Bowel Flashcards
What is meconium?
first feces from a newborn
what is newborn stool color dependent upon?
type of milk ingested
When do you develop duodenocolic reflex?
toddler/preschool age
What age do you typically do toilet training after?
22 months
Black tarry stool means
upper GI bleed
Clay colored stool means
liver disfunction- lack of bilirubin
What does yellow/green stool mean?
high fat content
normal amount of stool is
100-300 g/day
norm stool consistency is
soft, formed
What do intestines do besides make stool?
segmentation, peristalsis, absorption
what stimulates peristalsis?
walls of intestines
-duodenocolic reflex
where are nutrients and electrolytes absorbed?
duodenum and jejunum
what is the valsalva maneuver
- deep breath
- contract abd muscles
- contract pelvic floor
- stimulates vagal response
- can happen in response to bearing down when constipated
what effects does valsalva maneuver have on other body systems?
- slow heart rate
- unclog ears
- lower BP initially
- reset heart rhythm
- dizziness
which kind of fiber increases GI transit time? and examples
solube
-oat bran, barley, nuts
what kind of fiber decreases GI transit time? (and examples)
insoluble
-whole grains, fruit/veg
Which kind of fiber promotes loose stools?
insoluble
____% of stool is water
75
If you have increased GI motility will stool be solid or loose?
loose
-not enough water being absorbed by body
factors impacting bowel elimination
- activity
- ignoring urge leads to weakening urge over time
- change in routine
- pregnancy
- medications
When pregnant women take iron supplement, what happens to bowel habits?
constipation
when colon is diverted through a stoma?
colostomy
when ileum is diverted through a stoma?
ileostomy
-no large intestine
which is more likely to have issues with fluid and electrolyte loss- colostomy or ileostomy?
ileostomy b/c no large intestine
What are kock and j pouches?
surgical pouches to give patient control over ostomy bowel movement timing
Normal stoma is
pink
on abd surface
how much space b/w stoma and bag?
1/8- 1/4”
what does a dusky/blue stoma indicate?
poor circulation
what does a stoma that is retracting indicate?
potential for feces in ABD cavity –> peritonitis
when should ostomy pouch be emptied (volume in bag)
1/4-1/3 of way full
what do you rinse the pouch with after cleaning it?
clea warm water with 60 mL syringe
what if fecal contents leak around the pouch where it is attached to skin?
-change entire device
Scaphoid shaped ABD indicates
malnutrition
Distended ABD indicates
obstruction
Normal bowel sounds are heard within
5-15 seconds
when is auscultation preformed in ABD assessment?
before palpation!
if bowel sounds occur more than every 5 seconds =
hyperactive
how to listen to confirm absent bowel sounds
3-5 minutes = 1-2 minute/quadrant
what is most important factor for determining if someone is constipated or not?
routine
-3 days since last bowel movement might be normal for someone
signs of constipation
bloating fullness urge to defecate without ability to pass stool malaise loss of appetite nausea vomiting abd distention
definition of chronic constipation
constipation persistent for at least 12 weeks in a years time
common causes of constipation
meds, opioids, fiber, inactivity
what is usually the cause of fecal impaction?
result of untreated and unrelieved constipation
signs and sxs of fecal impaction
-several day constipation followed by INVOLUNTARY, LOOSE BM that does not relieve feeling of constipation
how is fecal impaction diagnosed?
digital rectal exam
what type of gastric motility causes diarrhea?
increased
What type of bowel sounds with diarrhea?
hyperactive
causes of diarrhea
meds, medical conditions, emotional changes
symptoms of diarrhea
cramping
nausea
Prolonged: burning sensation, anal inflammation, bleeding/breakdown
causes of fecal incontinence
- neurological injury
- spinal cord injury
- altered mental status
what causes gas?
bacteria activity in large intestine
Surgery and gas
- see gas when ambulating after surgery
- see gas with all surgery but more with ABD
what foods increase flatulence? what can help with that?
high fiber
-introduce new high fiber diet gradually
Distention requires…..
can be caused by…..
investigation and follow up
obstruction or tumor
What type of bowel activity could lead to an order for a stool specimen and culture?
-diarrhea or altered color
what is a fecal occult blood test
-tests presence of blood in stool
fecal occult blood test is screening test for
colorectal cancer b/c blood in stool may indicate cancer or polyps in rectum or colon
considerations for after a barium swallow
-impaction, constipation, increase fluids, chalky/white stool, adminster laxative
test for upper GI?
EGD
Lower GI tests and frequency for colorectal cancer screening
sigmoidoscopy- every 5 yrs
colonoscopy - every 10 years
After lower GI tests monitor for…
Dull abd pain (perforation)
bleeding
which is used more often? sigmoid or colon oscopy?
colonoscopy since it visualizes the entire colon
bulk laxative examples and fxn
metamucil, fibercon
-nonabsorbable fiber attracts water into large intestine
emollient (stool softeners) examples and fxn
colace, surfak
- allow more water to enter stool
- short term usage
osmotic laxative and fxn
milk of magnesia, fleet enema, miralax
- increase colon motility through release of CCK causing water retention in stool
- more frequent and softer stool
stimulant laxative and fxn
castor oil, senokot, ex-lax
-direct stimulation of intestinal mucosa
2 antidiarrheal treatments
loperamide
bismuth subsalicylate
medications to treat cause of diarrhea
- antimicrobials
- steroids used for inflammatory bowel disease
how do you treat CDiff?
fecal microbiota transplantation
-90% effective in treating
when should use use bowel training?
for people with neurological impairment
tools for bowel training
-schedule
partial sphincter control: pelvic floor exercise, abd massage, biofeedback
enema indication
- promote bowel movement
- clear bowel area before a procedure
Types of enemas (3)
small volume- mineral oil and steroids
large volume- tap water/saline
return flow- removes flatus
NG tube indications
- gastric decompression
- gastric lavage
- gastric feeding
how do you confirm NG tube placement?
xray!
**confirm before use!
