Lower GI Disorders Flashcards
Structure and Function Small Intestine
- 5-6 m long
- primary functions (digestion and absorption)
- composed of: Duodenum (where significant amounts of medication are absorbed), jejunum, ileum
Structure and Function: Large Intestine
- 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
Diarrhea: Broad Causes (usually a symptom of something)
- Decreased fluid absorption
- Increased fluid secretion
- Motility disturbance
Decreased fluid absorption
- oral intake of poorly absorbable solutes. Malabsorption or maldigestion. Mucosal damage. Radiation injury. Ischemic bowel. Decreased surface area for absorption. Enzyme insufficiency.
Increased fluid secretion
bacteria in your gut that shouldn’t be there. C-dif. certain drugs. osmotic laxatives. certain foods. tumors. certain hormonal influences
Motility disturbances
- hypermotility. Irritable bowel disease. Diabetes enteropathy.
Acute Infectious Diarrhea: Viral
- Examples
- Testing
- Treatment
- Rotavirus, norwalk virus
- vaccine - preventable
- supportive (slow oral rehydration)
Acute Infectious Diarrhea: Bacterial
- Examples
- Testing
- Treatment
- campylobacter. Clostridium difficile
- Stools for C&S, Stool for C diff
- antibiotics
Acute Infectious Diarrhea: Parasitic
- Examples
- Testing
- Treatment
- Giardia Lambia
- Stool for O&P
- Usually supportive; sometimes antibiotics
At risk:
- older adults
- people with reduced gastric acidity
- people on proton pump inhibitors
- people with immune compromised
- People with reduced intestinal flora (people on antibiotics)
Clostridium Difficile
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.
Who is at risk for C-Diff
- older adults
- those who are immune compromised
- Those who are hospitalized and/or on antibiotics
Assessment for C.Diff
- 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?
Goals of care: C.Diff
- 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
Nursing Interventions: C.diff
- 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
Constipation: causes
- insufficient fibre
- inadequate fluid intake
- medication side effects (slowing GI motility)
- lack of exercise
Clinical Manifestations: constipation
- highly varied, but can include mild abdominal discomfort to intestinal obstruction
- can contribute to complications of diverticulitis/diverticulosis
Treatment of Constipation
Treat the cause!
- bowel protocol - assess their last BM
Inflammatory Bowel Disease (IBM)
- 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
Croh’s
- 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
Ulcerative Colitis
- 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
Pathophysiology of Crohns
- 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
Symptoms of Crohns
- 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.
What is the most common site of Crohns
the terminal ileum which leads to presenting complaint of RLQ pain. Don’t mix up with appendicitis.
As Crohns disease progresses:
increased weight loss, electrolyte imbalances, anemia, increased peristalsis, pain
What do the majority of Crohns patients require?
- surgery. reserved for severe symptoms that are unresponsive to medication therapy or those with life-threatening complications. Not curative and the recurrence is high.
Life-threatening complication of Crohns
perforated bowel. Bowel contents are leaking into the abdominal cavity causing peritonitis
