Intestinal And Rectal Disorders

Question 1

Tenesmus

Answer 1

Ineffective and sometimes painful straining and urge to eliminate feces

Question 2

Constipation

Answer 2

fewer than 3 BM weekly or bowel movements that are hard dry small or difficult to pass

Question 3

Fissure

Answer 3

Normal or abnormal fold, grove or crack in body tissue

Question 4

Conservative treatment for anal fissure

Answer 4

Fiber supplements, stools softener, bulk agents, increase water intake, and sitz baths

Question 5

What are bulk agents

Answer 5

Bulking agents are various natural polysaccharides (usually of plant origin) that are poorly broken down in digestive process

Question 6

How does bulk agents help with diarrhea and constipation

Answer 6

Indigestible and Hydrophilic so water absorbs into them while in colon. Creates a gel like mass-> this extends colony and triggers parastatals and you poop

Question 7

Adverse effects of bulk forming laxatives

Answer 7

-Bloating and toots (bacterial colonization from sitting in colon)
-obstruction in immobile patients

Question 8

Toxic Megacolon

Answer 8

Inflammation extend into the muscularis - inhibits ability to contract and results in colon distention

Question 9

Symptoms of toxic megacolon

Answer 9

Fever, abdominal pain, distention, vomiting and fatigue

Question 10

Borborygmus

Answer 10

Rumbling and gurgling noise in belly made by digestion

Question 11

Vomiting results in which acid base imbalance?

Answer 11

Metabolic alkalosis
- loss of H ion chloride (HCl) and potassium from stomach leading to reduction of chloride and potassium in blood leading to metabolic alkalosis

Question 12

Labs for appendicitis

Answer 12

WBC: usually > 10,500 in appendicitis
C reactive protein: elevated within 12 hrs of symptoms maybe normal after 24 hours

Question 13

Paralytic ileus occurs in appendicitis when

Answer 13

After rupture - then you see abdominal distention

Question 14

Peritonitis manifestations

Answer 14

Tenderness, more pain upon movement, distended and muscles become rigid (maybe rebound tenderness.

N/V, anorexia, and the peristalsis is diminished then paralyzed (paralytic ileus)

Question 15

IBD diet to reduce inflammation and why

Answer 15

Low residue, high calorie, high protein diet (with supplemental vitamins and iron replacement to meet nutritional needs)
Reduce size and number of stools

Question 16

Food to avoid for IBD in attempt to reduce inflammation

Answer 16

Yogurt (high residue), fruit (high residue), salami (high fat), peanut butter (high residue)

Question 17

Residue is

Answer 17

Undigested food that creates stool

Question 18

Actual measurement of “regular BM)

Answer 18

Stool consistency and client comfort

Question 19

Intussusception of the bowel is

Answer 19

One part of the intestine telescopes into another portion of intestine
Shortens, cuts off blood supply- more common in babies than adults

Question 20

Volvulus is

Answer 20

Bowel that twists and turns onto itself and occludes blood supply

Question 21

Result of volvulus

Answer 21

Intestinal lumen becomes obstructed. Gas and fluid accumulate in trapped bowel

Question 22

Adhesion

Answer 22

Intestinal obstruction (most common in SI) where loops of intestine adhere to an area that is healing slowly after surgery

Fibers that adhere during the healing can kink the healthy tissue that need to move during digestion

Question 23

Anorecral abscess

Answer 23

Infection in the area near the anus or rectum - follows path of least resistance

Question 24

Who is most likely to get anorectal abscess?

Answer 24

Crowns and AIDS patients basically shine who is severely immunosuppressed

Question 25

Cause of anorectal abscess

Answer 25

Obstruction of anal gland with dried debris causing a retrograde infection.

Question 26

Anorectal abscess can lead to

Answer 26

Fissures

Question 27

Dietary instructions for patient experiencing constipation

Answer 27

At least 2 L/day fluid intake Prune or apple juice Regular meals Record of diarrhea (see if anything they ate irritate their bowels)

Question 28

Medical management of peritonitis

Answer 28

fluid, electrolyte, and colloid replacement Intravenous solution = several liters isotonic solution for hypovolemia

Question 29

Bulk forming laxative meds

Answer 29

- Metamucil - Psyllium hydrophilic Mucilloid - Wheat dextrin

Question 30

Large and greasy stool is indicative of

Answer 30

Intestinal malabsorption

Question 31

Watery stools are characteristic of disorders in the

Answer 31

Small bowel

Question 32

Loose, semisolid stools are associated more with

Answer 32

Large bowel issues

Question 33

Crohns patients that are losing weight will most likely need parenteral nutrition because

Answer 33

They have impaired ability to ingest or absorb food orally or enterally

Question 34

Mucus and pus in stool indicate what disease/condition

Answer 34

inflammatory enteritis or colitis (ulcerative)

Question 35

digital exams should be conducted for and at what time frame

Answer 35

Detecting colorectal cancer - annually - after 40

Question 36

CEA test is what and why

Answer 36

“Carcinoembryonic Antigen” Is a tumor marker basically because this is usually only found in tissues of baby’s in the womb - blood (or fluid) test for patients who already have been treated for cancer. - monitors response to treatment and can detect metastasis or recurrence

Question 37

Proctosigmoidoscopy is what and is recommended when

Answer 37

A proctoscope that is about 6 inches long used to look in anus and rectum for tumors, polyps, bleeding or inflammation - at 50 - every 3-5 years

Question 38

Regional enteritis aka

Answer 38

Crohn’s disease

Question 39

General overview of Crohn’s disease

Answer 39

- Clustered ulcers take on cobblestone appearance - characterized by remissions and exacerbations - pain in lower right quadrant - lesions are not continuous and are separated by normal tissue

Question 40

Signs of IBD

Answer 40

-Mild diarrhea - sometimes fever and ABD discomfort

Question 41

Colorectal cancer signs

Answer 41

- bloody stools - no abdominal discomfort

Question 42

Signs of diverticulitis

Answer 42

Chronic constipation Occasional diarrhea N/V Abdominal distention

Question 43

Liver failure signs

Answer 43

Jaundice Coagulopathies Edema Hepatomegaly

Question 44

Zollinger-Ellison syndrome

Answer 44

Pancreatic tumors - Hyperacidity due to tumors secreting gastrin in duodenum then it inactivates pancreaticsecretions Oily shit More prone to ulcers (ulcer diathesis)

Question 45

Steatorrhea

Answer 45

Oily stool From an increase in fat excretion

Question 46

Stimulant laxative meds

Answer 46

Bisacodyl Senna

Question 47

Saline agent medication

Answer 47

Magnesium hydroxide

Question 48

Lubricant laxatives

Answer 48

Mineral oil Glycerin suppository

Question 49

Osmotic agent

Answer 49

Polyethylene glycol Sodium and potassium electrolytes

Question 50

Chloride channel activator

Answer 50

Lubiprostone - used for chronic opioid constipation with no cancer and not pregnant - don’t use for more than 4 weeks

Question 51

Serotonin-4 receptor agonist

Answer 51

Prucalopride - for chronic idiopathic constipation - mimics nervous poops without cardiac adverse effects

Question 52

Empty an ileostomy every

Answer 52

4-6 hours

Question 53

Tenesmus is most related to

Answer 53

Ulcerative colitis BUT is in bowel disorders as well

Question 54

Crohn’s hurts on the

Answer 54

Lower Right quadrant

Question 55

Ulcerative colitis tends to hurt on the

Answer 55

Left

Question 56

Priority assessments for IBD in general

Answer 56

- Pain - poop patterns - PO intake (absorption dehydration)

Question 57

Crohn’s and Ulcerative colitis differences

Answer 57

UC: doesn’t effect the muscle layer, poop more (like 4-20x/day), watery poop because colon is not absorbing water, nutritional deficiency due to peristalsis is in hyperdrive Crohn’s: can affect muscle layer, does not have malabsorption

Question 58

Treatment for IBD

Answer 58

1. Rest bowel (less pooping) 2. Control inflammation/combat infection 3. Correct malnutrition/ nutrition therapy 4. Alleviate stress 5. Relieve symptoms 6. Improve quality of life

Question 59

Labs for IBD

Answer 59

CBC hgb/hct, WBC, CRP (c reactive protein)

Question 60

Causes of ulcerative colitis

Answer 60

Genetic predisposition Environmental factors (smoking, infection, drugs, stress, medications)

Question 61

Symptoms of UC

Answer 61

- Urgent diarrhea (mild lower abdominal cramps then increased urgency, blood/mucus in stools) - Bloody stool - Pain in LLQ

Question 62

Treatment for UC

Answer 62

- Treat anemia - malnutrition - dehydration

Question 63

Crohn’s disease usually found in small intestines but can inflame in what segment of gi tract

Answer 63

Any segment in the GI tract - mouth to butt. Most common in the terminal ileum and ascending colon

Question 64

Terminal ileum is located

Answer 64

Last part of small intestine that connects to the cecum (first part of the large intestine)

Question 65

Crohn’s signs inside

Answer 65

Cobblestone appearance Can cause fistulas