BOWEL DIVERSION Flashcards
Anatomy of the small intestine
consists of the duodenum, jejunum and ileum.
- duodenum connects the stomach to the jejunum
- duodenum also contains the opening for common bile duct and pancreatic duct
- jejunum and ileum are closely fit in abdomen
anatomy of large intestine
the large intestine is the primary organ of bowel elimination and is divided into cecum, colon and rectum
- colon has 3 functions - absorption, secretion and elimination
fecal specimens (FOC V)
- Fobt - fecal occult blood testing - measures microscopic amounts of blood in stool
- O and p - stool for ova and parasite
- C and s- culture and sensitivity
- direct Visualization tests (endoscopy) - colonoscopy and sigmoidoscopy
- indirect Visualization X-ray with contrast - barium enema
what is rotavirus? what are the symptoms? how can you treat it?
Rotavirus is a viral infection that causes epidemic gastroenteritis and begins 24 hours after incubation
symptoms - mild - moderate fever, watery stools, vomiting
treatment - aimed at preventing dehydration
what is C. difficle? what are the symptoms? how can you treat it?
C. difficile is a bacterial infection caused due to antibiotic therapy.
symptoms - mild - moderate diarrhea, lower abdominal cramping
treatment - immediate discontinuation of antibiotic and in severe cases - eradication of c.difficle
when to collect stool specimen for someone who has C.difficle?
as soon as possible after onset of diarrhea occurs
What is IBS and how is it relieved?
Irritable bowel syndrome is a functional GI disorder
- symptoms include - abdominal pain, bloating, nausea, anorexia and diarrhea, altered bowel function
relieved by defecation and accompanied by a change in frequency or consistency of stool
What is inflammatory bowel disease? What are the types
- autoimmune disorder, chronic, reccurrent inflammation of intestinal tract. 2 main types
- Ulcerative colitis
- Crohn’s disease
Ulcerative colitis, signs and symptoms, pathophysiology
- characterized by inflammation, ulceration of colon and rectum. Starts at rectum moves up to sigmoid colon and spreads to colon
- can be acute or chrnoic
signs and symptoms - bloody diarrhea, abdominal cramping, tenesmus (sensation of needing to pass stool, accompanied by pain, crampoing and straining. Despite straining, little stool is passed. Recall urine with pain- dyuria??)
PATHO:
- multiple abscess (pocket of pus) develops in the intestinal gland and these abscesses break into submucosa, leaving ulcerations
- these ulceration destroy the muscosal epithelium, causing bleeding and diarrhea
- fluid and electrolyte loss
- protein loss
- psuedo polyps develop (i saw a picture of this and its gross)
crohn’s disease, signs and symptoms, pathophysiology
- chronic, nonspecific inflammtory bowel disorder of unknown origin
- can affect any part of the GI tract from mouth to anus
- most often seen in terminal ileum and colon
- inflammation involves all layers of bowel wall
- narrowing lumen
- may cause bowel obstruction
- microscopic leaks can allow bowel contents into peritoneal cavity (potential complication, indicates that fistula exist)
- 40% to 60% of recurrnace after surgery
SIGNS AND SYMPTOMS:
- depends on anatomic site but usually – diarrhea (no blood), colicky abdominal pain (cramp like pain), severe weight loss
PATHO:
- inflammation involves all layers of bowel wall
- skin lesion: segments of normal bowel occring between diseased portions
- ulcerations are deep and longitudinal and penetrate between islands of inflamed edematous mucosa - looks like a cobblestone
- microscopic leaks
- peritonitis may develop (redness and inflammation in the lining of abdomen)
- abscess of fistulous tract that communicate with other loops of bowel, skin, bladder, rectum or vagina may occur
white or clay coloured stools indicate ?
absence of bile pigment - obstructive jaundice
black or tarry coloured stools indicate ?
iron ingestion or upper gastrointestinal bleeding
pale with fat or frothy coloured stools indicate ?
malabsorption of fact
mucus or pus coloured stools indicate ?
colitis, excessive straining
bloody mucus coloured stools indicate ?
blood in feces, inflammation, infection and hemorrhoids
Consistency of feces:
liquid - diarrhea, reduced absorption
hard - constipation
NORMAL OR ABNORMAL??
a. frequency of stool more than 3 times a day
b. frequency of stool 2-3 times weekly
c. frequency of stool less than once a week
a. abnormal
b. normal
c. abnormal
what does a narrow, pencil shaped feces indicate?
anal or distal rectal carcinoma
diagnostic studies (Happy Birthday Sara)
- History and physical examination
- Blood studies:
- CBC - WBC - 4500 - 11,000, RBC - 4.5 million to 5.9 million for men, 4.1 million to 5.1 million for women, Hemoglobin - `14 to 17.5 gm/dL for men and 12.3 to 15.3 gm/dL for women
- serum electrolyte levels - sodium- 136 - 144 mmol/L, potassium - 3.7 to 5.1 mmol/L, calcium - 8.5 to 10.2 mg/dL
- serum protein levels - 60 to 83 g/L - Stool cultures:
- pus, occult blood and mucus
What is a colonoscopy?
endoscopic examination of the rectum, small bowel and colon that uses a long flexible tube (colonoscope) inserted into the rectum
when is colonscopy used?
- used to diagnose suspected pathologic conditions and is recommended for pts. who have had a change in bowel habits, occult or obvious blood in stool and/or abdominal pain
- also used as a surveillance tool for pts. who have had colorectal cancer or IBD or for those at risk for colon cancer
who performs anf endoscopy and how long is the whole thing?
- physician trained in GI endoscopy, performs this test in 30-60 minutes
- pt is heavily sedated and bowel must be clean and free of fecal material
when is a bowel prep ready? hint: based on colour
when it is light orange, mostly clear - almost ready
yellow, light, clear - ready anything other than this color is not ready
What is a sigmoidoscopy?
- examination of the interior of the sigmoid, colon and rectum
- preparation is similar to colonoscopy and light sedation is required
- takes about 15-20 minutes and is performed by physician trained in GI endoscopy
what is done before a sigmoidoscopy?
- bowel prep
- 2 fleet enemas are usually sufficient
- ingest only a light meal for breakfast the morning of the procedure