Intestinal disorders Flashcards
What is diverticulosis? How is it formed?
Tiny pockets, or diverticula in the lining of the bowel. It is formed by increased pressure on weakened spots of intestinal walls by cad, waste or liquid.
Where is diverticulosis most commonly found?
95-98% is in the sigmoid colon
Which population is diverticulosis most common?
10% in people over 40, 50% of people over 60
What are symptoms and complications of diverticulosis?
Has relatively few symptoms, is not reversible, and complications occur in about 20% of people and include bleeding and diverticulitis.
What is diverticular bleeding?
Chronic injury to small blood vessels next to the diverticula
What are the s/s of diverticular bleeding?
Bright red/wine-colored stools
Painless urge to defecate
Copious bleeding that stops spontaneously
What is diverticulitis?
Inflammation and infection in one or more of the diverticula, then they become blocked with waste.
S/S of diverticulitis?
Can occur suddenly
Alternating diarrhea with constipation
Painful cramps/tenderness in lower abdomen
Chills or fever over 101
Recurrent UTC (colovesicular fistula)
Severe/generalized abdominal pain (diffuse peritonitis)
Back or LE pain (perforation)
Diverticular Disease (DD) Risk factors
Low-fiber diet Advanced age Obseity Pelvic floor disorder Males have greater risk High fat intake Lack of regular physical activity
Preventing Diverticular Disease
Maintain good bowel habits (be regular, don’t strain)
20-35 grams of fiber a day
Exercise regularly
Drug therapy for diverticular disease
Antibiotics - fight infection
Anticholinergics- relieve cramping
Analgesics- relieve pain
Surgical procedures for diverticular disease
Colonoscopy with electrocoagulation (stops bleeding)
Sigmoidectomy
Hartman’ procedure (detatch colon from rectom and reconnect somewhere else)
How does race affect diverticular disease?
Traditionally disease of western society, L sided gut pain, but eastern societies have R sided gut pain –> related to cultural diet
How does age affect diverticular disease?
Incidence rises with age, rare in people younger than 40
Prognosis, morbidity and mortality related to diverticular disease
Good prognosis with early detection, but morbidity is worse in younger patients
Colorectal Cancer (CRC) Incidence/survival
70% colon (large intestine), 30% Rectum
Early detection- 5 year survival is 90%
Metastatis to lymph nodes: 35-60%
Metastasis to liver: <10%
Symptoms of colorectal cancer
Blood in stool Change in bowel habits Stools narrower than usual General stomach discomfort Frequent gas/pains/indigestion Unexplained weight loss Low back pain
Risk factors of colorectal cancer
Inflammation of bowel (DD)
Family history of CRC or polyps
Certain hereditary syndromes
Lifestyle: lack of physical activity, fruits and veggies, low fiber/high fat diet, obesity, alcohol consumption, tobacco use
Preventing colorectal cancer
Routine screening for 50+
Increase physical activity
Eating fruits and veggies
Limit alcohol and tobacco
CRC Screening: FOBT
Checks for occult blood in stool –> place a small amount of stool from 3 consecutive stool on test cards, return to MD, recommended yearly
CRC Screening: Flexible Sigmoidoscopy
Use a strong laxative/enema, a narrow, flexible lighted tube is inserted into rectum and lower colon, may remove abnormalities, recommended every 5 years
CRC Screening: Double-Contrast barium enema
Enema with barium solutions… X-ray of rectum and colon. Barium coats lining of intestines so abnormalities are visible on x-ray. Recommended every 5 years
Colonoscopy
Similar to sigmoidoscopy but tube is longer to see entire colon –> sedative for comfort. Can remove abnormalities, recommended every 10 years
Treatment of CRC
- Removal of tumor
- Resection
- Colostomy
- Chemotherapy
PT Implications of CRC
May initially present with LBP!!! Hip/thigh pain- referred from iliopsoas abcess Consider bowel and bladder function Be aware of colostomy bag Avoid valsalva maneuver
What is a paralytic Ileus?
Neurogenic or muscular impairment of peristalsis, functional intestinal obstruction
Signs and symptoms of paralytic ileus
Mild to moderate abdominal pain Absent bowel sounds Dehydration Generalized abdominal distention Constipation
Diagnosing paralytic ileus
Use clinical s/s
Radiography of abdomen
Barium enema
Treatment of paralytic ileus
Remove the cause, restrict oral intake (or completely eliminate)
Aspiration of gastric secretions
Paraenteral nutrition
Epidemiology of Crohn’s disease
4-10 per 100,000 annually, more common in west/caucasians and females, onset is at mean of 26
What happens to the involved bowel in Crohn’s?
It is thickened and narrowed, may have deep mucosal ulcers, skip lesions present
Clinical features of Crohn’s
Prolonged Diarrhea (80%)
Low-grade fever
Generalized fatigability
Abdominal pain
Inducing remission in crohn’s
Oral glucocorticosteroids
Enteral nutrition
Mantenance (medical management) of Crohn’s
Aminosalicylates
Azathioprine, mycophenolate mofetil
Biologicals
Antibiotics: Ciprofloxacin and metronidazole
Surgical management of crohn’s
Indicated with: failure of medical therapy, failure to thrive
Complications: toxic dilatation, obstruction, perforation, abscesses, fistulas
Prognosis of Crohn’s
Follows a chronic relapsing course, 6-10 times more likely to develop bowel cancer, but < UC
Incidence of Ulcerative Colitis (UC)
Chronic GI disease, onsets most commonly at 10-40, 20% have a family history, equal prevalence in men and women, cancer risk is increased
Pathogenesis of UC
Lesions in large intestines, rectum
Inflammation of mucosal/submucosal layers… symptoms come and go, fairly long periods between flare-ups
What symptoms are common in UC AND Crohn’s?
Skin rashes and joint pain
What symptom is unique to UC? (IE, not present in Crohn’s?)
Abdominal pain is relieved by a bowel movement (pain in crown’s is not)
What is the most serious complication in UC?
Toxic Megacolon
What are some other manifestations of UC?
Arthritis, ankylosing spondylitis
Inflammation of eyes, skin, and mucous membranes
Hepatitis, bile duct carcinoma, colon cancer
Diagnosis of UC
Exclusion based on medical history and clinical presentation
Sigmoidoscopy
Barium enema
Drug therapy for UC
Aminosaliclylates
Steroids
Immune modifiers
Antibiotics
Prognosis of UC
20% mortality rate when complications occur in in first 10 years
10 years of chronic attacks can lead to colon cancer
Removal of affected section helps prevent CRC
Surgery for UC
Emergency surgery for toxic megacolon
IPAA (Ileal pouch-anal anastomosis) – elective
Implications for IBD
Screen for medical disease any time a pt presents with LBP, hip, or SI pain of unknown origin
Know what meds a pt is taking
Observe for signs of dehydration
