Lower GI problems

Question 1

Appendicitis Pathophysiology

Answer 1

Acute Inflammation of the vermiform appendix- the blind pouch attached to the cecum of the colon.

Question 2

Appendicitis Assessment

Answer 2

Abdominal pain in the epigastric or periumbilical area is the initial symptom of classic appendicitis.

McBurney’s point

Perforation-sudden relief of pain; leads to peritonitis.

Question 3

Appendicitis Diagnostic Tests

Answer 3

CBC
Ultrasound
MRI
CT-main way to diagnosis

Question 4

Appendicitis Medical Management

Answer 4

Nonsurgical management includes:

• NPO-possible surgery
• IV fluids
• Semi-fowler’s position-decreases pain/pressure
• Analgesics
• No laxatives or enemas
• No heat-increases inflammation

Question 5

Surgical Management of Appendicitis

Answer 5

Laparoscopy or laprotomy to rule out appendicitis-non rupture

Preoperative care as for general anesthesia surgeries

Operative procedure-appendectomy

Question 6

Peritonitis

Answer 6

Life threatening acute inflammation of visceral/parietal peritoneum and endothelial lining of abdominal cavity, or peritoneum

Primary or secondary peritonitis

Rigid, board like abdomen, abdominal pain, distended abdomen, high fever, tachycardia, dehydration, low urine out put, hiccups (pressure on diaphragm), compromised respiratory status, nausea and vomiting

Question 7

Non Surgical Management of Peritonitis

Answer 7

IV fluids
Broad-spectrum antibiotics
Daily weight monitored
Fluid volume assessed
Nasogastric suctioning
NPO status
Oxygen
Pain management

Question 8

Inflammatory Bowel Disease (IBS)

Answer 8

Characterized by chronic, recurrent inflammation of intestinal tract.

• periods of remission are interspersed with periods of exacerbation
• exact cause is unknown
• there is no cure

Question 9

Crohn’s Disease

Answer 9

Familial tendencies
Peaks ages 15-40 years
Unknown autoimmune factors

Nausea and vomiting
Abdominal pain and distention
Tenderness in RLQ
Severe diarrhea
Low grade fever
Steatorrhea due to decreased bile salt resorption
Severe malabsorption

Later signs/symptoms

• weight loss
• dehydration
• electrolyte imbalance
• anemia

Complications

• intra-abdominal abscesses
• intestinal fistula
• peritonitis
• deficiency in fat soluble vitamins

Question 10

Diverticula

Answer 10

Causes:

• thought to be low fiber
• obesity
• smoking
• sedentary lifestyle
• steroid use
• NSAIDs
• Aspirin

Question 11

Assessment of Diverticulosis/Diverticulitis

Answer 11

Osis:

• cramping in the lower abdomen
• bloating
• constipation
• diarrhea

Itis:

• pain-lower left abdomen, sudden onset
• fever and chills
• nausea and vomiting
• change in bowel habits
• bleeding

Question 12

Medical Management of Diverticular Disease

Answer 12

Nutrition: initially with a flare up-clear liquid; then high fiber and low fat to reduce stool volume and transit time.

IV fluids with electrolytes to correct imbalances

Avoidance of any irritating foods and liquids

Cold foods and smoking increase intestinal motility

TPN may be needed

Antibiotics and antispasmodics

Question 13

Hernia Pathophysiolgoy

Answer 13

Weakness in the abdominal muscle wall through which a segment of bowel or other abdominal structure protrudes.

Classification

• reducible-can stick back in
• Irreducible-cannot replace
• strangulated-stuck with no blood supply

Types of hernia include:

• inguinal
• femoral
• umbilical
• incisional or ventral-abdominal incision