lower GI disorders Flashcards
primary constipation
Normal transit (functional)
* Slow transit
* Pelvic floor or outlet dysfunction
secondary constipation
Diet
Medications
➢ Opioids, iron, bismuth, antacids, anticholinergics
Neurogenic
Endocrine or Metabolic Pregnancy
Aging
Osmotics laxatives
Poorly absorbed molecule that create an osmotic gradient within the intestinal lumen that results in increased water retention.
Includes: Lactulose (can be used in DM, not absorbed), sorbitol, polyethylene glycol (PEG), milk of magnesia,
Stimulant laxatives
Works by direct stimulatory effects of the myenteric plexus on contact with the colonic mucosa and also inhibits absorption of water thereby inducing peristalsis.
Include: Senna, Cascara, Bisacodyl
Enema
Stimulate the colon
Lubricate the rectum
Add water to the colon
Caution in immune suppressed
Major mechanisms of diarrhea
osmotic
secondary
motility
systemic effects of diarrhea
Dehydration
Electrolyte imbalance
Weight loss
consequences of diarrhea
Risk of dehydration
Electrolyte disturbance
Acute on chronic renal failure
Orthostatic hypotension/falls risk
Arrythmias
Infectious (outbreak)
Types of GI bleed
Upper gastrointestinal bleeding
Lower gastrointestinal bleeding
Occult bleeding
Intestinal obstruction
any condition that prevents the flow of chyme through the intestinal lumen
two types of obstruction
Simple obstruction: Mechanical blockage of the lumen
Functional obstruction (paralytic ileus)
Failure of intestinal motility
Often occurs after intestinal or abdominal surgery, pancreatitis, or hypokalemia
Proximal vs distal intestinal obstruction
Proximal: Pain felt in central mid abdomen, colicky, bilious vomiting (before constipation)
Distal: Pain felt lower in the abdomen, spasms longer. Constipation occurs earlier and vomiting less intense.
Red Flags intestinal obstruction
Fever, tachycardia, severe tenderness, rigidity are ominous Consider peritonitis / perforation
Diverticula
Herniations of mucosa through the muscle layers of the colon wall, especially the sigmoid colon
Diverticulosis
Asymptomatic diverticular disease
Diverticulitis
Inflammatory stage of diverticulosis
pathophysiology of diverticulitis
Episodes of high intraluminal pressure (constipation), leading to herniation of a weak colonic wall.
Diverticular disease more common with low fiber Western diets.
Acute diverticulitis results from blocking of fecal material in the diverticula,
promoting infection, inflammation, micro-perforation and abscess formation.
Occursin 30% with diverticula, mostly in sigmoid colon
Diverticulitis Risk Factors
Increases after age 40,
more females,
low fiber,
inactivity,
obesity,
corticosteroids.
possible complications of diverticular disease
abscess, fistula, obstruction, bleeding, or perforation.
S+S with diverticular disease
History of acute deep, steady, severe, LLQ abdominal pain with low grade fever
Mild leukocytosis, change in stools, diarrhea or constipation (more common), tenesmus, nausea and vomiting, irritated voiding symptoms may be noted.
Pain increases with defecation
Lab test for diverticular disease
Routine labs and liver enzymes
Pregnancy test if indicated
CBC – mild to moderate leukocytosis
Stool guaiac – 25% positive
Urine – usually normal
Abdominal x-ray – rule out free air, ileus, obstruction CT abdomen/pelvis preferred diagnostic
Refer to GI if severe
Treatment of diverticular disease
Bowel rest - Clear fluids until improvement,
Slowly advance as tolerated - Low fiber diet in acute phase, bland diet once improved.
High fiber diet after acute phases (bran, whole grains, fruit, vegetables)
Bulk forming agents – psyllium
Avoid nuts and seeds in diet
Avoid laxatives, enemas, antidiarrheal agents
Broad abx with anaerobic activity 7 – 10 days
Metronizadole 500mg Bid + Ciprofloxacin 500 mg
Appendicitis signs and possible causes
Obstruction, foreign bodies, infection
Rebound tenderness to RLQ
complications of appendicitis
Perforation, peritonitis, and abscess formation are the most serious complications
