lower gi Flashcards
Inflammatory Bowel Disease (IBD)
includes what two things?
Crohn’s Disease (CD) Ulcerative Colitis (UC)
IBD: Crohn’s Disease
Chronic inflammation any part of the GI tract (mouth to anus
- unknown origin
- Interference with digestion and absorption
- Adhesions & fistulas
- Delayed growth & sexual maturation
“Skip lesions
Inflammation occurs in characteristic distribution. The affected areas are separated by areas of normal tissue
- inflammation stimulates intestinal motility.
- .Damaged walls impair processing and absorption of food.
- Progressive inflammation & fibrosis may cause obstructed areas.
Crohns Disease treatment
Glucocorticoid used in treatment – immunosuppression, delayed would healing, Osteoperosis, ulcers and gastritis, fluid retention, hypertension, weight gain, skin bruising.
you need surgery for Crohns when
you gotta drain and abscess
- fistulas
- hemorrhage
- perforation
- obstruction
IBD: Ulcerative Colitis Progression
Inflammation starts in the rectum
Mucosa and submucosa are inflamed.
Tissue destruction interferes with absorption of fluid and electrolytes in the colon.
you cant treat it but you can cut it out
Manifestations
Marked diarrhea - with up to 12 stools per day
Contains blood and mucus
Accompanied by cramping pain
Complications - Severe acute episodes—toxic megacolon may develop
study slide 10
for the differences between cloitis and chrons
IBD: Treatment
Team approach Anti-inflammatory medications Sulfasalazine Glucocorticoids Antimotility agents Nutritional supplements Antimicrobials Immunotherapeutic agents Patients who have perianal fistulas or abscesses may need special skin care.
As the patient’s condition improves, the nurse should allow for more self-care, provide frequent rest periods, and advise the patient of the importance of rest and avoidance or control of emotional stress.
IBD: Ulcerative Colitis
Surgical resection
- Ileostomy or colostomy
- Total proctocolectomy with permanent ileostomy
- Total protocolectomy with ileoanal reservoir
Postoperative care ?
IBD: Age-Related Considerations
- -with UC, the distal colon is usually involved (proctitis).
- -with CD the colon rather than the small intestine tends to be involved.
- -There is less recurrence of CD in older patients treated with surgical resection.
- -The degree of inflammation tends to be less than in the younger patient.
IBS
A chronic functional disorder characterized by intermittent and recurrent abdominal pain associated with an alteration in bowel function (diarrhea or constipation or both)
Other symptoms:
lower abdominal pain, abdominal distension, excessive flatulence, bloating, sensation of incomplete evacuation; urge to defecate, urgency, nausea , diarrhea or constipation or alternating
IBS: Manifestations & Diagnosis
Types: Abnormal gastrointestinal mobility and secretion Visceral hypersensitivity Post infectious IBS Overgrowth of flora Food allergy or intolerance Psychosocial factors
Diagnosis: Based on signs and symptoms Testing for food allergies Testing for bacterial or parasitic infections No single cure for IBS
Appendicitis
Obstruction of the appendiceal lumen
–By a fecalith, gallstone, or foreign material
Fluid builds up inside the appendix.
–Microorganisms proliferate
Appendiceal wall becomes inflamed.
- -Purulent exudate forms
- -Appendix is swollen.
Ischemia and necrosis of the wall
–Results in increased permeability
Bacteria and toxins escape into surroundings.
–Leads to abscess formation or localized bacterial peritonitis
Abscess may develop when inflamed area is walled off.
–Inflammation and pain may temporarily subside.
Localized infection or peritonitis develops around the appendix.
–May spread along the peritoneal membranes
Increased necrosis and gangrene in the wall
–Caused by increasing pressure in the appendix
Appendix ruptures or perforates
- -Release of contents into peritoneal cavity
- -Generalized peritonitis
- —-May be life-threatening
Appendicitis:
Treatment
Antimicrobial drugs
Surgical removal of appendix and
Appendicitis: Manifestations
Pain
- -Related to the inflammation
- -rebound tenderness Involvement of parietal peritoneum over appendix
Nausea & vomiting
Inflammation Manifestations
After rupture
–Pain subsides temporarily.
Pain recurs—severe, generalized abdominal pain and guarding
Low-grade fever and leukocytosis
–Development of inflammation
Boardlike abdomen, tachycardia, hypotension
- -As peritonitis develops, abdominal wall muscles spasm.
- Toxins lead to reduced blood pressure.
Appendicitis: Nursing Management
NPO - Until the patient is seen by a health care provider, nothing should be taken by mouth (NPO) to ensure that the stomach is empty in the event that surgery is needed.
NO HEAT - Local application of heat is not advised because it may cause the appendix to rupture.
Assess for peritonitis.
Pre-Operative Care
Diverticular Disease
-Development of diverticulum
-Diverticulum = Outpouching (herniation) of the mucosa through the muscular layer of the colon
Form at gaps between muscle layers
Factors:
- Congenital weakness of wall may be a factor
- Weaker areas bulge when pressure increases.
Diverticular Disease diff types
- Asymptomatic (most cases)
- Diverticulosis= Asymptomatic diverticular disease
- Diverticulitis= stasis of material in diverticula leads to inflammation and infection.
Diverticular Disease: Diverticulitis
MANIFESTATIONS
Cramping, tenderness, nausea, vomiting
Slight fever and elevated white blood cell count
Treatment of diverticulitis
Antimicrobial drugs
Dietary modifications to prevent stasis
Diverticular Disease: Nursing Management
- Uncomplicated disease: high-fibre diet and bulk laxatives - psyllium hydrophilic mucilloid (Metamucil).
- In acute diverticulitis: goal for colon to rest & inflammation to subside.
Keep patient on NPO status with parenteral fluids for hydration.
Observe patient for signs of possible peritonitis.
Administer broad-spectrum antibiotic therapy.
Monitor temperature and WBC count.
*Intestinal Obstruction
- Lack of movement of intestinal contents through the intestine
- Aka: Bowel Obstruction (BO)
- More common in small intestine
*Mechanical obstructions
Result from tumors, adhesions, hernias, other tangible obstructions, Adhesions that twist or constrict intestine, Masses (tumors or foreign bodies), Intussusception , Gradual obstruction from chronic inflammatory conditions
*Functional obstructions
Result from impairment of peristalsis (Spinal cord injury, Paralytic ileus - caused by toxins or electrolyte imbalance, Abdominal surgery (follows surgery); Spinal shock following spinal cord injuries; Inflammation related to severe ischemia; Pancreatitis, peritonitis, infection in the abdominal cavity; Hypokalemia; Mesenteric thrombosis; Toxemia)
*Intestinal Obstruction
1.Distending the intestine - Gases and fluids accumulate proximal to the blockage
2.Increasingly strong contractions - of proximal intestine - to move contents along
3.Pressure increases in lumen.
More secretions enter the intestine.
Compression of veins in wall
Intestinal wall becomes edematous
Prevention of absorption
4.Intestinal distention leads to persistent vomiting loss of fluid and electrolytes = Hypovolemia
5.Intestinal wall becomes ischemic & necrotic.
If obstruction is not removed, gangrene ensues.
6.Ischemia & necrosis → decreased innervation & cessation of peristalsis
7.Paralytic ileus occurs - if it is not a cause to begin with.
*Infection
Obstruction promotes rapid reproduction of intestinal bacteria.
Some produce endotoxins.
Affected wall becomes necrotic and more permeable
Bacteria and toxins leak into peritoneal cavity (peritonitis) or into blood (bacteremia and septicemia).
*Perforation -
of the necrotic segment may occur, Generalized peritonitis & septic shock
*Paralytic ileus -
Pain is steady, Bowel sounds decrease or are absent.
*Mechanical obstruction of small intestine
Severe colicky abdominal pain
Intermittent bowel sounds can be heard.
*Vomiting and abdominal distention
Occurs quickly with obstruction of small intestine
Vomiting is recurrent, eventually with bile-stained content
Obstruction of the small intestine is a
medical emergency!
*Obstruction of large intestine
Develops slowly, with mild signs
Constipation
Mild abdominal pain, followed by abdominal distention
Anorexia, vomiting, more severe pain
*Treatment of large intestine
Treatment of underlying cause
Fluid and electrolyte replacement
Surgery and antimicrobial therapy
*STUDY SLIDE 37
ITS the differences of small and large obstructions
*Peritonitis
Inflammation of the peritoneal membranes
*Chemical peritonitis may result from:
Enzymes released with pancreatitis Urine leaking form a ruptured bladder Chyme spilled from a perforated ulcer Bile escaping from the ruptured gallbladder Blood Any other foreign material in the cavity
Bacterial peritonitis caused by:
Direct trauma affecting the intestine
Ruptured appendix
Intestinal obstruction and gangrene
Any abdominal surgery -
If foreign material is left or infection develops
*Pelvic Inflammatory Disease -
through fallopian tubes
*Peritonitis S&S
Sudden, severe, generalized abdominal pain
Localized tenderness at site of underlying problem
Vomiting common, abdominal distention
Dehydration, hypovolemia, low blood pressure
Decreased blood pressure, tachycardia, fever, leukocytosis
*Peritonitis TREATMENT
Depends on primary cause
Surgery might be required.
Massive antimicrobial drugs—specific to causative organism
*Surgery is treatment of choice for hernias.
- Truss - wear a firm pad placed over the hernia and held in place with a belt, the nurse should check for skin irritation caused by the continual rubbing and pressure of the truss.
- After an inguinal hernia repair, assess for difficulty voiding
hEMorrhoids
Teaching measures:
Prevention of constipation
Avoidance of prolonged standing or sitting
Proper use of over-the-counter (OTC) drugs available for hemorrhoidal symptoms
The need to seek medical care for severe symptoms of hemorrhoids (e.g., excessive pain and bleeding, prolapsed hemorrhoids) when necessary
