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NURS 2514 > 6 - Lower GI Problems > Flashcards

6 - Lower GI Problems Flashcards

1
Q

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

A

they are all inflammatory disorders

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2
Q

what is appendicitis?

A
  • 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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3
Q

what is the usual cause of appendicitis?

A

appendicitis is usually caused by obstruction by a fecalith or foreign material or if the appendix becomes twisted

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4
Q

what are the clinical manifestations of appendicitis?

A

periumbilical pain –> LRQ pain as appendix becomes permeable and localized peritonitis occurs
N + V + FEVER
general signs + symptoms of peritonitis

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5
Q

what is peritonitis?

A

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

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6
Q

what are some causes of chemical peritonitis?

A 
perforated ulcer
ruptured gallbladder
pancreattis
ruptured spleen
hemorrhage into peritoneal cavity
ruptured bladder
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7
Q

what are some causes of bacterial peritonitis?

A 
perforated appendix
intestinal obstruction
mesenteric thrombosis
pelvis inflammatory disease
septic abortion
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8
Q

what are the clinical manifestations of peritonitis?

A
  • severe generalized abdominal pain
  • N + V
  • rigid abdomen w rebound tenderness
  • septicemia
  • hypovolemic shock w tachycardia
  • paralytic ileus
  • fever / leukocytosis
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9
Q

what are the 2 types of inflammatory bowel diseases?

A

crohn’s disease + ulcerative colitis

- both autoimmune

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10
Q

what is crohn’s disease?

A

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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11
Q

which part of the GI tract does crohn’s disease most often effect? when does it develop?

A

most often effects the ileum but can occur anywhere along the GI tract

often develops in childhood or adolescence

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12
Q

what are the clinical manifestations of crohn’s disease?

A
  • RLQ pain + distention
  • intestinal obstruction
  • diarrhea
  • fistulas
  • exacerbations + remissions
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13
Q

describe intestinal obstruction as a clinical manifestation of crohn’s disease

A
  • inflammation + fibrosis affecting all layers of the GI tract lead to a thick, rigid wall (stricture) + predisposes to obstruction
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14
Q

describe diarrhea as a clinical manifestation of crohn’s disease

A

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

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15
Q

describe fistulas as a clinical manifestation of crohn’s disease

A

ulcers may penetrate the GI wall and create an abscess or fistula between adjacent structures

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16
Q

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

A

characterized by diarrhea, cramping, melena

may be induced by antiinflammatory drugs

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17
Q

what are the indications for surgical therapy for crohn’s disease?

A
  • 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
18
Q

where does inflammation occur in ulcerative colitis?

A

begins at the rectum, progresses proximally through the large intestine and involves the mucosa and submucosa only

19
Q

what are the clinical manifestations of ulcerative colitis?

A
  • 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
20
Q

what is malabsoroption syndrome? what are the possible causes?

what are the possible causes?

what are the most common malabsorption syndromes?

A

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
21
Q

what is celiac disease?

what are the clinical manifestations?

A

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

22
Q

what is the dx + care mechanism for celiac disease

A

o antibody blood test + endoscopy

o gluten avoidance is the only effective therapy

23
Q

what is lactase deficiency?

what are the clinical manifestations?

how do we diagnose it? manage it?

A 
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
24
Q

what is intestinal obstruction? what are the 2 types?

A
  • = 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

25
Q

describe mechanical obstruction

A

o mechanical obstruction: physical obstruction
 inguinal hernia
 volvulus
 intussusception
 tumor
 scar tissue + adhesions from previous surgery
 diverticular disease

26
Q

describe functional obstruction

A 
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
27
Q

identify the clincal manifestations of intestinal obstruction?

A

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

28
Q

compare SI + LI obstructions in terms of their onset

A

SI: rapid onset
LI: gradual onset

29
Q

compare SI + LI obstructions in terms of vomiting

A

SI: FREQUENT + COPIOUS VOMITING
LI: Late manifestation of vomiting

30
Q

compare SI + LI obstructions in terms of pain

A

SI: colicky, cramp-like, intermittent pain
LI: low-grade, cramping abd pain

31
Q

compare SI + LI obstructions in terms of BMs

A

SI: feces for a short time
LI: absolute constipation

32
Q

compare SI + LI obstructions in terms of abd distension

A

SI: distension depends on location of obstruction; can be minimal or greatly increased
LI: greatly increased

33
Q

what is diverticular disease?

where does it most often occur?

A
  • herniations of the mucosa and submucosa through the muscularis layer of the colon wall
  • 95% of cases involve the sigmoid colon
34
Q

what are the symptoms of diverticular disease?

A

most people remain asymptomatic other than constipation or diarrhea, occasionally the diverticula become inflamed (diverticulitis) or may bleed

35
Q

what are the risk factors for diverticular disease?

A
  • consumption of highly refined foods
  • less dietary fiber
  • chronic constipation
  • these all increase the pressure in the lumen and may cause herniation
36
Q

what are the clinical manifestations of diverticulosis?

A
  • mild abd pain + constipation due to increased muscle contraction necessary to maintain the forward propulsion of feces
  • episodes of constipation, disrrhea, + flatulence
37
Q

what are the manifestations of diverticulitis?

A 
•	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
38
Q

how can we treat diverticular disease?

A

increase fecal bulk, encourage regular defecation, and abx as necessary

39
Q

what are the 2 types of polyps of the large intestine?

A

hyperplatic (benign)

adenomatous (pre-cancerous / cancerou)

40
Q

how do we dx + treat polyps of the LI?

A

colonoscopy + removal

41
Q

why does a low fiber diet increase the risk of colorectal cancer?

A

diet low in fiber creates smaller + slower fecal bulk which could incrase the amt of time a carcinogen spends in the colon

42
Q

what are the clinical manifestations of colorectal cancer?

A

bleeding and / or occult blood
change in bowel habits, diarrhea, constipation, incomplete emptying
bobwel obstruction can occur in a L sided tumor

NURS 2514 (10 decks)

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