intestinal disorders Flashcards
diverticular disease is?
Diverticulosis, also known as “diverticular disease”, is the condition of having diverticula in the colon, which are outpocketings of the colonic mucosa and submucosa through weaknesses of muscle layers in the colon wall. These are more common in the sigmoid colon, which is a common place for increased pressure. This is uncommon before the age of 40, and increases in incidence after that age.
what is another name for the tiny pockets in the lining of the bowel?
diverticula
diverticulosis is formed by?
increased pressure on weakened spots of the intestinal walls by gas, waste, or liquid
where is diverticulosis most common?
95-98% of the time in the sigmoid colon
diverticulosis occurs in _____% over 40 and _____% of people over 60
10%
50%
True or False
There are many symptoms to diverticulosis
False
there are few
Diverticulosis: it is _______ reversible and complications occur in about _____% of people
rarely
20
what is diverticular bleeding?
chronic injury to small blood vessels next tot he diverticula
what is diverticulitis?
inflammation and infection in one or more diverticula
diverticula become blocked with waste
what are S/S of diverticular bleeding?
bright red-colored/wine-colored stools
painless urge to defecate
copious bleeding that stops spontaneously
S/S of diverticulitis?
Can occur suddenly and without warning
Alternating diarrhea with constipation
Painful cramps/ tenderness in lower abdomen
Chills or fever over 101°
Recurrent urinary tract infections (colovesicular fistulas)
Severe/ generalized abdominal pain (diffuse peritonitis)
Back or lower extremity pain (perforation)
diverticular disease risk factors are?
Low-fiber diet Advanced age Obesity Pelvic Floor disorder (females) Male gender= diverticulitis High fat intake Lack of regular physical activity
true or false
Men have a higher chance of diverticulitis
True
how can diverticular disease be prevented?
maintain good bowel habits
fiber consumption
exercise regularly
what is the recommended amount of fiber intake according to the American Dietetic Association?
20 to 35 grams a day
what are 3 drug therapies for DD?
antibiotics for infection
anticholinergics for relieving cramps
analgesic for pain relief
in an emergency with DD, a ______ procedure is performed
Hartmans
what is the Hartmans Procedure?
In an emergency- detach the sigmoid colon from the rectum, close the rectum, reconnect the sigmoid colon directly to an opening created on the surface of the body
Reversed within 6 months
a colonoscopy with __________ can be used to stop bleeding
electrocoagulation
DD primarily affects ?
industrialized western societies
males= females
older age
western societies have _____ sided gut pain while eastern societies have _____ sided gut pain
left
right
complications occur in about ____-____% of patients with diverticulosis during life
10-20%
morbidity for DD is worse in _______ patients
younger
Prognosis of DD is ______ with early detection and treatment of complications
good
what is Colorectal Cancer (CRC) ?
cancer of colon (large intestine) and/or rectum
CRC affects the colon about ____% of the time
70%
CRC affects the rectum about ____% of the time
30%
if CRC is found early, the 5 year survival is _____%
90
if CRC metatsis to lymph nodes, the 5 year survival goes to ____-____%
35-60%
if CRC metastasis to liver, the 5 year survival goes to _____%
<10%
True or False
When CRC first develops, the symptoms are the worse
False
1st develops with no symptoms
what are S/S of CRC?
Blood in stool
Change in bowel habits
Stools narrower than usual
General stomach discomfort
Frequent gas/ pains/indigestion
Unexplained weight loss
Low Back Pain
what are CRC risk factors?
Inflammation of bowel (DD)
family history of CRC or colorectal polyps
certain hereditary syndromes
lifestyle factors
Lifestyle factors that increase the chance of CRC include?
Lack of regular physical activity Low fruit and vegetable intake Low-fiber and high-fat diet Overweight/obese Alcohol consumption Tobacco use
what does CRC prevention include?
CRC Screening Increasing physical activity Eating fruits & vegetables Limit alcohol consumption Avoid tobacco
True or False
All men and women aged 50 years or older routinely screened
True
what are the 4 screening options for CRC?
Fecal Occult Blood Test (FOBT)
Flexible Sigmoidoscopy
Double-contrast Barium Enema
Colonoscopy
what is the fecal occult blood test?
checks for occult blood in stool
At home, you place a small amount of your stool from 3 consecutive bowel movements on test cards
Return the cards to your doctor’s office or a lab
Recommended yearly
the FOBT is recommended ______?
yearly
what is the flexible sigmoidocopy?
Before test, use a strong laxative and/or enema
A narrow, flexible, lighted tube inserted in rectum and the lower portion of the colon
May remove abnormalities
Recommended every five years
Flexible Sigmoidoscopy is recommended every ______ years?
5
what is the double-contrast barium enema?
enema with a barium solution
X-ray of the rectum and colon
Barium coats lining of intestines so that polyps/ abnormalities visible on X-ray
Recommended every 5years
Double-Contrast Barium Enema is recommended every ______ years?
5
what is a colonoscopy?
Given a sedative for comfort
Narrow, flexible, lighted tube to look at the inside of the rectum and the entire colon
May remove abnormalities
Recommended every 10 years.
Used as a follow-up test if anything unusual is found during other screening tests
what test is used a follow up if any other the other test are positive?
colonoscopy
the colonoscopy is similar to the______ ______, but the tube is _____ and allows visions of the _____ ____?
flexible sigmoidoscopy
longer
entire colon
CRC treatment includes?
Tumor Removal
Resection
Colostomy
Chemotherapy
what is a colostomy?
a surgical operation in which a piece of the colon is diverted to an artificial opening in the abdominal wall so as to bypass a damaged part of the colon.
CRC may initially present to a PT as ____ ___ ___
low back pain
Hip/thigh pain may be referred from ______ ______
iliopsoas abscess
PT need to make sure pts avoid the ___ ____during exercises?
valsalva maneuver
what is paralytic Ileus?
is a disruption of the normal propulsive ability (peristalsis) of the gastrointestinal tract
functional intestinal obstruction
signs and symptoms of Paralytic Ileus include?
Mild to moderate abdominal pain
Absent bowel sounds
Dehydration
Generalized abdominal distention
Constipation
how is paralytic Ileus diagnosed?
Clinical signs and symptoms
Radiography of abdomen
Barium enema
what is the treatment of paralytic Ileus?
Removal of the cause
Restricted oral intake
Complete elimination of food and fluids
Aspiration of gastric secretions
Parenteral nutrition
what is Crohn’s Disease?
a chronic inflammatory disease of the intestines, esp. the colon and ileum, associated with ulcers and fistulae.
Crohn’s Disease is more common in ?
the west and Causcasians
M:F of Crohn’s disease?
1 : 1.2
Crohns disease occurs at a mean age of _____, although elderly are also at ______ risk
26
increased
pathology of crohn’s disease?
Involved small bowel is thickened and narrowed
Colonic fistulae-enteroenteral,enterovaginal, or enterocutaneous
Deep mucosal ulcers
Skip lesions
what are Skip lesions?
A skip lesion is a wound or inflammation that is clearly patchy, “skipping” areas that thereby are unharmed. It is a typical form of intestinal damage in Crohn’s disease, but may also be the kind of damage to the renal tubules in acute tubular necrosis
clinical features of Crohn’s Disease include?
Prolonged diarrhea in 80%
Low-grade fever
Generalised fatigability
abdominal pain
Medical management of Crohn’s Disease includes?
inducing remission through the use of oral glucocorticosteroids and/or enteral nutrition
maintenance through the use of drugs
surgical management of Crohn’s disease is indicated when?
failure of medical therapy
complications such as toxic dilatation, obstruction, perforation, abscesses, fistulas
failure to thrive
______% of pts with Crohn’s disease require an operation at some point
80%
pt’s with Crohn’s disease are ___-___ times more likely to develop bowel cancer, but < ____
6-10
Ulcerative colitis
Ulcerative Colitis (UC) is?
form of inflammatory bowel disease (IBD). Ulcerative colitis is a form of colitis, a disease of the colon (the largest portion of the large intestine), that includes characteristic ulcers, or open sores. The main symptom of active disease is usually constant diarrhea mixed with blood, of gradual onset.
True or False
UC is an acute GI disorder?
False
chronic
age of onset for UC is?
any age, but 10-40 years are most common
UC male to female prevalence?
equal
True or False
pt’s with UC are at an increased chance of cancer
true
True or False
Pts with UC can help prevent cancer risk with bowel resection
true
where are the location of lesions in UC?
large intestine; rectum
UC: inflammation and ulceration involve the _____/_____ layers
mucosal/submucosal
True or False
The symptoms of UC come and go, fairly short periods between flare-ups
False
long periods
Clinical manifestations of just UC?
1st symptom – progressive loosening/bloody stools Abdominal pain (relieved by BM)
Clinical manifestations of just Crohn’s Disease?
Abdominal pain (not relieved by BM) Abdominal mass Anorexia
Clinical manifestations that are common in both UC and Crohn’s disease?
Diarrhea
Weight Loss
Skin rashes
Joint pain
a related serious acute complication of UC and Crohn’s disease is?
toxic megacolon
diagnosis of UC is done by?
exclusion based on medical Hx & clinical presentation
sigmoidoscopy
barium enema
what are the 4 major drug classes used today to treat UC?
aminosaliclylates
steroids
Immune modifiers
antibiotics
True or False
UC can be managed without hospitalization
True
UC: there is a ______% mortality rate when complications occur in the first ten years
20%
UC: 10 years of chronic attacks can lead to?
colon cancer
UC: how can colon cancer be prevented?
removal of the affected section
what is IPPA?
ileal pouch-anal anastomosis
primary elective operation for UC pts
what are the PT implications for IBD?
Screen for medical disease any time a pt presents with LBP, hip, or SI pain of unknown origin
Know what medications a pt is taking
Observe for any signs of dehydration
