Colon/Small intestine Lecture Flashcards
Which gender is IBS seen more frequently in?
Women 2-3x more common
IBS is a diagnosis of…
exclusion
Pt education
Avoid triggers
Dietary therapy (high fiber)
Pharm therapy:
Antispasmodics, antidiarrheal, psychotropic, serotonin receptor agonists
Tx for IBS
(really specific/individualized for pt and case)
Medical emergency most of the time
Can be due to physical obstruction (foreign body, tumor, etc)
Can be due dysfunction of peristalsis
Bowel obstruction
Decrease or absence of intestinal paralysis
typically associated with trauma, surgery, infection or severe metabolic disease
Paralytic ileus
Volvulus
Twisting of intestine
Intussusception
Telescoping of intestine
Severe cramping abdominal pain
N/V
Inability to pass stool, gas
Increased bowel sounds early on, decreased late**
Abdominal swelling, distention
Bowel obstruction
Upright Xray may illustrate air fluid levels and multiple dilated loops of bowel
Bowel obstruction
When can you NOT give a barium swallow/enema?
If you suspect a perforation
NPO
Relieve pressure via nasal to stomach cannula
IV fluid, pain management
Relieve obstruction
Tx underlying issue if paralytic
Surgery often required
Bowel obstruction
Tissue death
Perforation
Sepsis
Death
Complications of failue ro recognize or treat a bowel obstruction
Inadequate flow of oxygenated blood to the intestines resulting in tissue death
Ischemic bowel
Inflammation and injury to the small intestine resulting in decreased blood flow
Mesenteric ischemia
Inflammation and injurt to the large intestine resulting in decreased blood flow
Ischemic colitis
Acute= emergency!!!! high mortality rates
Chonic=blood supply present but insufficient to meet needs of intestines
Mesenteric ischemia
Gold standard for diagnosing mesenteric ischemia?
CT of abdomen WITH contrast!
Can be anywhere in GI tract
Multiple, interrupted lesions
Chron’s disease
Only located in colon
Continuous lesions
Ulcerative colitis
“Cure” for ulcerative colitis?
Colectomy
Diagnostic test of choice for Chron’s/Ulcerative colitis?
Colonoscopy
Acute toxic colitis with dilation and immbolity of colon
medical emergency!
Risk of rupture can lead to sepsis, death
Toxic megacolon
Can occur as a complication of:
Ulcerative colitis
Chron’s
Psuedomembranous colitis
Infections: shigella, campylobacter, c.dif
Toxic megacolon
Radiographic evidence of dilation..greater than 6cm in transverse colon
3 out of these 4:
temp over 101.5
HR over 120 bpm
Leukocytosis over 10.5
anemia
Toxic megacolon
- reduce distention
- correct fluid/electrolytes
- treat toxemia, any contributing factors
Tx goals of toxic megacolon
Abdominal pain
Fever
Nausea
classic triad for appendicitis
Initial symptom in intermittent periumbilical or epigastric pain
in about 12 hours, localizes to RLQ (McBurney’s point), becomes constant, and is worsened by movement leading to rebound tenderness on PE
Appendicitis
Autoimmune disorder of the small intestine, genetic component, manifests as abdominal pain, intermittent diarrhea, constipation, fatigue and anemia
Celiac disease
Intolerance to gluten, ingestion of gluten triggers an immune response in turn causing damage to small intestine leading to nutritional deficits secondary to absorption issues
Celiac disease
Diarrhea
Steatorrhea
Excessive gas, bloating, abdominal distention
Bowel pattern changes
Weight loss
Fatigue
Weakness
Celiac disease
How is diagnosis of celiac confirmed?
Biopsy of small intestine
Rare! (2% of GI cancers)
Symptoms:
Vague abdominal discomfort
Nutritional deficiency
Anorexia
Jaundice
Obstruction
**often not diagnosed until mets to other places
Small intestine cancers
Elevated alk phos…can mean?
Something going on with the bone!
clue that there may be cancer going on somewhere!!! (ie colon cancer)
Apple core lesion on X ray…CLASSIC for..
Colon cancer
How often do you check:
Fecal occult blood test?
Every year after age 50
How often do you check:
Flex sig?
Every 5 years over 50
How often do you do colonoscopies?
Every 10 years over 50
