Intestinal/Rectal Disorders Flashcards
Constipation
- infrequent/irregular stools
- abnormal hardening of the stool
- decrease in volume of stool
- retention of stool for prolonged time
What are some causes of constipation?
- meds
- physical condition
- endocrine disorders
- poor diet
- age/lifestyle
S/S of Constipation
- < 3 bowel movements/week
- abdominal pain/distention
- anorexia
- straining w/ BM
- small, hard, dry stool
- hemorrhoids
- anal fissures
- hypoactive bowel sounds
What can you do to help patient poop?
- increase fiber/fluid
- laxatives
- discontinue meds causing prob
- do not ignore urge
- relieve anxiety
- bowel training
What to do with Bowel Training?
- improve consistency w/ stool
- establish regular time for elimination
- stimulate emptying on routine basis
Complications from Constipation
- impaction
- hemorrhoids
- anal fissures
- megacolon
- straining
How to treat an impaction and what to watch for?
- care w/ digital removal
- watch for Vagal Response
What does the vagal response cause?
- bradycardia
- hypotension
- syncope
How can hemorrhoids be treated?
sitz bath
analgesic ointment
creams
good hygiene
What does straining cause?
- initially lowers BP
- secondary reaction is a rapid increase in BP above normal
- if patient strains too long may ultimately lead to vasovagal response
Diarrhea
- increased frequency of BM
- increased amount of stool
- liquid/watery stool
Acute Diarrhea
- < 2 weeks
- usually infectious
Chronic Diarrhea
- > 4 weeks
- physiological conditions
Risks for Diarrhea
- meds
- enteral feeding
- physiologic disorder
- infections
- food intolerance/allergies
- traveler’s diarrhea
S/S of Diarrhea
- frequent, watery stool
- abdominal distention
- cramps
- intestinal rumbling
- hyperactive bowel sounds
- excessive thirst
- anorexia
- incontinence
What can be done to treat diarrhea?
- treat underlying process
- control symptoms
- hydration
- low fiber/bulking diet
- avoid caffeine/carbonated beverages
- avoid milk, high fat foods, fresh fruits/veggies
What meds can be taken to reduce number of stools?
Lomotil or Imodium
What complications can occur from diarrhea?
- dehydration
- electrolyte imbalance-may cause Dig toxicity for those taking Digoxin
- skin breakdown
What is the most common GI disorder?
irritable bowel syndrome
Irritable Bowel Syndrome (IBS)
- colon becomes hypersensitive
- overreacts to stimulation
- instead of slow rhythmic muscle movements you have muscle spasms
S/S of IBS
- diarrhea/constipation (separate or mixed)
- pain brought on by eating and improved with defecation
- abdominal distention
Treatment for IBS
- relieve pain
- control symptoms
- learn triggers
- high fiber/increase fluids
- antidepressants/antispasmodics
- smoking/alcohol cessation
- small, frequent meals
- reduce stress
Malabsorption
-inability to absorb major vitamins, minerals, and nutrients
What are some causes of malabsorption?
- celiac sprue
- Zollinger-Ellison Syndrome
- gastric/intestinal surgeries
- lactose intolerance
- inhibited bacterial growth in bowel
S/S of Malabsorption
- loose, bulky stools/diarrhea
- gray color/yellow
- fatty/oily stool, foul smelling stool
- abdominal distention/pain
- fatigue/malaise
- weight loss/malnutrition
- easy bruising
- osteoporosis
- vision probs
Treatment for Malabsorption
- supplementation of vitamins, minerals, nutrients
- management for primary disease state
- anti-diarrheal
- oral/IV fluid
- monitor/treat complications
Appendicitis
inflammation of the appendix leading to increased pressure w/in the appendage
What is the most common reason for emergency abdominal surgery?
Appendicitis
S/S of Appendicitis
- vague/dull pain in the periumbilical area that progresses to RLQ as sharp pain
- low grade fever
- nausea w/w/o vomiting
- loss of appetite
- rebound tenderness
- constipation or diarrhea
How can appendicitis be diagnosed?
- physical exam
- symptoms
- labs-CBC (elevated WBC’s)
- diagnostic imaging- abdominal x-ray/CT scan
Treatment for Appendicitis
- surgery usually immediate
- prophylactic antibiotics
- IV fluids
- NPO
Perforation of Appendix
rupture of appendix
- peritonitis
- abscess
What happens with pain and perforation of appendix?
Pain may be relieved initially w/ perforation but wide spread intense pain quickly returns
Treatment for Perforation
- abdominal cavity lavage
- JP drain 5-7 days post op-drainage will be increased b/c of washout, clear to pus colored
- NG tube until BS return
What does A-P-P-E-N-D-I-X stand for?
A-abdominal pain P-point of McBurney's = most pain P-poor appetite E-elevated temp N-nausea w/ or w/o vomiting I-increase WBC's, inability to pass gas or BM X-experiences rebound tenderness
Diverticulosis
weakening of intestinal muscle wall leads to herniation of the mucosa
-sac like pouch forms that collects bowel contents = diverticulitis
S/S of Diverticulosis/Diverticulitis
Losis -vague GI symptoms Litis -acute onset of pain -constant, mild, severe, most often LLQ -fever, increased WBC's -N/V
Colonoscopy Management
- clears liquids day before
- laxative prep afternoon/night before
- patent IV
- vital signs
- monitor for severe, acute pain, N/V, fever/chills, abdominal distention
Laxative Prep for Colonoscopy
- mix w/ something flavored
- keep chilled
- follow w/ chaser
- causes frequent forceful diarrhea
- bloating, cramping
- N/V
Treatment for Diverticulitis Outpatient
- clear liquid diet until symptoms are gone, then high fiber/low fat
- antibiotics 7-10 days (cipro & flagyl)
- OTC pain reliever (avoid NSAIDS)
- antispasmodics (bentyl & levsin)
Treatment for Diverticulosis Inpatient
- IV fluids/NPO
- NG tube to suction
- IV antibiotics
- Dilaudid for pain
Surgical Treatment for Diverticulosis
- Abscess-CT guided percutaneous drainage
- Resection (colectomy) w/ anastomosis
- Colectomy w/ double barreled colostomy
CT Guided Percutaneous Drainage
imaging guidance used to place a needle or catheter through skin into the abscess to remove or drain infected fluid
-offers faster recovery
Resection w/ Anastomosis
area of diverticulitis removed and two remaining ends are rejoined
What are some complications from Diverticulosis Surgery?
DVT
pneumonia
infection
hemorrhage
Complications of Diverticulitis
- peritonitis
- abscess
- perforation
Peritonitis (Hot Abdomen)
inflammation of the lining of abdominal cavity and lining of organs w/in (peritoneum)
S/S of Acute Abdomen (Early) Peritonitis
- generalized pain aggravated by movement
- N/V
- low grade fever
- diminished BS
S/S of Late Stage Peritonitis
- constant, localized at site of infection
- rigid abdomen/distention
- rebound tenderness
- tachypnea, tachycardia, hypotension, dyspnea
- leukocytosis
Treatment for Peritonitis
- IV fluid Bolus-treat hypovolemia
- pain meds/antiemetics
- NG tube for decompression
- respiratory assistance
- high dose, broad spectrum antibiotics
- surgery to treat cause
Crohn’s Disease
inflammatory bowel disease that leads to chronic inflammation w/ development of scattered ulcerations on the mucosa
S/S of Crohn’s Disease
- comes on gradually
- pain (RLQ) unrelieved by defecation
- fatigue
- diarrhea/intense cramping especially after eating
- weight loss/malnutrition/anemia
- electrolyte imbalances
Complications from Crohn’s Disease
- perforation
- anal fissures
- anal fistulas
Anal Fissure
tear
Anal fistula
tunnel that develops between the skin and anus
Intestinal Symptoms of Crohn’s Disease
- arthritis
- tender, red nodules
- eye disorders
- oral ulcers
Ulcerative Colitis
chronic disease of the colon in which the lining of the colon becomes inflamed and develops ulcerations that are continuous in nature
S/S of Ulcerative Colitis
- bloody mucous diarrhea/+ guaiac
- abdominal pain
- urgency/constant feeling of need to defecate
- fever/fatigue
- anorexia/weight loss/malnutrition
- N/V, dehydration
Complications of Ulcerative Colitis
- hypovolemic shock
- perforation
- kidney stones
- colon cancer
- hemorrhage
- toxic mega colon
Toxic Megacolon
- chronic distention of the colon
- abdominal pain
- distention
- tachycardia
- fever/diarrhea
- if not responsive to treatment w/in 72 hrs surgery is necessary
What part of the colon does Crohn’s disease effect?
Ascending, transverse, and descending
What part of the colon does Ulcerative Colitis effect?
Descending into the anus
Daily Treatment for Inflammatory Bowel Disease
- increase oral fluids
- low residue/high protein/ high calorie
- vitamin supplements
- avoid smoking, caffeine, alcohol, excessive dairy
- NSAID’s will reduce likely bleeding
- methotrexate/Imuran/remicade (immunosuppressants)
Treatment for Flare-Ups of IBD
- NPO/IV fluids
- systemic corticosteroids
- IV antibiotics
- TPN for long term inability to tolerate PO
- antidiarrheal/bulking agent
- pain meds
- surgery
Polyps
- usually no symptoms (maybe bleeding)
- usually benign
- removal during colonoscopy
Colo-Rectal Cancer
- 3rd most common site for cancer
- 2nd common cause of death men 40-79
- early diagnosis w/ prompt treatment is best cure
- asymptomatic until late stages
When do screenings for Colo-rectal cancer begin?
age 50
How often are screens for Colo-rectal caner performed?
- NO fam hx q 10 years
- Fam hx or findings q 5 yrs
Intestinal Obstructions
a blockage prevents the normal flow of digestive contents through the intestines
Small Bowel Obstructions
Most Common
- intussusception (telescoping)
- twisting of the bowel
- tumors/hernias
- adhesions
Large Bowel Obstructions
- tumors
- diverticulitis
- inflammatory bowel disease
Small Bowel Obstruction S/S
- acute symptoms
- colicky, wavelike, cramping pain
- blood/mucous may pass
- no stool
- vomiting of stomach contents, then bile, then feces
- abdominal distention
- diminished bowel sounds
Large Bowel Obstruction S/S
- progress slowly
- constipation
- melena
- stool becomes smaller in size
- abdominal distention
- weight loss/anorexia
- crampy lower abdominal pain
- fecal vomiting
Treatment for SBO
- NG tube for decompression
- NPO/IV fluids
- surgery to correct cause
Treatment for LBO
- colonoscopy for decompression and correction
- surgery to correct cause
- rectal tube for decompression
Pilonidal Cyst
- thought to be the result of a hair that grows into the subQ tissue
- may be congenital secondary to abnormal epithelial skin growth
Where do pilonidal cysts usually develop?
lower sacral area
S/S of Pilonidal Cyst
- asymptomatic until inflammation/infection
- redness
- swelling
- drainage at site
Treatment fir Pilonidal Cyst
- oral or IV antibiotics
- incision and drainage
- surgery if abscess forms
