lower GI disorders

Question 1

lower GI disorders

Answer 1

appendicitis
peritonitis
irritable bowel syndrome (IBS)
inflammatory bowel disorder (IBD): Crohn’s, ulcerative colitis
diverticulosis/diverticulitis

Question 2

causes of appendicitis

Answer 2

appendix is obstructed –> leads to inflammation

Question 3

complications of appendicitis

Answer 3

gangrene
abscess formation
peritonitis

Question 4

pain and appendicitis

Answer 4

classic pain: RLQ in periumbilical area

rebound pain: severe pain after release of palpating hand over RLQ

sudden pain relief: may indicate rupture/peritonitis

Question 5

clinical manifestation of appendicitis

Answer 5

begins as dull, steady pain in periumbilical area –> progresses over 4-6 hours & localizes to RLQ

*low grade fever
*Nausea
*anorexia

Question 6

diagnosis appendicitis

Answer 6

clinical s/s
increase WBC
abd ultrasound/sonogram
exploratory laparotomy

ultrasound is used to get sonogram (pic ultrasound takes)

Question 7

peritonitis

Answer 7

inflammation of the peritoneum (serous membrane that lines abd cavity and covers visceral organs

Question 8

what happens to the peritoneum if you have peritonitis?

Answer 8

inflammation
fluid shifts –> 3rd spacing –> can lead to hypovolemic shock and sepsis
decreased peristalsis

can lead to paralytic ileum and intestinal obstruction

Question 9

causes of peritonitis

Answer 9

perforated ulcer
pancreatitis
ruptured gallbladder
ruptured spleen
ruptured bladder
ruptured appendix

Question 10

clinical manifestations of peritonitis

Answer 10

usually sudden and severe (can’t move/talk)
abdominal pain
tenderness
N/V
rigid board-like abd

fever, elevated WBC, increased HR, decreased BP

Question 11

treatment of peritonitis

Answer 11

difficult

treat with anti-inflammatories
treat underlying cause likely results in decreasing inflammation of the peritoneum

Question 12

IBS

Answer 12

chronic condition characterized by alterations in bowl pattern d/t changes in intestinal motility *chronic and frequent constipation (IBSC)
*chronic and frequent diarrhea (IBSD)

Question 13

IBS symptoms

Answer 13

vary by individual
-abd distention, fullness, flatus, and bloating
-intermittent abd pain exacerbated by stress and relieved by defecation
-bowel urgency
-intolerance to certain foods (sorbitol, lactose, gluten)
-stool with mucous (no blood)

Question 14

psychosocial stress and IBS

Answer 14

emotional stress does not cause IBS
IBS can cause stress/psychological problems
IBS can be made worse by stress

Question 15

cause of IBS

Answer 15

unknown but thought to be triggered by stress, food, hormone changes, GI infections, menstrual cycles

Question 16

IBD

Answer 16

crohns and ulcerative colitis

chronic inflammation of the intestines
exacerbations and remissions

Question 17

IBD is more common in…

Answer 17

women
caucasians
jews
smokers

Question 18

cause of IBD

Answer 18

genetically autoimmune activated by an infection

Question 19

patho of crohn’s disease

Answer 19

lymph structures of the GI tract are blocked –> tissue becomes engorged and inflamed –> deep linear fissures and ulcers develop in a patchy pattern in the bowel wall
*skip lesions
*cobblestone appearance

Question 20

complications of crohn’s disease

Answer 20

malnutrition (anemia)
scar tissue and obstructions
fistulas - connection between 2 things that shouldn’t be connected
cancer

Question 21

clinical manifestations of crohn’s disease

Answer 21

crampy lower abd pain (RLQ)
watery diarrhea
palpable abd mass (RLQ)
mouth ulcers
s/s of fistulas

systemic:
weight loss, fatigue, no appetite, fever, malabsorption of nutrients

Question 22

ulcerative colitis

Answer 22

inflammation of the mucosa of the RECTUM and COLON
usually develops in the 3rd decade of life

more common in white people of European descent (ashkenazi jewish descent) – occasionally in black, rare in asians

Question 23

patho of ulcerative colitis

Answer 23

1. inflammation begins in rectum and extends in a continuous segment that may involve ENTIRE colon 2. leads to large ulcerations
2. necrosis of epithelial tissue can result abscesses (CRYPT abscesses)
3. colon + rectum try to repair the damage with granulation tissue

Question 24

why is the colon and rectum repairing damage with the granulation tissue a problem?

Answer 24

tissue is fragile and bleeds easily

Question 25

clinical manifestations of ulcerative colitis

Answer 25

abd pain
bloody diarrhea
systemic: weight loss, fatigue, no appetite, fever

Question 26

complications of ulcerative colitis

Answer 26

hemorrhage (bc bleeding of new granulated tissue)
perforation
cancer
malnutrition
anemia
strictures
fissures
abscesses
TOXIC MEGACOLON
colorectal carcinoma
fluid, electrolyte and pH imbalances
liver disease (d/t inflammation and scarring of bile ducts)

Question 27

toxic megacolon

Answer 27

complication of UC

a rapid dilation of the large intestine that can be life-threatening

Question 28

patho of diverticulOSIS

Answer 28

diverticula is developed with small pouches in lining of colon that bulge outward through weak spots

may be congenital or acquired
located: DESCENDING colon

Question 29

cause of diverticulOSIS

Answer 29

low fiber diet with resulting chronic constipation

Question 30

clinical manifestations of diverticulOSIS

Answer 30

usually asymptomatic
discovered accidentally or with presentation of acute diverticulitis

Question 31

diverticulITIS

Answer 31

inflammation of one or more pouches (diverticula) - usually from retained fecal matter

Question 32

clinical manifestations fo diverticulITIS

Answer 32

abd pain - LLQ
fever
increased WBC
constipation or diarrhea

acute: passage large quantity of frank blood

may resolve spontaneously