Exam 2- Disorders of the Lower GI Tract Flashcards
Abnormal infrequency or irregularity of defecation, abnormal hardening of stools making passage difficult and painful
Constipation
Meds that cause constipation
Opioids, antiemetics
Increase in frequency of bowel movements (more than 3 per day), and altered consistency
Diarrhea
ABG complication with diarrhea
Metabolic acidosis
Involuntary passage of stool from the rectum
Fecal incontinence
Most common GI condition
IBS
Diet for IBS
High fiber diet (soluble-psyllium)
Med for IBS
Metamucil (soluble-psyllium)
IBS med for diarrhea
Loperamide
IBS med that slows motility
Lotronex
IBS med probiotic
Lactobacillus
Anti-diarrheal
Imodium
Diagnostic stool tests for IBS
- Fecal occult blood test
- C-Diff
- Culture
Basic labs for IBS
- CBC
- CMP
- PT/PTT
- INR
- Liver test
- Amylase
- Lipase
- Triglycerides
Endoscopy for IBS (2)
- Sigmoidoscopy
- Colonoscopy
LGI surgeries
- Colectomy
- Ostomies
(Ileostomy and colostomy)
Signs for ileostomy
More watery, yellow/green, located R lower side typically
Signs for colostomy
More formed, brown typical color, stool more solid because water has been reabsorbed from colon
- Can be located in ascending colon, transverse, or descending
Acute abdomen disorders
- Appendicitis
- Diverticulitis
- Peritonitis
- Bowel obstruction
- Colon cancer
Inflammation or edema as a result of becoming kinked or occluded by a fecalith (hardened mass of stool), tumor, lymphoid hyperplasia, or foreign body
Appendicitis
Appendicitis pathophysiology
Appendix fills with pus, becomes ischemic-bacterial overgrowth occurs which can lead to gangrene
Appendicitis pain location
Peri-umbilical pain localized to RLQ within a few hours
With appendicitis, relied of pain may indicate…
Rupture
Food and bacteria retention in a diverticulum producing infection and inflammation
Diverticulitis
Foods that can cause diverticulitis
Nuts, seeds, popcorn, seeds on strawberries
Inflammation of diverticulum can lead to…
Perforation, abscess formation, peritonitis, and bleeding
Acute onset or mild to severe pain in the LLQ. What is this?
Diverticulitis
What diagnostic testing is contraindicated with diverticulitis?
Colonoscopy
Management for diverticulitis
Analgesics
Antispasmodic agents
Antibiotics 7-10 days
Increase bulk laxatives (metamucil) (not stimulants)
High fiber
Docusate
Stool softener, bulk forming
Derived from leaf that irritate GI structures and increase peristalsis
Senokot
Entrance of microorganisms into peritoneal cavity as a result of
- Rupture of internal organs
- Trauma
- Surgical procedures
Peritonitis
Complications of peritonitis (2)
SEPSIS AND SHOCK
Pathophysiology of peritonitis
- Tissue edema
- Development of exudate
- Increased protein, WBCs, cellular debris, and blood in peritoneal fluid
Which disorder involves abdominal pain becoming more localized and aggravated by movement?
Peritonitis
Tender, distended, board like abdomen is a manifestation of…
Peritonitis
Clinical manifestations of peritonitis
- Decreased bowel sounds (paralytic ileus)
- Hypotension
- Tachycardia
- Increased WBCs
Medical management for peritonitis
Antiemetics
Antibiotics
Bowel decompression (NG tube)
Peritonitis nursing management
- Ongoing assessment, serial exams
- Pain management: multimodal (positioning)
- Accurate I&O (CVP, UO, Drains)
Blockage of intestines preventing the flow of intestinal contents
Bowel obstruction
Signs of improvement with peritonitis
- Decreased temp and pulse rate
- Softening of abdomen
- Return of bowel sounds
Types of bowel obstructions
- Mechanical
- Functional
- Partial vs. complete
Mechanical bowel obstruction
Something in the way (tumor)
Functional bowel obstruction
Just not working
Partial vs. complete bowel obstruction
Partial: not fully obstructed
Vomiting and BM at the same time is r/t viral infection or severe issue with thyroid. What type of bowel obstruction is this?
Functional
Most common site for bowel obstruction
Small intestine
Three causes for bowel obstruction
- Adhesions
- Hernias
- Neoplasms
15% of bowel obstructions occur in…
Large intestine
- most in sigmoid colon
- Carcinoma
- Diverticulitis
- Inflammatory bowel disorders
- Benign tumors
- Symptoms develop slowly
- Constipation, lack of flatulence
- May vomit feces
- Crampy lower abdominal pain; distention; bloating
Large bowel obstruction
- GI contents above the obstruction increase
- Extreme pain (crampy wavelike)
- Vomiting; can have diarrhea followed by lack of stool/gas
- Dehydration (Acidosis may results from loss of fluid and NA)
Small bowel obstruction
Hypovolemic shock can happen if this is untreated
Small bowel obstruction
WIth a bowel obstruction, we do a lab study for lactate. What does this mean?
It means not getting enough adequate perfusion (blood flow to the bowels), so it results in gangrene
Management for bowel obstructions
- NGT (decompression)
- Monitoring drainage
- Fluid/lytes replacement
- Careful management of pain (SE of opioids)
Bowel obstruction teaching
- Bowel program: High fiber prevention
- Avoidance of constipating substances
- Increased activity
- Medications that can impact
Gold standard diagnostic for bowel obstruction
Chest X-Ray to check placement (or KED)
Colon cancer risk factors
- Increasing age
- Family hx of colon cancer or polyposis
- Previous colon cancer/adenomatous polyps
- Inflammatory bowel disease (Crohn’s or UC)
- High-fat, high protein, low fiber diet
- Genital cancer or breast cancer
- ETOH, smoking, obesity
- History of Gastrectomy
When should you start screening for colon cancer?
45
Colon cancer screening options
- Stool test
- Direct visualization test
How is colon cancer determined
Determined by location of tumor, stage of disease, and function of portion of bowel where tumor is located
Clinical manifestations of colon cancer
- Change in bowel habits
- Blood in stool; anemia
- Anorexia
- Weight loss, “B-Symptoms”
- Fatigue
Diagnosis of colon cancer
- Abdominal and rectal exam
- FOBT, CEA, CA 19-9 (tumor markers)
- CT A/P
- Endoscopy with bx (colonoscopy)
Complications of colon cancer
- Bowel obstruction
- Hemorrhage
- Perforation
- Abscess formation (a dead piece of tumor that causes gangrene and sepsis)
- Peritonitis
- Sepsis
- Shock
Chemo treatment for colon cancer
FOLFOX, immunotherapy, neuroendocrine tumors
Can you live without your colon?
Yes
