Intestinal And Rectal Disorders Flashcards
Tenesmus
Ineffective and sometimes painful straining and urge to eliminate feces
Constipation
fewer than 3 BM weekly or bowel movements that are hard dry small or difficult to pass
Fissure
Normal or abnormal fold, grove or crack in body tissue
Conservative treatment for anal fissure
Fiber supplements, stools softener, bulk agents, increase water intake, and sitz baths
What are bulk agents
Bulking agents are various natural polysaccharides (usually of plant origin) that are poorly broken down in digestive process
How does bulk agents help with diarrhea and constipation
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
Adverse effects of bulk forming laxatives
-Bloating and toots (bacterial colonization from sitting in colon)
-obstruction in immobile patients
Toxic Megacolon
Inflammation extend into the muscularis - inhibits ability to contract and results in colon distention
Symptoms of toxic megacolon
Fever, abdominal pain, distention, vomiting and fatigue
Borborygmus
Rumbling and gurgling noise in belly made by digestion
Vomiting results in which acid base imbalance?
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
Labs for appendicitis
WBC: usually > 10,500 in appendicitis
C reactive protein: elevated within 12 hrs of symptoms maybe normal after 24 hours
Paralytic ileus occurs in appendicitis when
After rupture - then you see abdominal distention
Peritonitis manifestations
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)
IBD diet to reduce inflammation and why
Low residue, high calorie, high protein diet (with supplemental vitamins and iron replacement to meet nutritional needs)
Reduce size and number of stools
Food to avoid for IBD in attempt to reduce inflammation
Yogurt (high residue), fruit (high residue), salami (high fat), peanut butter (high residue)
Residue is
Undigested food that creates stool
Actual measurement of “regular BM)
Stool consistency and client comfort
Intussusception of the bowel is
One part of the intestine telescopes into another portion of intestine
Shortens, cuts off blood supply- more common in babies than adults
Volvulus is
Bowel that twists and turns onto itself and occludes blood supply
Result of volvulus
Intestinal lumen becomes obstructed. Gas and fluid accumulate in trapped bowel
Adhesion
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
Anorecral abscess
Infection in the area near the anus or rectum - follows path of least resistance
Who is most likely to get anorectal abscess?
Crowns and AIDS patients basically shine who is severely immunosuppressed
Cause of anorectal abscess
Obstruction of anal gland with dried debris causing a retrograde infection.
Anorectal abscess can lead to
Fissures
Dietary instructions for patient experiencing constipation
At least 2 L/day fluid intake
Prune or apple juice
Regular meals
Record of diarrhea (see if anything they ate irritate their bowels)
Medical management of peritonitis
fluid, electrolyte, and colloid replacement
Intravenous solution = several liters isotonic solution for hypovolemia
Bulk forming laxative meds
- Metamucil
- Psyllium hydrophilic Mucilloid
- Wheat dextrin
Large and greasy stool is indicative of
Intestinal malabsorption
Watery stools are characteristic of disorders in the
Small bowel
Loose, semisolid stools are associated more with
Large bowel issues
Crohns patients that are losing weight will most likely need parenteral nutrition because
They have impaired ability to ingest or absorb food orally or enterally
Mucus and pus in stool indicate what disease/condition
inflammatory enteritis or colitis (ulcerative)
digital exams should be conducted for and at what time frame
Detecting colorectal cancer
- annually
- after 40
CEA test is what and why
“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
Proctosigmoidoscopy is what and is recommended when
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
Regional enteritis aka
Crohn’s disease
General overview of Crohn’s disease
- 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
Signs of IBD
-Mild diarrhea
- sometimes fever and ABD discomfort
Colorectal cancer signs
- bloody stools
- no abdominal discomfort
Signs of diverticulitis
Chronic constipation
Occasional diarrhea
N/V
Abdominal distention
Liver failure signs
Jaundice
Coagulopathies
Edema
Hepatomegaly
Zollinger-Ellison syndrome
Pancreatic tumors
- Hyperacidity due to tumors secreting gastrin in duodenum then it inactivates pancreaticsecretions
Oily shit
More prone to ulcers (ulcer diathesis)
Steatorrhea
Oily stool
From an increase in fat excretion
Stimulant laxative meds
Bisacodyl
Senna
Saline agent medication
Magnesium hydroxide
Lubricant laxatives
Mineral oil
Glycerin suppository
Osmotic agent
Polyethylene glycol
Sodium and potassium electrolytes
Chloride channel activator
Lubiprostone
- used for chronic opioid constipation with no cancer and not pregnant
- don’t use for more than 4 weeks
Serotonin-4 receptor agonist
Prucalopride
- for chronic idiopathic constipation
- mimics nervous poops without cardiac adverse effects
Empty an ileostomy every
4-6 hours
Tenesmus is most related to
Ulcerative colitis
BUT is in bowel disorders as well
Crohn’s hurts on the
Lower Right quadrant
Ulcerative colitis tends to hurt on the
Left
Priority assessments for IBD in general
- Pain
- poop patterns
- PO intake (absorption dehydration)
Crohn’s and Ulcerative colitis differences
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
Treatment for IBD
- Rest bowel (less pooping)
- Control inflammation/combat infection
- Correct malnutrition/ nutrition therapy
- Alleviate stress
- Relieve symptoms
- Improve quality of life
Labs for IBD
CBC
hgb/hct, WBC, CRP (c reactive protein)
Causes of ulcerative colitis
Genetic predisposition
Environmental factors (smoking, infection, drugs, stress, medications)
Symptoms of UC
- Urgent diarrhea (mild lower abdominal cramps then increased urgency, blood/mucus in stools)
- Bloody stool
- Pain in LLQ
Treatment for UC
- Treat anemia
- malnutrition
- dehydration
Crohn’s disease usually found in small intestines but can inflame in what segment of gi tract
Any segment in the GI tract - mouth to butt. Most common in the terminal ileum and ascending colon
Terminal ileum is located
Last part of small intestine that connects to the cecum (first part of the large intestine)
Crohn’s signs inside
Cobblestone appearance
Can cause fistulas
