CROHN'S, ULCERATIVE COLITIS, DIVERTOCULAR DISEASE & APPENDICITIS

Question 1

Can happen to anywhere in the MOUTH TO ANUS, patchy inflammation

Answer 1

CROHN’S DSE also called as REGIONAL ENTERITIS

Question 2

Location: mouth to anus= Terminal ileum cecum in the RLQ
Pattern: discontinuous, patchy, skip (cobble stone appearance), regional
depth: mucosa- serosa (transmural lesion)

Answer 2

Crohn’s Disease

Question 3

s/sx of Crohn’s Dse

Answer 3

1. RLQ pain with diarrhea (mucus, pus, blood)
2. Triggered by: Eating
3. Unrelieved by: Defecation
4. Crampy abdominal pain
5. Abdominal Tenderness (pain upon tenderness)
6. (+) steatorrhea
7. N&v
8. wgt loss

Question 4

complication of Crohn’s dse.

Answer 4

1. malabsorption/ malnutrition
2. stenosis/ stricture formation
3. Fistula formation = abnormal passage way between two organs (BUHO)*

Question 5

dx test test

Answer 5

1. Barrium swallow (UGIS)**
2. Colonoscopy (cobble stone appearance)
3. increased ESR&CRP
4. increased wbc
5. cbc= decreased Hgb & hct
6. (+) streatorrhea

Question 6

Location: Colon-rectum to proximal colon
Pattern: Continuous
Depth in superficial mucosa

Answer 6

Ulcerative Colitis

Question 7

-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

Answer 7

this in the s/ sx Ulcerative Colitis

Question 8

complications of Ulcerative Colitis

Answer 8

1. fluid & electrolyte imbalance
2. anemia
3. toxic megacolon - colon is paralyze (nag stay ang tay sa colon)

colonic distention- perforation- peritonitis

Question 9

Dx test of Ulcerative colitis

Answer 9

1. colonoscopy
2. Proctosigmoidoscopy
3. CBC decreased hgb and hct
4. increased wbc increased ESR &CRP
5. Positive hematochezia

Question 10

mgt for ulcerative colitis

Answer 10

Goal: to rest the bowl
1. NPO
2. IVF
3. Antidiarrheal drugs
4. Drugs
- amino salicylates
-corticosteroids “sone”=for severe
-Immunodilators=maintenance
-antibiotic

Question 11

can ulcerative colitis can be cure?

Answer 11

yes! by removing the colon to prevent perforation and peritonitis

Question 12

can crohn’s dse can be cure

Answer 12

NO!

Question 13

surgery for Ulcerative colitis

Answer 13

1. 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

Question 14

Diet for ileostomy

Answer 14

Diet as tolerated except seeds

Question 15

Diet for J-pouch Ileoanal anastomosis

Answer 15

decrease fiber intake
increased protein &calories
vitamins supplementation and iron supplementation

Question 16

sac like herniation of intestinal wall because of low fiber diet. common in aging

Answer 16

Diverticular Disease

Question 17

single pouch of diverticula

Answer 17

Diverticulum

Question 18

Multiple pouch of diverticula without s/sx. affected Sigmoid colon

Answer 18

Diverticulosis

Question 19

inflammation of diverticula with s/sx cause of entrapment of fecal material and bacteria. affected also sigmoid colon

Answer 19

Diverticulitis

Question 20

-Pain in LLQ (crampy)
-n/v, anorexia, fever
-Increased wbc (leukocytosis)

Answer 20

S/sx of diverticular disease

Question 21

dx test for diverticular colitis

Answer 21

divercolosis- colonoscopy
divercolitis- ct-scan with contrast agent

Question 22

Mgt of divercolitis and losis

Answer 22

divercolosis= increased fiber
divercolitis= decreased fiber

drug: psyllium
-bulk forming

Question 23

Surgery of Diverticular disease

Answer 23

HARTS MANNS Procedure
remove of the affected colon+ stoma formation+ end colostomy)

Question 23

it is the storage of the good bacteria

Answer 23

Appendix

Question 24

what is the location of the appendix

Answer 24

MC Burney’s point

Question 25

there is Increased mucus & bacterial build up because of obstruction. and it is because of fecalith, seeds and tumor

Answer 25

appendicitis

Question 26

it has pain in periumbilical around 4-6hrs in the RLQ (mc burney’s pain)
-n/v, anorexia and fever

Answer 26

appendicitis

Question 27

n/c of appendicitis

Answer 27

1. DON’T GIVE LAXATIVES - if there is constipation, fever and RLQ suspects there is appendicitis
2. NO ENEMA
3. NO WARM COMPRESS
4. NO PAIN MEDS- Allowed given if naa na sa hospital, diagnosed na siya and for surgery na siya

Question 28

what is the comfortable position of the px with appendicitis

Answer 28

knee- chest position

Question 29

All (+) in Rovsing’s sign, Blumberg sign, Passive sign, Obturator sign, mc burney’s sign, dunphy sign

Answer 29

Appendicitis

Question 30

(+) RLQ pain upon palpitation of LLQ

Answer 30

Rovsign’s sign * this is also the early sign of appendicitis

Question 31

(+) rebound tenderness

Answer 31

Blumberg sign

Question 32

(+) RLQ pain Passive extension of the R leg

Answer 32

passive sign

Question 33

(+) RLQ pain upon internal and external rotation of the flexed R leg

Answer 33

obturator sign

Question 34

localized RLQ pain

Answer 34

mc burney’s sign

Question 35

abdominal pain during coughing

Answer 35

Dunphy sign

Question 36

what is the dx test of appendicitis

Answer 36

1. ultrasound
2. Ct scan
3. Pregnancy test- related to ectopic preg

Question 37

what is the mgt of appendicitis

Answer 37

STAT APPENDECTOMY- to prevent rupture

Question 38

N/c for appendicitis

Answer 38

1. npo
2. ivf
3. iv antibiotics
4. NGT insertion= Gavage

Question 39

it is to GI Decompression attached at the low suction relief (salem sumptube)*

Answer 39

NGT insertion

1 way lumen= intake gavage= lumen tube
2 way lumen= for lavage and gavage= salemsumptube)

Question 40

health teaching post op care of appendicitis px

Answer 40

1. deep breathing and coughing exercise
   -if pain during deep breathing = give pain meds PRN
   -if coughing- splint the pt to protect the insition
2. turning position Q2
3. early ambulation

Question 41

Position post appendectomy

Answer 41

low fowlers position 15-30 degree