Ch 40 (ulcers) & Ch 41 (intestine/rectal disorders) Flashcards
Pt education for gastritis
modify diet: refrain from alcohol and irritating foods, avoid NSAIDs
recommend pharm. therapy: PPI (omeprazole), antacid (tums) etc.
chronic: promote rest, reduce stress
Gastritis
inflammation of the stomach mucosa (common)
- acute: erosive vs. non erosive
- chronic
Erosive gastritis
form of acute gastritis usually caused by local irritants (ex: aspirin, NSAIDS, alcohol)
Non-erosive gastritis
Acute form of gastritis that is caused by infection from H. Pylori
Chronic gastritis
prolonged inflammation due to irritants or H. Pylori
-may be associated with some AI diseases, diet, medications, substance (alcohol, smoking), or chronic reflux of pancreatic secretions
Chronic gastritis manifestations
fatigue, heartburn (pyrosis), belching, sour taste, halitosis, food intolerance (caffeine, spicy or fatty foods)
-may have vitamin deficiency due to malabsorption of B12
Acute gastritis manifestations
- rapid onset of abdominal pain/discomfort, indigestion (dyspepsia), anorexia, nausea, vomiting, hiccups
-may cause bleeding: vomit, stool (melena- black/tarry stools, or hematochezia- bright red, bloody stools)
H. Pylori mgmt
If untreated, could lead to PUD and cancer.
- combo of drugs: PPI, abx, and sometimes bismuth salts
Peptic Ulcer Disease
Erosion of mucous membrane forms excavation in the stomach, pylorus, duodenum or esophagus
causes: NSAIDS, H. Pylori
PUD manifestations
dull, gnawing pain or burning in the mid-epigastrium or back, sometimes heartburn (pyrosis), bleeding, sour burps
Gastric ulcer pain
pain occurs immediately after eating, 30-40% awake with pain at night
Duodenal ulcer pain
pain relieved by eating but reoccurs 2-3 hours after; 50-80% awake with pain at night
PUD complications
Gastric outlet syndrome
hemorrhage: if large (2000-300mL) usually vomited, if small its usually passed in the stool
Gastric outlet obstruction syndrome
any condition that mechanically impeded normal gastric emptying
Gastric outlet syndrome symptoms
n/v, constipation, epigastric fullness, anorexia and later weight loss
Gastric outlet syndrome mgmt
NG tube to decompress the stomach (output >400 mL indicates obstruction), IV fluids and e-, balloon dilation or surgery
GI bleed manifestation
vomit, pain, stool (melena or hematochezia)
Perforation manifestations
sudden/severe upper abdominal pain that may be referred to the right shoulder, vomiting and collapse, tender board-like abdomen, symptoms of shock or impending doom
Perforation
erosion of ulcer through gastric serosa into peritoneal cavity
penetration
erosion of ulcer through gastric serosa into adjacent structures (back and epigastric pain not relieved by medication)
Abdominal emergency perforation/penetration mgmt
monitor NG tube, I/O, electrolytes, infection, peritonitis, abdominal pain, bowel tones, distention
Pharmacology for constipation
- Softeners: pull water into colon (ex: docusate- colace)
- osmotic agent: cleanses colon rapidly (ex: goLYTELY, or polyethylene glycol- PEG)
- Stimulants: increase peristalsis (ex: senekot or bisacodyl- dulcolax)
- Bulk forming/fiber: diarrhea and constipation (citrucel- methylcellulose, metamucil- psyllium)
- saline agent: milk of magnesia
- Enemas/lubricant (glycerin suppository)
constipation complications
<3 BM/week
- decreased cardiac output, fecal impaction, hemorrhoids, fissures, rectal prolapse, megacolon
fecal incontinence mgmt
fiber supplementation, loperamide prior to meals, bowel training, pelvic floor training, surgical repair of anal sphincter, skin care
C-diff
most common HAI induced by prolonged/high dosage of abx use- promoting abnormal growth of dangerous microbe
C-diff prioritization
stop the spread by instilling precautions, skin care on bottom,
C-diff mgmt
contact + precautions, bleach wipes to clean, vancomycin or flatly, fecal transplant
malabsorption manifestations
hallmark: diarrhea or frequent loose or bulky foul smelling stools
-steatorrhea: fatty stools
-weight loss, anemia, fatigue, anorexia, vitamin deficiency
common malabsorption diseases
celiac (AI), crohn’s, lactose intolerance
peritonitis
inflammation of the peritoneum- serous membrane lining abdominal cavity and covering the viscera
Primary peritonitis
spontaneous
Secondary peritonitis
trauma, ulcer perforates
- most common
Tertiary peritonitis
opportunistic infection (HIV, TB)
- most rare
peritonitis causes
-bacterial or secondary to fungal infection
-organisms from GI or female reproductive organs
-trauma, surgery, inflammation of surrounding organs (ex: kidneys from dialysis)
peritonitis manifestations
severe abdominal pain, n/v, anorexia, elevated temp, tachycardia, abdomen distended/rigid/rebound tenderness, aggravated by mvmt, decreased bowel tones
peritonitis mgmt
- IV fluids, colloids, e- replacement (several liters of isotonic fluids
- abx
- surgery depending on cause
- NG tube for decompression
- antiemetics
- pain mgmt
appendicitis
appendix becomes inflamed and edematous and obstructs orifice and bloodflow
- becomes ischemic
- bacterial overgrowth occurs
- gangrene and perforation occurs
appendicitis manifestations
vague pre-umbilical pain (dull, poorly localized), eventually progressed to sharp RLQ pain
- anorexia and nausea
- low grade fever
- tenderness (at McBurrey’s point)
- abdominal distention may occur
-PAIN MAY DISAPPEAR IF RUPTURED
appendicitis complications
- gangrene
- perforation- occurs 6-24 horus after pain begins, leads to peritonitis
these require immediate surgery, IV fluids and abx
diverticulosis diagnosis
multiple diverticula without inflammation
Diverticular disease cause
high intra-luminal pressure, low volume, and decreased muscle strength
diverticulum
saclike herniation of lignin of the bowle that extends through a defect in the muscle layer
diverticululitis
infection and inflammation of diverticula
manifestions: acute onset of mild to severe cramping in LLQ
- change in bowel habits, bloating, nausea, fever, leukocytosis
Diverticular disease complications
abscess formation, bleeding, peritonitis, rectal bleeding, fistula formation, scarring
Obstruction prioritization
mechanical obstruction
caused from pressure on the intestinal wall preventing normal flow of intestinal contents
Functional/paralytic obstruction
(paralytic ileus)- the intestinal musculature can’t propel the contents along
s/s of obstruction
crampy, colicky wavelike abd. pain, n/v, bloating, inability to pass gas, abdominal distention, loss of appetite, maybe diarrhea
Obstruction mgmt
decompression of bowel (NG), fluid replacement, NPO, serial X-rays, surgery
Ulcerative Colitis
mucosa of the colon becomes diffusely ulcerated and inflamed
(exacerbations and remissions are common)
Ulcerative Colitis manifestations
bleeding is common, diarrhea with mucus and blood, LLQ pain (starts from anus and progresses up the descending colon), fatigue, anorexia, weight loss, fever, vomiting, dehydration, >6 BM/day
Crohn’s disease
regional enteritis- chronic inflammation in separate portions of bowel lining
Crohn’s disease manifestations
cobblestone appearance and skip lesions, chronic diarrhea, RLQ pain unrelieved by defecation, and tenderness, cramping after meals
- gradual onset of symptoms, progressive, relentless and often debilitating
- late: weight loss, malnutrition, secondary anemia
Crohn’s diagnosis
endoscopy, abdominal CT and/or MRI
- cbc, ESR, albumin/protein levels
Crohn’s complications
obstruction or stricture, fistulas, fluid and e- imbalance, malnutrition
UC diagnosis
colonoscopy is definitive, and X-ray
- stool blood studies, CBC, CMP, albumin, CRP
UC complications
cancer, toxic megacolon, perforation, bleeding
Surgical mgmt of IBD
one-stage resection: inflamed area removed, primary end to end is anastomoses
multiple stage: diseased colon resected, no anastomosis, healthy end brought out of abdomen to set up a stoma for a colostomy
Ostomy Care
early ambulation, pain mgmt, stoma should be pink to bright red, shiny. shouldn’t be swelling or drainage
- strict I/O
- may need NG suction and irrigation
- progress diet
- assess for nausea and distention
