Lower GI Disorders

Question 1

Lower GI Disorders (5)

Answer 1

appendicitis
peritonitis
irritable bowel syndrome (IBS)
inflammatory bowel disease (IBD)
diverticulosis/diverticulitis

Question 2

Appendicitis: Definition

Answer 2

inflammation of the appendix
in lower right quadrant

Question 3

Appendicitis: Etiology (2)

Answer 3

appendix is OBSTRUCTED
leads to inflammation

Question 4

Appendicitis: Complications (3)

Answer 4

gangrene
abscess formation
PERITONITIS

Question 5

Appendicitis: Key Points (3)

Answer 5

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

Question 6

Appendicitis: CM (6)

Answer 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

Question 7

Appendicitis: Diagnosis (4)

Answer 7

clinical S/S
increased WBC
abdominal sonogram
exploratory laparotomy

Question 8

Peritonitis: Definition

Answer 8

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

Question 9

What happens to the peritoneum in peritonitis?

Answer 9

inflammation
fluid shifts- third spacing (can lead to hypovolemic shock and sepsis)
decreased peristalsis

Can lead to paralytic ileus and intestinal obstruction

Question 10

Peritonitis: Causes (6)

Answer 10

perforated ulcer
pancreatitis
ruptured appendix
ruptured bladder
ruptured gallbladder
ruptured spleen

Question 11

Peritonitis: CM (9)

Answer 11

usually sudden and severe
severe abdominal pain
tenderness
rigid “board-like” abdomen
N/V
Others:
fever
increased WBC
increased HR
decreased BP

Question 12

Irritable Bowel Syndrome (IBS): Definition

Answer 12

chronic condition characterized by: alterations in bowel pattern due to changes in intestinal motility:
chronic and frequent
constipation (IBSC)
chronic and frequent
diarrhea (IBSD)

Question 13

IBS: Symptoms (6)

Answer 13

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

Question 14

Psychosocial Stress and IBS

Answer 14

IBS is almost never the result of primary psychological causes
IBS can be exacerbated by stress
IBS can cause stress and psychological problems

Question 15

IBS: Causes

Answer 15

UNKNOWN
“Triggered” by:
stress
food
hormone changes
GI infections
In women, menses

Question 16

IBD: Main Types (2)

Answer 16

Crohn’s Disease
Ulcerative Colitis

Question 17

IBD: Definition

Answer 17

a group of life-changing, chronic illnesses

two separate disorders (Crohn’s Disease and Ulcerative Colitis)

Question 18

IBD: Characterized by

Answer 18

chronic inflammation of the intestines
exacerbation and remissions

Question 19

IBD: More common in? (4)

Answer 19

WOMEN
Caucasians
Persons of Jewish descent
Smokers

Question 20

IBD: Etiology

Answer 20

genetically AUTOIMMUNE activated by infection

Question 21

Crohn’s Disease: Pathogenesis

Answer 21

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)

Question 22

Crohn’s Disease: Complications (4)

Answer 22

malnutrition
-anemia
scar tissue and obstructions
fistulas
cancer

Question 23

Crohn’s Disease: CM (10)

Answer 23

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

Question 24

Ulcerative Colitis: Definition

Answer 24

inflammation of the rectum and colon

Question 25

Ulcerative Colitis: Incidence

Answer 25

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

Question 26

Ulcerative Colitis: Pathogenesis

Answer 26

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

Question 27

Ulcerative Colitis: CM (6)

Answer 27

abdominal pain
bloody diarrhea
SYSTEMIC:
-weight loss
-fatigue
-no appetite
-fever

Question 28

Ulcerative Colitis: Complications (13)

Answer 28

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

Question 29

Diverticulosis: Definition

Answer 29

development of diverticula
-small pouches in lining of colon that bulge outward through weak spots
May be congenital or acquired

Question 30

Diverticulosis: Cause

Answer 30

thought to be caused by low fiber diet with resulting chronic constipation

Question 31

DIverticulosis: Location

Answer 31

Usually: DESCENDING colon

Question 32

Diverticulosis: CM

Answer 32

usually asymptomatic
discovered accidently
OR
with presentation of acute diverticulitis

Question 33

Diverticulitis: Definition

Answer 33

INFLAMMATION of one or more of the pouches (diverticula)
usually from retained fecal material

Question 33

Diverticulitis: CM (6)

Answer 33

abdominal pain- LLQ
fever
increased WBCs
constipation or diarrhea
ACUTE- passage large quantity of frank blood
may resolve spontaneously

Question 34

Diverticulitis: Complications (3)

Answer 34

perforation
peritonitis
obstruction