6 - Lower GI Problems Flashcards
what do appendicitis, peritonitis, and gastroenteritis have in common?
they are all inflammatory disorders
what is appendicitis?
- inflammation of the vermiform appendix
- increasing pressure w/in the appendix due to inflammation + obstruction leads to ischemia + necrosis
- inflammation can increase permeability of appendix –> localized peritonitis as intestinal bacteria leak into peritoneal cavity
- pressure continues rising which leads to perforation or rupture of the appendix
what is the usual cause of appendicitis?
appendicitis is usually caused by obstruction by a fecalith or foreign material or if the appendix becomes twisted
what are the clinical manifestations of appendicitis?
periumbilical pain –> LRQ pain as appendix becomes permeable and localized peritonitis occurs
N + V + FEVER
general signs + symptoms of peritonitis
what is peritonitis?
inflammation of the peritoneal membranes; caused by chemical irritation or bacterial infection
what are some causes of chemical peritonitis?
perforated ulcer ruptured gallbladder pancreattis ruptured spleen hemorrhage into peritoneal cavity ruptured bladder
what are some causes of bacterial peritonitis?
perforated appendix intestinal obstruction mesenteric thrombosis pelvis inflammatory disease septic abortion
what are the clinical manifestations of peritonitis?
- severe generalized abdominal pain
- N + V
- rigid abdomen w rebound tenderness
- septicemia
- hypovolemic shock w tachycardia
- paralytic ileus
- fever / leukocytosis
what are the 2 types of inflammatory bowel diseases?
crohn’s disease + ulcerative colitis
- both autoimmune
what is crohn’s disease?
inflammatory process characterized by ulcerative “skip lesions” that involve the entire thickness of the GI wall and the creation of nodules / “cobblestone appearance” to the mucosa
which part of the GI tract does crohn’s disease most often effect? when does it develop?
most often effects the ileum but can occur anywhere along the GI tract
often develops in childhood or adolescence
what are the clinical manifestations of crohn’s disease?
- RLQ pain + distention
- intestinal obstruction
- diarrhea
- fistulas
- exacerbations + remissions
describe intestinal obstruction as a clinical manifestation of crohn’s disease
- inflammation + fibrosis affecting all layers of the GI tract lead to a thick, rigid wall (stricture) + predisposes to obstruction
describe diarrhea as a clinical manifestation of crohn’s disease
damage to the GI mucosa prevents absorption and inflammation can increase motility
describe fistulas as a clinical manifestation of crohn’s disease
ulcers may penetrate the GI wall and create an abscess or fistula between adjacent structures
describe exacerbations + remissions as a clinical manifestation of crohn’s disease
characterized by diarrhea, cramping, melena
may be induced by antiinflammatory drugs
what are the indications for surgical therapy for crohn’s disease?
- drainage of abdominal abscess
- failure to respond to conservative therapy
- fistulas
- inability to decrease corticosteroids
- intestinal obstruction
- massive hemorrhage
- perforation
- secondary hydronephrosis
- severe anorectal disease
- suspicion of carcinoma
where does inflammation occur in ulcerative colitis?
begins at the rectum, progresses proximally through the large intestine and involves the mucosa and submucosa only
what are the clinical manifestations of ulcerative colitis?
- rectal bleeding
- diarrhea (tissue obstruction interferes w absorption in the LI which results in small volume of diarrhea)
- colon obstruction + dilation due to inflammation
- colorectal carcinoma
- autoimmune diseases
what is malabsoroption syndrome? what are the possible causes?
what are the possible causes?
what are the most common malabsorption syndromes?
results from impaired abs of fats, carbs, proteins, minerals, vits
o biochemical or enzyme deficiencies o bacterial proliferation o disruption of SI mucosa o disturbed lymphatic and vascular circulation o surface area loss • most common malabs syndrome = lactose intolerance o followed by: IBD celiac tropical sprue cystic fibrosis
what is celiac disease?
what are the clinical manifestations?
autoimmune disorder against gluten protein
o malabs + vitamin deficiencies due to inflammation + atrophy of SI villi
o pale, voluminous, and abnormally odorous diarrhea
o abdominal pain + cramping; bloating w abdominal distension
what is the dx + care mechanism for celiac disease
o antibody blood test + endoscopy
o gluten avoidance is the only effective therapy
what is lactase deficiency?
what are the clinical manifestations?
how do we diagnose it? manage it?
lactase deficiency = deficient / absent lactase enzyme • manifestations o abd bloating + cramps o flatulence o diarrhea o nausea o borborygmi o vomiting • dx o breath, blood, and stool tests • nursing mgmt. o lactose avoidance o lactase supplements
what is intestinal obstruction? what are the 2 types?
- = any situation where there is impaired mvmt of the intestinal contents
- most commonly occurs in the SI but can occur in the LI (symptoms develop slowly in this case)
2 types: mechanical + functional
describe mechanical obstruction
o mechanical obstruction: physical obstruction
inguinal hernia
volvulus
intussusception
tumor
scar tissue + adhesions from previous surgery
diverticular disease
describe functional obstruction
o functional obstruction (paralytic ileus): neurological impairment or failure of propulsion peritonitis pancreatitis Crohn’s ulcerative colitis electrolyte abnormalities mesenteric thrombus spinal cord injury any severe medical illness
identify the clincal manifestations of intestinal obstruction?
o borborygmi: mechanical obstruction results in audible rumbling sounds as the intestine attempts to push its contents forward
o absence of bowel sounds in functional obstruction
o pain + distension
o vomiting – quicker + more severe in proximal obstructions
o hypovolemic shock
o ischemia / necrosis peritonitis as intestinal bacteria + toxins leak into the blood + peritoneal cavity
compare SI + LI obstructions in terms of their onset
SI: rapid onset
LI: gradual onset
compare SI + LI obstructions in terms of vomiting
SI: FREQUENT + COPIOUS VOMITING
LI: Late manifestation of vomiting
compare SI + LI obstructions in terms of pain
SI: colicky, cramp-like, intermittent pain
LI: low-grade, cramping abd pain
compare SI + LI obstructions in terms of BMs
SI: feces for a short time
LI: absolute constipation
compare SI + LI obstructions in terms of abd distension
SI: distension depends on location of obstruction; can be minimal or greatly increased
LI: greatly increased
what is diverticular disease?
where does it most often occur?
- herniations of the mucosa and submucosa through the muscularis layer of the colon wall
- 95% of cases involve the sigmoid colon
what are the symptoms of diverticular disease?
most people remain asymptomatic other than constipation or diarrhea, occasionally the diverticula become inflamed (diverticulitis) or may bleed
what are the risk factors for diverticular disease?
- consumption of highly refined foods
- less dietary fiber
- chronic constipation
- these all increase the pressure in the lumen and may cause herniation
what are the clinical manifestations of diverticulosis?
- mild abd pain + constipation due to increased muscle contraction necessary to maintain the forward propulsion of feces
- episodes of constipation, disrrhea, + flatulence
what are the manifestations of diverticulitis?
• inflammation of diverticula can occur from fecal stasis o results in lower left abd pain * often called left-sided appendicitis • melena or occult blood in the stool • slight fever • elevated white cell count • complications include: o obstruction o perforation o abscess formation o peritonitis
how can we treat diverticular disease?
increase fecal bulk, encourage regular defecation, and abx as necessary
what are the 2 types of polyps of the large intestine?
hyperplatic (benign)
adenomatous (pre-cancerous / cancerou)
how do we dx + treat polyps of the LI?
colonoscopy + removal
why does a low fiber diet increase the risk of colorectal cancer?
diet low in fiber creates smaller + slower fecal bulk which could incrase the amt of time a carcinogen spends in the colon
what are the clinical manifestations of colorectal cancer?
bleeding and / or occult blood
change in bowel habits, diarrhea, constipation, incomplete emptying
bobwel obstruction can occur in a L sided tumor
