bowel obstruction tx - initial tx - partial obstruction - emergency

- NPO, NG suctioning, IV fluids, monitoring - IV hydration, NG decompression - if a mechanical obstruction is suspected, especially large bowel

colon part 1 Flashcards by Mai Wells

normal bowel function

constipation defintion

3 stools per day to 3 stools per week

constipation is a decrease in stool volume and increase in stool firmness accompanied by straining

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describe the bowel sounds and symptoms in an obstruction

small

large

hight pitched and comes in rushes

small: abd pain, distention, vomiting partially digested food, obstipation
large: distention and pain

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sx of volvulus

cramping abdominal pain and distention(rigid), nausea, vomiting, and obstipation

maybe signs of shock

abdominal tymphany, tachycardia, fever, severe pain with ischemia

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how to dx volvulus

abdominal plain film which shows colonic distention

CT with oral contrast

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how to dx malabsorption

72 hr fecal fat test; d-xylose test

diarrhea, bloating, abdominal discomfort;

may have wt loss, steatorrhea, edema

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what if a fecal fat test if nml in malabsorption

think pancreatic insufficiency and abnormal bile salt metabolism

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what is a D-xylose test for

to distinguish maldigestion(pancreatic insufficiency, bile salt deficiency) from malabsorption

nml rules out malabsorption

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pt older than 50 y/o with new onset constipation

evaluate for colon cancer

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constipation treatment

increase fiber to 10-20 gm/day and

fluid intake to (1.5-2L/day)

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small and large bowel obstructions common causes

small: adhesion or hernias
large: neoplasm

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test to look for a bowel obstruction

initial: upright radiograph may illustrate air-fluid levels and multiple dilated loops of bowel
definitive: CT abdomen

CBC: leukocytosis if there is ischemia or necrosis

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bowel obstruction tx

initial tx
partial obstruction
emergency

NPO, NG suctioning, IV fluids, monitoring
IV hydration, NG decompression
if a mechanical obstruction is suspected, especially large bowel

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volvulus defintion

common area

twisting of bowel, commonly in sigmoid or cecal area of the bowel, emergent!

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volvulus tx

endoscopic decompression

or surgery

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abdominal tymphany, tachycardia, fever, severe pain with ischemia

volvulus ischemia

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digestion, absorption, impaired blood or lymph flow

can cause problems with malabsorption

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fistulas, abscesses, aphthous ulcers, renal stones, predisposition to colonic cancer

complications of crohns

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.what is celiac disease

common where

autoimmune: inflammation of the small bowel due to rxn with alpha gliadin in gluten containing foods (wheat, rye, barley)

most common in Europe and US

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.sx of celiac disease

what about in infants and children

diarrhea, steatorrhea, flatulence, wt loss, weakness, abdominal distention

dermatitis herpetiformis (pruritic papulovesicular rash on extensor surfaces, neck, trunk, scalp)

kids: failure to thrive, growth delays

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.how to dx celiac disease

diagnostic: small bowel biopsy (atrophy of villi)

screen with transgluaminase IgA antibodies test of choice.

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.what part of the bowel does crohns involve

population

the small and large bowel, most commonly the terminal ileum and right colon. rectum is spared!!

skip areas are characteristic

smokers have signficant increased risk

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.crohns vs UC onset

c: gradual; UC: gradual or sudden

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.crohns vs UC distribution

C: mouth to anus, skip areas, spares rectum. UC: distal to proximal, continuous

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.crohns vs UC depth of lesions

C: transmural. sometimes leading to fistulas

UC: mucosal surface

.crohns vs UC symptoms

C: diarrhea(non bloody) and pain. UC: bloody pus filled diarrhea(more than 6 per day is severe), tenesmus

.what is tenesmus

feeling that u constantly need to pass stools even though ur bowels are empty

.crohns vs UC complications

C: fistulas common, perianal disease, iron/B12 def, granulomas UC: toxic megacolon, primary sclerosing cholangitis, colon ca

.diarrhea in crohns and UC

crohns: no visible blook UC: bloody diarrhea hallmark

.tx for crohns ileocolonic illeal and proximal colon severe/refractory

ileocolonic: mesalamine (5-ASA) or po glucocorticoid illeal and proximal colon: glucocorticoid severe/refractory: azathioprine, methotrexate, anti TNF agents(infliximab)

.where does pain occur in UC

pain less common but occurs in left lower quadrant

.toxic megacolon and colon cancer in crohns vs UC

more likely in UC

scleritis, episcleritis, arthritides, sclerosing cholangitis, erythema nodosum, pyoderma gangrenosum...

complications of UC

crohns vs UC: smoking

smoking increases disease in crohns but protective in UC

barium enema for UC ok

no, can b/c of risk of perforation. do colonoscopy or sigmoidoscopy

.tx for UC

topical or oral aminosalicylates first line immunodulators for refractory disease surgery: total proctocolectomy

.tests for crohns

upper GI series initial test of choice: string sign endoscopy: cobblestoning bx will reveal transmural inflammation, noncaseating granulomas

increased sedimentation rate, anemia, nutritional and electrolyte imbalances during what

crohns exacerbations

UC starts where onset

starts distally, at the rectum, and progresses proximally disease is CONTINUOUS gradual onset but also can be abrupt

UC tests

anemia, increased ESR, decreased serum albumin abdominal plan film xray may show colonic dilation \*\*sigmoidoscopy or colonoscopy best method for dx avoid colonoscopy and barium edema in acute disease because of risk of perforation and toxic megacolon

avoid what tests in crohns and UC

Crohns: avoid contrast studies and endoscopic procedures because of possibility of inducing toxic megacolon or perforation UC: avoid colonoscopy and barium edema in acute disease because of risk of perforation and toxic megacolon

.best tests for crohns and UC

crohns: upper GI series with small bowel follow through UC: sigmoidoscopy or colonoscopy

crampy abdominal pain 4-5 minutes; vomiting typically follows pain

small bowel obstruction

leading cause of small bowel obstruction in kids and adults

kids: hernia adults: adhesions

postprandial bloating, intermittent crampy abdominal pain, loud BS, vomiting, constipation

bowel obstruction

dehydration and metabolic alkalosis

small bowel obstruction

lactic acidosis

prognostic sign in necrotic bowel

stepladder appearance on xray

small bowel obstruction

serologic screening tests (IgA antiendomsysial[EMA] and antitissue transglutaminase antibodies)

for celiac disease

constipation - gender - dx how - palpate stool where - kind of laxatives to give

females less than 2 BM a week LLQ osmotic and stimulant

abdominal tymphany tachycardia, fever, severe pain

volvulus

.cobblestone appearance elevated WBC

crohns

.labs: anti-Saccharomyces cerevisiae antibodies, iron/B12 def.

crohns

.string sign on upper GI series

crohns

.stovepipe or lead pipe sign

.UC mild/mod/severe description

mild: 4 or less BM moderate: over 4 loose BM severe: 6 loose BM, severe pain, signs of toxicity

.cyclosporine, tacrolimus, -mab drugs, methotrexate, 6 mercaptopurine, azathioprine

UC and crohns meds

.diarrhea dermatitis herpetiformis (pruritic papulovesicular rash on extensor surfaces, neck, trunk, scalp)

celiac disease

.test of choice for lactose intolerance

hydrogen breath test

.nut allergy ____ mediated timing of exposure

IgE wait until 3 yo

colon part 1 Flashcards

IBD, bowel obs, celiac