6 - Lower GI Problems Flashcards by Jillian Henry

what do appendicitis, peritonitis, and gastroenteritis have in common?

they are all inflammatory disorders

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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

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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

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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

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what is peritonitis?

inflammation of the peritoneal membranes; caused by chemical irritation or bacterial infection

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what are some causes of chemical peritonitis?

perforated ulcer
ruptured gallbladder
pancreattis
ruptured spleen
hemorrhage into peritoneal cavity
ruptured bladder

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what are some causes of bacterial peritonitis?

perforated appendix
intestinal obstruction
mesenteric thrombosis
pelvis inflammatory disease
septic abortion

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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

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what are the 2 types of inflammatory bowel diseases?

crohn’s disease + ulcerative colitis

- both autoimmune

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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

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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

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what are the clinical manifestations of crohn’s disease?

RLQ pain + distention
intestinal obstruction
diarrhea
fistulas
exacerbations + remissions

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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

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describe diarrhea as a clinical manifestation of crohn’s disease

damage to the GI mucosa prevents absorption and inflammation can increase motility

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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

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describe exacerbations + remissions as a clinical manifestation of crohn’s disease

characterized by diarrhea, cramping, melena

may be induced by antiinflammatory drugs

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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