Lecture 3 Intestinal Disorders Flashcards
what are the components of the small intestine?
duodenum
jejunum
ileum
what is the function of the small intestine?
absorb nutrients
what are the components of the large intestine?
cecum
ascending colon
transverse colon
descending colon
sigmoid colon
rectum
anus
what is the function of the large intestine?
absorb water and electrolytes
what is IBS?
chronic changes in bowel function without evidence of tissue changes or inflammation
risk factors for IBS
female sex
stress
diet - alcohol and caffeine
clinical manifestations of IBS
constipation
diarrhea
abdominal pain, bloating, distention
management of IBS
stress reduction
adequate sleep
exercise
restrict irritating foods
medications for IBS
psyllium for fiber and dicyclomine for both types
loperamide and alosetron for IBS D
lubiprostone for IBS C
dietary management of IBS
30-40 grams of fiber per day
food and bowel habit diary
avoid trigger foods
adequate fluid intake
avoid alcohol and smoking
probiotics
what is primary peritonitis?
spontaneous bacterial peritonitis
usually see in people with liver disease and ascites
what is secondary peritonitis?
related to perforation of abdominal organs and spillage of contents into abdominal caviity
clinical presentation of peritonitis
diffuse abdominal pain or intense localized pain
pain worse with movement
rebound tenderness
rigid, distended abdomen
anorexia, N/V
paralytic ileus
how is peritonitis diagnosed?
aspiration and culture of fluid
X ray
CT scan
medications for peritonitis
analgesia
anti emetics
IV antibiotics
treating peritonitis
drainage - pericentesis
surgery
diverticulum
sac like herniation of bowel lining
diverticulosis
existence of diverticula, asymptomatic
diverticulitis
inflammation and infection of diverticula
risk factors for diverticulitis
older age
low fiber diet
NSAIDs
family history
complications of diverticulitis
fistulas
abscesses
perforation
hemorrhage
obstruction
peritonitis
clinical manifestations of diverticulosis
chronic constipation
clinical manifestations of diverticulitis
LLQ cramping, acute onset
constipation
bloating
nausea
fever
bleeding
diagnosing diverticulitis
CBC for leukocytosis, decreased H&H
abd CT scan with contrast
provider orders to anticipate for diverticulitis
electrolyte test
NPO - bowel rest and potential surgery
IV medications and fluid if NPO
H&H
pain meds, antiemetics if N/V
nursing priorities for diverticulitis
s/s of electrolyte imbalances
pain control
s/s of infection
uncomplicated diverticulitis management at home
clear liquid diet
rest
advance slowly to high fiber low fat diet
maybe pain meds and antibiotics
Hospital management of complicated diverticulitis
NPO
IV fluids
NG suction if vomiting and distention present
antibiotics
potentially opioid analgesia
surgical interventions for diverticulitis
one-stage resection - anastomosis of intestine
hartmann’s procedure
hartmann’s procedure
proctosigmoidectomy - colon and rectum separated
colostomy is created
colostomy may be reversed at later time
what is IBD?
inflammatory bowel disease
inflammation or ulceration of bowel
Crohn’s or UC
risk factor’s for IBD
age
race/ethnicity
family history
smoking
use of NSAIDs
viral illness
what causes IBD?
immune response that causes inflammatory changes
where does crohn’s disease occur?
can affect all the layers of the bowel and can occur anywhere in GI tract
most common is distal ileum and ascending colon
long term bowel change from crohn’s disease
bowel thickening and fibrosis can cause narrowing of intestinal lumen
complications of Crohn’s disease
intestinal obstruction
malnutrition/malabsorption
fistulas
abscesses
increased risk of colon cancer
clinical manifestations of Crohn’s
crampy abdominal pain worse after eating
diarrhea and steatorrhea
anorexia
weight loss, anemia
fever, leukocytosis
how does diseased tissue of Crohn’s differ from diseased tissue of UC?
crohn’s - ulcers and edematous patches
UC - desquamation, shedding of epithelium causes bleeding and diffuse lesions
where does UC occur?
superficial - mucosal and submucosal layers
affects rectum and colon
long term bowel changes from UC
bowel shortens, narrows, and thickens
clinical manifestations of UC
diarrhea with mucus, pus, blood
LLQ pain
cramping
anorexia
vomiting
diagnosing UC
colonoscopy
fecal occult blood test
CBC
stool studies to rule out other causes
barium enema
CT scan or MRI
complications of UC
perforation
bleeding
toxic megacolon
signs and symptoms of toxic megacolon
fever
vomiting
abdominal pain and distention
treatment for toxic megacolon
NG suction
IV fluids, electrolytes, antibiotics, corticosteroids
surgery
course of Crohn’s vs UC
crohn’s - prolonged and variable, may have exacerbations and remissions
UC - exacerbations and remissions
frecquence of bleeding Crohn’s vs UC
Crohn’s - bleeding is rare
UC - bleeding is common
skin and pouch care for ostomy
pouch should be worn at all times, with proper fit of wafter to avoid skin contact with stool
inspect skin and check for seal
empty regularly to avoid leaking or bursting
diet after ostomy placement
