GI Disorders Flashcards
What stops diarrhea
Immodium
Who’s at risk for c-diff
Those on chemo or abx
Goals for care and nursing interventions:
Replace fluid and electrolytes
. Pharmacological management – meds? Table 45-3
3. Limit/prevent peri-anal skin breakdown
4. Manage nutritional intake
5. Prevent transmission
What does not kill C-diff
Hand santitizer
Inflammatory Bowel Disease
Autoimmune disease
Tissue damage caused by overactive, inappropriate, & sustained inflammatory response
More prevalent in industrialized regions of world
Two types of IBD
Crohns
Ulcerative Colitis
Crohns disease occurs where
Any part of the GI tract may be affected (mostly small intestine)
Inflammation involves all layers of the bowel wall (transmural)
Inflammation is discontinuous – skip lesions
SS of Crohns
*diarrhea, *abdominal pain, malabsorption and nutritional deficiencies, weight loss (severe), fever (during acute episodes),
Prognosis of Crohn’s
No curative sx
Ulcerative Colitis occurs where
Only the colon is involved
Inflammation of inner lining
Continuous inflammation from rectum upward
May appear as a fulminating crisis (severe)or as a chronic disorder.
SS of Ulcerative colitis
Bloody diarreha*abdominal pain, tenesmus (Still need to go after you’ve gone), rectal bleeding
Prognosis for colitis
Removal of large bowel is generally curative
STUDY IBD complications
Crohn’s disease complications
Intestninal
- Scar tissue, strictures, obstructure
Fistulas
Perforation, abscesses, peritonitis
Fat malabsorption - low Vit K
Extra intestinal, ;iver dx, anemia
Intestinal complications of colitis
Intestinal
*Bleeding, perforation (most often associated with toxic megacolon), *toxic megacolon, colonic dilation, *fulminant colitis, pseudopolyps
Increased risk of colorectal cancer
Extraintestinal colitis complications
Directly related to colitis, or nonspecific mediated by disturbance in immune system – anemia
Arthritis, osteoporosis, erythema nodusum, Pyoderma gangrenosum, mouth ulcers.
Toxic Megacolon
inflammation and infection cause the colon to dilate(enlarge). Walls thin as colon enlarges - loses functionality
- Cannot remove gas or feces from the body
- Can cause rupture
- Life threatening if it ruptures
Labs for IBD diagnositics
Anemia
Increased CRP (Increases with inflammation), increased WBC
Electrolytes
Stool samples
Studies (scopes) of IBD
Varium enema, colonscopy, sigmoidoscopy endoscopy
When should scopes NOT Be done in IBD
In ulcerative colitis when recturm and colon are severely inflamed
Biopsy
Malabsorption in IBD
Varies bw crohns and UC - depends on area affected
- Low albumin levels (protein in blood that is not being absorbed with IBD)
Drug therapy for IBD
Sulphasalazine (Salofalk, Dipentum etc)- locally acting anti-inflammatory
Corticosteroids
Immunosuppressive drugs (cyclosporin)
Nutrition for IBD
NPO in acute state
High-calorie, high-protein, low-residue diet with vitamin & iron supplements
Special dietary restricitons usually not necessary
Enteral supplements and TPN
Avoid fiber, brown rice, whole wheat bread
- White rice, white bread etc.
Why sx for IBD
Blockages, ruptures, tissue changes indicating cancer, exacerbations that can not be controlled
Crohn’s Drug therapy
Sulphasalazine
Corticosteroids
Flagyl
Biological drug therapies
Sx therapy for crohns
Not curative
Intestinal resection with anastomosis of healthy bowelN
Nutritional therapy
Elemental diet & parenteral nutrition
Low in residue, roughage & fat
High in calories & protein
May need to exclude milk & milk products
Vitamin B12 injections (malabsorption)
Colorectal cancer
A malignant disease of colon, rectum, or both
2nd most common cause of cancer death in Canada
Highest % of colorectal cancers in Canada are located in rectum, ascending colon & sigmoid colon
Risk factors for coloretal cancer
Being over 50 years
Genetic predispostioin
COlorectal polyps
Chronic IBD
Family hx
Obesity
Hx of cancer
Red meat intake
Smoking/alcohol
Prevention of colorectal cancer
Mixed evidence but diet seems to play an important role
Obesity 2x risk
Dietary recommendations:
Avoid?
Removal of polyps
Secondary prevention and dx
Early detection is essentional
GOBT every 1-2 yrs after 50
Clinical SS of colorectal cancer
Usually asymptomatic till advanced
Rectal bleeding
Alternating constipation & diarrhea
Gas or bloating
Change in stool caliber (narrow, ribbon-like)
Sensation of incomplete evacuation
Loss of appetite/early satiety
Crampy, colicky abdominal pain
Weight loss/lethargy
Iron deficiency/ Occult bleeding
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Diagnostics for Colorectal cancer
Digital ExamFecal Occult Blood Test (FOBT) q2yrsFecal Immunochemical Test (FIT) Colonoscopy /Sigmoidoscopy /Barium enemaLabs – which ones
CEA (carcinoembryonic antigen)
Labs for Colorectal cancer
CBC and electorlytes
Clotting factors
Dukes staging for colon cancer
Duke A: Invasion into bot not thorugh bowel wall
Dukes B: invasion through bowel wall but not into lympth
Dukes C: Invovlemend of lymph nodes
Dukes D: Wedspread metastases
Tx of colorectal cancer
Surgery is only curative treatment
Colostomy
Resection
Chemotherapy
Radiation
Which type og colostomies are often temporary
DOuble barrel and loop
What should a stoma look like
Pink/red NOT pale - indicates bad blood flow
Assessment of colonostomies
Stoma site (see Table 45-34)
Color
Edema
Bowel function
Bleeding
Perineum
Assess perineal wound if end colostomy performed
When are ostomy bags chaged
1-2/3
Post op care for ostomies
NG suction
Maintain gastric decompression by NG suction
Do not remove suction until peristalsis returns
Reduce colic pain
Promote ambulation
Progress diet as peristalsis returns
Monitor abdominal and rectal wound
Prevent infection
Assess for bleeding from rectal wound
Monitor drainage from catheter and abdominal drain site 100-150 mls in 24 hours
Prevent complications – high risk for DVT!
Risk for injury increased r/t nursing diagnoses
Infection, stoma problems (necrosis, retraction, stenosis, obstruction), general post-op complications.
Know difference bw Crohns and Colitis, know complications, Know LABS amd diagnostics
