CROHN'S, ULCERATIVE COLITIS, DIVERTOCULAR DISEASE & APPENDICITIS Flashcards
Can happen to anywhere in the MOUTH TO ANUS, patchy inflammation
CROHN’S DSE also called as REGIONAL ENTERITIS
Location: mouth to anus= Terminal ileum cecum in the RLQ
Pattern: discontinuous, patchy, skip (cobble stone appearance), regional
depth: mucosa- serosa (transmural lesion)
Crohn’s Disease
s/sx of Crohn’s Dse
- RLQ pain with diarrhea (mucus, pus, blood)
- Triggered by: Eating
- Unrelieved by: Defecation
- Crampy abdominal pain
- Abdominal Tenderness (pain upon tenderness)
- (+) steatorrhea
- N&v
- wgt loss
complication of Crohn’s dse.
- malabsorption/ malnutrition
- stenosis/ stricture formation
- Fistula formation = abnormal passage way between two organs (BUHO)*
dx test test
- Barrium swallow (UGIS)**
- Colonoscopy (cobble stone appearance)
- increased ESR&CRP
- increased wbc
- cbc= decreased Hgb & hct
- (+) streatorrhea
Location: Colon-rectum to proximal colon
Pattern: Continuous
Depth in superficial mucosa
Ulcerative Colitis
-LLQ pain with bloody diarrhea (+ blood, mucus and pus) called HEMATOCHEZIA. >5-6 Bloody motility a day
-Affect LOWER GI
-Intermittent Tenesmus
-N/V anorexia and fever
-wgt loss
this in the s/ sx Ulcerative Colitis
complications of Ulcerative Colitis
- fluid & electrolyte imbalance
- anemia
- toxic megacolon - colon is paralyze (nag stay ang tay sa colon)
colonic distention- perforation- peritonitis
Dx test of Ulcerative colitis
- colonoscopy
- Proctosigmoidoscopy
- CBC decreased hgb and hct
- increased wbc increased ESR &CRP
- Positive hematochezia
mgt for ulcerative colitis
Goal: to rest the bowl
1. NPO
2. IVF
3. Antidiarrheal drugs
4. Drugs
- amino salicylates
-corticosteroids “sone”=for severe
-Immunodilators=maintenance
-antibiotic
can ulcerative colitis can be cure?
yes! by removing the colon to prevent perforation and peritonitis
can crohn’s dse can be cure
NO!
surgery for Ulcerative colitis
- Total colectomy with ileostomy
common effluent= liquid with digestive enzyme
2.Total Colectomy with J-pouch ileoanal anastomosis
Common risk of ileostomy
1. skin excoriation
2. fluid electrolyte imbalance
Diet for ileostomy
Diet as tolerated except seeds
Diet for J-pouch Ileoanal anastomosis
decrease fiber intake
increased protein &calories
vitamins supplementation and iron supplementation
sac like herniation of intestinal wall because of low fiber diet. common in aging
Diverticular Disease
single pouch of diverticula
Diverticulum
Multiple pouch of diverticula without s/sx. affected Sigmoid colon
Diverticulosis
inflammation of diverticula with s/sx cause of entrapment of fecal material and bacteria. affected also sigmoid colon
Diverticulitis
-Pain in LLQ (crampy)
-n/v, anorexia, fever
-Increased wbc (leukocytosis)
S/sx of diverticular disease
dx test for diverticular colitis
divercolosis- colonoscopy
divercolitis- ct-scan with contrast agent
Mgt of divercolitis and losis
divercolosis= increased fiber
divercolitis= decreased fiber
drug: psyllium
-bulk forming
Surgery of Diverticular disease
HARTS MANNS Procedure
remove of the affected colon+ stoma formation+ end colostomy)
it is the storage of the good bacteria
Appendix
what is the location of the appendix
MC Burney’s point
there is Increased mucus & bacterial build up because of obstruction. and it is because of fecalith, seeds and tumor
appendicitis
it has pain in periumbilical around 4-6hrs in the RLQ (mc burney’s pain)
-n/v, anorexia and fever
appendicitis
n/c of appendicitis
- DON’T GIVE LAXATIVES - if there is constipation, fever and RLQ suspects there is appendicitis
- NO ENEMA
- NO WARM COMPRESS
- NO PAIN MEDS- Allowed given if naa na sa hospital, diagnosed na siya and for surgery na siya
what is the comfortable position of the px with appendicitis
knee- chest position
All (+) in Rovsing’s sign, Blumberg sign, Passive sign, Obturator sign, mc burney’s sign, dunphy sign
Appendicitis
(+) RLQ pain upon palpitation of LLQ
Rovsign’s sign * this is also the early sign of appendicitis
(+) rebound tenderness
Blumberg sign
(+) RLQ pain Passive extension of the R leg
passive sign
(+) RLQ pain upon internal and external rotation of the flexed R leg
obturator sign
localized RLQ pain
mc burney’s sign
abdominal pain during coughing
Dunphy sign
what is the dx test of appendicitis
- ultrasound
- Ct scan
- Pregnancy test- related to ectopic preg
what is the mgt of appendicitis
STAT APPENDECTOMY- to prevent rupture
N/c for appendicitis
- npo
- ivf
- iv antibiotics
- NGT insertion= Gavage
it is to GI Decompression attached at the low suction relief (salem sumptube)*
NGT insertion
1 way lumen= intake gavage= lumen tube
2 way lumen= for lavage and gavage= salemsumptube)
health teaching post op care of appendicitis px
- deep breathing and coughing exercise
-if pain during deep breathing = give pain meds PRN
-if coughing- splint the pt to protect the insition - turning position Q2
- early ambulation
Position post appendectomy
low fowlers position 15-30 degree
