#6 Gastrointestinal System Flashcards
Tumours of the colon ?
1.) Ascending (right) colon tumours are generally large and bulky.
2.) Tumours of the descending (left) colon are small and button like masses
What is a rectal carcinoma ?
generally located 15cm from the anus opening, spreads transmurally (passing through an anatomical wall) to the vagina in women or prostate in men.
Clinical manifestations colon tumours
pain, bloody stool and bowel habit change
colorectal cancer diagnosis tools/treatment ?
fecal occult blood test and colonoscopy. treatment is usually surgical removal, with chemotherapy and radiotherapy used.
what is ulcerative colitis
inflammatory disease that causes ulceration, abscess formation and necrosis of the colonic and rectal mucosa
symptoms of ulcerative colitis
cramping pain, bleeding, frequent diarrhoea, dehydration and weight loss
what is crohn’s disease ?
similar to ulcerative colitis, however it affects both the large and small intestines and ulceration tends to involve all lumen layers.
symptoms of crohns disease ?
‘skip lesion’ fissures and granulomas, abdominal tenderness, diarrhoea and weight loss.
what is a peptic ulcer ?
an area of mucosal inflammation and ulceration caused by excessive secretion of gastric acid or disruption of the protective mucosal barrier, or both.
3 types of peptic ulcers ?
gastric, duodenal and stress
gastric ulcer ?
develop near parietal cells, generally in the antrum and become chronic. gastric secretions may be normal or decreased and may get pain after eating.
duodenal ulcers ?
most common peptic ulcer, associated with increased numbers of parietal (acid-secreting) cells in the stomach, elevated gastrin levels and rapid gastric emptying.
Pain occurs when the stomach is empty and is relieved with food or antacids. Duodenal ulcers usually heal spontaneously and recur frequently.
Stress Ulcers ?
acute form of peptic ulcer that accompany’s severe illness, systemic trauma or neural injury. Emotinal stress may cause stress ulcers. Usually occurs in multiple sites of the stomach and duodenum.
what is malnutrition ?
lack of nourishment from inadequate amounts of kilojoules, protein, vitamins or minerals.
starvation ?
extreme state of malnutrition
what does short-term starvation result in ?
stimulates stored glucose to be produced from glucose stores and non-carbohydrate molecules
Long-term starvation ?
Triggers the breakdown of ketone bodies and fatty acids, resulting in proteolysis (protein breakdown) which is advanced stage and death will ensue if nutrition is not restored
What does a intestinal obstruction prevent ?
The normal movement of chyme through the intestinal tract. It can involve the SI or LI. Can be due to
1.) intussusception (part of intestine sliding into another part
2.) Volvulus (twisting or knotting of the intestinal tract)
3.) abdominal hernia (organ pushes through containing structure)
4.) paralytic ileus (motor activity of bowel impaired- not a physical block)
Vomiting ?
forceful emptying of the stomach by gastrointestinal contraction and with the exception of projectile vomiting, which is directly associated with vomiting centre in the brain.
Diarrhoea ?
can be caused by excessive fluid drawn into the intestinal lumen by osmosis (osmotic diarrhoea), excessive secretion of fluids by intestinal mucosa (secretory diarrhoea) or gastrointestinal motility.
Is a particular concern for young children, who are susceptible to changes in fluid balance. Severe dehydration from diarrhoea can be fatal. (childhood diarrhoea caused by rotavirus)
Gastrointestinal bleeding ?
Manifestations include
1.) haematemesis (vomiting of blood)
2.) melaena (dark, tarry stools)
3.) maematochezia (frank bleeding from the rectum)
Occult bleeding can be detected only by testing stools or vomitus for the presence of blood.
Abdominal distension ?
accompanies bowel hypermotility (high activity) and the accumulation of fluids in the peritoneal cavity. it may indicate underlying bowel disease.
Diverticula Disease ?
- Outpouchings of colonic mucosa through the muscle layers of the colon wall
- Related to diets high in refined foods and a lack of fibre in a patient
- Defined as the inflammation of one or more diverticula. pathogenesis is unclear.
Normal assessment for suspected diverticulitis ?
history, physical examination and investigation for inflammatory disease (fever, nausea, vomiting, pain and haemorrhagic disease)`
Routine investigations for diverticulitis ?
Urinalysis, Hb, white cell count, blood cultures, urea and electrolytes, x-ray if suspected bowel obstruction or perforation and CT scan
Routine nursing care for diverticulitis ?
Nil by mouth, administer IV fluids, administer antibiotics, monitor all fluid intake and output on FBC, administer analgesia, frequent vital sign obs, O2 therapy as prescribed, record and report bowel actions
common complications of acute diverticulitis
intestinal bleeding, fistulas, abscess, colonic obstruction and bowel perforation with peritonitis.
key clinical management strategy for diverticulitis
appropriate antibiotics, combination of amoxycillin+clavulanate and metronidazole and a hartman’s procedure
Metoclopramide
Brand name: maxalon
IFU: Nausea + vomiting
DC: Antiemetic
MOA: Dopamine antagonists
PE: empty by the stomach + increase intestinal motility
ROA: Oral, IM or IV
CSE: Restlessness, drowsiness and fatigue
Prochlorperazine
Brand Name: Stemetil
IFU: Nausea + Vomiting
Drug Class: Anti-emetic
MOA: Dopamine antagonists
PE: Phenothiazine antiemetic
ROA: Oral + IV
CSE: Constipation, dry mouth + drowsiness
Ondansetron
Brand name: Ondaz
IFU: Nausea +Vomiting
DC: Antiemetic
MOA: 5-HT3 Receptor antagonists
PE: Antagonism of 5HT3 receptors on neurons located in CNS and peripheral
ROA: Oral + IV
CSE: Headache, Local IV site injection reactions.
Hyoscine Butylbromide
Brand name: Buscopan
IFU: Spasm of the GI tract
DC: Antispasmodic
MOA: Muscarinic receptor antagonists
PE: Reduces the tone and peristalsis of smooth muscle
ROA: Oral + IV
CSI: Rash, tachycardia and dry mouth
Amoxil
Brand name: Amoxicillin
IFU: Infections due to susceptible organisms incl skin, repiratory etc
DC: Penicillin antibiotic
MOA: Aminopenicillin, broad spectrum
PE: Bactericidal action against gram positive and gram negative susceptible organisms
ROA: Oral and IV
Gentamicin
Brand Name: Gentamicin
IFU: Infections due to susceptible organisms, bacteraemia, RTI and periontitis
DC: Aminoglycoside, antibiotic
MOA: Bactericidal aminoglycoside
PE: inhibiting protein synthesis in susceptible bacteria
ROA: IV
CSE: Dizziness, vertigo, tinnitus, roaring in the ears and hearing loss which may be irreversible
Metronidazole
Brand name: Flagyl
IFU: Severe anaerobic infection
DC: Nitroimidazole antibiotic
MOA: bactericidal action
ROA: Oral + IV
CSE: Nausea + vomiting
Cefotaxime
Brand Name: Cefotaxime
IFU: intra-abdominal infection and other infections
DC: Cephalosporins antibiotic
MOA: Bactericidal action
PE: Bactericidal effect is due to cell wall synthesis
ROA: IV
CSE: Hypersensitivity reactions, angioedema, bronchospasm and malaise
