesmus and bloody diarrhea. CD is a chronic inflammatory disorder of the alimentary tract. It is associated with high levels of proinflammatory cytokines. Referral to a gastroenterologist specializing in IBD may be needed. To confirm diagnosis, a flexible sigmoidoscopy is necessary in cases of UC and a colonoscopy is necessary in cases of CD. The goal for treatment of IBD is to suppress the immune system and help heal the bowel. Initial treatment for patients with mild to moderate UC includes 5-aminosalicyclic acid compounds.
Some drugs, like aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), have been blamed for peptic ulcer formation. The most common peptic ulcers are duodenal ulcers. Risk factors for the development of peptic ulcer disease are chronic NSAID use, older age, Helicobacter pylori infection, use of anticoagulant or anti-platelet medications, history of prior ulcers, use of corticosteroids, alcohol use, and smoking. One of the goals of treatment for the patient with peptic ulcer disease is eradication of H. pylori infection. Complications that develop if peptic ulcer is untreated include gastrointestinal bleeding, gastric cancer and gastric outlet obstruction, with bleeding the most common. Most patients with peptic ulcer disease are asymptomatic. When symptoms do arise, dyspepsia is a common complaint. Sucralfate, a formula of aluminum hydroxide and sulfated sucrose, is given to patients with peptic ulcer disease to protect the gastric and duodenal mucosa.
This chapter discusses the incidence and risk factors, assessment, laboratory and image testing, diagnosis and treatment of constipation. Constipation affects 15" of adults in Western countries and 33" of patients older than 60. History is important when trying to determine the cause of constipation. The patient should be asked for a detailed description of bowel movements, including how many per day or week, how often, and how long has constipation been a problem. A complete blood count and complete metabolic panel should be obtained. Several electrolyte imbalances can cause constipation. Constipation is often caused by inadequate fiber intake or hydration, inactivity, or can be medication-related. Providers should encourage patients with acute constipation to increase hydration and fiber intake to 20 to 35 grams per day. Nutritional modification may be enough to resolve constipation and can likely prevent further episodes. In some cases of chronic constipation, nonpharmacologic treatments are helpful.
Informal and loosely generated models of White identity development began to emerge in the late 1970s and early 1980s; however, the first formal White identity development model, or typology, was proposed by Helms in 1984. This chapter describes her model, followed by an application of the model to the opening vignette. It identifies strategies for educators and student affairs practitioners to work with students like Craig to begin to more fully understand his Whiteness, the sociopolitical realities of race on campus and, in general, increase his multicultural competence, and engage in healthy interracial interactions. The chapter also discusses the summary of the literature examining the steps educators and student affairs practitioners can take to promote their own cross-cultural interactions and multicultural knowledge in order to more effectively work with students struggling with their own racial identity, followed by the strategies to promote healthy interracial interactions among students.
This chapter discusses the incidence and risk factors, assessment and laboratory findings, diagnosis and management of celiac disease. Celiac disease is considered an autoimmune disorder with a genetic component. If left untreated, patients with celiac disease have an increased risk of developing gastrointestinal cancers and enteropathy-associated T-cell lymphoma. Some of the disease’s symptoms are asymptomatic, whereas some have severe malabsorption issues with skin manifestations. Celiac disease is frequently found in patients who have other autoimmune disorders. A serologic test called immunoglobulin A (IgA) anti-tissue transglutaminase (tTGA) is performed to detect possible celiac disease in patients over two years old. Characteristic histological changes of celiac disease are villous atrophy, crypt hyperplasia, intraepithelial lymphocytosis, and mucosal inflammation. The only curative treatment for celiac disease is strict adherence to a gluten-free diet (GFD). It is important to recognize other vitamin deficiencies in patients with celiac disease, including B 12, D, iron, and folate.
Holland theorized six distinct worker personalities (Realistic, Investigative, Artistic, Social, Enterprising, and Conventional). This is often referred to as RIASEC. The theory includes six work environments that correspond to the same personality types (Realistic, Investigative, Artistic, Social, Enterprising, and Conventional). Although people possess aspects of each type, the general thesis of the theory is that salient types (work personalities) will emerge in each individual. Holland’s work represents a significant contribution to career development and counseling. Understanding Holland’s focus on interests as expressions of personality aids career counselors and student development specialists in helping students gain critical self-understanding. Exploring the match between personalities and work environments is a fundamental aspect of applying this theory to student development. Helping students to explore and learn about different careers that may be of interest to them is congruent with the goals of higher education institutions and student development theories.
Integral to theories of moral development is the matter of not only what individuals think but also how they think. Across the life span, moral development is shaped by challenging events that prompt individuals to question the frameworks they have created for finding ways to determine what is good and what is bad. College students encounter new ideas and values that differ from those of their families, in the classroom, in the residence hall, in the dining facility, in the student union, and sometimes on the athletic field or court. In order to illustrate how moral development unfolds within a college student population, this chapter introduces a fictitious character who displays each stage of moral development for two theories–Lawrence Kohlberg’s (1963, 1984) and Carol Gilligan’s (1982) models of moral development. The chapter discusses the underpinnings of two specific moral development theories.