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Med Surg III Exam 3 > Intestinal disorders > Flashcards

Intestinal disorders Flashcards

1
Q

What is diverticulosis? How is it formed?

A

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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2
Q

Where is diverticulosis most commonly found?

A

95-98% is in the sigmoid colon

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3
Q

Which population is diverticulosis most common?

A

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

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4
Q

What are symptoms and complications of diverticulosis?

A

Has relatively few symptoms, is not reversible, and complications occur in about 20% of people and include bleeding and diverticulitis.

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5
Q

What is diverticular bleeding?

A

Chronic injury to small blood vessels next to the diverticula

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6
Q

What are the s/s of diverticular bleeding?

A

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

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7
Q

What is diverticulitis?

A

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

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8
Q

S/S of diverticulitis?

A

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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9
Q

Diverticular Disease (DD) Risk factors

A 
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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10
Q

Preventing Diverticular Disease

A

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

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11
Q

Drug therapy for diverticular disease

A

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

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12
Q

Surgical procedures for diverticular disease

A

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

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13
Q

How does race affect diverticular disease?

A

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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14
Q

How does age affect diverticular disease?

A

Incidence rises with age, rare in people younger than 40

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15
Q

Prognosis, morbidity and mortality related to diverticular disease

A

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

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16
Q

Colorectal Cancer (CRC) Incidence/survival

A

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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17
Q

Symptoms of colorectal cancer

A 
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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18
Q

Risk factors of colorectal cancer

A

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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19
Q

Preventing colorectal cancer

A

Routine screening for 50+
Increase physical activity
Eating fruits and veggies
Limit alcohol and tobacco

20
Q

CRC Screening: FOBT

A

Checks for occult blood in stool –> place a small amount of stool from 3 consecutive stool on test cards, return to MD, recommended yearly

21
Q

CRC Screening: Flexible Sigmoidoscopy

A

Use a strong laxative/enema, a narrow, flexible lighted tube is inserted into rectum and lower colon, may remove abnormalities, recommended every 5 years

22
Q

CRC Screening: Double-Contrast barium enema

A

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

23
Q

Colonoscopy

A

Similar to sigmoidoscopy but tube is longer to see entire colon –> sedative for comfort. Can remove abnormalities, recommended every 10 years

24
Q

Treatment of CRC

A
  • Removal of tumor
  • Resection
  • Colostomy
  • Chemotherapy
25
Q

PT Implications of CRC

A 
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
26
Q

What is a paralytic Ileus?

A

Neurogenic or muscular impairment of peristalsis, functional intestinal obstruction

27
Q

Signs and symptoms of paralytic ileus

A 
Mild to moderate abdominal pain
Absent bowel sounds
Dehydration
Generalized abdominal distention
Constipation
28
Q

Diagnosing paralytic ileus

A

Use clinical s/s
Radiography of abdomen
Barium enema

29
Q

Treatment of paralytic ileus

A

Remove the cause, restrict oral intake (or completely eliminate)
Aspiration of gastric secretions
Paraenteral nutrition

30
Q

Epidemiology of Crohn’s disease

A

4-10 per 100,000 annually, more common in west/caucasians and females, onset is at mean of 26

31
Q

What happens to the involved bowel in Crohn’s?

A

It is thickened and narrowed, may have deep mucosal ulcers, skip lesions present

32
Q

Clinical features of Crohn’s

A

Prolonged Diarrhea (80%)
Low-grade fever
Generalized fatigability
Abdominal pain

33
Q

Inducing remission in crohn’s

A

Oral glucocorticosteroids

Enteral nutrition

34
Q

Mantenance (medical management) of Crohn’s

A

Aminosalicylates
Azathioprine, mycophenolate mofetil
Biologicals
Antibiotics: Ciprofloxacin and metronidazole

35
Q

Surgical management of crohn’s

A

Indicated with: failure of medical therapy, failure to thrive
Complications: toxic dilatation, obstruction, perforation, abscesses, fistulas

36
Q

Prognosis of Crohn’s

A

Follows a chronic relapsing course, 6-10 times more likely to develop bowel cancer, but < UC

37
Q

Incidence of Ulcerative Colitis (UC)

A

Chronic GI disease, onsets most commonly at 10-40, 20% have a family history, equal prevalence in men and women, cancer risk is increased

38
Q

Pathogenesis of UC

A

Lesions in large intestines, rectum

Inflammation of mucosal/submucosal layers… symptoms come and go, fairly long periods between flare-ups

39
Q

What symptoms are common in UC AND Crohn’s?

A

Skin rashes and joint pain

40
Q

What symptom is unique to UC? (IE, not present in Crohn’s?)

A

Abdominal pain is relieved by a bowel movement (pain in crown’s is not)

41
Q

What is the most serious complication in UC?

A

Toxic Megacolon

42
Q

What are some other manifestations of UC?

A

Arthritis, ankylosing spondylitis
Inflammation of eyes, skin, and mucous membranes
Hepatitis, bile duct carcinoma, colon cancer

43
Q

Diagnosis of UC

A

Exclusion based on medical history and clinical presentation
Sigmoidoscopy
Barium enema

44
Q

Drug therapy for UC

A

Aminosaliclylates
Steroids
Immune modifiers
Antibiotics

45
Q

Prognosis of UC

A

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

46
Q

Surgery for UC

A

Emergency surgery for toxic megacolon

IPAA (Ileal pouch-anal anastomosis) – elective

47
Q

Implications for IBD

A

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

Med Surg III Exam 3 (8 decks)

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