Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS 523: Bowel and Bladder Continence > Disordered Defecation > Flashcards

Disordered Defecation Flashcards

1
Q

Defecation and Micturition Similarities

A

Storage (accommodation)
Outlet (internal and external sphincters)
Pelvic floor muscles (levator ahi muscle, puborectalis sling, innervated by pudendal nerve)
Innervation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Storage: Accommodation

A

Waste stored at low-pressure

Low pressure prevent reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Internal Sphincter

A

Involuntary muscle
Tonically contracted to prevent leakage
Automatically relaxes as filling occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

External Sphincter

A 
Striated muscle
Consciously controlled
Not maximally contracted
Contracts more when "time not right"
Overrides internal sphincter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pelvic Floor Muscles

A

Supports pelvic organs
Levator ani muscle and puborectalis sling
Voluntary control
Wrap around urethra, vagina, rectum as pass through pelvic floor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Peripheral Nervous System: Sympathetic Innervation

A

Continence nerves T10-L2
- gut motility and secretion
Relaxes bladder
Tightens internal sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Peripheral Nervous System: Parasympathetic Innervation

A

Continence nerves S2-S4
+ gut motility and secretion
Contracts bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Central Nervous System: Pons

A

Unconscious
Initiates bladder contractions
Instructs internal sphincter to relax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Central Nervous System: Frontal Lobe

A

“Social Continence”
Interrupts message from pons
If time is right, sphincter relaxes to allow urine/BM passage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Factors Contributing to Bowel Control Issues

A 
Antibiotics
Enteral feedings
Hypoproteinamia
Crohn's
Chronic Ulcerative Colitis
Bowel obstruction
Fecal impaction
Radiation therapy
Chemotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Mechanisms for Bowel Continence

A 
Transit time
Stool consistency
Stool volume
Awareness of filling
Intact pelvic floor and sphincter muscles
Rectal capacity and compliance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Intake/Output Volume

A

Oral fluid intake: 1-2 L/day
Small intestine secretions: 6-7 L/day
Volume at ileocecal valve: 1-1.5 L/day
Volume in rectum: 50-100 cc/day

Small intestine absorbs 7-9 L/day
Colon absorbs 1 L/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Mucosal Layer

A

Secretes mucus to lubricate mucosal lining = forward movement of food bolus and prevention of abrasions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Villi

A

+ absorptive surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Transit, Consistency, Volume Factors

A 
Ileosecal valve
Structures intact
Absorption
Peristalsis
Segmentation and austral contractions
Diet (fiber)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ileocecal Valve

A

Gradual release of contents into colon

Prevents backward movement of stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Segmentation

A

Mixing action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Haustral Contractions

A

Pushes stool forward

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Myenteric plexus aka Auerbach’s plexus

A

Regulates colon motility
Detects bowel distention and luminal irritants
Between muscles in colon wall
Intrinsic (enteric) NS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Submucosal Innervation: Meissner’s plexus

A

Detects bowel distention and luminal irritants

Intrinsic (enteric) NS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Increased Rectal Capacity

A

2nd to chronic delayed defecation, - sensitivity to distention, ineffective contractility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Decreased Rectal Capacity/Compliance

A

Experience normal sensation and muscle function
Extreme urgency
Associate w/ damage to mucosal surface (IBD, radiated bowel)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Awareness of Rectal Filling

A

Normal volume delivered in normal period of time
En Masse contractions move stool forward (1 - 2x/day)
Voluntary
Conscious control in anal canal (transition zone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Anal Canal

A

Columnar epithelium above Dentate Line
Squamous epithelium below Dentate Line
Begin to detect sensation in Transition Zone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Rectoanal Inhibitory Reflex

A

Rectum distends

Internal anal sphincter (IAS) relaxes automatically (reflexively)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Sampling Reflex

A

With internal sphincter relaxed, rectal contents come into contact w/ anal canal
Squamous epithelial cells discriminate btwn flatus and stool, liquid and solid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Anal Wink

A

Reflex
Indicates pudenal nerve intact
Stroke perianal skin
External sphincter contracts = contraction of muscle around anus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Forces Influencing Defecation

A

Propulsive: val salva, gravity, peristalsis
Resistive: External compression, rectal compliance, external sphincter, puborectalis muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Upper Urinary Tract

A

Kidney: 60 cc/hr urine production, + w/ age
Renal pelvis: store 15-30 cc urine
Ureter: peristalsis moves 5-15 cc urine to bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Lower Urinary Tract

A

Bladder: detrusor, body, neck, base
Detrusor compliance: stores 300-600 cc, - compliance = + filling pressure = urine reflux
Urothelium: Transitional epithelium
Urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Urethra

A

Collapsible
Proximal urethra is sphincter mechanism in males
Entire urethra functions as female sphincter
Distal 2/3 fused to vaginal wall
Coaptation: mucus +surface tension and adherence
Voluntary control of sphincter and pelvic floor
Innervated by Pudendal from S2-S4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Bladder Filling and Storage

A

Detrusor relaxed / Sphincter contracted

Controlled by Sympathetic Nervous System (T10-L2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Bladder Emptying Phase

A

Controlled by Parasympathetic (S2-S4)
Detrusor extends
Signal sent to micturition center (S2-S4)
Pons replies to contract bladder (empty)
Frontal lobe interrupts Pons if time not right to void
If time right, sphincter relaxes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Age-Related Bladder Control

A 
- bladder capacity
\+ urine output at night
- sensory awareness of filling
- urinary flow rate
- urethral closing pressure and length 2nd to - estrogen
- ability to delay voiding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Bowel Diary

A

Frequency, volume, consistency of continent and incontinent stools
Keep 1-2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Physical exam

A

Tighten anus and bear down: note weakness, nerve damage, prolapse, sphincter disruption
Digital exam: tumor, impaction, prolapse, hemorrhoids, musculature exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Anorectal Manometry

A

Measures pressures w/i anal canal during rest, contraction, relaxation
Localizes and quantifies sphincter deficits
Determines length of anal canal
Provides estimate of sampling reflex, rectal sensation/capacity/compliance
Mean and maximal resting pressure
Mean and maximal squeeze pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Mean and Maximal Resting Pressure

A

Reflects status of function of internal anal sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Mean and Maximal Squeeze Pressure

A

Reflects status of function of external anal sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Anal EMG

A

Useful when evaluating anal incontinence 2nd to disruption of external anal sphincter mechanism
Benefit in locating severed ends of sphincter muscle
PAINFUL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Pudendal Nerve Terminal Motor Latency (PNTML)

A

Checks for nerve damage to EAS (pudendal neuropathy)
+PNTML (2.2+ msec) = - conduction in terminal part of pudendal nerve to the EAS
Assesses - rectal filling sensation
May influence prognosis after surgical corrections of sphincter defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Endoanal Ultrasonography (EAUS)

A

Probe size of finger inserted into anal canal
Probe rotates 360 to provide image of IAS and EAS
IDs defects, asymmetry, thickness of sphincter muscle
Simple, painless, accurate, repeatable
Follow-up after surgical correction of incontinence
- need for EMG 2nd to correlation w/ absent electromyographic activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Rectal Compliance Study

A

Ability of rectum to distend or stretch and store stool at low pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Defecography

A

Evaluates function of anorectal unit during BM

IDs pelvic floor dysfunction affecting stool evacuation (prolapse, rectocele, non-relaxing puborectalis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Barium Enema

A

View structures of colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Motility Studies

A

Follow contrast material progression through intestinal tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Bristol Stool Scale: Type 1

A

Stools in separate, hard lumps
Nut-like
Stool remains in colon longest amount of time
Sign of constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Bristol Stool Scale: Type 2

A

Sausage-like stool
Lumpy
Indicate toxic constipation and need for intestinal cleaning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Bristol Stool Scale: Type 3

A

Normal
Sausage-like
Cracks is surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Bristol Stool Scale: Type 4

A

Normal
Smooth and soft
Form of sausage or snake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Bristol Stool Scale: Type 5

A 
Soft blobs w/ clear-cut edges
Easily pass through digestive system
Soft diarrhea 
Possible risk of bowel disease
Indicates toxic and need for regular intestinal cleaning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Bristol Stool Scale: Type 6

A

Fluffy pieces w/ ragged edges
Mushy stools
Indicate diarrhea
Indicates toxic and need regular intestinal cleaning

53
Q

Bristol Stool Scale: Type 7

A

Mostly liquid w/ 0 solid pieces
Passed quickly through colon
Indicative of severe diarrhea as result of viral or bacterial infection
See doctor ASAP

54
Q

Bristol Stool Scale: Type 8

A

Mucous-like consistency w/ bubbles and foul odor
Unsafe amount of alcohol/drugs
Not originally part of scale

55
Q

Intrinsic Innervation

A

Inside bowel
Meissner’s cells (in submucosal layer of bowel)
Auerbach’s plexus (in mucosal layer of bowel)
Regulates colonic motility
Triggered by colonic distention and intraluminal irritants
Not affected by SCI
Intrinsic (enteric) NS

56
Q

Extrinsic Innervation

A

Outside bowel
Innervated by Autonomic Nervous System
Involuntary
Sympathetic or Parasympathetic

57
Q

Sympathetic pathway

A

Arise from T10-L2
- intestinal motility and secretion
Loose stools occur if innervation disrupted

58
Q

Parasympathetic pathway

A

Arise from S2-S4
+ peristalsis and intestinal secretion in L colon
Contributes to reflex activity w/i distal colon
Severe constipation occurs if sacral cord lesion occurs, but may respond to stimulant program because Intrinsic system is intact

59
Q

External Anal Sphincter (EAS)

A

Bilateral motor innervation: Contains smooth (involuntary) and striated (voluntary) muscle

60
Q

Smooth Muscle of EAS

A 
Keeps sphincter in resting state of tonic contraction
Involuntary control (smooth muscle) by intrinsic nervous system
61
Q

Striated Muscle of EAS

A

Voluntary control to delay defecation

Primarily innervated by Somatic nerve through branches of pudendal nerve exiting at S2-S4

62
Q

Pudendal Nerve Tests

A 
Anal wink: Contraction of EAS when perianal skin stroked at 3 or 9 o'clock
Bulbocavernous relex (BCR): Contraction of EAS when glans penis squeezed or clitoris is tapped
Positive contraction = innervation of striated muscles of pelvic floor
63
Q

Internal Anal Sphincter (IAS): Structure

A

Smooth circular muscle 3cm in length

Encircles anorectal junction and proximal 2cm of anal canal

64
Q

Internal Anal Sphincter (IAS): Innervation

A

Sympathetic nervous system
Tonically contracted to maintain anal canal in closed position
Involuntary control

65
Q

Internal Anal Sphincter (IAS): Autonomic Reflexes

A

Important for continence
Rectoanal inhibitory reflex: relaxation of IAS in response to rectal distention
Sampling reflex: sensory receptors in anal canal “sample” bowel contents to determine is gas, liquid, or solid stool

66
Q

Acute Diarrhea

A

Lasts -4wks
Self-limiting in non-hospitalized pt
Symptom management
Clinical eval after 7 days if pt immunosuppressed, elderly, or deteriorating
Caused by viral, protozoal, or bacterial infection

67
Q

Manifestations of Inflammatory Diarrhea

A

Stool w/ blood, leukocytes, pus or mucus
Fever over 38.5
Prostration

68
Q

Risk Factors or Inflammatory Diarrhea

A 
Travel
Unusual food/fluid
Contaminated food/fluid
Exposure to sick
Anal sexual intercourse
69
Q

Secretory Diarrhea

A

Volume of H2O and electrolytes secreted into bowel lumen overwhelms absorptive capacity
Caused by infectious agent, malabsorbed substances, malignant tumors, prostaglandins produced 2nd to colitis

70
Q

Manifestations of Secretory Diarrhea

A 
Large volume of stool (+1 L/day)
Neutral stool pH
0 reduction in stool when fasting
Hyponatremia 2nd to excessive Na loss
Stool osmotic gap of less than 50 mOsm/kg
71
Q

Absorptive Diarrhea (Osmotic)

A

Inadequate or reduced absorption by bowel

72
Q

Absorptive Diarrhea (Osmotic): Causes

A

Alterations in intestinal mucosa
Conditions producing hyperosmolar substances into lumen of bowel that block transport of H2O and electrolytes into epithelium
Hyperosmolar substances in lumen = osmotic force that pulls H2O and electrolytes INTO bowel lumen

73
Q

Examples of Absorptive Disorders

A

Alteration in mucosal surface: malnutrition, NPO, hypoproteinemia, +bowel reduction, villi atrophy, IBD

74
Q

Causes of Osmotic Diarrhea

A

Intolerance to sugars

Fat malabsorption syndromes

75
Q

Manifestations of Absorptive Diarrhea

A 
- volume stool (-L/day)
Acidic stool pH
K loss exceeds Na loss = hypokalemia
Stool output volume - by fasting 2nd to malabsorbed substance eliminated
Stool osmolality gap + 50 mOsm/kg
76
Q

Motility Disorders

A 
\+ motility = - contact time btwn contents and mucosa
IBD
IBS
Rapid gastric emptying
Infectious diarrheas
77
Q

Diminished Motility

A

Causes severe constipation, impaction, cramping
Fluid secreted into lumen behind bolus = liquid stool seeps around obstruction
Stagnation of stool = bacterial growth

78
Q

Examples of Mixed Diarrhea Disorders

A 
Laxative abuse (+ motility and - absorption)
Infectious diarrhea 2nd to C.diff (toxins cause secretory diarrhea and alter absorptive function)
AIDS-related (infectious and malabsorptive, 4-6 L of stool)
79
Q

Rome II Criteria for Constipation

A

2+ symptoms for 12 weeks during 12 months in pt w/o IBS
Straining
Lumpy or hard stool
Sensation of incomplete evacuation
Manual maneuvers to facilitate evacuation
(All more than 25% of time)

80
Q

Risk Factors for Constipation

A 
Female
Nonwhite
Low socioeconomic status
\+ age
- calorie, - fiber diet
Sedentary
Comorbid medical conditions
Neuromuscular disorders
Strain/sprain in sacroiliac region
SCI
Herpes zoster
Psychotic disorder
Opioid analgesics
81
Q

Normal Transit Constipation

A

Most common type of constipation
Colon function is normal
Extrinsic contributing factors

82
Q

Inadequate Fiber or Fluid

A
  • stool volume = hard, small caliber stools

- peristaltic activity = + contact w/ mucosa = + H2O absorption

83
Q

Decreased Activity Level

A
  • gut motility

- pelvic floor muscle tone

84
Q

Poor Toileting Behavior

A

Suppression of urge/delay in defecation = dehydrated stool

85
Q

Constipating Medications

A 
Antocholinergics
CV meds
Anticonvulsants/antiparkinsons meds
Narcotics
Vinca alkaloids
Cation containing meds (antacids, Ca, Fe)
Nonsteroidal anti-inflammatory meds
86
Q

Slow-Transit Constipation

A 
Colonic inertia
- in frequency (1x/week or less)
Bloating, ABD discomfort
Common in young women at puberty
-  peristaltic contractions = dehydrated stool
\+ pressure in rectum and sigmoid
87
Q

Etiologic Factors for Slow-Transit Constipation

A 
Neurologic lesion
Condition damaging autonomic nervous system
Low SCI
Parkinson's
MS
Cholecystokinin (CCK)
88
Q

Obstructed Defecation Syndromes

A 
Inability to eliminate stool even w/ soft consistency
Difficulty initiating defecation
Failure to achieve complete evacuation 
Feeling of blockage
Retained stool
89
Q

Pelvic Floor Dyssynergia

A

Cause of obstructed defecation syndrome
Failure to relax pelvic floor muscles
Inadvertent contraction of anal sphincter
tx: pelvic muscle re-education w/ biofeedback

90
Q

Pelvic Floor Dyssynergia: Diagnosis

A

2+ of following:
Anorectal manometry shows + in anal pressure
Inability to expel balloon in 3 min
+ colonic transit time (retain 5+ radiopaque markers after 120 hours)
Inability to expel barium during defecography

91
Q

Rectocele

A

Common cause of obstructed defecation
Herniation of anterior rectal wall into posterior vagina
Straining pushes stool into vaginal pouch
Risks: vag delivery, hysterectomy, postmenopausal, connective tissue disorders, chronic straining
tx: pessary or surgical repair

92
Q

Rectal Prolapse

A

Cause of obstructed defecation
Rectal mucosa protrudes from anus
Assess pt bearing down while lying/standing
tx: surgical repair to prevent innervation problems

93
Q

Irritable Bowel Syndrome (IBS)

A

ABD pain, bloating, distention, incomplete emptying, changes in stool freq/consistency
Pain relieved w/ defecation
Constipation-predominant, diarrhea-predominant or intermittent
Affects women commonly
Appears in late adolescence
Diagnosis by exclusion

94
Q

Rome II Diagnosis of IBS

A 
3 months continuous/recurrent
ABD pain or discomfort: 
* relieved by defecation
* associated w/ change in stool freq/consistency
2+ at least 25% of time
* altered stool freq/form/passage
* passage of mucus
* bloating
95
Q

IBS Treatment

A 
Address predominant bowel symptom
Control dietary factors
Provide education
Symptom diary 
Cognitive behavior therapies
0 pharmacologic regulation of serotonin in GI tract
96
Q

Complete Fecal Incontinence

A

Formed or liquid stool/gas

Damage to external anal sphincter or neurologic lesion

97
Q

Partial Fecal Incontinence

A

Leakage of gas and liquid stool only

Common if internal anal sphincter damaged

98
Q

Seepage and Soiling

A

Leakage of small amounts of stool in pt who is continent

Compromised sensory awareness or rectal distention

99
Q

Encopresis

A

Fecal soiling in peds (4+ in age)
Occurs w/ functional constipation
No organic or anatomic lesion
2nd to fear, stress, diet, distraction

100
Q

Retentive Encopresis

A 
Associate w/ constipation
May develop megacolon
Overflow stooling
Formed, ribbon-like stool or loose, odorous, and thin
Painful bowel movements
Several accidents/day
101
Q

Non-retentive Encopresis

A

0 evidence of constipation
Stress related
Primary: pt is 4+ and never been continent (organic or stressed)
Secondary: bowel control for 1 yr before incontinence (psychologic issues)

102
Q

BRAT Diet

A

Bananas, Rice, Applesauce, Tapioca
+ stool consistency
- H2O in stool
Also use yogurt, cheese, marshmallows, wheat, pectin-containing fruits (apples)

103
Q

Bulking Agents

A

Psyllium
Guar gum
Thicken stool by absorbing fluid and slow intestinal transit time

104
Q

Constipation Treatment

A 
- peristaltic inhibitors
\+ fluid and fiber
25-30 g fiber/day
Introduce slowly to prevent distention/gas
30mL/kg fluid
105
Q

Sphincteroplasty

A

If sphincter disrupted
Dissect back to healthy muscle and ends overlapped to complete ring
Common following OB trauma

106
Q

Graciloplasty

A

Compensates for weak sphincter
Overlapped ends of sphincter gracilis muscle mobilized from leg attachment
Wrapped around anus
Limitations: inability to voluntarily contract muscle and inability to provide sustained resistance

107
Q

Dynamic Graciloplasty

A

Electrical stimulation converts fast-twitch muscle fibers to slow-twitch
+ duration of contraction
Electrical stimulus interrupted w/ hand-held device when time to defecate

108
Q

Artificial Anal Sphincter

A

Cuff placed around anal canal to serve as anal sphincter
Reservoir implanted into groin or lower and
Pump implanted into into scrotum or labia
Cuff filled w/ fluid from reservoir to compress anal canal
Deflate cuff to defecate

+ need for revision = reserved for refractory incontinence
Cuff left deflated for 6-8 weeks for healing

109
Q

Adapt to loss of sensory awareness or sphincter control

A

Stimulated defecation program
Antegrade continence enema (ACE) procedure
Colostomy
Stool containment and skin protection (absorptive products,
anal plug)
External collection (pouches, internal drainage system)

110
Q

Peds age for continence

A

Toilet training btwn 24 - 30 months
Bowel and bladder control when awake at 3 yrs
Bowel continence at age 4

111
Q

Neurologic Readinenss Criteria

A

Reflex sphincter control (begins at 9 months)

Myelinization of pyramidal tracts (complete btwn 12-18 mo)

112
Q

Psychological Readiness Criteria

A

Motor: able to walk to WC, sit on toilet, take off clothes
Cognitive: Communicate urge
Instructional: follow 1-2 step commands
Misc: desire, positive relationship with caregivers

113
Q

Imperforate Anus

A

Absence of visible opening
Distal bowel ends above or below levator ahi pelvic muscle
Temp diverting colostomy
Pull through surgery at 18-20lbs (12-15 mo)
Fecal incontinence common after surgery

114
Q

Hirschsprung’s Disease

A

0 ganglion cells in colon/rectum = 0 peristalsis
Always involves rectum may go retrograde into colon
Bouts of obstruction and impaction
tx: remove aganglionic segment and create colostomy when baby is 12-15 mo/20 lbs
Fecal incontinence common after surgery

115
Q

Biofeedback

A

When nerve pathway intact but unable to contract adequately

116
Q

Stimulated Defecation Program

A

Decreased sensory awareness in chronic rectal distention or neurogenic bowel

117
Q

Complete Incontinence

A

External sphincter

118
Q

Partial Incontinence

A

Internal sphincter

119
Q

Seepage and Soiling

A

Leakage btwn BMs in continent patient
Smearing
- sensory awareness
Hemorrhoid or prolapse

120
Q

Autonomic and Enteric Nervous System

A

Responsible for internal anal sphincter

121
Q

Neurologic Lesions

A

Alter sensory awareness of rectal filling
Diabetic neuropathy, MS, SCI, Myelomeningocele
tx: Maintain solid stool

122
Q

Pudendal Nerve Damage

A

Difficult deliveries, large babies, forceps, chronic straining
tx: Maintain formed stool, biofeedback to + sensory awareness

123
Q

Cognitive Impairment

A

Pathways intact but - interpretation of message

ex: dementia
tx: Stimulated defecation program w/ suppositories

124
Q

Chronic Rectal Distention

A

Chronic constipation = distended rectum w/o urge to defecate
May cause megarectum
tx: Disimpaction, colonic cleaning, stimulated defecation program w/ suppositories

125
Q

Anorectal Lesions

A

Hemorrhoids, rectal prolapse
Fail to sense slight distention
IAS relaxes but EAS doesn’t respond
tx: Bulking agents, biofeedback to + awareness

126
Q

Spinal Cord Injury

A

Unable to contract EAS, altered sensation of rectal filling
IAS and rectoanal inhibitory reflex intact (enteric NS)
tx: maintain soft/formed stool, stimulated defecation program

127
Q

Pudendal Neuropathy

A

EAS (somatic NS) affected = reduced ability to delay BM

tx: maintain formed stool, stimulated defecation program, artificial sphincter

128
Q

Increased Capacity/Compliance

A

Chronic delays in defecation (megarectum) = reduced sensitivity to distention
tx: disimpaction, colonic cleansing, maintain soft/formed stool, stimulated defecation program

129
Q

Reduced Capacity/Compliance

A

Fibrotic rectal unit
Inflammatory process (IBD, gastroenteritis) or fibrotic changes (radiation, ischemic injury)
Unable to relax rectal wall to accommodate stool
tx: management of underlying disease, fecal diversion

NURS 523: Bowel and Bladder Continence (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions