Bowel conditions and colonoscopy procedures Flashcards
Discuss fibre
30-40g a day
Edible part of plants and carbs that is not digested
Insoluble fibre = bowel regularity (legumes, vegetables, fruits, nuts, wheat, oats, brown rice)
Soluble fibre = slows rate of digestion and absorption of food (barley, ispaghula, rye, vegetables
Three main features of diverticular disease
Development of diverticula
bowel wall thickened
internal diameter of bowel is narrowed
Signs and symptoms of Diverticular disease
Early stage = no symptoms, cramping lower left abdominal discomfort
diarrhoea, incontinence, blood may mix with stool
infection may cause fever, nausea, vomiting
Diverticular disease management
asymptomatic = no treatment
bowel rest = low fibre or fluid only diet
antibiotics = infection no complication, respond in few days
Pain relief
Severe or acute = hospitalisation, surgery, untreated (bleeding, blockage, abscess, perforation of bowel wall)
How can diverticular disease be prevented?
30g fibre in diet
Diet = fruits, vegetables, whole grain cereals
Inc water intake = 8 cups a day
regular exercise
How is coeliac disease diagnosed?
Serological blood test = for patient consuming gluten, unreliable in children <4 yrs
gastroscopy & biopsies = small bowel to confirm diagnosis, dont need to stop gluten
genotype testing = patient on gluten free diet, screened for human leukocyte antigen, disease excluded if negative
List coeliac disease symptoms
Asymptomatic
fatigue, weakness, lethargy, GI problems (bloating, flatulence, nausea, abdominal pain, indigestion)
nutrition deficiencies (folate, zinc, Vit D, Vit B12)
anaemia, osteoporosis, infertility in women
How is coeliac disease treated?
Remove cause - lifelong gluten free = no wheat, barley, rye
Initiate = vitamin/mineral supplement, Ca2+ supplement,
temporary restriction of lactose = due to damage of villi
assess meds for gluten, refer to dietician
What is coeliac disease?
chronic inflam disease of small intestines = damage to small bowel due to exposure to dietary gluten
Flat, reduced surface area of small intestine = malabsorption of nutrients, minerals
Bowel cancer symptoms
No symptoms until advanced (Sometimes)
common symptoms = rectal bleeding, bright red
altered bowel habits = constipation, diarrhoea
unexplained tiredness, anaemia
abdominal pain/cramping
List bowel cancer risk factors
> 50 yrs of age
family history
previously had polyps
IBD = crohns, ulcerative colitis
smoking, alcohol, obesity
poor diet = lack fibre, high fat
What screening is done for bowel cancer?
Faecal occult blood test (FOBT) = detect small amounts of blood, not 100% accurate, most well researched screening, test every 2 yrs
Done in Aus for people aged 50, 55, or 65
Invited to screen every 2 yrs until 74
When can FOBT not be completed?
during/within 3 days of either side of menstrual period
haemorrhoids if bleeding
recently had colonoscopy
blood present in urine/present in toilet bowl
Outline general preparations for colonoscopy
Clear liquid diet for 1-3 days before procedure
Laxatives taken to prepare bowel
different prep instruction depending on time of day of procedure
What products are used in colonoscopy prep?
Macrogol 3350 = osmotic laxative
Magnesium +/- sodium picosulfate = osmotic laxative
sodium phosphate = osmotic laxative
What are the requirements for Macrogol 3350?
No food 2 hours prior to starting, every 15-20 mins until faecal discharge is clear
reduced fluid shifts
less risk of dehydration & electrolyte disturbances
What are the requirements for magnesium +/- sodium picosulfate?
same efficacy of macrogol, less volume, better tolerated
Risk of fluid shifts, dehydration, electrolyte disturbances
use with caution in advanced age (>65 yrs), kidney or heart disease
What are the requirements for sodium phosphate?
Not first line = inc risk of complications, 3 portions in 20 mins, repeat dosing after 10-12 hrs
Avoid = advanced age, kidney or heart disease, dehydration, hypercalcaemia, people taking drugs affecting renal perfusion and function
Describe a food intolerance
non-immune mediate ADR
causes pain/emotional distress but not life threatening
exposure via GI
Describe food allergy
immune-mediated response –> release of IgE
Anaphylactic reaction
involves exposure via GI, skin, and/or airways
How to prevent food allergies
Probiotics and prebiotics (foods)= help bacteria stick and grow
hypoallergenic formulations = hydrolysed formula
Time complementary feeding no earlier than 4 months
Omega 3 fatty acids, vit D = immune system
What are the common allergies in Australia?
milk, eggs, soy, tree nuts, fish, shellfish, and wheat
What tests diagnose allergies?
Skin prick test = allergen drop placed on back or forearm and skin is pricked. Positive reaction (15-2 mins)= wheal and flare (>3mm diameter) at site of test
ELISA-based assy = measure food specific IgE in circulation
Immediate skin application food test (I-SAFT) = determine contact sensitivity, raw food to unbroken skin, positive result = wheal/flare response
Food challenge = determine if allergy is out grown, small but inc amounts of food and monitor
What is a primary deficiency of lactose?
minimal lactase from birth, continues to decline and req dietary modification
What is secondary deficiency of lactose?
GI illness/intestinal disorders damage small intestine BB
Onset = 30 mins to 2 hrs of lactose ingestions
Lactose intolerance symptoms
bloating, cramps, flatulence, diarrhoea, nausea, stomach pains
Symptoms occur due to inc fluid and gas in bowel
Where can colostomies be found?
created out of the end of the large intestine to divert waste from GI tract
Ascending (not very common), transverse (temporary), descending (most common), sigmoid
explain the one piece colostomy system
Pouch and skin barrier are combined in single unit
Closed ended system w/ disposable pouch for one time use, lightweight and flexible
Drainable system = allows pouch to be drained and reused
Explain the two piece colostomy system
pouch and skin barrier are two separate pieces coupled together with plastic ring
allows patient to change pouch without removing skin barrier
closed or drainable pouches
How do you influence stoma output?
Inc output = laxative
Dec output = loperamide (reduce gut motility) or PPIs (reduce gastric secretion)
What are some common skin complications seen with stoma?
irritant dermatitis = appliance leaking, wrong size
- red, weepy, painful
- apply protective paste
Skin allergies = reaction to remover wipes, tapes, or adhesive barrier
- red, itchy, stinging
- remove cause and consider antihistamine and steroid cream if severe
