Exam 1: Lower GI Flashcards
The lower GI consist of what ?
- Large intestine
- Small intestine
- Rectum
- Anus
Diarrhea is defined as ?
Loose or liquid stools - 3 or more a day
True or False: All diarrhea is considered infectious until tested ?
True
Causes of Diarrhea ?
- Infections (viral, bacterial, parasitic)
- medications
- anything w/ magnesium in it
- Antibiotics can interrupt the flora of the GI tract - immunocompromised
- etc,.
How is Diarrhea managed ?
- Tx the cause
- Replace fluid & electrolytes
What is a complication of Diarrhea ?
Dehydration
True or False: Immunocomprimised pt’s are at risk for C-Diff ?
True
Constipation is defined as what ?
Difficult or infrequent stools - < 3 per week)
What are some causes of Constipation ?
- Diet
- Lifestyle
- Medications
- Narcotics*** (OIC = opioid induced constipation)
- Not enough daily fluid intake
What are some pt. education points about constipation ?
- utilize Fiber !!
- Miralax
- Prunes
- 2L of non-carinated liquid a day
- Avoid chronic use of laxatives and enemas
(can exacerbate constipation)
What is a complication of constipation ?
Hemorrhoids
Acute abdominal pain can be caused by what kinds of things ?
- Inflammation
- Appendicitis
- Diverticulitis
- Gastroenteritis
- Peritonitis
- Perforation or rupture - Obstruction
- Internal bleeding
Acute abdominal pain caused by inflammation can be caused by what types of things ?
- Appendicitis
- Diverticulitis
- Gastroenteritis
What can Peritonitis lead to ?
Septic shock
because abdominal contents are leaving the cavity they are meant for
True or False: Surgery may be needed for acute abdominal pain ?
True
Chronic abdominal pain can be caused by what types of things ?
- IBS
- Inflammation
- IBD
- Chronic pancreatitis
- Hepatits
- Adhesions
- Vascular insufficiencies
Adhesions are caused by what ?
Previous abdominal surgeries
What is Hepatitis ?
Inflammation of the Liver
Vascular insufficiencies are common with the ______________ artery ?
Mesinteric artery
What is the Pathophysiology of Chronic Pancreatitis ?
Pancreatic enzymes can’t exit the pancreas, so they are sort of chewing up the pancreas. (aka: Autodigesting)
What are Manifestations of Appendicitis ?
- RLQ pain (McBurney’s point)
- Rebound tenderness (classic sign)
- N & V
- Fever (aka: febrile)
- Leukocytosis (elevated WBCs)
What is Rebound Tenderness ?
When you press slowly and firmly, and then remove your hand/pressure quickly, and the pt. experiences more pain as you move your hand away
Where is McBurney’s point ?
Between the belly button and the right illiac crest
True or False: The surgery for the management of Appendicitis, is often done Laparscopically, especially if caught early or it didn’t rupture ?
True
What are we worried about If Appendicitis ruptures ?
periotonitis
True or False: people with laparoscopic appendectomies typically will not stay over night, but if they do its typically just one night ?
True
True or False: Pt’s with appendectomies can advance their diet as tolerated ?
True
How soon after an appendectomy can pt’s ambulate ?
A few hours after surgery
How soon after an appendectomy can pt’s resume normal activities ?
Within a few weeks (depending on doctor)
What is the main contributing factor for Diverticulitis ?
Diets without enough Fiber
Diverticulitis is more common with what type of diets ?
Western diets b/c we have more refined carbohydrates
What is Diverticulitis ?
Inflammation of the Diverticula
Where is Diverticulitis common in ?
Descending & Sigmoid colon
What are complications of Diverticulitis ?
perforation –> peritonitis or stricture –> Obstruction
Acute Diverticulitis problems are usually managed how ? and include things such as ?
managed outpatient
- Colon rest
- Clear liquids
- If hospitalized NPO/NG
- may or may not, it depends on if there having a lot of N&V - PO antibiotics
- If hospitalized, IV antibiotics & fluids
What is the management/teaching focused on for Diverticulitis ?
- High fiber diets** (fresh fruits, vegetables, low fat diet)
- Fluids* (2-3L per day/ 8-10 glasses per day)
- Stool softners* (to help w/ passage of stool through the lower colon)
Diverticulitis pain will present where ?
LLQ (descending part of colon)
True or False: If the Diverticulitis becomes to much of a problem, then it will need to be resected ?
True
What are the Manifestations of Periotonitis ?
- Abdominal pain
- Abdominal rigidity
- N & V
- Malaise
- Fever
- Increases WBC
- Tachycardia
What is the Management of Periotonitis ?
- NPO
- IV fluids
- Possible NG to low intermittent suction
- IV antibiotics
- If theres been a little bit of leakage into the abdomen
- Pain management
- Surgery –> drain
What is an intenstinal blockage ?
Bowel contents cannot pass through the GI tract
What is a MECHANICAL Intestional Obstruction also known as ?
Physical obstruction
Where does a mechanical obstruction usually occur ?
Small intestine (Because its skinnier)
What are causes of Physical Intestional Obstructions ?
- Adhesions
- Hernia
- Strictures
- Cancer
- Volvulus (the bowel actually twists on itself and causes an obstruction)
What are Examples of Physical (Mechanical) obstruction ?
- Tumor
- Stool
- Fibroid
What is a Non-mechanical Intestional Obstruction also known as ?
Peristalsis absence
What are causes of Non-mechanical Intestional Obstructions ?
Neuromuscular or Vascular disorders
Neuromuscular
- Drugs
- Nerves being turned off during surgery
Vascular disorders
- Embolus
- Atherosclerosis (maybe in the mesenteric artery)
What does a paralytic ileus = ?
No Peristalsis
What is Irritable Bowel Syndrome (IBS) defined as ?
Chronic intermittent abdominal pain
True or False: IBS tends to be diagnosed on symptoms alone ?
True
True or False: IBS comes and goes, and theres no known organic cause ?
True
What are the 3 categories of IBS based on still patterns ?
- IBS w/ diarrhea
- IBS w/ constipation
- IBS mixed
IBS with Diarrhea is more common in which sex ?
Men
IBS with Constipation tends to be more common in which sex ?
Women
What is the goal of IBS ?
Treat symptoms & Avoid triggers
-Pt’s really have to try and identify what the triggers are and avoid them
What are some triggers for IBS ?
- Stress
- Anxiety
- Some foods
True or False: With Inflammatory Bowel Disease, pt’s will have exacerbations & remissions ?
True
True or False: With IBD theres often a…
- Family history
- Genetic predisposition
- There may be an autoimmune component
True
True or False: With IBD we often see widespread tissue destruction ?
True
True or False: Environment can play a role in IBD ?
True
True or False: You should never smoke with IBD, as it exacerbates the issue ?
True !
What is the biggest thing were trying to encourage pt’s to do who have a bowel obstruction to try and get it resolved ?
Walk, Walk, Walk, Walk !!!!
Get them up and moving, and try to get the nerves to wake up!
What is Tx for a Partial Bowel Obstruction ?
- Usually put an NG in
- Decompress
- Let the abdomen rest
- IV fluids
- Wait for the obstruction to clear
- Sometimes even the physical obstructions will back off after a while. SAME thing with the Non-mechanical, where we have the nerves that have gone to sleep and were waiting for them to wake up
What is the Tx for a complete bowel obstruction ?
The pt. may need surgery
- they may need to resect that part of the intestine.
What is a Malignant Bowel Obstruction ?
Part of the intestine is narrowed, b/c theres cancer pushing on it.;
What is the Tx for a Malignant Bowel Obstruction ?
They can try and go in and place a stent in the small intestine to try and keep that part of the intestine open.
True or False: Crohn’s disease can occur throughout any part of the small or large intestine (aka: Anywhere) ?
True!
Crohn’s disease most commonly affects what ?
The small intestine
Ulcerative colitis involves what ?
The colon ONLY (Left side of the abdomen)
- descending colon & Sigmoid colon
Ulcerative Colitis is a disease of what ?
The Large intestine (colon) & Rectum
____________________ is Chronic inflammation of the intestinal tract ?
Ulcerative Colitis
What disease has an increased risk of colon cancer ?
Ulcerative Colitis
- Because of the continuous ulceration, inflammation, & irritation of the colon. Whenever tissue is injured repeatedly, the cell structure changes and then theres more of a chance for a change to malignant or cancerous tissues.
True or False: With Ulcerative Colitis there is…
- bleeding & shallow ulcers of the colon ?
- Abscess formation ?
- Colon becomes thin and fragile ?
True
What are Manifestations of Ulcerative Colitis ?
- Bloody Diarrhea (w/large amounts of fluid & electrolyte loss)
- Abdominal pain
- Fever
- Weight loss
- Rectal bleeding (more common with UC)
What are some intestinal complications with Ulcerative Colitis ?
- Hemorrhage
- Strictures
- Perforation
- Toxic Megacolon
- Colonic dilation
What is Toxic Megacolon ?
A shift of fluid into the Lumen of the Large intestine
What is Colon dilation ?
The colon will be stretched as the bowel contents are trying to pass through
What diagnostics are used to manage Ulcerative Colitis ?
- Colonoscopy (can see entire colon)
- Sigmoidoscopy (can only visualize lower colon)
What are the goals of treatment for the management of Ulcerative Colitis ?
- Bowel rest (may involve NPO, clear liquids - depends on situation)
- Control inflammation (may use steroids, immunosuppressants, etc.) (example of a medication = Sulfasalazine (anti-inflammatory))
- Combat infection (w/antibiotics/antimicrobials)
- Correct malnutrition (Can be done w/ TPN - depending on how long the pt. is unable to eat)
- Alleviate stress
- Symptomatic relief with drug therapy
- pain meds & anti-anxiety meds can be used
What is the Management of Mild to Moderate Ulcerative Colitis ?
- Low-roughage diet - no milk or milk products
- Antimicrobials (to prevent or treat secondary infections
- Sulfasalazine (anti-inflammatory effects)
- Anti-inflammatory (corticosteroids)
- Anticholinergics
- Decrease gastric motility, relief of smooth muscle spasm (Ex: Dycyclomine)
There should be caution not to use Anticholinergics with what ?
Toxic megacolon or Severe disease
What is the Tx for Severe Ulcerative Colitis ?
- IV fluids & electrolytes
- Blood transfusions
- b/c they have bleeding or hemorrhage with the UC
- NPO (may have TPN to meet their nutritional needs
- NG tube to LES
- Antimicrobials
- Steroids
- TPN (if needed)
- Surgery if no improvement with the above interventions
- Colon resection with ileostomy
What type o Surgery is done if there is no improvement with UC interventions ?
Colon resection with Ileostomy
True or False: Crohn’s disease can really occur anywhere in the GI tract (mouth to anus) ?
True
What is Crohn’s disease ?
Chronic Nonspecific inflammatory bowel disease
Where is Crohn’s disease frequently seen in ?
Terminal Ileum (small intestine)
What is the internal appearance of Crohn’s disease ?
Cobble stone formation
True or False: With Crohn’s disease there can be Malabsorption & nutritional deficiencies ?
True
What are concerns with Crohn’s disease ?
- Fissures
- Strictures
- Abscesses
- Perforation
__________: Are sort of like irritations, scratches, abrasions of the intestional tissues ?
Fissures
__________: Are narrowing due to inflammatin ?
Strictures
__________: Are pus filled pockets ?
Abscesses
Whats the main thing to keep in mind about the manifestations of Crohn’s disease ?
Depends on which area is involved
True or False: Crohn’s disease is insidious and nonspecific, making it hard to pin down ?
True
What are the Manifestations of Crohn’s disease ?
- Diarrhea (usually not bloody)
- could be up to 20 to 25 per day
- Fatigue
- Abdominal pain
- Weight loss
- Fever
What does the collaborative management do Crohn’s disease involve ?
- High calorie, High protein, High vitamin, Low residue, milk free diet! (NO LACTOSE!)
- Antimicrobials
- If we think theres a risk for infection
- Corticosteroids
- To reduce inflammation of the intestine
- TPN if necessary
- Physical & Emotional rest
- Possible surgery
When managing Crohn’s, what does a Low residue diet mean ?
NO fruits or vegetables ! when somebody is having a flair
When managing Crohn’s why do we want pt. to have a milk free diet (No lactose) ?
B/c we don’t want things to move any faster through the GI tract than it already is !
- we want things to slow down :)
What are type of Malobsorption Syndromes ?
- Celiac Disease
- Lactase deficiency
- Short bowel syndrome
True or False: Celiac disease is an Autoimmune disease ?
True
What is Celiac disease related to ?
Gluten !!
What is Celiac disease ?
Damage to the small intestine that occurs from wheat, barley, and rye
*it ends up causing a protein, fat, carbohydrate metabolism
To manage the disease, many people with Celiac disease do what ?
go Gluten Free !!
people will instead tuen to corn, rice, etc
True or False: Gluten is a substance in wheat, barley, and rye that causes a problem ?
True
Individuals with a lactase deficiency will typically experience what types of symptoms ?
- Bloating
- Gas
- Cramping
- Diarrhea
- etc,.
True or False: Lactase is typically present and needed for the breakdown of Lactose ?
True
With what syndrome is there not enough surface area in the small intestine to absorb the nutrients that are required for adequate nutrition ?
Short Bowel Syndrome
- generally we say that 2/3 of the bowel has been resected…
What is the Tx for Lactase deficiency aimed at ?
Generally aimed at avoiding lactose, and also taking a Lactase supplement
What are the Manifestations of Short Bowel Syndrome ?
- Chronic Diarrhea
- Vitamin & Mineral deficiencies
What is the Tx for Short Bowel Syndrome ?
Small frequent meals
- some people may require tube feedings at night to get all the nutrients that they are not getting during the day
__________ are defined as, a protrusion of an internal organ such as the intestines through an opening or weakness in the abdominal wall ?
Hernia(s)
What are types of Lower GI Hernias ?
- Inguinal
- Umbilical
- Femoral
- Ventral or Incisional
What type of Hernia is the Most common ?
Inguinal
Where is an Inguinal Hernia typically located ?
Down in the groin area
With Inguinal Hernia’s the intestine is either slipping through the ___________________ in men or the __________________ in females ?
Men = Spirmadic cord Women = Round Ligament
__________ Hernia, is where the rectus muscle gets muscle gets weakened in the abdomen & you see a protrusion of the intestine, right around the belly button area ?
Umbilical Hernia
________ Hernia, occurs when the intestines sort of slips through the femoral vein ?
Femoral Hernia
_________ or _________ Hernias are weakened areas due to the site of a previous surgical incision (ex: C-section scar)
Ventral or Incisional Hernia
What is the Management/Treatment of Hernia’s ?
- Generally includes surgery
- Very often Laproscopically
- surgeon typically goes in and reinforces the weakened area with mesh
- Lifting restrictions (< 10lbs for 6-8 weeks)
A ___________ Hernia, mean that the bowel has been pinched and lost circulation ?
Strangulated Hernia
- In this case part of the bowel may need to be resected (the dead part)
