Lower GI problems Flashcards
Primary causes of diarrhea
infectious organisms –> usually viruses (can be bc of PPIs)
Cdif is almost always hospital aquired –> (can be bc of broad spectrum antibiotics)
Diarrhea: upper GI, lower GI, CDI
upper: large volume watery stools
lower: small volume bloody diarrhea (fever)
CDI: colitis and intestinal perforation
When shouldn’t you give antidiarrheals?
for infectious diarrhea –> you won’t get the infection out
use antibiotics instead
How to treat cdif
wash hands - no sanitizer
oral vancomycin or fidaxomicin for 10 days
stop nonessential meds
if recurrent: fecal transplant
Which drugs cause constipation and why is constipation an issue?
opioids cause it –> take narcotics with stool softeners
obstruction leads to perforation
Acute abdominal pain
Medical emergency
-could be organ damage, obstruction, bleeding, perfortation, peritonitis
**give pregnancy test, then probably x-ray
abdominal trauma
can be blunt or perforating –> blunt is usually worse
often messes up liver or spleen
Concerns: shock, peritonitis, abdominal compartment syndrome (fucks with repiration and cardiac/kidney func)
IBS
chronic abdominal pain or discomfort along with weird bowel patterns
-no known cause, but phychological stuff impacts it
IBS-C = women
IBS-D = men
Appendicitis
fecalith obstructs lumen of appendix leading to distention, venous engorement, mucu/bacteria buildup, gangrene, perforation, peritonitis
Manifestations of appendicitis
pain at McBurney’s point esp with coughing/sneezing
jump on right foot or lie still with right leg flexed
How to treat appendicitis
immediate surgery to avoid rupture and peritonitis
Preop: IV fluid/pain meds; NPO, antiemetics
Peritonitis: primary vs secondary
primary = blood borne organisms
secondary = perforation of organs that spill contents into peritoneal cavity
complications of peritonitis
hypovolemic shock, sepsis, intraabdominal abscess, paralytic ileus, ARDS
Treatment of peritonitis
-may or may not require surgery
-IV for fluid and antibiotics
-analgesia and knees flexed for pain
-rest and sedatives for anxiety
-monitor VS, I/O, and O2
-antiemetic
-NPO!!! NG tube if needed
Gastroenteris
inflammation of stomach and small intestine
often from viruses in food
you don’t really do much - it goes away on its own
IBD
Inflammation of GI tract with sporadic periods of remision and exacerbation –> autoimmune
2 types:
Ulcerative colitis = colon
Crohn’s disease = anywhere- mouth to anus
Treat with steroids
Triggers for IBD
-diet, smoking, and stress which alter flora
-high sugar or fat intake
-low fruit, veggie, omega-3, or fiber
-NSAIDs, antibiotics, oral contraceptives
-genetic factors
Characteristics of Crohn’s
-ulcers, strictures, leaks, abscesses, fistulas
-weight loss
-pain
-fever
-diarrhea/cramping
-rectal bleeding
Ulcerative colitis characteristics
-affects mucosal layer and prevents absorption
-pseudopolyps form
-bloody diarrhea (sometimes w/ protein)
-anemia
-fever, weight loss, pain, fatigue
Complications of IBD
-hemorrhage, strictures, perforation, abscess, fistula, cdif, colonic dilation
-high risk of colorectal cancer
-malabsorption, liver disease, osteoporosis
-multiple sclerosis, ankylosing spondylitits
How to treat ulcerative colitis
Total proctocolectomy with ileal pouch/ anal anastomosis or permanent ileostomy
cures the issue, but is extremely mentally traumatic
How to treat Crohn’s disease
surgeries to resect disease sections with reanastomosis
-often recurs
-can result in short bowel syndrome
strictureplasty - opens narrowed areas
NOT CURATIVE
Food for IBD
sometimes can’t be tolerated during exacerbation
may need liquid enteral feedings
then gradually introduce foods again to determine what makes it worse
IBD in old ppl
proctitis and left sided UC more common
increased risk of hospitalization and mortality
increased risk of infection and cancer
anemia, malnutrition, volume depletion
my be physically unable to get to bathroom
Intestinal obstruction: simple vs strangulated
simple = intact blood supply
strangulated = no blood supply
Intestinal obstruction: mechanical vs nonmechanical
mechanical:
-SBO = surgical adhesions, hernias, strictures from Crohns
-LBO: colorectal cancer or diverticular disease
nonmechanical:
-neuromuscular parasympathetic innervation reducing peristalsis
-paralytic ileus
pseudo intestinal obstruction
GI motility disorder
-major surgery, electrolyte imbalance, neuro conditions
-usually malnourished
vascular obstruction
emboli or thrombi alter blood supply
what happens to bowel when there’s an obstruction
distal bowel empties and collapses
proximal bowel accumulates shit, increasing pressure and capillary permeability –> fluids and electrolytes go into peritoneal cavity –> intestinal muscles get fatigues and peristalsis stops –> decreased circulating blood volume –> hypotension and hypovolemic shock
Interprofessional care of obstruction
emergency surgery if strangulation or perforation
resection of obstructed segment with anastomosis
partial or total colectomy or ileostomy for obstruction or necosis
colonoscopy to remove polyps, dilate strictures, laser destruction, and remove tumors
Treatment of obstruction
NG tube
antiemetics
get cultures
corticosteroids with antiemetics if malignant
Sessile vs pedunculated polyps
sessile = flat, broad-based, attached to wall
pedunculated = attached to wall by thin stalk (bigger)
Genetic stuff w/ polyps
Family adenomatous polyposis (FAP)
-autosomal dominant and recessive
-may have thousands of polyps that’ll be cancerous by 40
-hafta remove colon and rectum by age 25
polyps removal
need to remove all
none are normal
watch for bleeding post op
colorectal cancer
more common in men
HNPCC is genetic thing –> family risk (FAP)
*also obesity, smoking, alc, DM
growth of CRC
-start from polyp on inner lining of colon or rectum and grows
-invades wall of colon or rectum, lymph nodes, and vasculature and spreads
-inferior rectal vein –> portal vein –> liver –> lungs, bones, brain
CRC manifestations
(common, early, and late)
(R vs L)
don’t happen til late
Common = anemia, bleeding, pain, pooping issues
Early: fatigue and weight loss
Late: pain, palpable mass, hepatomegaly, ascites
R: bleeding and diarrhea
L: hematochezia and bowel obstruction
Diagnostic study for CRC “gold standard”
Colonoscopy
-remove polyps
-every 10 yrs starting at 45
-every 5 yrs starting at 40 if high risk
why would you do a bowel resection or ostomy surgery?
remove cancer
repair perforation, fistula, or injury
relieve obstruction or stricture
treat abscess, iflammation, or hemorrhage
Risks of bowel surgeries
infection
bleeding
perforation
anastomosis leak
Ostomy
hole for fecal matter to go through (temp or perm)
ileostomy: involuntary drainage
colostomy: possible regurgitation
Continent ileostomy
terminal ileum made into pouch with nipple valve and abdominal stoma
APR for UC or FAP
manually drained with catheter
permanent
ideal conditions for a stoma
w/in rectus muscle to decrease risk of hernia
flat surface to create a seal that’s less likely to break
patient should be able to see it, but it should be hidable
Normal output for ileostomy
1500-1800 ml/day at first
then bowels adapt and increase absorption, so volume is 500 ml/day
Post op for IPAA
transient incontinence of mucus
kegel exercise after 4 weeks
perianal skin care
phantom rectal pain
Special considerations to optimize poop when you have an ileostomy
2-3 L of water per day
Chew food thoroughly especially meat, food with skinds, and hard foods
Sex stuff with ileostomies
males may have temporary ED for 3-12 months
females may have less sensation, dryness, or orgasm issues –> no pregnancy issues though
