GIT - Lower - Conditions Flashcards
1
Q
Irritable Bowel Syndrome (IBS)
A
- characterised by a variable combination of chronic and recurrent intestinal symptoms not explained by structural or biochemical abnormalities
- S&S - abdominal pain, altered bowel function, flatulence, bloating, nausea & anorexia, constipation or diarrhoea, anxiety or depression
- abdominal pain usually relieved by defaecation, pain usually intermittent, cramping, in the lower abdomen, does not occur at night or interfere with sleep
- increased motility and contractions thought to be connected to psychological and physiological stress
- women affected more than men
- diagnostic - symptoms lasting at least 12 weeks in the last 12 months, relief with defaecation, onset associated with a change in bowel frequency and faecal appearance, history of lactose intolerance
- treatment - stress management, increase fibre, avoid precipitating dietary intake, antispasmodics, anticholinergics
2
Q
Inflammatory Bowel Disease
A
- autoimmune disease characterised by chronic inflammation of the GIT
- Crohn’s Disease & Ulcerative Colitis - share many of the same features, periods of unpredictable episodes of exacerbation & remission, unknown cause, no cure
- common features - diarrhoea, bloody stools, weight loss, abdominal pain, fever, arthritis
3
Q
Crohn’s Disease
A
- recurrent, granulomatous (mass of inflamed granulation tissue), inflammatory response
- mucosa has a cobblestone appearance caused by fissures & crevices that develop, submucosa affected by inflammation & fibrosis, affects entire thickness of bowel
- eventually bowel wall becomes thickened & inflexible
- skip lesions
- most commonly affects proximal portion of the colon or terminal ileum, can affect anywhere from mouth to anus
- usually strikes in 20s / 30s, women slightly more affected than men
4
Q
Crohn’s Disease - Signs & Symptoms
A
- insidious onset
- crampy abdominal pain (especially after meals)
- diarrhoea - rare - bleeding (never feel bowel has been totally emptied)
- fatigue
- weight loss
- malnutrition
- secondary anemia
- fever
- complications
- fistula formation
- abdominal abscess formation
- intestinal obstruction
5
Q
Ulcerative Colitis
A
- non-specific inflammatory condition of the colon, confined to the rectum & colon, usually begins in the rectum & spreads along the colon
- affects mainly mucosa & submucosa
- affected area tends to be continuous rather than skipping areas as Crohn’s does
- mucosal layer often develops tongue like projections that resemble polyps & are called pseudopolyps, bowel wall thickens due to repeated episodes of colitis
- can occur at any age
6
Q
Ulcerative Colitis - Signs & Symptoms
A
- severe diarrhoea - can be up to 30-40 bowel movements a day, stools typically contain blood / mucus
- abdominal pain
- cramping abdominal pain
- rectal bleeding - common in UC
- urgent need to defecate
- tenesmus (intermittent)
- anorexia
- fatigue / weakenss
- fever
- vomiting
- anemia
7
Q
Inflammatory Bowel Disease - Management
A
- depends on disease type & severity
- aim is to reduce inflammation, maintain fluid & electrolyte balance, and relieve symptoms
- nutritional therapy - low fat & fibre, high calorie & protein, supplementary vitamins & iron, if acute, nil orally, IVT / TPN
- medications - steroids - don’t stop abruptly, random BSLs, have with food, suppress immunity & increase risk of infection
- medical management usually sufficient for ulcerative colitis, surgical treatment is used for persistent clinical manifestations
- 75% with crohn’s disease will require ileostomy or bowel resection
- 25-40% with ulcerative colitis will need surgery
8
Q
Diverticular Disease
A
- condition in which the mucosal layer of the colon herniates through the muscularis layer
- can be multiple diverticula, mainly in the sigmoid colon
- caused by dietary factors (not enough fibre), decrease in physical activity, poor bowel habits (avoiding urge to defecate), effects of aging
- may be asymptomatic, symptoms can include ill defined low abdominal discomfort, changed bowel habits, bloating, flatulence
- diagnosed by x-ray
9
Q
Diverticulitis
A
- complication of diverticular disease, inflammation and gross or microscopic perforation of the diverticulum, with development of small, localised abscess
- S&S - pain in the lower left quadrant, nausea & vomiting, tenderness in the lower left quandrant, slight fever, elevated white cell cound
- complications - perforation with peritonitis, haemorrhage, bowel obstruction, fistular formation (usually involving bladder)
- diagnosis - history, presenting manifestations, barium enema x-rays (avoided in acute diverticulitis), CT scans, ultrasound scans
10
Q
Diverticulitis - Management
A
- goal is to relieve symptoms and rest bowel
- uncomplicated
- high residue diet
- anticholinergic medications (to stop activity of bowel)
- increased fluid intake
- acute
- NBM
- bed rest
- parenteral fluids
- antibiotics
- analgesics
- may need emergency colostomy
11
Q
Bowel Obstruction
A
- mechanical
- surgical adhesions
- hernias and tumors
- can occur within days of surgery, weeks, or even years
- large bowel obstructions usually due to cancer
- non mechanical
- paralytic ileus - general anesthesia causes bowel paralysis, no peristatic movements
- usually after bowel surgery
- impairs ability of gut contents to pass through, if not treated, strangulation and gangrene may occur
- more common in small bowel
12
Q
Bowel Obstruction - Clinical Manifestations
A
- nausea & vomiting
- abdominal pain
- abdominal distention (specific to obstruction)
- no flatus
- with paralytic ileus - no bowel sounds
13
Q
Bowel Obstruction - Diagnosis
A
- abdominal x-ray
- barium enema (if perforation suspected no barium that can leak & cause peritonitis or septic shock
- FBE
- U&E (GIT conditions = N&V, diarrhoea, electrolyte imbalance need bloods)
- on xray - stepladder pattern, lines caused by fluid, domes by gas - looks like a stepladder
14
Q
Bowel Obstruction - Management
A
- NBM
- IV fluid replacement
- NG tube, rest GI tract & decompress
- FBC
- assess vomitus
- auscultate bowel (hyperactive, hypoactive, absent)
- mouth care
15
Q
Bowel Obstruction - Prevention
A
- early management - hernias
- decrease risk of fecal impaction
- post surgery - listen for bowel sounds before fluids / food given
- in surgery - less handling of bowel
