Chapter 47 Lower Gastrointestinal Problems Part 3 Flashcards
What is celiac disease?
An autoimmune disease that causes damage to the small intestinal mucosa triggered by ingesting gluten.
Celiac disease is also known as celiac sprue and gluten-sensitive enteropathy.
What proteins trigger celiac disease?
Gluten, a protein found in wheat, barley, and rye.
Gluten is the main dietary trigger for celiac disease.
At what age can celiac disease occur?
Celiac disease can occur at any age.
Symptoms often begin in childhood.
What is the prevalence of celiac disease worldwide?
Affects about 1 in 100 people worldwide.
This statistic indicates the global impact of the disease.
What is the risk for first-degree relatives of someone with celiac disease?
10% chance of developing the disorder.
Genetic predisposition plays a significant role in the development of celiac disease.
What other autoimmune diseases are associated with celiac disease?
- Rheumatoid arthritis
- Type 1 diabetes
Celiac disease is often associated with other autoimmune conditions.
What are the three factors necessary for developing celiac disease?
- Genetic predisposition
- Gluten ingestion
- Immune-mediated response
These factors are essential for the onset of celiac disease.
What percentage of people with celiac disease have the HLA-DQ2 allele?
About 95%.
The remaining 5% have HLA-DQ8.
What happens to gluten in genetically susceptible persons?
Prolamin peptides bind to HLA-DQ2 and/or HLA-DQ8, activating an inflammatory response.
This response leads to tissue damage in the small intestine.
Where is damage most severe in celiac disease?
In the duodenum.
The duodenum has more exposure to gluten compared to other parts of the intestine.
What is the primary cause of tissue destruction in celiac disease?
Chronic inflammation.
This inflammation results from the immune response to gluten ingestion.
True or False: Celiac disease is the same as tropical sprue.
False.
Tropical sprue is a chronic disorder occurring primarily in tropical areas, distinct from celiac disease.
Fill in the blank: The inflammation in celiac disease lasts as long as _______ continues.
gluten ingestion
Continuous gluten ingestion perpetuates the inflammatory response.
What is one cause of malabsorption related to bacterial issues?
Bacterial Proliferation
Includes conditions such as parasitic infection and tropical sprue.
Name a biochemical deficiency that can lead to malabsorption.
Lactase deficiency
This is a common cause of lactose intolerance.
List three conditions that fall under biochemical or enzyme deficiencies causing malabsorption.
- Biliary tract obstruction
- Chronic pancreatitis
- Cystic fibrosis
Which syndrome is associated with pancreatic insufficiency?
Zollinger-Ellison syndrome
Characterized by gastrin-secreting tumors leading to increased gastric acid.
What are two conditions that can disturb lymphatic and vascular circulation, leading to malabsorption?
- Heart failure
- Lymphoma
Which disease is associated with small intestinal mucosal disruption?
Celiac disease
An autoimmune disorder triggered by gluten.
What surgical procedure can result in surface area loss leading to malabsorption?
Billroth II gastrectomy
This procedure involves the resection of part of the stomach.
Fill in the blank: Chronic pancreatitis is a cause of malabsorption due to _______.
Biochemical or enzyme deficiencies
True or False: Crohn’s disease is a cause of malabsorption.
True
What is SBS an acronym for in the context of malabsorption?
Short Bowel Syndrome
A condition resulting from surgical removal of a significant portion of the intestine.
Name a condition that can lead to malabsorption due to surface area loss.
Distal ileal resection, disease, or bypass
What are the cardiovascular manifestations of malabsorption?
Hypotension, Peripheral edema, Tachycardia, Dehydration
These manifestations result from protein malabsorption and hypovolemia.
What gastrointestinal symptoms are associated with malabsorption?
Diarrhea, Flatulence, Glossitis, Cheilosis, Stomatitis, Steatorrhea, Weight loss
Symptoms arise from impaired absorption of water, sodium, fatty acids, bile salts, carbohydrates, and bacterial fermentation of unabsorbed carbohydrates.
What hematologic conditions can result from malabsorption?
Anemia, Hemorrhagic tendency
Caused by impaired absorption of iron, cobalamin, folic acid, and deficiencies of vitamin C and K.
What musculoskeletal symptoms are indicative of malabsorption?
Bone pain, Muscle wasting, Tetany, Weakness, Muscle cramps
These symptoms can be linked to calcium and vitamin deficiencies.
Which neurological symptoms may occur due to malabsorption?
Altered mental status, Night blindness, Paresthesias, Peripheral neuropathy
These can be associated with deficiencies such as vitamin A and cobalamin.
What skin manifestations are associated with malabsorption?
Brittle nails, Bruising, Dermatitis, Hair thinning and loss
These symptoms may be linked to protein malabsorption and vitamin deficiencies.
What are the potential consequences of impaired calcium absorption?
Osteoporosis, Osteomalacia
Resulting from hypocalcemia, hypophosphatemia, and inadequate vitamin D.
Fill in the blank: Protein malabsorption can lead to _______.
[key learning term]
This can cause various systemic issues including edema and weakness.
True or False: Anemia can be a manifestation of malabsorption.
True
Anemia is often due to deficiencies in iron, cobalamin, and folic acid.
What vitamin deficiencies are commonly associated with malabsorption?
Vitamin A, Vitamin C, Vitamin K, Thiamine, Folate, Riboflavin, Cobalamin, Niacin, Zinc
These deficiencies can lead to multiple systemic manifestations.
What causes steatorrhea in malabsorption?
Malabsorption of fat
This leads to the presence of undigested fat in the stool.
What are classic manifestations of celiac disease?
Foul-smelling diarrhea, abdominal pain, flatulence, abdominal distention
Some individuals may not exhibit obvious GI symptoms.
List atypical signs and symptoms of celiac disease.
- Joint pain
- Liver problems
- Fatigue
- Peripheral neuropathy
- Reproductive problems
These symptoms can occur without typical gastrointestinal manifestations.
What is dermatitis herpetiformis?
An intensely pruritic, vesicular skin lesion that occurs as a rash on various body parts
Common locations include the buttocks, scalp, face, elbows, and knees.
What nutritional deficiencies may occur in celiac disease?
- Protein
- Fat
- Carbohydrate absorption
This can lead to weight loss, muscle wasting, and signs of malnutrition.
What can abnormal serum folate, iron, and cobalamin levels lead to?
Anemia
These deficiencies are common in patients with celiac disease.
What dietary restrictions may patients with celiac disease need to follow?
Refrain from lactose-containing products until the disease is under control
Lactose intolerance is common in celiac patients.
What are the potential consequences of inadequate calcium intake and vitamin D absorption in celiac disease?
Decreased bone density and osteoporosis
These conditions can complicate the health of individuals with celiac disease.
Who should be screened for celiac disease?
- Close relatives of affected individuals
- Young patients with decreased bone density
- Patients with anemia of unknown cause
- Individuals with certain autoimmune diseases
Early diagnosis and treatment can prevent complications.
How is celiac disease diagnosed?
History, physical assessment, and serology testing
The tissue transglutaminase IgA antibody test is the best serologic test.
What is the gold standard for confirming celiac disease diagnosis?
Histologic evidence from biopsies showing flattened mucosa and loss of villi
Genotyping for HLA-DQ2 and/or HLA-DQ8 antigens may also be performed.
What is the only effective treatment for celiac disease?
A strict gluten-free diet
Most patients need to adhere to this diet for life.
What type of monitoring is required for patients with celiac disease?
- Periodic nutrition evaluations
- Laboratory monitoring for anemia and malnutrition
- Bone density screening every 2 to 3 years
Patients often require daily vitamin and mineral supplements.
What role does a dietitian play in managing celiac disease?
Teach patients how to eat a nutritionally adequate diet considering food preferences, cultural traditions, and food availability
Dietitians can also help patients read medication and food labels.
What challenges do patients face when maintaining a gluten-free diet?
Difficulty when traveling or dining out, feeling embarrassed discussing gluten-free options
Mobile apps can help find gluten-free menu options at restaurants.
What is lactase deficiency?
A condition in which the lactase enzyme is deficient or absent
Lactase is necessary to break down lactose into glucose and galactose.
What are common causes of primary lactase insufficiency?
- Genetic factors
- Certain ethnic or racial groups (especially those with Asian or African ancestry)
Low lactase levels often develop in childhood.
What symptoms can result from lactose malabsorption?
- Bloating
- Flatulence
- Cramping abdominal pain
- Diarrhea
Symptoms typically occur within 30 minutes to several hours after lactose ingestion.
How is lactose intolerance diagnosed?
- Lactose tolerance tests
- Hydrogen breath tests
- Genetic testing
These tests help determine the presence of lactase deficiency.
What is the primary goal of treatment for lactose intolerance?
To improve patient symptoms and prevent malnutrition
Limiting lactose intake usually leads to symptom improvement.
What alternatives are available for patients with lactose intolerance?
Lactose-free milk products
Lactase tablets can also be used to aid digestion.
What condition is characterized by insufficient surface area in the small intestine for nutrient absorption?
Short bowel syndrome (SBS)
SBS leads to an inability to meet energy, fluid, electrolyte, and nutrition needs.
What are common causes of short bowel syndrome?
- Diseases that damage the intestinal mucosa
- Surgical removal of too much small intestine
- Congenital defects
Examples include Crohn’s disease and cancer.
What percentage of the small intestine loss is likely to develop short bowel syndrome?
50% to 75%
The extent of SBS is influenced by the length and area of the remaining small intestine.
What clinical manifestations result from short bowel syndrome?
- Dehydration
- Weight loss
- Diarrhea
- Malnutrition
- Vitamin deficiencies
- Electrolyte imbalances
- Abdominal pain
- Flatulence
- Steatorrhea
Patients may also develop lactase deficiency and bacterial overgrowth.
What medications are approved by the FDA for the treatment of short bowel syndrome?
- Somatropin
- Glutamine
- Teduglutide (Gattex)
These medications enhance intestinal adaptation and absorption.
True or False: Patients with intact terminal ileum, ileocecal valve, and colon rarely have problems with short bowel syndrome.
True
The presence of these structures aids in nutrient absorption.
What should be included in the diet for patients with short bowel syndrome?
- High in protein
- High in complex carbohydrates
- Low in fat
- Low in simple sugars
- Soluble fiber (if colon is present)
A dietitian should be consulted for tailored nutrition support.
What are hemorrhoids?
Abnormally dilated hemorrhoidal veins
Hemorrhoids can be classified as internal or external based on their location.
What is the main treatment goal for patients with short bowel syndrome?
To maintain normal nutrition, achieve a good quality of life, and be free from complications
This often involves a combination of PN, EN, medications, and diet.
Fill in the blank: Patients with short bowel syndrome may require _______ or _______ at night for severe malabsorption.
[PN] or [EN]
PN stands for parenteral nutrition, and EN stands for enteral nutrition.
What is the role of bile acids in relation to diarrhea in short bowel syndrome?
Stimulate intestinal fluid secretion and reduce colonic fluid absorption
Cholestyramine can help reduce diarrhea caused by unabsorbed bile acids.
What are hemorrhoids?
Hemorrhoids are swollen veins in the rectal area that can cause pain, bleeding, and discomfort.
What causes hemorrhoids?
Hemorrhoids develop due to increased anal pressure and weakening of connective tissue supporting the hemorrhoidal veins.
List factors that increase the risk for hemorrhoids.
- Pregnancy
- Constipation
- Straining to defecate
- Diarrhea
- Heavy lifting
- Prolonged standing and sitting
- Obesity
- Ascites
What are the clinical manifestations of internal hemorrhoids?
Painless, bright red bleeding with stools, on toilet paper, or dripping into the toilet water.
What happens if internal hemorrhoids become constricted?
The patient will report pain.
What symptoms indicate prolapsed internal hemorrhoids?
Pressure with defecation and a protruding mass.
How do external hemorrhoids differ from internal hemorrhoids?
External hemorrhoids are reddish-blue, seldom bleed, may cause itching and burning, and usually do not cause pain unless thrombosed.
What is a thrombosed hemorrhoid?
A thrombosed hemorrhoid is a hemorrhoid that has developed a blood clot, causing pain and inflammation.
How are external hemorrhoids diagnosed?
External hemorrhoids can be diagnosed with visual inspection and digital rectal examination (DRE).
What diagnostic methods are used for internal hemorrhoids?
DRE, anoscopy, and sigmoidoscopy.
What is the first-line therapy for hemorrhoids?
Normalizing stool consistency by treating constipation or diarrhea.
What dietary measures can help prevent constipation?
A high-fiber diet and increased fluid intake.
What non-pharmacological measures can help with hemorrhoid discomfort?
Warm sitz baths (15 to 20 minutes, 2 or 3 times each day).
What types of medications can be used to relieve hemorrhoid symptoms?
- OTC ointments
- Creams
- Suppositories
- NSAIDs for pain
What is rubber band ligation?
A nonsurgical treatment where a rubber band is placed around a hemorrhoid to constrict circulation, causing necrosis and sloughing off.
When is a hemorrhoidectomy indicated?
When there is marked prolapse, excessive pain or bleeding, or large or multiple thrombosed hemorrhoids.
What is the difference between primary and secondary intention healing after hemorrhoidectomy?
Primary intention involves suturing the tissue, while secondary intention leaves the area open for healing.
What is the focus of nursing care after a hemorrhoidectomy?
Pain control and promoting wound healing.
What is the primary concern of patients regarding bowel movements after a minor procedure?
Severe pain and discomfort
What type of analgesia is commonly used for patients post-procedure?
Multimodal analgesia
Which medications are often included in multimodal analgesia?
- Opioids
- NSAIDs
- Topical lidocaine
- 2% diltiazem
- Glyceryl trinitrate
What should be administered before the first bowel movement to reduce discomfort?
Pain medication
What is the purpose of stool softeners like docusate?
To help form a soft, bulky stool that is easier to pass
What intervention is done if a patient does not have a bowel movement within 2 or 3 days?
An oil-retention enema
What is the purpose of a warm sitz bath for patients?
To provide comfort and keep the anal area clean
What is an anal fissure?
A linear skin tear in the anal mucosa
What are common causes of anal fissures?
- Trauma from hard stools
- Anal intercourse
- Foreign body insertion
- Childbirth
- Local infections (e.g., syphilis, gonorrhea)
How is an anal fissure classified based on its duration?
- Acute: less than 6 weeks
- Chronic: longer than 6 weeks
What is the hallmark symptom of an anal fissure?
Severe anal pain
What can cause anal fissures to bleed?
Trauma from bowel movements
What is the recommended conservative treatment for anal fissures?
- Fiber supplements
- Increased fluid intake
- Sitz baths
- Topical analgesics
What surgical procedure is recommended if conservative treatment for anal fissures fails?
Lateral internal sphincterotomy
What is an anorectal abscess?
A collection of perianal pus
What typically causes an anorectal abscess?
Obstruction of the anal glands leading to infection
What are common organisms that cause anorectal abscesses?
- E. coli
- Staphylococci
- Streptococci
What are the symptoms of an anorectal abscess?
- Local severe pain
- Swelling
- Foul-smelling drainage
- Tenderness
- Fever
What is the primary treatment for an anorectal abscess?
Surgical drainage
What is an anal fistula?
An abnormal tunnel from the anus or rectum to the surface of the skin
What are common causes of anal fistulas?
- Anorectal abscess
- Infections
- Crohn’s disease
- Cancer
- Trauma
- Radiation
What may occur if feces enter an anal fistula?
Infection
What is the typical surgical treatment for an anal fistula?
Fistulotomy
What is the nursing care required after surgical treatment for an anal fistula?
Care is the same as after a hemorrhoidectomy
What is the incidence of anal cancer in the United States?
Around 8700 people are diagnosed each year
Anal cancer is uncommon in the general population but its incidence is increasing
What virus is associated with about 90% of anal cancer cases?
Human papillomavirus (HPV)
HPV is a significant risk factor for anal cancer
What are common risk factors for anal cancer?
- Smokers
- HIV-positive homosexual men
- Immunocompromised individuals
- Women with cervical, vaginal, or vulvar cancer
These groups are at higher risk for developing anal cancer
What is the most common presenting sign of anal cancer?
Rectal bleeding
Other symptoms may include rectal pain, itching, and pressure
What screening methods are recommended for high-risk individuals for anal cancer?
- Digital rectal exam (DRE)
- Anal Pap tests
Screening is crucial for early detection in high-risk populations
What does an anal Pap test involve?
Swabbing the anal lining to examine cells for changes
This test helps identify dysplasia or neoplasia
What imaging technique allows visualization of the anal mucosa?
High-resolution anoscopy
A biopsy can also be obtained during this procedure
What is the primary treatment for anal cancer?
Combination of low-dose radiation and chemotherapy
Treatment depends on the size and depth of the lesions
What chemotherapy agents are commonly used for anal cancer?
- Mitomycin
- Cisplatin
- FU
These agents are used in various combinations
What is a pilonidal sinus?
A small tract under the skin between the buttocks in the sacrococcygeal area
It is thought to be of congenital origin
What is the etymology of the term ‘pilonidal’?
‘A nest of hair’
The condition often involves hair penetration into the skin
What occurs if the skin around a pilonidal sinus becomes infected?
It forms a pilonidal cyst or abscess
Symptoms arise only when there is an infection
What is the treatment for a pilonidal abscess?
Incision and drainage
The wound may be closed or left open to heal by secondary intention
What nursing care is recommended for a pilonidal abscess?
- Warm, moist heat applications
- Sitz baths
- Educating the patient on dressing care
Comfort measures are important for patient care
True or False: Pilonidal sinuses always present symptoms.
False
Symptoms occur only if there is an infection
Fill in the blank: A pilonidal sinus is thought to be of _______ origin.
[congenital]
This suggests it may be a condition present from birth
