Intestinal disorders Flashcards by jenny westbrook

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.

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Where is diverticulosis most commonly found?

95-98% is in the sigmoid colon

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Which population is diverticulosis most common?

10% in people over 40, 50% of people over 60

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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.

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What is diverticular bleeding?

Chronic injury to small blood vessels next to the diverticula

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What are the s/s of diverticular bleeding?

Bright red/wine-colored stools
Painless urge to defecate
Copious bleeding that stops spontaneously

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What is diverticulitis?

Inflammation and infection in one or more of the diverticula, then they become blocked with waste.

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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)

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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

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Preventing Diverticular Disease

Maintain good bowel habits (be regular, don’t strain)
20-35 grams of fiber a day
Exercise regularly

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Drug therapy for diverticular disease

Antibiotics - fight infection
Anticholinergics- relieve cramping
Analgesics- relieve pain

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Surgical procedures for diverticular disease

Colonoscopy with electrocoagulation (stops bleeding)
Sigmoidectomy
Hartman’ procedure (detatch colon from rectom and reconnect somewhere else)

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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

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How does age affect diverticular disease?

Incidence rises with age, rare in people younger than 40

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Prognosis, morbidity and mortality related to diverticular disease

Good prognosis with early detection, but morbidity is worse in younger patients

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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%

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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

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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

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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