Lower GI problems

Question 1

what is gastroenteritis

Answer 1

inflammation of the mucosa of the stomach and small intestine
manifestations include nausea, vomiting, diarrhea, abdominal cramping, and distension
-fever, increased WBC
-blood or mucous may present in stool
-most cases self limiting
-pt may be NPO until emesis is stopped
-if dehydration has occurred, IV replacement may be necessary

Question 2

what is inflammatory bowel disease?

Answer 2

-an autoimmune disease that currently refers to two disorders of the GI tract

Question 3

what are the two disease of inflammatory bowel disease

Answer 3

Crohns disease and ulcerative colitis

• both commonly occur during teen and adulthood
• both diseases can be debilitating

Question 4

what is ulcerative colitis?

Answer 4

• Inflammation involves the mucosa ONLY
• The disease begins in the rectum and spreads proximally along the colon in a continuous fashion
• multiple abscesses develop in the intestinal glands

Question 5

what happens as ulcerative colitis advances?

Answer 5

• as the disease advances, the abscesses break into the submucosa, leaving ulceration
• these ulcerations also destroy the mucosal epithelium, causing bleeding and diarrhea

Question 6

what are some clinical manifestations of ulcerative colitis?

Answer 6

• abdominal pain and bloody diarrhea
• mild disease, diarrhea may consist of one or two semi formed stools containing small amounts of blood per day
• in severe cases, diarrhea is bloody, contains mucus and occurs 10-20 times a day
• in addition, fever and weight loss, anemia, tachycardia, and dehydration are present

Question 7

complications of ulcerative colitis?

Answer 7

• toxic megacolon (extensive dilation and paralysis of colon)
• bleeding, and fulminant colitis are the most common complications
• perforation is most often associated with toxic megacolon by may occur alone

Question 8

A patient who has had ulcerative colitis for more than 10 years has an increased risk for what?

Answer 8

colorectal cancer

-pt should be screened regularly with colonoscopy

Question 9

Diagnostic tests for ulcerative colitis?

Answer 9

• colonoscopy with biopsy
• other tests which can supplement diagnosis (barium enema, fecal sample, complete blood count (CBC), C-reactive protein (CRP), sedimentation rate (ESR)

(blood test, electroylte tests, protein levels)

Question 10

What will a CBC test show for ulcerative colitis?

Answer 10

-shows iron-deficiency anemia from blood loss through stool

Question 11

what will other diagnostic tests for ulcerative colitis show?

Answer 11

• decreased sodium, potassium, chloride, bicarc, and magnesium are caused by fluid & electroyle losses from diarrhea
• hypoalbuminemia is present with severe disease and results from protein loss from bowel

Question 12

why is a stool culture collected for diagnostic examination for ulcerative colitis?

Answer 12

-stool cultures should be obtained to rule out infectious causes of inflammation

Question 13

what drug therapy is available for ulcerative colitis?

Answer 13

• Sulphasalazine is effective

- oral prednisone (effective in tx of mild to moderate disease without systemic manifestations)

Question 14

what drug has been used in severe cases of ulcerative colitis when a pt failed wo respond to the usual drugs (before surgery is considered)

Answer 14

-immunosuppressive drugs (cyclosporine)

Question 15

what surgical therapy is available for ulcerative colitis?

Answer 15

Approx 80-85% of pts go into remission with help of therapy
15-20% will require surgery
-surgery is indicated for when:
-the pt doesnt response to tx
-exacerbations are frequent and debilitating
-massive bleeding, strictures, or obstruction
-carcinoma develops

Question 16

Nutritional therapy for ulcerative colitis?

Answer 16

• the dietitian is important member of the team
• a high calorie, high protein, low residue diet with vitamin and iron supplements is frequently prescribed
• often, enteral supplements are parental nutrition are often necessary

Question 17

what foods to avoid when have ulcerative colitis?

Answer 17

-cold foods, high residual foods (whole wheat bread, cereal with brain, nuts, raw fruit) and smoking increase GI motility and should be avoided

Question 18

what is attention focused to during the acute phase of UC?

Answer 18

-focused on hemodynamic stability, pain control, fluid and electroyle balance, and nutritional supports

Question 19

nursing implementations for UC?

Answer 19

• accurate intake and output records must be maintained
• the # and characteristcs of stools monitored
• teaching related to tx, drugs, diet, diagnosis tests, and disease and its managment is important
• rest is important in managing UC

Question 20

What will any person who has 10-20 bowel movements a day with rectal discomfort have?

Answer 20

-they may present anxious, frustrated, discouraged, and depressed

Question 21

what is Crohns disease?

Answer 21

• a chronic disease of unknown origin that can affect any part of the GI tract from mouth to anus
• often occurs between ages 15-30
• characterised by inflammation of segments of the Gi tract, most often in the terminal ileum and colon
• areas of involvement are usually discontinuous with skip lesions, with segments of normal bowel occurring between diseased portions
• the areas of inflammation can extend through all layers of the bowel walls
• care of crohns disease pt is similar to pt with UC

Question 22

Onset of Crohns?

Answer 22

• usually comes with nonspecific complains such as diarrhea, fatigue, abdominal pain, weight loss, and fever
• diarrhea is usually NON bloody

Question 23

what occurs when Crohns disease progresses?

Answer 23

-there is weight loss
malnutrition
dehydration
electroyle imbalances
anemia
increased peristalsis
pain around umbilicus and right lower quadrant
possible perianal disease

Question 24

Complications of Crohns?

Answer 24

• scar tissue from the inflammation and ulceration narrows the lumen of the intestine- may cause strictures and obstructions
• fistulas are an cardinal feature and may develop between segments of bowel
• fat malabsorption causes deficiency in the fat-soluble vitamins (A,D,E,K)
• the pt may have an intolerance to gluten

Question 25

diagnostic studies for Crohns?

Answer 25

• similar to UC
• diagnosis by barium studies and endoscopy with biopsy
• barium studies are useful in determining the location and extent of the disease and may reveal findings such as stricture formations and fistulas

Question 26

Drug therapy for Crohns?

Answer 26

• Corticosteroid therapy is effective in reducing inflammation and supressing disease
• Metronidazole (flagyl) is useful in tx of the disease in the perianal area
• Infliximab has been shown to reduce the degree of inflammation in pts who are refractory to other drug therapies

Question 27

nutritional therapy for pts with crohns?

Answer 27

• parental nutrition may be given to pts when severe, it has been given before and after surgery to promote wound healing and reduce complications
• diet should be high calorie, high protein, fat free, no residual substrate that is absorbed in small bowel

Question 28

what foods should be avoided for pts who have crohns?

Answer 28

MIlk and milk products

Question 29

what may develop as result of malabsorption in Crohns?

Answer 29

• vitamin deficiencies
• vitamin B12 injections every month may be needed because the inability for the terminal ileum (if affected) to absorb this vitamin

Question 30

what might patients who have perianal fistulas or abscesses need?

Answer 30

special skin care

Question 31

what teaching is important for Crohns pt?

Answer 31

• importance of rest and diet managment
• perianal care
• action and adverse effects of drugs
• symptoms of recurrences of disease
• when to seek medical care
• use of stress managment techniques