Lower GI Disorders Flashcards

1
Q

Structure and Function Small Intestine

A
  • 5-6 m long
  • primary functions (digestion and absorption)
  • composed of: Duodenum (where significant amounts of medication are absorbed), jejunum, ileum
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2
Q

Structure and Function: Large Intestine

A
  • 2 m long
  • primary functions (absorption of water and electrolytes, formation of feces, bacteria in colon play role in the metabolism of bile salts, estrogens, androgens, lipids, carbs, drugs and various nitrogenous substances, protein digestion)
  • Cecum –> ascending colon –> transverse colon –> descending colon –> sigmoid colon –> rectum –> anus
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3
Q

Diarrhea: Broad Causes (usually a symptom of something)

A
  1. Decreased fluid absorption
  2. Increased fluid secretion
  3. Motility disturbance
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4
Q

Decreased fluid absorption

A
  • oral intake of poorly absorbable solutes. Malabsorption or maldigestion. Mucosal damage. Radiation injury. Ischemic bowel. Decreased surface area for absorption. Enzyme insufficiency.
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5
Q

Increased fluid secretion

A

bacteria in your gut that shouldn’t be there. C-dif. certain drugs. osmotic laxatives. certain foods. tumors. certain hormonal influences

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6
Q

Motility disturbances

A
  • hypermotility. Irritable bowel disease. Diabetes enteropathy.
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7
Q

Acute Infectious Diarrhea: Viral

  • Examples
  • Testing
  • Treatment
A
  • Rotavirus, norwalk virus
  • vaccine - preventable
  • supportive (slow oral rehydration)
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8
Q

Acute Infectious Diarrhea: Bacterial

  • Examples
  • Testing
  • Treatment
A
  • campylobacter. Clostridium difficile
  • Stools for C&S, Stool for C diff
  • antibiotics
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9
Q

Acute Infectious Diarrhea: Parasitic

  • Examples
  • Testing
  • Treatment
A
  • Giardia Lambia
  • Stool for O&P
  • Usually supportive; sometimes antibiotics
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10
Q

At risk:

A
  • older adults
  • people with reduced gastric acidity
  • people on proton pump inhibitors
  • people with immune compromised
  • People with reduced intestinal flora (people on antibiotics)
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11
Q

Clostridium Difficile

A

most serious antibiotic related diarrhea because the antibiotic has destroyed the normal flora of the gut and there is now room for C. Diff to grow because it is a part of our normal flora, lives there without causing symptoms. Gram-positive spore-forming bacteria that causes pseudomembranous colitis.

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12
Q

Who is at risk for C-Diff

A
  • older adults
  • those who are immune compromised
  • Those who are hospitalized and/or on antibiotics
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13
Q

Assessment for C.Diff

A
  • clinical manifestations: bristol stool chart, look at risk factors and other GI symptoms. Abdo pain? nausea? what does emesis look like? Do an abdominal assessment. if they have diarrhea: what does it look like? how liquid is it? is there any blood? is it black? look at their labs: are there altered electrolytes? particularly sodium or potassium? fever? loss of appetite?
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14
Q

Goals of care: C.Diff

A
  • prevent transmission
  • cease diarrhea and resume normal bowel patterns (this is done by identifying that they have C.diff - look for risk factors and send a stool culture for C.diff if they have risk factors and significant diarrhea - then put them on contact precautions until the results come back) (accurate diagnostics and then appropriate treatment)
  • maintain and/or replace fluid & electrolytes (monitor VS and electrolytes and then monitor for replacement as needed)
  • Prevent malabsorption & malnutrition
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15
Q

Nursing Interventions: C.diff

A
  • Imodium/lomotil (reduces gastric motility) bad idea with acute infectious diarrhea because diarrhea is the body’s way of trying to get rid of toxic organisms and infectious agents. instead, find the source and treat with supportive care.
  • institute contact precautions
  • pharmacological management
  • limit/prevent peri-anal skin breakdown
  • manage nutritional intake: refer to dietician
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16
Q

Constipation: causes

A
  • insufficient fibre
  • inadequate fluid intake
  • medication side effects (slowing GI motility)
  • lack of exercise
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17
Q

Clinical Manifestations: constipation

A
  • highly varied, but can include mild abdominal discomfort to intestinal obstruction
  • can contribute to complications of diverticulitis/diverticulosis
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18
Q

Treatment of Constipation

A

Treat the cause!

- bowel protocol - assess their last BM

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19
Q

Inflammatory Bowel Disease (IBM)

A
  • Autoimmune disease characterized by idiopathic inflammation & ulceration
  • includes Chron’s and ulcerative colitis
  • tissue damage caused by overactive, inappropriate, & sustained inflammatory response
  • Commonly occurs during teenage years and early adulthood with 2nd peak in 60s-80s
  • Higher incidence in caucasian people & family members
  • more prevalent in industrialized regions of the world
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20
Q

Croh’s

A
  • colon has a cobblestone look due to deep fissuring in the inflamed mucosal tissue
  • ulcerations are deep and longitudinal and penetrate between islands of inflamed edematous mucosa
  • thickening of the bowel wall occurs as well as narrowing of the lumen which can cause stricture development
  • happens anywhere in the bowel from the mouth to the anus
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21
Q

Ulcerative Colitis

A
  • occurs only in large intestine
  • colon appears inflamed and reddened and ulcers are visible
  • mucosa is hyperemic and edematous
  • multiple abscesses develop on the intestinal glands as the disease develops - abscesses break into the submucosa leading to ulcerations. Destroy intestinal epithelium causing bleeding and diarrhea
  • Does not go through all three layers of the intestinal wall like Chron’s
  • Loss of fluid and electrolytes occur because of decreased mucosal surface area for absorption
  • Breakdown of cells results in protein loss in the stool
  • Thickened musculature - shortening of the colon
  • Polyps - tongue-like projections into the colon
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22
Q

Pathophysiology of Crohns

A
  • any part of the GI tract may be affected (mostly the small intestine)
  • inflammation involves all layers of the bowel wall (transmural)
  • inflammation is discontinuous skip lesions
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23
Q

Symptoms of Crohns

A
  • diarrhea, abdominal pain, abdominal distension, fatigue, weight loss, fever.
  • manifestations depend on anatomic site, extent of the disease process, and whether or not there are complications
  • onset: insidious with non-specific complaints: weight loss, nausea, abdominal pain, fever maybe.
  • diarrhea - non-bloody. result of inflammatory process or malabsorption.
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24
Q

What is the most common site of Crohns

A

the terminal ileum which leads to presenting complaint of RLQ pain. Don’t mix up with appendicitis.

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25
Q

As Crohns disease progresses:

A

increased weight loss, electrolyte imbalances, anemia, increased peristalsis, pain

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26
Q

What do the majority of Crohns patients require?

A
  • surgery. reserved for severe symptoms that are unresponsive to medication therapy or those with life-threatening complications. Not curative and the recurrence is high.
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27
Q

Life-threatening complication of Crohns

A

perforated bowel. Bowel contents are leaking into the abdominal cavity causing peritonitis

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28
Q

Pathophysiology of UC

A
  • only the colon involved
  • inflammation of inner lining
  • continuous inflammation from rectum upward
29
Q

Symptoms: UC

A

bloody diarrhea, abdominal pain, anorexia, weight loss, dehydration (if severe)

30
Q

where does UC begin

A

in the rectum and spreads proximally

31
Q

proper management UC

A

watch nutrition, and replacement to facilitate healing of the inflamed bowel.

32
Q
  • Surgery

- pain

A

Surgery can be curative

Pain varies from mild lower abdominal cramping to severe abdominal pain

33
Q

Crohns Disease Intestinal Complications

A
  • scar tissue, strictures, obstruction
  • fistulas
  • perforation, abscesses, peritonitis
34
Q

Crohns Disease Extraintestinal Complications

A
  • arthritis, liver disease, cholelithiasis, anemia
35
Q

UC Intestinal Complications

A
  • bleeding, perforation, toxic megacolon, colonic dilation, fulminant colitis, pseudopolyps
36
Q

UC Extraintestinal Complications

A
  • Directly related to colitis, or nonspecific mediated by disturbance in immune system - anemia
37
Q

IBD Diagnostics: History and physical

A
  • S&S: type and location of abdo pain, bloody diarrhea, weight loss, fatigue. Presence of extra-intestinal symptoms - erythema nodosum (red bumps on shins), joint issues, liver involvement, redness of the eyes
38
Q

IBD Diagnostics: Labs

A

Anemia - can be related to blood loss OR in Crohns when terminal ileum is involved, there is lack of vitamin B12 which is required for RBC production. Increased CRP, increased sedimentation rate and leukocytosis (increased WBC)

39
Q

IBD Diagnostics: Malabsorption

A

varies between Crohns and UC - depends on area affected. Low albumin levels (protein in the blood that is not being absorbed with IBD)

40
Q

IBD Diagnostics: Studies

A
  • Barium enema, colonoscopy, sigmoidoscopy, endoscopy - visualization of lesions (cobblestone pattern or friable appearance) and biopsy for microscopic pathology
41
Q

Fistulas

A

secretions coming out where they shouldnt

42
Q

UC Collaborative Care: Goals of Care

A
  • Rest bowel
  • control inflammation
  • manage fluids & nutrition
  • Manage patient stress
  • Provide education about disease and treatment
  • provide symptomatic relief
43
Q

UC Collaborative Care: Drug Therapy

A
  • Sulphasalazine (Salofalk, dipentum)
  • Corticosteroids
  • Immunosuppressive drugs
44
Q

UC Collaborative Care: Surgery

A
  • Total proctocolectomy with permanent ileostomy

- Total proctocolectomy with ileoanal reservoir

45
Q

UC Nutrition

A
  • NPO in acute state
  • High-calorie, high-protein, low-residue diet with vitamin & iron supplements
  • Special dietary restrictions usually not necessary
  • Enteral supplements & TPN
46
Q

Collaborative Care Crohn’s - Drug Therapy

A
  • Sulphasalazine
  • Corticosteroids
  • Flagyl
  • Biological drug therapies
47
Q

Crohn’s - Surgical Therapy

A
  • Not curative

- Intestinal resection with anastomoses of healthy bowel

48
Q

Crohn’s Nutritional Therapy

A
  • elemental diet & parenteral nutrition
  • low in residue, roughage & fat
  • high in calories & protein
  • may need to exclude milk & milk products
  • Vitamin B12 injections
49
Q

Pathophysiology-related nursing diagnosis

A
  • diarrhea
  • dehydration secondary to diarrhea
  • imbalanced nutrition: less than body requirements
  • impaired skin integrity
  • pain
  • ineffective self-health management
50
Q

Psychosocial nursing diagnosis

A
  • anxiety
  • ineffective coping
  • body image disturbances
51
Q

what is colorectal cancer

A
  • a malignant disease of the colon, rectum, or both
  • 2nd most common cause of cancer death in Canada
  • Highest % of colorectal cancers in Canada are located in the rectum, ascending colon & sigmoid colon
  • approx. 20% in reach of examining finger - digital rectal exam
  • approx. 50% within reach of sigmoidoscope
52
Q

Risk Factors

A
  • Age > 50
  • Obesity
  • Genetic dispositions
  • Colorectal polyps
  • Chronic IBD
  • Family history
  • History of Cancer
  • Red meat intake
  • Smoking/alcohol
53
Q

Pathologic Staging - Dukes staging system (not commonly used)

A
  • Primarily based on the degree to which the tumor has grown through the wall of the colon
  • survival 90-100% at stage A
  • Survival < 15% at stage D
54
Q

Pathologic Staging - TNM system

A
  • degree of invasion of primary tumor
  • lymph node involvement
  • presence of metastasis
55
Q

Primary Prevention of Colorectal Cancer

A
  • mixed evidence but diet seems to play an important role
  • dietary recommendations
  • avoid smoking, excessive red meat, excessive alcohol
  • Removal of polyps
56
Q

Secondary prevention & diagnosis

A
  • early detection of essential
  • FOBT every 1-2 years after age 50; positive findings followed up with sigmoidoscopy, colonoscopy or barium enema; screen more frequently if high risk
57
Q

Left Side Clinical Manifestations of Colorectal Cancer

A
  • rectal bleeding
  • alternating constipation & diarrhea
  • change in stool caliber (narrow, ribbon like)
  • sensation of incomplete evacuation
  • occur earlier due to smaller lumen size
58
Q

Right side Colorectal cancer clinical manifestations

A
  • usually asymptomatic
  • vague, abdominal discomfort
  • crampy, colicky abdominal pain
  • iron-deficiency anemia
  • occult bleeding
59
Q

Treatment of Colorectal Cancer

A
  • decrease growth and spread of tumour
  • surgery is the only curative treatment
  • colostomy
  • resection
  • chemotherapy
  • radiation
60
Q

Colostomy

A
  • a portion of the colon is removed or bypassed, and the stoma is formed from the remaining section of the functional colon
  • may be temporary or permanent
  • single-barrel
  • double barrel
  • loop
61
Q

Ileostomy

A
  • In an ileostomy, the entire colon is removed or bypassed, and the stoma is formed from the ileum
62
Q

Post-operative Care

A
  • preventing complications (stomal necrosis, obstruction)
  • Assessment (stoma site: pink, raised, health-looking, moist, slightly protruding, not retracting, assess surrounding skin for infection; bowel function: bowel sounds, flatus, distention, any pain that we wouldnt expect; perineum: assess perineal wound if end colostomy performed)
63
Q

Post-operative care interventions - NG Suction

A
  • maintain gastric decompression by NG tube

- do not remove suction until peristalsis returns

64
Q

Post-operative care interventions - Reduce colic pain

A
  • may use rectal tube & promote ambulation
65
Q

Post-operative care interventions

A
  • progress diet as peristalsis returns

- Prevent complications - high risk of DVT!

66
Q

Post-operative care interventions - Monitor abdominal and rectal wound

A
  • prevent infection
  • assess for bleeding from rectal wound
  • monitor drainage
67
Q

Nursing Diagnoses - Risk for injury related to

A
  • infection, stoma problems (necrosis, retraction, stenosis, obstruction), general post-op complications
68
Q

Nursing Diagnoses - Ineffective management/knowledge deficit

A
  • Good education regarding management of ileostomy or colostomy is essential!
69
Q

Nursing Diagnoses

A

Body image disturbance