Gastrointestinal disorders (pptx 2) Flashcards
List 10 disorders of the large intestine
1) Constipation
2) Diarrhea
3) Crohn’s Disease
4) Ulcerative colitis
5) Large bowel obstruction (LBO)
6) Appendicitis
7) Irritable bowel syndrome (IBS)
8) Diverticular disease
9) Volvulus
10) Hemorrhoids
What type of muscle makes up the internal sphincter?
Smooth muscle
What type of muscle makes up the external sphincter?
Striated voluntary muscle
How does gastrocolic reflex occur?
Occurs when food enters the stomach & causes movement in the colon
When does the urge to defecate come?
When movement of feces goes into sigmoid/ rectum
Defecation:
What happens to the nerve endings during defecation? Hint: 2
1) Nerve endings in rectum become stretched which sends a signal to the sacral spinal cord
2) Signal goes back to the descending & sigmoid colons, rectum & anus
How can we control the process of defecation?
By contracting the external sphincter
How does contracting the external sphincter prevent defecation?
Calms down the sensation until next round of peristalsis occurs
Much better if it occurs naturally than artificially stimulated
What else can pass thru the intestine?
Gas
What is gas? Hint: 2
1) Swallowed air → can be 500 mL per meal
2) Bacterial fermentation fo food
What is borborygmic?
Rushing of fluids & gurgling sounds as gas moves
What is the most common GI complaint & how is it characterized?
Constipation → infrequent, incomplete, or difficult passage of stool
Dx of chronic constipation (6 mos or >) Rome criteria Hint: 5
1) < 3 spontaneous BMs per week
2) Passage of hard/ lumpy stool w > 25% defecations
3) Straining > 25% defecations
4) Incomplete evacuation or obstruction > 25% of time
5) Manual maneuvers to remove stool > 25% of time
What is Tx of constipation directed towards?
Directed towards relieving the cause
List 2 causes of constipation
1) Primary (idiopathic)
2) Secondary
What is secondary constipation?
1) r/t medical conditions, medications, structural abnormalities, lifestyle
List the medical conditions, meds, structural abnormalities & lifestyle causes of secondary constipation
1) Primary disorder of GI motility
2) Disease processes → Diabetes, MS, spinal cord injury, obstruction, etc
3) Opioids
4) Post surgery
5) Diet → poor fluid intake
List 3 diet concerns associated with constipation
1) High carb/ low fiber diet
2) Soluble fiber
3) Insoluble fiber
How does soluble fiber affect digestion?
Attracts water & turns to gel during digestion; slows digestion
List 9 things soluble fibers are found in
1) Oat bran
2) Barley
3) Nuts
4) Seeds
5) Beans
6) Lentils
7) Peas
8) Fruits & vegetables
9) Psyllium
List 4 fruits considered soluble fibers
1) Apples
2) Pears
3) Strawberries
4) Blueberries
List 5 things insoluble fibers are found in
1) Wheat bran
2) Lentils
3) Whole grains
4) Bran cereal
5) Shredded wheat
List 2 grains & 3 vegetables considered insoluble fibers
1) Couscous
2) Brown rice
3) Carrots
4) Zucchini
5) Celery
How do insoluble fibers affect digestion?
Adds bulk to the stool and helps food pass faster through the intestines
List 8 types of laxatives
1) Chemical/ stimulants
2) Bulk forming/ stimulants
3) Osmotic stimulants
4) Surfactant laxatives
5) Lubricants
6) Emollients
7) Saline cathartics
8) GI opioid receptor antagonists
List 6 contraindications for taking laxatives
1) Severe abd pain, nausea, cramps
2) Appendicitis, enteritis, diverticulitis
3) Ulcerative colitis
4) Acute surgical abdomen
5) Fecal impaction
6) Habitual use (Abuse)
How chemical/ stimulant laxatives improve defecation?
By increasing motility through irritating the mucosa & increasing water in stool
How do chemical/ stimulant laxatives work? Hint: 3
1) Releases prostaglandins & cAMP
2) Increases smooth muscle contractions & electrolytes which stimulates peristalsis
3) Increases water in intestines
Routes of admin for chemical/ stimulant laxatives
1) Oral (works in 6-12 hrs)
2) Rectal suppository (works in 15-20 min)
List 4 medications considered chemical/ stimulant laxatives
1) Bisacodyl (Dulcolax)
2) Cascara
3) Castor oil
4) Senna (Sennokot)
List 4 side effects of chemical/ stimulant laxatives
1) Diarrhea
2) Abd cramping
3) Nausea
4) Fluid & electrolyte imbalance
How do bulk stimulant laxatives work?
Increase GI motility by increasing size of fecal matter
Used for short-term constipation
Bulk stimulants are the drug of choice for which age group? Hint: 3
1) Elderly
2) Post-partum
3) Those w poor diets
List 2 things to remember when giving bulk stimulant laxatives
1) Need to be taken w plenty of water
2) Best given at night as they are slow acting
Are bulk stimulants safe during pregnancy?
YES
List 3 medications considered bulk stimulant laxatives
1) Methycellulose (Citrucel)
2) Polycarbophil (FiberCon)
3) Psyllium (Metamucil)
List 4 side effects of bulk stimulant laxatives
1) Diarrhea
2) Abd cramping
3) Nausea
4) Fluid & electrolyte imbalance
How do osmotic stimulant laxatives work?
Work by having solutes that increase osmotic “pull of fluid” into GI tract
What do osmotic stimulants increase?
Increase the pressure in GI tract & stimulate more intestinal motility
Osmotic stimulants should be used with caution in what type of patients?
Renal impairment
What is a concern of using osmotic stimulants?
Abuse concerns
List 6 medications considered osmotic stimulants
1) Magnesium sulfate (Epsom salts)
2) Magnesium citrate
3) Magensium Hydroxide (Milk of mag)
4) Lactulose
5) Polyethylene glycol (Miralax)
6) Polyethylene glycol electrolyte solution (GoLytely)
List 4 side effects of osmotic stimulants
1) Diarrhea
2) Abd cramping
3) Nausea
4) Fluid & electrolyte imbalance
How do lubricants work?
Used to make defecation easier w/o stimulating movement of the GI tract
List 3 medications considered lubricants
1) Mineral oil
2) Glycerin
3) Docusate (Colace)
Surfactant laxatives HInt: 3
AKA: stool softeners
1) Makes defecation easier w/o stimulating movement of GI tract
2) Given when straining to have BM is harmful
3) Do NOT rely on medication to provide relief/ prevent constipation
List 2 types of GI opioid receptor antagonists
1) Methylnaltrexone (Relistor)
2) Naldemedine (Symproic)
When is Methylnaltrexone used?
For opioid-induced &/or refractory constipation
How does Methylnaltrexone work? Hint: 2
1) Selective antagonist to opioid binding at mu-receptor
2) Does NOT cross BBB → acts specifically at peripheral opioid receptor sites (GI tract), but does NOT affect analgesic effects of opioids in CNS
How does Naldemedine (Symproic) work?
Opioid antagonist approved for Tx of opioid-induced constipation in adults w chronic non-cancer pain
List 9 consequences of constipation
1) Abd or rectal discomfort
2) Painful defecation
3) N/V
4) Anorexia
5) Impaction
6) Ileus
7) Hemorrhoids
8) Ruptured bowel
9) Anal fissure
How many grams of fiber should a pt consume each day?
Need 20-35 g per day
What can higher amounts of dietary fiber cause?
Bloating & gas pains
List 3 things we can find fiber in
1) Fiber 1 cereal or bars biggest fiber bang → more fiber per serving than metamucil
2) Psyllium (metamucil), methylcellulose (Citrucel)
3) Fruit (Apples, peaches, pears, raisins, grapes, cherries)
What should patients be told to increase w fiber intake?
Increase fluids
List 3 patient education points for someone experiencing constipation
1) Exercise
2) Bathroom hygiene (footstool); Leave enough time; Schedule time period
3) Stool diary → Bristol chart
List 7 types of stool and level of constipation on the Bristol stool chart
1) Separate hard stools (very)
2) Lumpy & sausage like (Slightly)
3) A sausage shape w cracks in surface (Normal)
4) Like a smooth, soft sausage or snake (Normal)
5) Soft blobs w clear-cut edges (Lacking fiber)
6) Mushy consistency w ragged edges (Inflammation)
7) Liquid consistency w no solid pieces (inflammation)
What is classified as diarrhea?
Loose or watery stools > 3 per day
List 6 causes of diarrhea
1) Infection
2) Drug-induced
3) emotional stress
4) Colitis
5) Diabetes mellitus
6) Liver disease
List 5 other factors of diarrhea
1) Water content
2) Presence of unabsorbed food
3) Bacteria content
4) Intestinal secretions/ mucus
5) Children vs. adult
List 5 systemic clinical manifestations of diarrhea
1) Dehydration
2) Electrolyte imbalances
3) Metabolic acidosis/ alkalosis
4) Weight loss
5) Signs of infection
List 4 local clinical manifestations of diarrhea
1) Cramps
2) Abdominal pain
3) Steatorrhea
4) Hematochezia
List 3 types of diarrhea
1) Osmotic diarrhea
2) Secretory diarrhea
3) Exudative diarrhea
Osmotic diarrhea Hint: 3
1) Injury to gut, dietary factors, or problem w digestion
2) Ex. lactose intolerance
3) Associated w large stool volumes
Secretory diarrhea Hint: 3
1) Intestines secrete more fluids & electrolytes than can be absorbed
2) Ex. Infection & inflammation
3) Associated w large stool volumes
Exudative diarrhea Hint: 3
1) alterations in mucosal integrity, epithelial loss, enzyme destruction
2) Ex. Inflam disease, cancer, cancer Tx
3) Assoicated w > 6 stools a day
List 10 Tx options for diarrhea
1) Remove cause
2) Fluid & electrolyte replacement
3) Opioids → paregoric; deodorized tincture of opium (DTO)
4) Diphenoxylate HCL/ atropine (lomotil)
5) Loperamide (imodium)
6) Yogurt
7) Kaolin/ pectin (kaopectate)
8) Bismuth subsalicylate (Pepto bismol)
9) Bulk forming agents
10) Probiotics
How does diphenoxylate HCL/ atropine work? Hint: 2
1) Decreases peristalsis
2) Promotes reabsorption of water from GI tract
List 6 side effects of diphenoxylate HCL/ atropine
1) Nausea
2) Dry mouth
3) Urinary retention
4) Dizziness
5) Sedation
6) Restlessness
Route of admin for diphenoxylate HCL/ atropin
Oral
How many times a day can Diphenoxylate HCL/ atropine be given?
Up to 4 x a day
List 2 contraindications for giving Diphenoxylate HCL/ Atropine
1) Do NOT use in children < 4 yrs
2) Hepatic impairment
List 3 drug interactions of Diphenoxylate HCL/ Atropine
1) Barbiturates
2) Tranquilizers
3) Alcohol
How does Loperamide (Imodium) work?
Slows intestinal motility & by affecting water 7 electrolyte movement thru bowel; decreases peristalsis
Route of admin for Loperamide
Oral
List 5 side effects of Loperamide
1) Constipation
2) Dizziness
3) Nausea
4) Abdominal cramping
5) Urinary retention
List 5 contraindications for giving Loperamide
1) Children < 2 yrs
2) Pts w bloody stools/ high fever
3) Pts w acute ulcerative colitis
4) Pts w bacterial enterocolitis caused by invasive organisms (salmonella, shigella, campylobacter)
5) Pts w pseudomembranous colitis
List 12 consequences of diarrhea
1) Dehydration
2) Orthostasis
3) Electrolyte imbalances
4) Malnutrition
5) CV or renal compromise
6) Impaired immune function
7) Perianal skin breakdown
8) Reduced absorption of oral meds
9) Pain
10) Anxiety
11) Exhaustion
12) Decreased quality of life
What gender experiences IBS more commonly
Females
IBS is characterized by variable combo of ____ & ____ intestinal Sx
Chronic & recurrent intestinal Sx
List 8 clinical manifestations/ Sx of IBS
1) Abd pain
2) Altered bowel function
3) Flatulence
4) Bloating
5) Nausea
6) ANorexia
7) Constipation
8) Diarrhea
What can IBS be associated with?
Increased motility & abnormal intestinal contractions associated w stressful situations
List 3 things for a pt with IBS to avoid
1) Fatty/ gas producing foods
2) Caffeine
3) Alcohol
List 6 medications used to Tx IBS
1) Alosetron
2) Eluxadoline
3) Lubiprostone
4) Lyoscyamine
5) Anti-spasmotics
6) Anticholinergics
