Lower GI Flashcards
Appendicitis
Inflammation of the appendix
Characterized by Rousing’s sign, pain
Treatment is surgical removal
Diverticulosis
Multiple diverticula without inflammation
Chronic constipation, bowel irregularities, nausea, anorexia, bloating, abdominal distention
Diverticulitis
Infection and inflammation of the diverticula
Symptoms include mild/severe pain in LLQ, nausea, vomiting, fever, chills, and leukocytosis
Diverticular Disease
May occur anywhere in the intestine but most common in the sigmoid colon
Diagnosis is usually by colonoscopy
Care of Patient with Diverticulitis
Encourage fluid intake of at leased 2 L/day
Soft foods with increased fiber, such as cooked vegetables
Exercise
Bulk laxatives (psyllium) and stool softeners
Peritonitis
Inflammation of the peritoneum
Rupture and contamination are complications
Characterized by diffuse pain, tenderness, elevated WBC
Inflammatory Bowel Disease
Crohn’s Disease and Ulcerative Colitis
More prevalent in Jewish people, characterized by exacerbations and remissions
Cause is unknown
Crohn’s Disease
Regional Enteritis
Most common in distal ileum or ascending colon
Extends to all layers of the bowel
Ulcers develop, lumen narrows
Signs and Symptoms of Crohn’s Disease
Gradual onset
Pain in RLQ
Cramping after meals
Diarrhea, steatorrhea, blood in the stool
Weight loss, nutritional deficiency
Abscesses or fistulas
Diagnostics of Crohn’s Disease
CBC, CMP, ESR, Fecal Occult Blood
Barium studies (“String sign”)
CT, MRI
Capsule endoscopy, balloon endoscopy
Proctosigmoidoscopy/Colonoscopy
Ulcerative Colitis
Usually begins in the rectum
Multiple ulcerations, contiguous
Bowel narrows, bleeding occurs
5% develop colon cancer
Signs and Symptoms of Ulcerative Colitis
Diarrhea, passage of mucus and pus
LLQ pain, spasms of the rectum, rectal bleeding
Diagnostics of Ulcerative Colitis
Stool analysis
CBC, CMP
X-Ray, CT, MRI
Sigmoidoscopy/Colonoscopy
Treatment of Inflammatory Bowel Disease
Reduce inflammation
Low residue, high protein, high calorie diets
Medications
Bowel rest
Surgery
Medications for Inflammatory Bowel Disease
Sedatives and antidiarrheals
Pain relievers
Iron/Calcium supplements
Aminosalicylates
5-ASA
Corticosteroids
Immune system suppressors
Antibiotics
Irritable Bowel Syndrome
Noninflammatory
Functional disorder
Abdominal pain, constipation, urgent bowel movements
Associated with stress, anxiety, depression
Colorectal Cancer
3rd most common cause of cancer deaths in the US
Manifestations include change in bowel habits: blood in the stool, tenesmus, symptoms of obstruction, pain
Early Detection of Colorectal Cancer
Beginning at age 50, both men and women should have:
Flexible sigmoidoscopy every 5 years, or colonoscopy every 10 years, or double-contrast barium enema every 5 years, or yearly fecal occult blood test
Diagnostic Evaluation of Colorectal Cancer
Abdominal and rectal exam
Stool for occult blood
Barium enema
Proctosigmoidoscopy/Colonoscopy with biopsy and cytology
CEA elevations
Liver Dysfunction
Glycogen is replaced with lipids
Inflammatory cell infiltration and growth of fibrous tissue
Possible regeneration of cells
End result is a fibrotic liver
Clinical Manifestations of Liver Dysfunction
Jaundice, portal hypertension and ascites, esophageal varices, hepatic encephalopathy or coma, nutritional deficiencies
Prehepatic Jaundice
Hemolytic
Result of increased destruction of RBCs
Hepatic Jaundice
Hepatocellular
Results from injury or disease of parenchymal cells of the liver
Posthepatic Jaundice
Caused by an obstruction of the bile duct
Bile is reabsorbed and stains the body
Urine is deep orange and frothy, stools are clay colored
Pruritus, fat intolerance, elevated bilirubin and alkaline phosphate
Portal Hypertension
Obstructed blood flow through the liver results in increased pressure throughout the portal venous system
Results in ascites, esophageal varices
Treatment of Ascites
Low-sodium diet
Diuretics
Bed rest
Paracentesis
Administration of salt-poor albumin
Transjugular intrahepatic portosystemic shunt
Esophageal Varices
Complex tortuous veins at the lower end of the esophagus
Develop in areas where collateral and systemic circulations communicate
Contain little elastic tissue and are fragile
Hepatic Encephalopathy
Changes in neurologic and mental responsiveness ranging from sleep disturbances to lethargy to coma
Result of liver being unable to convert ammonia to urea
Ammonia crosses the blood-brain barrier and causes neurologic toxic manifestations
Characteristic symptom is asterixis (flapping tremors involving arms and hands)
Fetor hepaticus (musty, sweet odor on patient’s breath)
Medical Management of Hepatic Encephalopathy
Eliminate precipitating cause
Lactulose to reduce serum ammonia levels
IV glucose to minimize protein catabolism
Protein restriction
Reduction of ammonia from GI tract by gastric suction, enemas, oral antibiotics
Discontinue sedatives, analgesics, and tranquilizers
Nutritional Therapy for Hepatic Encephalopathy
Dietary deficiencies of thiamine, folic acid, and vitamin B12
Diet high in calories (3000 kcal/day), increased carbohydrates, moderate to low fat, normal protein
Hepatitis A
Spread by poor hand hygiene; fecal-oral
Incubation is 15-50 days, illness may last 4-8 weeks
Manifestations include mild flulike symptoms, low-grade fever, anorexia, later jaundice and dark urine, indigestion, enlargement of liver and spleen
Management of Hepatitis A
Good handwashing, safe water, vaccine, immunoglobulin
Bedrest during acute stage
Nutritional support
Hepatitis B
Transmitted through blood, saliva, semen, and vaginal secretions
Major worldwide cause of cirrhosis and liver cancer
Incubation of 1-6 months
Insidious and variable, similar symptoms to hepatitis A
Management of Hepatitis B
Alpha interferon and antiviral agents (lamivudine, adefovir)
Best rest and nutritional support
Vaccinations
Hepatitis C
Transmitted by blood and sexual contact
Most common bloodborne infection
A cause of 1/3 of cases of liver cancer and the most common reason for liver transplant
Variable incubation period
Symptoms usually mild, chronic carrier state frequently occurs
Management of Hepatitis C
Antiviral medications (interferon, ribavirin)
Alcohol and medications that irritate the liver should be avoided
Screening of blood supply
Hepatitis D
Only persons with hepatitis B are at risk
Blood and sexual contact transmission
Likely to develop fulminant liver failure or chronic active hepatitis and cirrhosis
Hepatitis E
Transmitted by the fecal-oral route
Incubation period is 15-65 days
Resembles hepatitis A
Clinical Course of Hepatitis
Asymptomatic and subclinical
Preicteric phase: flulike symptoms, hepatomegaly, lymphadenopathy
Icteric Phase of Heptatitis
Jaundice, pruritus, RUQ pain, liver tenderness, increased bilirubin and AST and ALT and alkaline phosphatase, mild weight loss, respiratory difficulty
Post Icteric Phase of Hepatitis
Usually full recovery in 6 months
Decline in symptoms
Resolution of abnormal lab results
Gradual increase in comfort
Types of Cirrhosis
Laennec’s Cirrhosis (Alcoholic)
Postnecrotic cirrhosis
Biliary cirrhosis
Clinical Manifestations of Cirrhosis
Intermittent mild fever
Vascular spiders, reddened palms, unexplained epistaxis
Ankle edema, flatulent dyspepsia, morning indigestion, abdominal pain
Firm, enlarged liver, splenomegaly
Clinical Manifestations of Decompensated Cirrhosis
Jaundice, weakness, muscle wasting, weight loss, clubbing of fingers
Purpura, spontaneous bruising, epistaxis, sparse body hair, white nails, gonadal atrophy
Portal hypertension, ascites, esophageal varices, hepatic encephalopathy
Cholecystitis
Inflammation of the gallbladder
Cholelithiasis
Gallstones
Risk factors include fair, fat, forty, female, flatulent, fertile
Signs and Symptoms of Gallbladder Problems
Pain, Murphy’s sign, changes in color of urine and stool, fever, N/V, jaundice
Diagnosing Gallbladder Issues
X-Ray, ultrasonography, radionuclide imagine, cholecystography, endoscopic retrograde cholangiopancreatography
Treatment of Gallbladder Issues
Diet, bowel rest, NG suction, IV fluids, analgesia
Extracorporeal or intracorporeal lithotripsy
Cholecystectomy
Acute Pancreatitis
Pancreatic duct becomes obstructed and enzymes back up, causing autodigestion and inflammation of the pancreas
Chronic Pancreatitis
Progressive inflammatory disorder with destruction of the pancreas
Cells are replaced by fibrous tissue
Pressure within the pancreas increases, obstructing the pancreatic and common bile ducts
Causes of Acute Pancreatitis
Alcoholism, biliary tract disease, abdominal surgery, trauma, infections, metabolic problems, medications
Signs and Symptoms of Acute Pancreatitis
Pain, nausea/vomiting, abdominal distention, fever, hypotension, respiratory distress, steatorrhea
