Lower GI Disorders Flashcards
Lower GI Disorders (5)
appendicitis
peritonitis
irritable bowel syndrome (IBS)
inflammatory bowel disease (IBD)
diverticulosis/diverticulitis
Appendicitis: Definition
inflammation of the appendix
in lower right quadrant
Appendicitis: Etiology (2)
appendix is OBSTRUCTED
leads to inflammation
Appendicitis: Complications (3)
gangrene
abscess formation
PERITONITIS
Appendicitis: Key Points (3)
Classic Pain: RLQ in periumbilical area
Rebound Pain: pain is SEVERE after release of palpating hand in the RLQ
Sudden Pain Relief: may indicate rupture- peritonitis
Appendicitis: CM (6)
peak incidence 10-12 years
begins as dull, steady pain in periumbilical area
progresses over 4-6 hours and localizes to RLQ
low grade fever
nausea
anorexia
Appendicitis: Diagnosis (4)
clinical S/S
increased WBC
abdominal sonogram
exploratory laparotomy
Peritonitis: Definition
inflammation of the peritoneum (serous membrane that lines abdominal cavity and covers visceral organs)
What happens to the peritoneum in peritonitis?
inflammation
fluid shifts- third spacing (can lead to hypovolemic shock and sepsis)
decreased peristalsis
Can lead to paralytic ileus and intestinal obstruction
Peritonitis: Causes (6)
perforated ulcer
pancreatitis
ruptured appendix
ruptured bladder
ruptured gallbladder
ruptured spleen
Peritonitis: CM (9)
usually sudden and severe
severe abdominal pain
tenderness
rigid “board-like” abdomen
N/V
Others:
fever
increased WBC
increased HR
decreased BP
Irritable Bowel Syndrome (IBS): Definition
chronic condition characterized by: alterations in bowel pattern due to changes in intestinal motility:
chronic and frequent
constipation (IBSC)
chronic and frequent
diarrhea (IBSD)
IBS: Symptoms (6)
Vary by individual
Abdominal distension, fullness, flatus, and bloating
Intermittent abdominal pain exacerbated by stress and relieved by defecation
Bowel urgency
Intolerance to certain foods (sorbitol, lactose, gluten)
Non-bloody stool that may contain mucous
Psychosocial Stress and IBS
IBS is almost never the result of primary psychological causes
IBS can be exacerbated by stress
IBS can cause stress and psychological problems
IBS: Causes
UNKNOWN
“Triggered” by:
stress
food
hormone changes
GI infections
In women, menses
IBD: Main Types (2)
Crohn’s Disease
Ulcerative Colitis
IBD: Definition
a group of life-changing, chronic illnesses
two separate disorders (Crohn’s Disease and Ulcerative Colitis)
IBD: Characterized by
chronic inflammation of the intestines
exacerbation and remissions
IBD: More common in? (4)
WOMEN
Caucasians
Persons of Jewish descent
Smokers
IBD: Etiology
genetically AUTOIMMUNE activated by infection
Crohn’s Disease: Pathogenesis
lymph structures of the GI tract are blocked–> tissue becomes engorged and inflammed–> deep linear FISSURES and ULCERS develop in a “patchy” pattern in the bowel wall- skip lesions (cobblestone appearance)
Crohn’s Disease: Complications (4)
malnutrition
-anemia
scar tissue and obstructions
fistulas
cancer
Crohn’s Disease: CM (10)
Crampy lower abdominal pain (RLQ)
Watery diarrhea
Palpable abdominal mass (RLQ)
Mouth ulcers
S/S of fistulas
SYSTEMIC:
-weight loss
-fatigue
-no appetite
-fever
-malabsorption of nutrients
Ulcerative Colitis: Definition
inflammation of the rectum and colon
Ulcerative Colitis: Incidence
usually develops in the third decade of life
more common in:
-white people of European descent- esp. Ashkenazi Jewish descent
occasionally in Black/African Americans
Rare in Asians
Ulcerative Colitis: Pathogenesis
inflammation begins in the rectum and extends in a CONTINUOUS segment that may involve the entire colon
-inflammation leads to large ulcerations
-necrosis of the epithelial tissue can result abscesses- CRYPT ABCESSES
Colon and rectum try to repair the damage with new granulation tissue
-this is a problem because the tissue is fragile and bleeds easily
Ulcerative Colitis: CM (6)
abdominal pain
bloody diarrhea
SYSTEMIC:
-weight loss
-fatigue
-no appetite
-fever
Ulcerative Colitis: Complications (13)
hemorrhage
perforation
cancer
malnutrition
anemia
strictures
FISSURES
ABSCESSES
TOXIC MEGACOLON
-a rapid dilation of the large intestine that can be life-threatening
COLORECTAL CARCINOMA
liver disease
-from inflammation and scarring of bile ducts
F&E and pH imbalances
VTE and DVT
Diverticulosis: Definition
development of diverticula
-small pouches in lining of colon that bulge outward through weak spots
May be congenital or acquired
Diverticulosis: Cause
thought to be caused by low fiber diet with resulting chronic constipation
DIverticulosis: Location
Usually: DESCENDING colon
Diverticulosis: CM
usually asymptomatic
discovered accidently
OR
with presentation of acute diverticulitis
Diverticulitis: Definition
INFLAMMATION of one or more of the pouches (diverticula)
usually from retained fecal material
Diverticulitis: CM (6)
abdominal pain- LLQ
fever
increased WBCs
constipation or diarrhea
ACUTE- passage large quantity of frank blood
may resolve spontaneously
Diverticulitis: Complications (3)
perforation
peritonitis
obstruction
