GI Elimination Flashcards
what is IBS?
affects muscle contractions + colon sensitivity (disorder of intestinal motility)
chronic functional disorder w/ recurrent ab pain + altered bowel habits
affects freq of defecation + stool consistency
does NOT cause intestinal inflammation nor bowel damage
what is IBD?
consists of 2 separate disorders = cause inflammation (redness/swelling) and ulceration (sores) of small + large intestines
Ulcerative Colitis and Crohns Disease
acute + chronic results in nutritional deficits, altered bowel, infection, pain + fluid/electrolyte imbalances
what are the s/s of IBS?
diarrhea, constipation, bloating and abdominal pain, tenesmus
goal: relieve ab pain + control diarrhea/constipation
how is IBS diagnosed?
recurrent ab pain >= 1 day/wk plus 2 or more of:
- inc or improving pain (defecation)
- change in stool fre
- stool appearance/form
what is the treatment for IBS?
IBS w/ diarrhea (IBS-D):
Loperamide (dec peristalsis = controls diarrhea + fecal urgency)
Psyllium - bulk forming laxative
Alosetron - IBS specific med, selectively blocks 5-HT3 receptors = inc firmness in stools + dec urgency & freq
IBS w/ constipation (IBS-C):
Lubiprostone - inc fluid secretion to promote intestinal motility (contraindicated in bowel obstruction)
Linaclotide - inc fluid + motility in the intestine (relieves pain + cramps)
what is the nursing mgmt for IBS?
encourage self care
avoid trigger foods: dairy, wheat, corn, fried foods, high fat, alc, spicy foods, aspartame, caffeine, fructose, sorbitol
keep food + bowel diary
inc fluids + fiber
avoid large, heavy meals
good sleep habits/avoid sleep deprivation
teach stress reduction (yoga, exercise, meditation)
referral for anxiety, depression, CBT
what is the FODMAP diet?
F - fermentable
O - oligosaccharides (raspberries, grapefruit, dates, currants, banana, artichoke, leek, onion, garlic, brussel sprouts, beans, wheat, almonds, cashews, pistachios)
D - disaccharide (cow milk, goat milk, sheep milk, ice cream, yogurt, sour cream, cream cheese, brie)
M - monosaccharide (apples, pears, cherries, mango, asparagus, broccoli, sugar snap pea, agave syrup, high fructose corn syrup, honey)
A - and
P - polyols (apple ,lychee, nectarine, prune, cauliflower, corn, sweet potatoes, mushrooms, gum)
how is IBD characterized?
freq stools cramping ab pain, periods of exacerbation + remission
common sites of inflammation: joints (arthritis), skin/mouth (rash apthous ulcers, erythema nodosum), hepatobiliary (choloangitis, hepatitis)
ocular (uveitis)
what is ulcerative colitis?
cause: autoimmune response, genetics
location: large intestine only (rectum + sigmoid region)
affected layers: superficial/inner lining (Mucosa/submucosa)
pattern: continuous
stools per day: 15-20 (liquidly, watery, loose bloody
complications: toxic megacolon, hemorrhage, peritonitis
surgery: can cure disease
colon cancer risk: very high
what is Crohn’s disease?
cause: autoimmune response, genetics
location: anywhere along GI tract (ileum)
affected layers: all layers down to serosa
pattern: skip lesions
stools per day: 5-6 nonbloody
complications: fistulas, fissures, strictures, abscess, obstruction
surgery: only useful in tx complications
colon cancer risk: moderately inc
ulcerative colitis
chronic, recurrent episodes of inflammation + ulcerations in mucosal and submucosal layers of colon and rectum
bleeding from ulceration
narrow bowel (shortens/thickens) = partial bowel obstruction
severe = entire length of colon
mild - <= 4days
moderate - 4-6 days
severe - >=6day w/ continuous bleeding
abscesses, fistulas, fissures (uncommon)
what are the s/s of ulcerative colitis?
diarrhea with pus, mucus or blood (>6 stools/day)
LLQ abdominal pain
Cramping
Intermittent tenesmus
Anemia, pallor, fatigue w/bleeding
Anorexia, weight loss
lab levels for ulcerative colitis
decreased: hematocrit, hemoglobin, albumin, K+, Na, Mg, Ca, Cl
increased: WBC, ESR, CRP
positive: stool guiac
lab levels (ulcerative colitis
decreased: hematocrit, hemoglobin, albumin, K+, Na, Mg, Ca, Cl
increased: WBC, ESR, CRP
positive: stool guiac (occult blood)
what are the complications of ulcerative colitis?
toxic megacolon = rare, nonobstructive distention of colon (fever, ab pain, distention, vomiting, fatigue)
tx: within 72 hrs - NG tube suction, IVF, electrolytes, corticosteroids, antibiotics, may need surgery (LIFE THREATENING)
peritonitis
perforation (req surgery)
bleeding
colorectal cancer
Crohn’s Disease
chronic inflammation (extends through all layers of intestine)
can affect any part of GI tract (distal ileum, ascending colon
begin w/ crypt inflammation + abscesses –> dev into small, focal ulcers
lesions are sporadic + sharply demarcated w/ norm tissue in bt (called skip lesions)
as disease progresses, bowel thickens, narrows and become fibrotic
malabsorption + malnutrition can develop when jejunum + ileum become involved
what are the s/s of Crohn’s?
ab pain/cramping - RLQ
bloating/distention
tenderness/firmness on palpation
high pitched bowel sounds
ulcers (mouth + GI)
diarrhea = 5 loose stools/day w/ mucus or pus
rectal bleeding
steatorrhea - fatty stool
fever
anorexia, weight loss
lab levels for Crohns
decreased: hematocrit, hemoglobin, albumin, folic acid, B12, K+, Mg, Ca
increased: ESR, CRP, WBC
UA - pos for WBC
what are the complications for Crohn’s?
abscess formation
perforation (sudden rupture of bowel)
fistulas (abnormal channel)
stricture
partial bowel obstruction
fluid + electrolytes abnormalities
malabsorption + malnutrition (supplemental vitamins, minerals)
differences in Crohns v. ulcerative colitis
Crohns: depends on loc, ab pain, diarrhea, weight loss, fatigue, blood stools are variable, common malnutrition
Ulcerative Colitis: stool urgency, fatigue, inc bowel movements, mucous, ab pain, blood stools are common, malnutrition less common
what are diagnostics of IBD?
x ray - need to see free air, bowel dilation, obstruction
barium enema - visualizes rectum + large intestine (can distinguish ulcerative colitis)
CT, MRI, Ultrasound - can identify the presence of abscesses, thickening
magnetic resonance enterography - detailed images of small intestine
stool examination - presence of parasites or microbes
what are the goals of therapy?
reduce inflammation
induce + maintain remission
improve QoL
prev and minimize complications
anti inflammatories
dec inflammation
5-aminosalicylic acid (Sulfasalazine) - 1st line treatment for patient w/ mild to mod inflammation + used for long term maintenance = contraindicated in sulfa allergy, mon CBC, kidney, hepatic function, take med w/ full glass of water after meals, inc fluid intake (2 L/day), can take 2-4 wks to see therapeutic effects, can cause urine + skin to turn yellow-orange (norm)
sulfa free aminosalicylates (Mesalamine, Balsalazide, Osalazine) - effective @ prev + treating recurrence of inflammation, mon for kidney toxicity, adverse effects not as serious
immunomodulators
effective in inflammation reduction, dec steroid use, hospitalizations, surgery
takes time for effectiveness (up to 2 mo) - better for maintainence regimens
*mod to severe IBD
high infection risk + rare form of cancer
no live vaccines!
check for TB + hepatitis prior
immunosuppresants
(Azathioprine, Mercaptopurine, Thioguanine, Methotrexate, Cyclosporine)
anti-integrins (Vedolizumab)
janus kinase inhibitors (Tofacitinib)
anti-tumor necrosis factor (Infliximab, Adalimumab, Certolizumab - Crohns, Golimumab - UC
anti diarrheals
Loperamide
suppress # of stools, used to dec risk of fluid vol deficit + electrolyte imbalance
reduce discomfort
use of anti-diarrheals can lead to toxic megacolon (use cautiously)
pain relievers
Tylenol
avoid NSAIDs bc can cause flare ups
indications for surgery (UC)
Colon cancer, dysplasia/polyps, Toxic Megacolon, severe intractable bleeding, perforation, strictures
indications for surgery (Crohn’s)
Small bowel obstruction, abscess, perforation, hemorrhage, fistula formation, strictures
stricturoplasty
widens intestine at stricture w/out resecting intestine (usually Crohn’s)
proctocolectomy (total colectomy)
resection of colon + rectum w/ stoma formation from ileum (cures UC not Crohn’s)
restorative protocolectomy (IPAA)
for severe UC
connects ileum to anal pouch
temp diverting loop ileostomy for healing, closed 3 mo later
voluntary defecation + continence preserved
complications: leakage, stricture @ anastomosis site, pelvic abscess, fistula, SBO, pouchitis, infertility (pelvic dissection)
diet education
eat high protein, high cal + low residue (low fiber) diet
take vit supplements w/ iron
avoid HIGH fiber
avoid hard to digest foods (nuts, popcorn) + spicy, high fat, dairy, caffeine, alc
small freq meals
stay hydrated
probiotics
enteral or TPN if severe malnutrition
peritonitis
life threatening inflammation of peritoneum + lining (bacteria)
tx: place pt in fowlers or semi fowlers to promote drainage of peritoneal fluid + improve lung expansion; mon respiratory status, admin O2, NG suction, NPO, mon fluids/electrolytes, IV antibiotics
toxic megacolon
Massive dilatation of the colon – patient is at risk for perforation
Treatment: NG suction, IV fluids and antibiotics, prep for surgery
fluids and electrolytes imbalances
due to loss of fluid through diarrhea, vomiting, and NG suctioning
tx: monitor labs, I/Os, weight, assess for dehydration, provide replacement therapy
nursing interventions
vitals, asess bowels, focused GI assessment, NPO, IV fluids, mon/tx electrolyte imbalances, colon cancer screen (UC), pt education
