Exam 4- GI disorders Flashcards
Inflammatory bowel disease includes
ulcerative colitis and Crohn’s
what causes IBD
diet, air pollution, stress, smoking, high dietary intake of total fats, genetic component, NOD2 associated with Crohn’s
both Crohn’s and UC are characterized by
remission and exacerbations of diarrhea, abdominal pain, fecal urgency, weight loss, fever, fatigue
what are some complications of IBD
hemorrhaging, malnutrition, perforation, colonic dilation, extra-intestinal complications (such as joint d/o, thromboemboli, liver disease, kidney stones, gallstones)
Crohn’s disease characteristics
recurrent and progressive inflammatory response
affects any area of the GI tract and all layers of the bowel
out common in the distal ileum and proximal colon
sharp demarcation lesions (skip lesions)
fistulas are common
has a lot diarrhea, cramping, weight loss, malabsorption and nutritional deficiencies, rectal bleeding is not as common
Ulcerative Colitis
nonspecific inflammatory conditions of the colon and rectum
begins in the rectum and spreads proximally and continuously
primarily affects the mucosal layer
bloody diarrhea
lesions may become necrotic and ulcerate, pseudo polyps develop
bowel wall thickens with repeated exacerbation
abdominal pain
increased stool output with moderate disease with systemic symptoms
mucuos and blood in stools with fever, wt loss, anemia, tachycardia, dehydration for severe
what are the diagnostic procedures for both
H&P, CBC, stool analysis, endoscopy, barium enema, sigmoidoscopy/colonoscopy with biopsy
what kind of pharmacologic therapy is available
aminoslicyclates (causes discoloration of the skin and urine/photosensitivity)
corticosteroids
immunosuppressant agents (Imuran, methotrexate, cyclosporine)
antimicrobials
biologic therapy (used the most)- TNF inhibitors (infliximab, adalimumab)
analgesics
anticholinergics
antidiarrheals
vitaminsm/inerals
25-40% of ___ patients will require surgery
UC
what kind of surgeries are available for UC
colectomy with variations on ileostomy or ileoanal anastomosis
colectomy is curative - they will have a stoma an dileostomy
___ of Crohn’s patients will requirer surgery
75%
what kind of surgeries are available for Crohn’s
repair stricture, colectomy with ileostomy if the colon is affected
surgery results in remission but recurrence is high
t/f patients right out of surgery will need lower amounts of fluids
false
after an ileostomy the patient may put out __ a day
2L
what kind of diet do you need for UC
high calorie, high protein, and low residue
what kind of diet do you need for Crohn’s
high fiber
what qualifies as enteral therapy
NG tube, jejunostomy tube, and PEG tube
what are some issues associated with enteral therapy
intestinal edema, decreased peristalsis, bacterial/fungal stasis, gut permeability
t/f you need to wait for a BS reading before starting enteral feeding
F
gut mass decreases by __% after 7 days of fasting even with TPN
50
you cannot start tube feedings until
you get an x ray
types of enteral feeding tubes:
nasogastric, esophogostomy, nasoduodenal, gastrostomy, jejunostomy
Parenteral feeding
feeding through an IV, can even put Insulin in there
what are the indications for parenteral nutrition
- Chronic severe diarrhea and vomiting
- Complicated surgery or trauma
- GI obstruction
- Intractable diarrhea
- Severe anorexia nervosa
- Severe malabsorption
- Short Bowel Syndrome
- GI tract anomalies and fistulae
