Gastrointestinal Disorders (pptx 2, part 1)

Question 1

List 10 disorders of the large intestine

Answer 1

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

Question 2

What type of muscle makes up the internal sphincter?

Answer 2

Smooth muscle

Question 3

What type of muscle makes up the external sphincter?

Answer 3

Striated voluntary muscle

Question 4

How does gastrocolic reflex occur?

Answer 4

Occurs when food enters the stomach & causes movement in the colon

Question 5

When does the urge to defecate come?

Answer 5

When movement of feces goes into sigmoid/ rectum

Question 6

Defecation:

What happens to the nerve endings during defecation? Hint: 2

Answer 6

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

Question 7

How can we control the process of defecation?

Answer 7

By contracting the external sphincter

Question 8

How does contracting the external sphincter prevent defecation?

Answer 8

Calms down the sensation until next round of peristalsis occurs
Much better if it occurs naturally than artificially stimulated

Question 9

What else can pass thru the intestine?

Answer 9

Gas

Question 10

What is gas? Hint: 2

Answer 10

1) Swallowed air → can be 500 mL per meal
2) Bacterial fermentation fo food

Question 11

What is borborygmic?

Answer 11

Rushing of fluids & gurgling sounds as gas moves

Question 12

What is the most common GI complaint & how is it characterized?

Answer 12

Constipation → infrequent, incomplete, or difficult passage of stool

Question 13

Dx of chronic constipation (6 mos or >) Rome criteria Hint: 5

Answer 13

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

Question 14

What is Tx of constipation directed towards?

Answer 14

Directed towards relieving the cause

Question 15

List 2 causes of constipation

Answer 15

1) Primary (idiopathic)
2) Secondary

Question 16

What is secondary constipation?

Answer 16

1) r/t medical conditions, medications, structural abnormalities, lifestyle

Question 17

List the medical conditions, meds, structural abnormalities & lifestyle causes of secondary constipation

Answer 17

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

Question 18

List 3 diet concerns associated with constipation

Answer 18

1) High carb/ low fiber diet
2) Soluble fiber
3) Insoluble fiber

Question 19

How does soluble fiber affect digestion?

Answer 19

Attracts water & turns to gel during digestion; slows digestion

Question 20

List 9 things soluble fibers are found in

Answer 20

1) Oat bran
2) Barley
3) Nuts
4) Seeds
5) Beans
6) Lentils
7) Peas
8) Fruits & vegetables
9) Psyllium

Question 21

List 4 fruits considered soluble fibers

Answer 21

1) Apples
2) Pears
3) Strawberries
4) Blueberries

Question 22

List 5 things insoluble fibers are found in

Answer 22

1) Wheat bran
2) Lentils
3) Whole grains
4) Bran cereal
5) Shredded wheat

Question 23

List 2 grains & 3 vegetables considered insoluble fibers

Answer 23

1) Couscous
2) Brown rice
3) Carrots
4) Zucchini
5) Celery

Question 24

How do insoluble fibers affect digestion?

Answer 24

Adds bulk to the stool and helps food pass faster through the intestines

Question 25

List 8 types of laxatives

Answer 25

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

Question 26

List 6 contraindications for taking laxatives

Answer 26

1) Severe abd pain, nausea, cramps 2) Appendicitis, enteritis, diverticulitis 3) Ulcerative colitis 4) Acute surgical abdomen 5) Fecal impaction 6) Habitual use (Abuse)

Question 27

How chemical/ stimulant laxatives improve defecation?

Answer 27

By increasing motility through irritating the mucosa & increasing water in stool

Question 28

How do chemical/ stimulant laxatives work? **Hint: 3**

Answer 28

1) Releases prostaglandins & cAMP 2) Increases smooth muscle contractions & electrolytes which stimulates peristalsis 3) Increases water in intestines

Question 29

Routes of admin for chemical/ stimulant laxatives

Answer 29

1) Oral (works in 6-12 hrs) 2) Rectal suppository (works in 15-20 min)

Question 30

List 4 medications considered chemical/ stimulant laxatives

Answer 30

1) Bisacodyl (Dulcolax) 2) Cascara 3) Castor oil 4) Senna (Sennokot)

Question 31

List 4 side effects of chemical/ stimulant laxatives

Answer 31

1) Diarrhea 2) Abd cramping 3) Nausea 4) Fluid & electrolyte imbalance

Question 32

How do bulk stimulant laxatives work?

Answer 32

Increase GI motility by increasing size of fecal matter **Used for short-term constipation**

Question 33

Bulk stimulants are the drug of choice for which age group? **Hint: 3**

Answer 33

1) Elderly 2) Post-partum 3) Those w poor diets

Question 34

List 2 things to remember when giving bulk stimulant laxatives

Answer 34

1) Need to be taken w plenty of water 2) Best given at night as they are slow acting

Question 35

Are bulk stimulants safe during pregnancy?

Answer 35

YES

Question 36

List 3 medications considered bulk stimulant laxatives

Answer 36

1) Methycellulose (Citrucel) 2) Polycarbophil (FiberCon) 3) Psyllium (Metamucil)

Question 37

List 4 side effects of bulk stimulant laxatives

Answer 37

1) Diarrhea 2) Abd cramping 3) Nausea 4) Fluid & electrolyte imbalance

Question 38

How do osmotic stimulant laxatives work?

Answer 38

Work by having solutes that increase osmotic "pull of fluid" into GI tract

Question 39

What do osmotic stimulants increase?

Answer 39

Increase the pressure in GI tract & stimulate more intestinal motility

Question 40

Osmotic stimulants should be used with caution in what type of patients?

Answer 40

Renal impairment

Question 41

What is a concern of using osmotic stimulants?

Answer 41

Abuse concerns

Question 42

List 6 medications considered osmotic stimulants

Answer 42

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)

Question 43

List 4 side effects of osmotic stimulants

Answer 43

1) Diarrhea 2) Abd cramping 3) Nausea 4) Fluid & electrolyte imbalance

Question 44

How do lubricants work?

Answer 44

Used to make defecation easier w/o stimulating movement of the GI tract

Question 45

List 3 medications considered lubricants

Answer 45

1) Mineral oil 2) Glycerin 3) Docusate (Colace)

Question 46

Surfactant laxatives **HInt: 3**

Answer 46

**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

Question 47

List 2 types of GI opioid receptor antagonists

Answer 47

1) Methylnaltrexone (Relistor) 2) Naldemedine (Symproic)

Question 48

When is Methylnaltrexone used?

Answer 48

For opioid-induced &/or refractory constipation

Question 49

How does Methylnaltrexone work? **Hint: 2**

Answer 49

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

Question 50

How does Naldemedine (Symproic) work?

Answer 50

Opioid antagonist approved for Tx of opioid-induced constipation in adults w chronic non-cancer pain

Question 51

List 9 consequences of constipation

Answer 51

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

Question 52

How many grams of fiber should a pt consume each day?

Answer 52

Need 20-35 g per day

Question 53

What can higher amounts of dietary fiber cause?

Answer 53

Bloating & gas pains

Question 54

List 3 things we can find fiber in

Answer 54

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)

Question 55

What should patients be told to increase w fiber intake?

Answer 55

Increase fluids

Question 56

List 3 patient education points for someone experiencing constipation

Answer 56

1) Exercise 2) Bathroom hygiene (footstool); Leave enough time; Schedule time period 3) Stool diary → Bristol chart

Question 57

List 7 types of stool and level of constipation on the Bristol stool chart

Answer 57

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)

Question 58

What is classified as diarrhea?

Answer 58

Loose or watery stools > 3 per day

Question 59

List 6 causes of diarrhea

Answer 59

1) Infection 2) Drug-induced 3) emotional stress 4) Colitis 5) Diabetes mellitus 6) Liver disease

Question 60

List 5 other factors of diarrhea

Answer 60

1) Water content 2) Presence of unabsorbed food 3) Bacteria content 4) Intestinal secretions/ mucus 5) Children vs. adult

Question 61

List 5 systemic clinical manifestations of diarrhea

Answer 61

1) Dehydration 2) Electrolyte imbalances 3) Metabolic acidosis/ alkalosis 4) Weight loss 5) Signs of infection

Question 62

List 4 local clinical manifestations of diarrhea

Answer 62

1) Cramps 2) Abdominal pain 3) Steatorrhea 4) Hematochezia

Question 63

List 3 types of diarrhea

Answer 63

1) Osmotic diarrhea 2) Secretory diarrhea 3) Exudative diarrhea

Question 64

Osmotic diarrhea **Hint: 3**

Answer 64

1) Injury to gut, dietary factors, or problem w digestion 2) Ex. lactose intolerance 3) Associated w large stool volumes

Question 65

Secretory diarrhea **Hint: 3**

Answer 65

1) Intestines secrete more fluids & electrolytes than can be absorbed 2) Ex. Infection & inflammation 3) Associated w large stool volumes

Question 66

Exudative diarrhea **Hint: 3**

Answer 66

1) alterations in mucosal integrity, epithelial loss, enzyme destruction 2) Ex. Inflam disease, cancer, cancer Tx 3) Assoicated w > 6 stools a day

Question 67

List 10 Tx options for diarrhea

Answer 67

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

Question 68

How does diphenoxylate HCL/ atropine work? **Hint: 2**

Answer 68

1) Decreases peristalsis 2) Promotes reabsorption of water from GI tract

Question 69

List 6 side effects of diphenoxylate HCL/ atropine

Answer 69

1) Nausea 2) Dry mouth 3) Urinary retention 4) Dizziness 5) Sedation 6) Restlessness

Question 70

Route of admin for diphenoxylate HCL/ atropin

Answer 70

Oral

Question 71

How many times a day can Diphenoxylate HCL/ atropine be given?

Answer 71

Up to 4 x a day

Question 72

List 2 contraindications for giving Diphenoxylate HCL/ Atropine

Answer 72

1) Do NOT use in children < 4 yrs 2) Hepatic impairment

Question 73

List 3 drug interactions of Diphenoxylate HCL/ Atropine

Answer 73

1) Barbiturates 2) Tranquilizers 3) Alcohol

Question 74

How does Loperamide (Imodium) work?

Answer 74

Slows intestinal motility & by affecting water 7 electrolyte movement thru bowel; decreases peristalsis

Question 75

Route of admin for Loperamide

Answer 75

Oral

Question 76

List 5 side effects of Loperamide

Answer 76

1) Constipation 2) Dizziness 3) Nausea 4) Abdominal cramping 5) Urinary retention

Question 77

List 5 contraindications for giving Loperamide

Answer 77

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

Question 78

List 12 consequences of diarrhea

Answer 78

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

Question 79

What gender experiences IBS more commonly

Answer 79

Females

Question 80

IBS is characterized by variable combo of ____ & ____ intestinal Sx

Answer 80

Chronic & recurrent intestinal Sx

Question 81

List 8 clinical manifestations/ Sx of IBS

Answer 81

1) **Abd pain** 2) Altered bowel function 3) Flatulence 4) Bloating 5) Nausea 6) ANorexia 7) Constipation 8) Diarrhea

Question 82

What can IBS be associated with?

Answer 82

Increased motility & abnormal intestinal contractions associated w stressful situations

Question 83

List 3 things for a pt with IBS to avoid

Answer 83

1) Fatty/ gas producing foods 2) Caffeine 3) Alcohol

Question 84

List 6 medications used to Tx IBS

Answer 84

1) Alosetron 2) Eluxadoline 3) Lubiprostone 4) Lyoscyamine 5) Anti-spasmotics 6) Anticholinergics