a couple more lower GI probs

Question 1

Diverticula

Answer 1

saccular dilations or outpouchigs of the mucosa in the colon

common in older adults

Question 2

Diverticulosis vs diverticulitis

Answer 2

-osis = multiple, noninflamed diverticula

-itis = 1+ inflamed diverticula

Question 3

complications of diverticula

Answer 3

perforation, abscess, fistula, and bleeding

Question 4

where and why do diverticula happen

Answer 4

occur in weak points of left colon

caused by:
-genetics
-constipation/ lack of fiber
-obesity, inactivity, tobacco, alc, and NSAID

Question 5

manifestation of diverticulosis vs diverticulitis

Answer 5

-osis = motly asymptomatic (pain, gas, bloating)

-itis = acute pain, absent bwel sounds, vomiting, systemic infection

old ppl only have abdominal tenderness

Question 6

diagnostic study for diverticula

Answer 6

usual = signoidoscopy or colonoscopy

preferred = CT scan with oral contrast

Question 7

treat acute diverticulitis

Answer 7

bowel rest to reduce inflammation
-clear liquids, physical rest, analgesia

if severe:
-NPO, NG tube, IV antibiotics, bed rest
-look for abscess, bleeding, and peritonitis

Question 8

procedures for recurring diverticulitis

Answer 8

surgical resection with anastomosis or temporary colostomy

Question 9

Fistulas: usual location and early signs

Answer 9

rectal-vaginal

early signs = fever and abdominal pain

Question 10

treatment of fistulas

Answer 10

find it
IV fluid replacement
control infection
protect surrounding skin
manage I/O and drainage
food for healing

usually goes away by itself

Question 11

Hernia types

Answer 11

reducible = easily return to abdominal cavity

irreducible/incarcerated = can’t be put back - abdominal contents are trapped

**strangulated = blood supply compromised = emergency

Question 12

hernia manifestations

Answer 12

pain that increases with abdominal pressure

if strangulated: severe pain, vomiting, cramping, ab pain, distention

Question 13

treatments for hernias

Answer 13

herniorrhaphy = laser surgery repair
hernioplasy = reinforce weak area with wire or mesh
strangulated = emergency surgery and temporary colostomy

Question 14

Malabsorption syndrome

Answer 14

causes: lactose intolerance, IBD, CF, celiac, tropical sprue
signs: weigh loss, diarrhea, steatorrhea
disgnosis: stool, blood, CT, barium enema, D-xylose

treatment depends on cause

Question 15

Celiac

Answer 15

autoimmune disease that damages small intestine mucosa and is triggered by gluten

a/w rheumatoid arthritis, DM I, and thyroid disease

Question 16

3 factors affecting who gets celiac

Answer 16

genetic predisposition
gluten ingestion
immune mediated response

Genes = HLA allele –> chronic inflamation from gluten-specific peptide damages tissue and alters nutrient absorption

Question 17

manifestations of celiac

Answer 17

diarrhea, pain, gas, distension, malnutrition

atypical: joint pain, osteoporosis, enamel hypoplasia, fatigue, peripheral neuropathy repro probs, dermatitis herpetiformis

Question 18

Lactase deficiency: what is it? who gets it?

Answer 18

lactose malabsorption causes bacterial overgrowth in small bowel which damages intestine and interferes with absorption

Asians, Africans, or premies

Question 19

short bowel syndrome

Answer 19

not enough bowel to absorb enough nutrients
(usually when 70-75% has been removed)

manifests:
-dehydration, weight loss, diarrhea, vit and e- imbalances
-pain, gas, nutrient deficiencies, steatorrhea

Question 20

Gastrointestinal stromal tumors

Answer 20

rare cancer cells in wall of GI tract
manifests as nausea, early satiety and later GI bleeding
treat with surgery or tyrosine kinase inhibitors

Question 21

hemmorhoids

Answer 21

dilated hemorrhoidal veins either above or outside anal sphincter

risks = pregnancy, constipation, straining, heavy lifting, obseity, ascites, prolonged standing

Question 22

nursing management for hemmorhoids

Answer 22

sitz bath
OTC drugs
seek help if bleeding or prolapse

Question 23

Anal fissures

Answer 23

-caused by trama, STDs, inflammation
-high pressure and poor blood supply = ischemia = ulcer
-severe anal pain especially when pooping
-treatment = fiber, fluids, sitz, topical analgesia, stool softeners

Question 24

Anorectal abscess

Answer 24

perianal collection of pus due to obstruction of anal glands

pain, swelling, gross smell, fever, sepsis

Treat w/ antibiotics and surgical drainage

Nursing: moist heat, low fiber, positioning

Question 25

Anal fistula

Answer 25

happens bc of abscesses or Crohn’s
drainage

Sufgery = fistulotomy, LIFT, others

Question 26

Anal cancer

Answer 26

not common
-happens in gay, HIV smokers
-rectal pain, bleeding, fullness, and weird pooping

Screen w/ DRE and pap

diagnose with anoscopy, biopsy, or ultrasound

treat with surgery, chemo, or radiation