GI - Unit 1 - Intestinal Disorders Flashcards
What is gastroenteritis?
Inflammation in GI tract.
What are the symptoms of gastroenteritis? What is it in the acute phase?
Basically food poisoning! Symptoms include N/V, abd pain/cramping, low grade fever, headache, etc.
How do we treat gastroenteritis?
Antibiotics, anti-emetics (but we have to watch those because they can sometimes slow peristalsis which is bad because we want the bad organism/bug to get out of there!)
What are some examples of a protozoal infection?
Dysenteries, Amebiasis, Giardiasis, Parasitic infections, etc.
What are the symptoms of a protozoal infection?
Abd cramps, diarrhea, nausea, weight loss, weakness, etc.
How do we diagnose and treat a protozoal infection?
Stool for O&P and treat like gastroenteritis!
Appendicitis - what is it?
Inflammation of the appendix.
What are symptoms of appendicitis?
Vague abdominal pain –> RLQ pain. Also, McBurney’s Point (inbetween navel and hip), N/V - these come last.
If it’s N/V –> Abdominal Pain, that is ____.
If it’s ABD Pain then N/V, that is ____.
If it’s N/V –> Abdominal Pain, that is gastroenteritis.
If it’s ABD Pain then N/V, that is appendicitis.
How do we diagnose appendicitis?
WBC >10,000, Abdominal/Pelvic Xray & Ultrasound, Iv Fluids, Antibiotics, possibly surgery.
What is the Rovsing’s Sign?
When you push on the left abdomen, they feel pain in the right. It’s associated with appendicitis.
What is the psoas sign?
Pain when you flex hip. It’s associated with appendicitis.
What are some things we have to watch for in appendicitis (in regards to nursing diagnoses)?
Altered tissue perfusion, altered comfort, risk for infection, impaired skin integrity, fear of the unknown, etc.
What is peritonitis?
Acute inflammation of endothelial lining of the abdominal cavity or peritoneum.
What is Primary Peritonitis?
It’s rare - from infection in the blood.
What is secondary peritonitis?
Ruptured appendix, diverticulum, gallbladder, peritoneal dialysis, etc.
What are some symptoms of peritonitis?
Pain, abdominal distention, board-like abdomen, hypoactive bowel sounds, N/V, increased temp, shallow respirations, fear/anxiety, etc.
How do we diagnose peritonitis?
WBC, Blood cultures, paracentesis, exploratory surgery, abd. x-rays, etc.
Peritonitis - how do they treat it?
Meds (mycins, flagyl), surgery to remove damaged tissue or close perforation, etc. Sometimes they are so swollen they just leave the incision open!
What is a paralytic ileus/ileus?
Nerve impairment of bowel which decreases propulsion of bowel contents.
What cause an ileus?
Injuries to GI tract, abdominal surgery, c-section-, general anesthesia, IBD.
How do we prevent an ileus?
Avoid total bed-rest especially post-op, assess bowel sounds, etc.
What are symptoms of an ileus?
Slowed to NO bowel sounds, N/V, no stools, abdominal pain, increased abdominal girth, malaise, weakness, etc.
How do we treat an ileus?
Decompress bowel with NG, suction, NPO, IV, increase GI motility, etc. Reglan might work but it takes days to recover from!
What is ulcerative colitis?
Inflammation of intestinal mucosa that begins in rectum and progresses towards cecum. Leaves ulcerations. Causes perforation and fistula formation.
What are some symptoms of Ulcerative Colitis?
Bloody, mucousy diarrhea, rectal bleeding, anemia, nutritional impairment, fatigue, anorexia, weakness, abdominal cramps in the LLQ RELIEVED by defecation.
What is tenesmus?
When you feel like you constantly have to shit.
How do we diagnose UC?
Exam stool, H&H, WBC, proctosigmoidoscopy, etc.
What should we do as nurses for a patient with UC?
Relieve abdominal cramping & diarrhea, emotional support. etc.
What diet might help a patient with UC?
Lactose free, NO caffeine, no raw fruits or veggies, increase bulk forming (bran), hi cal drinks if NPO.
What are some complications of UC?
Electrolyte imbalance, mega colon.
What are some treatments of UC?
Medication or colon resection, temporary loop ileostomy, total proctolectomy with permanent ileostomy.
Where is an ileostomy usually located on the abdomen?
On the right side.
How should a stoma appear?
Pink, moist - should produce stool.
With an ileoanal reservoir, how many times a day do they poop? What is it like? How should we handle that?
6-8 times a day - liquid stool that’s irritating, so keep their butts clean!
What is Crohn’s disease?
Chronic, relapsing - autoimmune. Small lesions of mucosa, submucosa, etc - deep lesions - they have the SKIP lesions - so some areas are fine and others are not. They can be seen anywhere from the mouth to the anus!
What are some complications of Crohn’s?
Obstruction, abscesses, fistula’s, CA of small bowel and colon, malnutrition, anemia, bowel perforation, etc.
Is hemorrhage more common in UC or Crohn’s?
UC
What are some symptoms of crohn’s?
Diarrhea (usually no blood!), abd pain, tenderness in RLQ (UC is LLQ) relieved by defecation, fever, fatigue, malaise, weight loss, anemia, malnutrition.
How do we treat crohn’s? How do we diagnose?
Usually diagnosed by colonoscopy. Well balanced diet - lactose free, etc. Meds. Surgery if there's any complications, like from a fistula or obstruction. Support!
What is a fistula?
Bad connection between organs - could be bowel to bowel, bowel to skin, bowel to bladder, it just depends!
Where is Crohn’s most common?
Terminal ileum and jejenum.
What is irritable bowel syndrome?
Aka spastic bowel, colon, functional colitis, etc. - this is a syndrome with periods of constipation & diarrhea. Could be caused by low fiber, lactose, etc.
Is IBS more common in men or women?
Women!
What are symptoms of IBS?
Intermittent abd pain relieved by shitting. Also includes bloating, flatulence, etc.
How do we diagnose IBS?
We diagnose when we rule out every other possible disease.
How do we treat IBS?
Eliminate upsetting foods & treat symptoms. Meds could include Imodium, Zelnorm (tegaserod for peristalsis stimulation), metamucil, etc.
What is a herniation?
Abnormal protrusion of an organ through defect in muscular wall of abdomen.
What is an indirect hernia?
Improper closure of tract that develops as the testes before birth.
What is a direct hernia?
Weakness in inguinal wall.
What is a reducible hernia?
When sac returns into abdominal cavity.
What is an irreducible or incarcerated hernia?
One that can’t be moved - at risked for strangulation there!
Do we forcefully push a hernia back in?
NO
Post-op for hernia - should they lift 200 pounds?
Nope, shouldn’t lift over 20 lbs.
What is an intestinal obstruction? Mechanical vs. non
Mechanical - Physical barrier such as IBS. Something physical is causing the obstruction!
Non-mechanical - paralytic ileus, etc.
What are some symptoms of an intestinal obstruction in the small bowel?
Abd pain, cramping, N/V, constipation, distention, high pitched bowel sounds, etc. Vomit looks like bile.
What are some symptoms of an intestinal obstruction in the large bowel?
Lower abdominal distention, diarrhea, constipation, abd pain/cramping, local tenderness, desire to shit, high-pitched bowel sounds. They’ll have fecal-like vomit.
With a bowel obstruction with vomiting, what might the patient get into? Hint..it’s metabolic.
METABOLIC ALKALOSIS, because they’ve been vomiting and they’ve lost acid!
What are some diagnostic tests for an intestinal obstruction?
WBC, H&H, electrolytes (BUN might be elevated due to dehydration), BA swallow, enema, endoscopy.
How do we treat an intestinal obstruction?
Decompress bowel with NG (#2 things to do), NPO (#1 most important thing to do!!!), IV pain meds. Surgery might be possible! Don’t give meds to make them shit like go-litely!
What is a diverticula?
Saclike projections of mucosa through muscle layer.
What causes diverticula?
Diet, decreased activity, postponed defecation, etc.
What is diverticulosis?
Presence of diverticula.
What is diverticulitis?
Inflammation of diverticula.
Is diverticulitis easy for the elderly?
NO, it is most severe for them.
What are symptoms of diverticulitis?
Pain in the LLQ, constipation and/or diarrhea, narrow stools, N/V, low grade fever, distended abdomen, weakness, symptoms of bowel obstruction, etc.
How do we diagnose diverticulitis?
WBC, occult blood, BA enema, sigmoidoscopy (because it usually happens in the sigmoid colon!!!), CT, etc.
How do we treat diverticulitis?
Varies - meds, pain relief, stool softener, high fiber diet, NPO for bowel rest, bowel resection if needed, etc.
What are polyps?
Mass of tissue from bowel wall that protrudes into the lumen.
What does FAP mean?
familiar abnormal polyopsis? something with lots of polyps ha.
What’s a sessile polyps versus a pendunculated polyp?
Sessile = almost flat. Pendunculated = like a pendulum.
What are some treatments for colon cancer?
Laser treatment, colon resection, chemo, radiation - but usually isn’t caught until too late. :(
Colostomy locations = Give the 4.
Ascending for right sided.
Transverse (double barreled) for emergencies.
Descending colon.
Sigmoid.
Colostomy irrigation - how many ml inserted in the first 3 inches?
300-500 ml.
Stoma car - should be pink, moist, etc - should we limit gas forming foods?
YES
What are hemorrhoids?
Unnaturally swollen or distended veins in the anorectal region.
Internal vs. external hemorrhoids —
Internal is inside the anal tract - external is out.
How do we treat hemorrhoids?
Treat bleeding, pain, itching - maybe zap it off, band it off, etc.
Should we avoid strong laxatives with hemarrhoids?
YES. Support them and help them poop.
What are fissures?
Ulcers or tears in anus, chronic inflammation, etc.
What are fistulas in the butt?
Tunnel or tube like tract between anal canal and perianal skin. Caused often by Crohn’s.
