Inflammatory Bowel Diseases Flashcards
pathophysio of PERITONITIS
- type of ACUTE INFLAMMATION & INFECTION of the VISCERAL/PARIETAL PERITONEUM & affects the ENDOTHELIAL LINING of the abdominal cavity
- caused by CONTAMINATION of the PERITONEAL CAVITY via BACTERIA or CHEMICALS
what type of CHEMICALS can cause PERITONITIS?
- bile leakage
- pancreatic enzymes
- gastric acid
mortality rate of PERITONITIS
- can have SIGNIFICANT POST-OPERATIVE COMPLICATIONS
- can have around 50% mortality rate
[death rate = mortality rate]
physical assessment of PERITONITIS
- can have GUARDED BEHAVIOR
- ABDOMINAL PAIN that worsens with MOVEMENT
- tenderness and distention within the ABDOMEN
laboratory assessment of PERITONITIS
- WBC; elevated can indicate infection
- BLOOD CULTURING; identifies risk of bacterial infection/suspected sepsis
- BUN, CREATININE; KIDNEY FXN - can be affected by sepsis
- Hgb, Hc
- ABG, ox saturation
imaging assessment for PERITONITIS
- can enable X-RAYS or ULTRASOUNDS
- CT SCAN; often is the GOLD STANDARD for diagnosing peritonitis
- assesses for signs of INFLAMMATION, PERFORATION, ABSCESSES, or ISCHEMIA
- can assess for ACCUMULATION of AIR or FLUID within the abdomen
what are the PRIORITY COLLABORATIVE PROBLEMS to solve with patients with PERITONITIS?
- ACUTE pain
- POTENTIAL FLUID VOLUME SHIFT
want to take action by MANAGING this PAIN & RESTORING fluid volume balance
pathophysio of APPENDICITIS
- the ACUTE INFLAMMATION of the VERMIFORM APPENDIX
- seen within the RLQ
- often occurs due to OBSTRUCTION of the LUMEN OF THE APPENDIX»_space; causes INFECTION
- due to OBSTRUCTION; causes DECREASE of MUCOSAL BLOOD FLOW; creates a HYPOXIC APPENDIX
- can lead to PERITONITIS, GANGRENE, SEPSIS or PERFORATION
McBurney’s Point
- specific LOCATION located MIDWAY between the ANTERIOR ILIAC CREST & UMBILICIUS within the RLQ
- typical sign of LOCALIZED TENDERNESS for APPENDICITIS in the later stages
signs & symptoms of APPENDICITIS
- RLQ ABDOMINAL PAIN or REBOUND TENDERNESS
- NAUSEA & VOMITING
- slight fever
- diarrhea
- WBC elevation
- ultrasound; more enlarged appendix
interventions for APPENDICITIS
- can have NONSURGICAL MANAGEMENT; keeping patient NPO & giving IV FLUIDS
- usage of antibiotics
- can have SURGICAL MANAGEMENT; appendectomy
gastroenteritis
- the INFLAMMATION of the STOMACH & INTESTINES; due to infection most often
- COMMON health problem
- causes DIARRHEA & VOMITING
- can be SELF-LIMITING for around 3 days
- may need more MEDICAL ATTENTION for OLDER ADULTS/IMMUNOSUPPRESSED ADULTS
describe VIRAL GASTROENTERITIS
- can either EPIDEMIC VIRAL or NOROVIRUS
- EV: caused by PARVOVIRUS-TYPE ORGANISMS and is transmitted by the FECAL-ORAL ROUTE
- NV; transmitted by FECAL-ORAL ROUTE/RESP. ; can cause hypovolemia in older adults
in general; can cause CELL DEATH & MALABSORPTION
- can lead to more WATERY DIARRHEA
what are our BACTERIAL GASTROENTERITIS TYPES?
- CAMPYLOBACTER ENTERITIS
- E. COLI DIARRHEA
- SHIGELLOSIS
all transmitted by fecal-oral routes, contact with contaminated food, water, of animals
- can trigger INFLAMMATION, ULCERATION, and DYSENTERY/SECRETORY DIARRHEA
what are some HEALTH PROMOTION STRATS and DX PREVENTION for GASTROENTERITIS?
- handwashing!!
- proper sanitization of surfaces
- proper FOOD & BEVERAGE preparation
pathophysio of GASTROENTERITIS
- can occur where there are LARGE GROUPS of people in proximity - for NOROVIRUS
what are some aspects to look for during GASTOENTERITIS assessment?
- assessing RECENT TRAVEL of the patient / restaurants
- symptoms of N&V, cramping or diarrhea
- signs of HYPOKALEMIA; music. weakness or cardiac dysrhythmias
- signs of HYPOVOLEMIA
interventions for GASTROENTERITIS
- greater FLUID REPLACEMENT and ORAL FLUIDS
- DO NOT USE DRUG-SUPPRESSANTS FOR INTESTINAL MOTILITY
- usage of antibiotic therapy
- skin care to ANAL AREA; due to increased diarrhea; more susceptible to skin damage
(creams, wipes, barrier creams, or sitz baths)
why should we NOT give INTESTINAL MOBILITY SUPPRESSANTS when a patient has GASTROENTERITIS?
- have to think; the DIARRHEA is the body’s DEFENSE MECHANISM to REMOVE pathogens, toxins from its infection
- suppressing this can cause PROLONGATION of the illness
- can cause SEVERE BACTERIAL INFECTIONS and puts the patient for SYSTEMIC TOXICITY
what is ULCERATIVE COLITIS (CHRONIC IBD)?
- the WIDESPREAD CHRONIC INFLAMMATION of the RECTUM & the RECTOSIGMOID COLON
- can spread to the WHOLE ENTIRE COLON
- can have REMISSIONS & EXACERBATIONS
- often is CONFUSED with CROHN’S DX
describe the ETIOLOGY & GENETIC RISKS of ULCERATIVE COLITIS
- often found with hereditary hx & twins
- can increase COLON CANCER RISK with cellular changes
- around 3 million people have IBD/ around half with UC
- common age of diagnosis; 20 - 35
- is LESS COMMON in patients who SMOKE
signs & symptoms of UC
- bloody stools / watery diarrhea
- low-grade fevers
- can have nonspecific signs
- crampings/an URGE to defecate
important labs to monitor for UC patients
- Hc, Hgb
- increased WBC/C-reactive protein/ESR; assessment of blood loss from ulcerations/ assessment markers for inflammation
- ELECTROLYTE PANEL; Na, K, Cl
- albumin levels; risk for HYPOALBUMINEMIA
what are some DIAGNOSTIC ASSESSMENTS for UC?
- MRE
- UPPER ENDOSCOPIES
- COLONSCOPIES
what are the PRIORITY COLLABORATIVE PROBLEMS to MONITOR for UC PATIENTS?
- diarrhea
- acute or persistent pain
- potential for LOWER GI BLEEDING
describe CROHN’s DX and its pathophysio
- type of CHRONIC INFLAMMATORY DX of the SI, COLON or either
- causes a THICKENED BOWEL WALL due to its INFLAMMATION
- can spread through SKIP LESIONS within the COLON; can affect any parts between the GI TRACT to the PERIANAL AREA
some COMPLICATIONS;
- hemorrhages
- severe malabsorption
- malnourishment
- debilitation
- cancer
important history & physical assessment for CD
histories;
- weight loss
- different stool characteristics /rectal bleeding
- history of smoking **can increase severity
- fever
- abdominal pain
- deficiencies in folic acid/vitamin D/B12
PHYSICAL assessment;
- anemic patient
- distention/masses of the abdomen
- tachycardia
- diarrhea
lab assessments for CD
- similar to UC
(WBC, C-REACTIVE, ESR, ELECTROLYTE PANEL, ALBUMIN)
diagnostics for CD
- MRE
- ENDOSCOPY/COLONSCOPY
- CT SCAN
potential problems for CD patients
- DIARRHEA due to inflammation of bowel mucosa
- ACUTE or PERSISTENT PAIN - inflammation and ulceration of the bowel mucosa
- POTENTIAL FOR LOWER GI BLEEDING - can cause anemia
how can we MONITOR and PREVENT CD?
- having proper NUTRITION AND DRUG THERAPY
- having a LOW-FAT-SUGAR DIET / increase in veggies and fruit
- smoking cessation
- monitoring WEIGHT
- having proper SKIN CARE for diarrhea
what are the TYPICAL DRUGS used to treat CD?
- 5-AMINOSALICYLATES
- GLUCOCORTICOIDS
- IMMUNOSUPPRESSANTS/MODULATORS
- ANTIBIOTICS
diverticula
the HERNIATIONS/SACLIKE OUTPOUCHES of the MUCOSA within the muscle layers of the COLON WALL – SIGMOID
diverticulosis
the ASYMPTOMATIC DIVERTICULAR DX
diverticulitis
the actual INFLAMMATION stage of the DIVERTICULOSIS
pathophysio of diverticular dx
- can occur in either SI or LI; mainly affects the SIGMOID COLON
- have HYPERTROPHY OF THE COLON; causing more RIGIDITY & THICKENING of the MUCOSA
- often affects the weakest points of the INTESTINAL WALL (where the BV can interrupt the muscle)
- often occurs due to AGING and a LACK OF FIBER in diet
signs and symptoms of diverticular dx
- low-grade fever
- N&V
- abdominal pain
- constipation
- rectum bleeding
- more tenderness within the LLQ
- distention
labs for diverticular dx
- CBC/H&H
- STOOL OCCULT for blood
what is the PROPER DIET & NUTRITION for diverticular dx?
- want the patient to have LOW-FIBER DIET/CLEAR LIQUIDS first based on symptoms
- can also be NPO/usage of HG if severe symptoms occur
- IV FLUIDS
- increase dietary intake as symptoms fade
drugs often used for DIVERTICULAR DX
- antimicrobial drugs; METRONIDAZOLE + TMP/SMZ
- can also use CIPROFLOXACIN
- pain meds
what is the MOST COMMON SURGICAL PROCEDURE for patients with DIVERTICULAR DX?
- COLON RESECTION w/ or w/o a colostomy
patient education and care for diverticular dx
- proper care for COLOSTOMY and INCISION
- re-introducing FIBER once the inflammation decreases (increase to around 25 - 35 g per day once stable)
- high fruits and veggies/bulk-forming laxatives
- avoiding ALCOHOL
CELIAC DX
- type of MULTI-SYS AUTOIMMUNE DX
- is the CHRONIC INFLAMMATION of the SI MUCOSA - causes BOWEL WALL ATROPHY, MALABSORPTION, DIARRHEA
- can have REMISSIONS & EXACERBATIONS
- patient cannot TOLERATE GLUTEN - causes damage to SI EPITHELIUM
symptoms of CELIAC DX
- ANOREXIA
- DIARRHEA/STEATORRHEA
- ABDOMINAL PAIN/BLOATING
- distention
- weight loss
(often resolves with withdrawal of gluten)
treatment & diagnosis for CELIAC DX
- usage of autoantibody screening tests or blood tests/endoscopy
- having a LIFELONG ADHEREANCE to a GLUTEN-FREE DIET
