Study Guid Flashcards
where is the pancreas located?
only a small portion of the pancreas i s located in the right upper quadrent. the larger portion is located in the left upper quadrent
where is the pancrease in regards to the stomach?
it is positioned inferior to the stomach
what is positioned inferiror to the stomach?
the pancreas
what are the parts of the small intestine?
duodenum
jejunum
illium
what happend in the small intestine?
absorptio of
protien
carbohydrarted
fat digestion
what is villi?
finger like projections that increse absorption of nutrient
where are pancreatic enzimes and bile released?
in the duodenum
where does digestion occur?
in the jejunum
what has a rich blood supply and a muscular intestinal wall?
jejunum
what is the shortest segment of the small intestin?
duodenum
what is the first segment of the small intestin?
duodenum
where does digestion and absorption occure?
jejunum
what is the thickest portion f the small intestine?
jejunum
what has a rich blood supply and muscular intestinal wall?
jejunum
what is the lower portion of the small intestine?
illium
what connects to the large intestine at the ileocecal level?
illium
what inhibits the gastric motility and enzyme secreation?
the secreation of secretin and cholecystokinin
what pancreatic enzymes are stored in the duodenum and relased as chyme arrives?
cholecystokinin
what is released form the jejunum and duodenum when gastric, log fatty shains, and amino acids are present?
cholecystokinin
what stimulated the release of pancreatic enzymes that contract the gallbladder and relax the hepatopancreatic sphincter (sphincter of Oddi) for release of bile into the duodenum?
cholecystokinin
what is released from the small intestin in response to the presence of the acidic chyme in the small intestine?
secretin
what neutralizes the acidic chyme and protects the intestinal
sodium bicarbonate
what stimulates the liver and pancreas to release sodium bicarbonate
secretin
what is hematochezia?
the presence of blood in the stool can be described as bright blood in the stool
what is melena?
black, tarry, stool
what is the sequence of an abdominal assesment?
inspection
auscultation
precussion
palpation
what kind of bowels are caused by
opiods
anticholinergic medications
constipation
ileus (absence of normal gastrointestinal motility)
hypoactive bowel sounds
what kind of bowels are caused by cholinergic medications or infectious and inflammatory bowel disorders?
hyperactive bowel sounds
what do hypoactive sounds indicate?
obstruction
what do hyperactive bowel sounds indicate
obstruction
diarrhea
inflammatory bowel disorder
what do absent bowel sounds indicate
paralytic ileus casued by mechanical or neurological dysfunction
what do bruits indicate?
arterial obstruction
whooshing sound of a bruit may indicate partial obstruct of the vessel
is a bruit in the abdomen a normal varient?
no
what questions do you ask to asses the GI system
do you smoke? do you use prescription or OTC medications? do you use herbals? do you drink alcohol? recent antibiotic use? any recent international travel
what questions can you ask to asses the health HX of the GI system?
dietary practices
who prepaires your food at home?
do you fast for cultural or religious reasons?
do you have dietary restriction or cultural practices?
how often do you eat?
what do you consider to be healthy and unhealthy food?
do you use food to treat ilnesses?
any food intolerences?
any food allergies?
what questions can you ask to asses the health HX of the GI system?
preventitive health
what are your excersise habits?
have you had hepatitis vaccines?
have you had a colonoscopy or sigmoidoscopy? if so what were the results?
what is “cullen’s sign”?
blue or purple coloring around the periumbilical area
associated with intra-abdominal bleeding
what sound do you hear when you precuss over the liver or stomach?
flat dull sound
what can dulness also indicate?
precense of displaced fluid
constipation
ascites
what is dullness similer to in sound?
tapping on a ballon filled with water
what is the normal span of the liver?
6-12 cm
what is hepatomegaly?
term used to describe an enlarged liver
what is teqnique is used to asses the edge of the liver?
palpation, hooking technique
how do you perform a palpation, hooking technique?
- stand to the left of the patient and place fingers under the 12th rib
- when the patient inhales, the lives edge may come below the rib and be palpated by the providers fingers
what are the age related changes in bile synthesis??
- decreased bile synthesis
- widend common bile duct
- increased cholecystokinin secreation
what is the subjective data and objective data for age related changesin bile synthesis?
subjective data: ask about right upper quadrent pain, early satiety, decreased appetite
objective data: 1.inspection of the skin
2. palpation of the abdomen
what is the normal level of serum albumin?
3.4-5.1
what is a level of less than 3.5 g/dk of serum albumin indicate?
altered nutritional status
associated with increased morbidity and mortality in older adults
what is the normal level of prealbumin?
12-42 mg/dl
what do decresed levels of prealbumin indicate?
increased morbidity and mortality in older adults
what is considered a more accurate indicator of plasma protiens?
serum albumin or prealbumin
prealbumin
after an endoscopy what does the nurse monitor for before providing oral care?
and why?
the return of swallow
to decrease the risk of aspiration
after a lower endoscopy what is held teporarity due to the risk of bleeding?
anticoagulants and aspirin
ascetylsalic acid, or ASA
what is an Esophagogastroduodenoscopy
visualization of the esophaphagus, stomach, and duodenum
what is the rational of an Esophagogastroduodenoscopy
suspected upper gastrointestinal bleeding,
dysphagia
epigastric pain
what are the special considerations of Esophagogastroduodenoscopy
monitor return of gag reflex
vital signs
what is the NPO status of Esophagogastroduodenoscopy
8-10 hr prior to study
what are the significance of findings of Esophagogastroduodenoscopy
peptic ulcers
H pylori infection
gastritis
hiatal hernia
esophageal
- varices
- strictures
- cysts
describe
stomatitis
grade 1
functional symptoatic
clinical examination
able to eat a normal diet
redness of mucosa
describe
stomatitis
grade 2
functional symptoatic
clinical examination
symptomatic but can eat a modified diet
patchy oral ulcerations
describe
stomatitis
grade 3
functional symptoatic
clinical examination
symptomatic and unable to eat or drink by mouth
confluent oral ulcerations that bleed with minor trauma
describe
stomatitis
grade 4
functional symptoatic
clinical examination
symptoms are life threatening
tissue necrosis with significant bleeding; lifethreatening consequenses
describe
stomatitis
grade 5
functional symptoatic
clinical examination
death
death
when should mouth care be performed?
after each meal and as needed
what kind of a tooth brush do you use for proper mouth care?
soft-bristled
when doing mouth care what kind of rinse do you use?
warm saline
or
sodium bicarbonate (baking soda)
what kind of mouth wash should you not use to perform mouth care?
alchohol-containing mouth wash
lemon-glycerine swabs
what kind of mouth care can irritate a sore or implame oral tissue?
lemon- glycerin swabs
what kind of motuh care can irritate the oral mucosa?
alcohol containing mouth wash
what disease is caused by acid reflux for the stomach or duodenum into the esophagus?
GERD
what kind of disease has a backward flow of gastroduodenal contents (refluxate) into the esophagus and/or adjacent organs, producing a variety of clinical manifestations that may or maynot cause tissue damage
GERD
what disease has factors that are associated with a decrease in LES presure that influence transient or chronic gastroesophageal reflux
GERD
what are these examples of?
- Hiatal hernia
- LES hypotension
- Loss of esophageal motility
- Increased compliance of the hiatal canal
- Increased states of gastric secretion
- Eating large meals
- Delayed emptying of gastric contents
- Obesity
- Pregnancy
- Ascites
- Tight belts or girdles
- Presence of a nasogastric tube
GERD
what disease has this pathophysiology/ clinical manifestation?
retrograde flow of GI contents into the esophagus, resulting in inflammation
GERD
wich disease has this manifestation?
hyperemia (increased blood flow)
erosion (ulceration)
possible minor bleeding to the esophagus?
GERD
these are episods of acid reflux
what may be present during reflux?
pepsin and bile
what is the post-op care for laparoscopic nissen fundolipication?
- follow a soft diet for 1 week, untill swallowing improves.
avoid foods that arenot easy to swallow
take small bites and eat slowly
avoid activities that cause air to be swalloed. carbonated beverages, menoade, gum, stwas
driving is allowed 1 week and after narcotic pain medications have been discontinued
no heavy lifting
what kind of ristriction are these?
- After surgery, the doctor usually changes the original surgical dressing after 2 days. Steri-Strips are left intact and usually fall off in about 10 days. Keep them clean and dry and do not peel them off.
- Wash incisions with soap and water and pat them dry with a clean towel.
- Observe incisions for redness or drainage, and report any of these symptoms to the healthcare provider.
- Notify the healthcare provider for a fever greater than 101°F, or 38.3°C. Patients older than 65 years: report temperature above 100°F, or 37°C. Report nausea, vomiting, and severe bloating or unusual pain.
- Bring a list of questions to the first postoperative appointment, usually within 4 weeks after surgery.
Walking is encouraged.
Notify the healthcare provider for chest pain or difficulty breathing that gets worse with time.
• Continue antireflux medication regimen unless notified otherwise by a healthcare provider.
Postoperative Patient Education After Laparoscopic Nissen Fundoplication
what procedurehas these emergency care
Feeling very full, with inability to vomit or burp
- Thick drainage that has a foul odor coming from incisions
- Difficulty swallowing
- Abdomen that feels hard and painful
- Gauze that becomes soaked with blood
- Stools that are black, bloody, or tarry
- Vomiting up blood or “coffee grounds” emesis
- Difficulty breathing and feeling light-headed
- Coughing up blood, new chest pain when breathing in
- An arm or leg that is painful, swollen, warm, and red
Emergency care after Laparoscopic Nissen Fundoplication
what disease has this assessment of respiratory symptoms
aspiration pneumonia,
chronic cough,
morning hoarseness,
night-time wheezing,
adult-onset asthma,
laryngitis,
pharyngitis,
bronchitis with long-term regurgitation
GERD
what is a is a causative factor in the development of adult-onset asthma.
GERD
when do GERD respiratory symptoms occur?
occur with aspiration of acid reflux into the tracheobronchial tree, larynx, pharynx, nose, and mouth (especially when supine).
what medications should be limited when a patient has GERD?
spicy/fatty foods
caffeine
chocolate
carbonated beverages
acidic foods
pepermint
alchohol
what kind of medications should be limited with a patient that has GERD?
calcium channel blockers
anticholinergic medications
smoothmuscle relaxers
what should be avoided because decreeses the presure in the LES
smoking
alcohol
in a patient with GERD what should be avoided because it can irritate the lining of the esophagus
NSAID
Aspirin
when should a patient with GERD have there last meal?
2 hrs before lying suspine
with a patient with GERD what should you educate them on?
wear nonrestrictive clothing
maintain body weight
what bacteria causes gastritis?
Hpylori
what disease is caused by
Crohns’s disease
teberculosis
bile reflux
alchocol
NSAID
gastritis
what disease can lead to malapsoption of vit. b12. wich then leads to pernicious anemia?
gastritis
what test are used to dianose gastritis?
biopsy
upper GI x-ray series or endoscopy
stool testing
urea breath testing
histological examination of a tissue specimen
what diagnostic tests can rule out disorders that can siggest gastritis such as polyps and gastric neoplams
biopsy
upper GI x-ray series or endoscopy
histological examination of a tissue speciemn
stool testing
what are other names for stool testing?
guaiac
hematest
hemoccult
what diagnostic test can detect active infection w/ hpylori. a patient drinks a solution that contains a special carbon atom
urea breath testing for gastritis
what disease has these manifestations?
epigastric pain
nausea and vomiting
weight loss
Pain with spicy food
decreased appetite
changes in color of the stool
dehydration
upper GI bleeding.
Significant fluid or blood loss
Hypovolemic Shock
Pallor
Tachycardia
hypotension
acute gastritis
what kind of disease presents no symptoms?
atrophic gastritis
in what order should you rentroduce liquids after treatment?
1st- broth,tea,gelatin,carbonated beverages
2nd- ingestion of heavier liquids cream soups, pudding, milk
3rd, gradual reintroduction of solid food
what medications are associated with gastritis?
- proton pump inhibitor
- H2 receptor antagonis
- esome/lanso/panto-prazole
- antacids
- sucralfate (carafate)
- B12
- H pylory
what medications relive pain and discomfort
bloock and buffer gastric secreations for pain relief
PPIs & H2 receptor antagonist
what medication block enzyme in the gastric parietal cell?
PPI
what medication maintain the intragastric PH greater than 4?
Esome/lanso/panto-prazole
what medication decrese gastric acidiy by neutralizing the acid?
antacids
aluminum or magnesium compounds
maalox, mylanta
what has no effect on gastric PH but provides a physical barrier to prevent mucosal damage by gastric acid?
sucralfate (carafate)
what treatment is used for the eradication of H pylori
combination of PPI with to antibiotics for 7-14 days
what reduces the risk of antibiotic resistant H pylori strains?
using a combinations of antimicrobial agents
what therapies are recomended as the first-line treatmetn of H pylori?
PPI
what therapies are recomended as the second-line treatmetn of H pylori?
quadrupal therapy
what medications are in triple therapy?
PPI
clarithromycin
amoxicillin/metronidazole
what medications are in quadruple therapy?
bismuth
metronidazole
tetracycline
PPi
what are nursing diagnosis associated with gastritis?
Acute pain related to irritated stomach mucosa
- Anxiety related to treatment
- Deficient knowledge about dietary management and the disease process
- Risk for deficient fluid volume related to insufficient fluid intake and excessive fluid loss subsequent to vomiting
what is hematemesis?
vomiting of blood
gastritis
what may lead to vometing of blood? (hematemesis)
hemorragic gastritis
gastritis
when should you report hematemesis and why?
immidiatly
to prevent shock
gastritis
what does hematemesis look like?
bright red
dark coffe ground appearance
gastritis
what kind of bacteria causes gastroenteritis?
salmonella
campylobactor
shigella
what two bacterias come from ingesting raw or undercooked poultry?
salmonella and campylobacter
what kind of bacteria comes from ingesting raw or undercooked chicken and unpasturired milk?
transmited by dogs or cats with diarreha?
campylobacter
what kind of backteria comes form undercooked eggs
reptiles birds or amphibians?
salmonella
what kind of bacteria is transmitted person to person by fecal-oral rout or food born?
shigella
what can be a cause of gastereonteritis?
virus, bacteria, parasite
-noravirus/ rotavirus
acid suppresing medications
- PPI (it reduces the acidis environment that provides an initial defense against gastrointestinal infections)
what kind of food should be avoided in someone who has gastroenteritis?
caffeine and milk products
how should foods be reintroduced with someone who has gastroenteritis
gradually reintroduce foods starting with bland easy to digest foods
what kind of liquids are initially prescribed as tolerated for a patient recovering with gastroenteritis?
clear liquids are prescribed as tolerated
name the clear liquids that are prescribed to a patient who has gastroenteritis
oral glucose- electrolyte solutions
broth or bullon
take frequent small sips
what are the risk factors for Peptic ulcers?
H pylori
NSAID
Asprin
smoking
alchohol
sarcoidosis
crohns disease
rare infectious disease
other mediations
neoplasia
acid hypersecretory disorders
myeloproliferative disorder
systemic mastocytosis
ill patients (burns, head injury, physical trauma, organ failure)
what disease has this manifestation?
burning epigastric pian aggravated by fasting?
pain improved with food or antacids
duodenal ulcer
what kind of disease has this manifestation?
pain awakens patient from sleep because of nocturnal gastric acid secretion
duodenal ulcer
what kind of disease is triggered or worsend by eating?
gastric ulcer
what kind of disease occurs after meals with little or no reliefs from antacids
gastric ulcer
what kind of pain radiates below the costal margins into the back or right shoulder?
peptic ulcer desiease pain
duodenal/gastric ulcer
what kind of pain is located midline in the epigastrium near the xiphoid
Peptic Ulcer disease pain
what is a charecteristic of ulcer pain
PUD?
exacerbations occurs daily for a period of several weeks and then remits intill the next recurrence
what is the perfered diagnostic test for PUD?
Upper GI endoscopy
what are some other diagnostic test for PUD?
barrium upper GI x-rays
endoscopy
esophagogastroduodenoscopy
noninvasive testin
-serum antibody testing
- urease breath testing
- stool antigen testing
cbc
fecal occult blood test
what medications are given to a patient who has PUD
- antacids
- H2-receptors
- PPI
- Prostaglandin E analog
- sucrafate (carafate)
what medication neutralizes gastric acids
contains
aluminum hydroxide
sodium bicarbonate
calcium carbonate
magnesium hydroxide
simethicone
antacids
what medication
decreases acid production?
H2-receptor anatgonist
name some H2 receptor antagonist
ranitidine
nizatidine
cimetidine
formotidine
what should patients who must continue NSAID therapy use?
PPI
what medication blocks the final stage of hydrogen ion secretion by bloking the action of gastric parietal cell proton pump?
PPI
name some PPIs
omeprazole
lansoprazol
pantoprazole
what medication prevents mucosal damage in chronic users of NSAIDs
prostaglandin E analog
name a prostaglandin E analog
Misoprostol
what medication enhances mucosal defenses?
sucralfate (carafate)
what medication binds to necrotic ulcer tissue and serves as a barrier to acid, pepsin, bile, and can directly absorb bile salts
sucralfae (carafate)
what kind of diet should a patient with PUD follow?
no spices, alchohol, caffeine, smoking
6small meals a day or small hr meals
intake of adequate fluids
if bleeding=NPO
what complication of PUD has these charecteristics?
sudden, severe, without warning
symptoms of pain may not be present (common with NSAID use)
gastrointestinal bleeding
what complication of PUD has these characteristics?
circulatory shock may develop depending on amount of blood loss
acute hemorrage, sudden weakness, dizziness, cold, moist skin,
passage of loose tarry stools and coffe-ground emesis
gastrointestinal bleed
what complication of PUD has these characteristics?
ulcers on the anterior wall of stomach or duodenum
perforation is a seriuous medical condition requiring immidiate attention
perforation
what complication of PUD has these characteristics?
release of gastrointestinal contents into peritoneum
abdominal distention and third spacing
perforation
what complication of PUD has these characteristics?
peritonitis causes sudden intense epigastric pain
abdomen is tender to palpation, abdominal muscles are rigid, HYPOACTIVE OR ABSENT BOWEL SOUNDS
perferation
what complication of PUD has these characteristics?
caused by edema, spasm, contraction of scar tissue
interference w/ free passage of gastric contents
obstruction
what complication of PUD has these characteristics?
symptoms of early satiety, epigastric fullness and heaviness post meals, gastric reflux, weight loss, abdominal pain
vomiting of undigested food
obstruction
what is hematemesis?
vometing of blood
in a patient with gastrointestinal bleeding what is the hallmark of upper gastrointestinal bleeding?
hematemesis- vometing of blood
in a patient with gastrointestinal bleeding what is bright red blood in the emesis indicative of?
active bleeding
in a patient with gastrointestinal bleeding what does coffe-ground emesis indicate?
older blood that has had time to be reduces by acid in the stomach
in a patient with gastrointestinal bleeding
what is due to the degradation of blood in the small intestine and colon?
melena (black tarry stool with a foul odor)
what are the risk factors involved in Hiatal Hernia?
obesity
pregnancy
smoking
barrets esophagitis
50 or older- increses with age as supportive structures weaken over time
what is the most specific diagnostic test of Hiatal hernia?
barium swallow w/ fluoroscopy
name some diagnostic test for Hiatal Hernia
barrium swallow with fluroscopy
upper abdominal x-ray
endoscopy
esophagogastroduodenoscopy EDG
what are the clinical manefestations of hernias?
bulging or swelling at the site of the hernia
ache that radiates in the are of the hernia
feelings of fullness or presure in the area of the hernia
what disease has this clinical manifestation?
bulge or visible swelling
* associated when coughing or bering down
hernia
what disease has this clinical manifestation?
Strangulation clinical manifestations include abdominal distention, nausea, vomiting, pain, fever, and tachycardia.
*This is a medical emergency, and the patient must be prepared for surgery immediately to prevent the development of gangrene.
hernia
a patient with a stangulated hernia may present with what?
clinical manifestations of an intestinal obstruction
why must a patient with a strangulated hernia prepair for imidate surgery?
to prevent gangrene
what are the signs and symptomps for a patient with a strangulated hernia?
abdominal distention
nausea
vomiting
pain
fever
tachycardia
what pain management techniques should you give to a patient with a hernia?
tell them to avoid driving ot operating machinery while taking medication
what medication provides temporary relief from burning, itching, and pain? for a patient with hemorrhoids?
local anesthetics
benzocaine
dibucaine
lidocaine
what kind of medication forms a physical barrier on the skin to prevent irritation of the perianal regoin to a patient who has hemorrhoids?
protectants/ emollients
cocoa butter
lanolinen
white petroleum
zinc oxide
mineral oil
cod liver oil
shark liver oil
what medication promotes skin dryness, wich helps relieve itching, irritation and inflamation to a patioen who has hemorrhoids?
astringents
witch hazel
zinc oxide
calmaine
wich medication reduces inflammation in a patient who has hemorrhoids?
corticosteroids
hydrocortisone
what can lead to constipation and should be avoided because it will futher increase pain and bleeding at surgical site for a patient who has a hiatal hernia?
avoiding having a bowel mobement due to painful defecation
when is a mild laxitive ordered for a patient who has a hernia?
after 3 days
what do bulk laxitives require the use of for a patient who has a hernia?
the use of increased fluids
what mesures to prevent constipation are taken in a patient who has a hernia?
good sources of fiber such as;
whole grain
raw vegetables
fruit
what helps relive constipation in a patient who has a hernia?
increasing fluids & fiber
OTC stool softners (docusate sodium
what increses the chances of constipation in a patient with hemrroids?
narcotic anagesics
what medications are sed to treat IBS?
antidiarreheals
- loperamide (imodium)
tricyclic antidepressants (TCAs)
- ami-triptyline
- nor-triptyline
im-ipramine
des-ipramine
name some tricyclic antidepressants (TCAs)
ami-TRIPTYLINE- elavil
nor-TRIPTYLINE- pamelor
im-IPRAMINE- tofranil
des-IPRAMINE- norpramin
what medication block norepinephrine reiptake and are belived to slow transit time and improve pain tolerance?
Tricyclic antidepressants (TCAs)
Amitriptyline (Elavil); imipramine (Tofranil); nortriptyline (Pamelor); desipramine (Norpramin)
what medication slow bowel transit, enhance water absoption and stenghten anal sphincter tone, resulting in fewer stools but does not relive pain?
antidiarreahls
loperamide
imodium
are herbal medicines classifies as diatary medicins in the united states?
no
what are some reputible online resources for herbal remidies?
- Natural Medicines Comprehensive Database
- Natural Medicines Research Collaboration
- ConsumerLab
- Medline Plus Drugs and Supplement Directory
- National Institutes of Health National Center for Complementary and Alternative Medicine Herb Fact Sheets
- NIH Office of Dietary Supplements
what kind of ilness is a irritable bowl
its a psychological ilness
what is necessary for a patient with irritable bowl to have?
a therapeutic, trusting relashion ship
establish a trusting relationship
what kind of teaching should you give to a patient with IBS
no smoking
smoking cessation techniques
what increases GI motility, wich can increase pain/ diarrhea
smoking
what disease has 5-6 soft, loose, nonbloody stools a day?
crohns disease
what kind of disease has these charecteristics of stool?
loose, semiformed
crohns disease
what kind of disease has these charecteristics of stool?
frequent, watery, with blood and mucus
ulcerative colitis
what kind of disease has 10-20 liquid, bloody stools a day?
ulcerative colitis
what disease has elevated ESR is seen with inflamation?
Erythrocyte Sedimentation Rate Test (ESR Test)
crohns disease iflamitory bowel
what levels are used to determine nutritional status?
Albumin levels are frequently used to determine nutritional status,
what is the primary goal of treatment in IBD?
rest the bowel and control the inflamation
in what disease are monthly B12 injections may be necessary because of the inability of the ileum to absorb this nutrient.
crohn’s disease
how do you give vit to a patient who has cronh’s IBD?
liquid vitamin
how do you give vit to a patient who has cronh’s IBD?
liquid vitamin
what medication are given to a patient who has IBD?
biological therapies
antidiarrheals
what medications provide symptom relief and bowel rest?
these medications must be used with caution becuse they can cause colon dilation
antidiareahls
name some antidiarrheals
loperamide- imodium
atropine sulfate- lomotil
dipnoxylate hydrochloride
name some biologic therapies
centoLIZUMAB- cimzia
nataLIZUMAB-humira
adalimUMAB-tysabri
what kind of medication
alter a persons immune response
an inflammatory protien called TNF
traditionally used as second line agents but are now prescribed as an earlier treatment
biologic therapies
what medications have many toxic side effects like blood dyscrasias, infection, pancreatitis
digestive intolerence
biologic therapies
what are the 4 surgical options for ulcerative colitis?
- proctocolectomy with permanent illiostomy
- proctoclectomy with continent ileostomy (Kock pouch)
- abdominal colectomy with ileoanal anastamosis
- colectomy, mucosal protectomy and ileal pouch-anal canal anastomosis (IPPA)
what surgical option is it when the colon and rectum are removed, and the anus is closed
the ileostomy is peminent
proctocolectomy with permanent ileostomy
what surgical option is it when the colon is removed
the distal portion of the ileum is used to crete a pouch, wich serves for stool
the patient must then insert a catheter into the pouch several times a day to eleminate the stool
proctocolectomy with continent ileostomy (Kock pouch)
what surgical option is it when the colon is removed and the ileum is sutured to the anal canal
leakage of stool is a problem for these patients
abdominal colectomy with ileoanal anastomosis
what surgical option is it when a 2 step procedure is performed?
1st procedure- colon and rectal mucosa are removed
ileoanal reservoir is created by using a portion of the ileum
a temporary ileostomy is created
2nd surgery is performes 2-3 months after the pouch heals
the ileostomy is reversed
normal continence of bowel is restored
j pouch
Colectomy, mucosal proctectomy, and ileal pouch-anal canal anastomosis (IPAA)
what are some complications of IBD
- Enterocutaneous fistula (between skin and intestine)
- Enteroenteral fistula (between intestine and intestine)
- Enterovesicular fistula (between bowel and bladder)
- Enterovaginal fistula (between bowel and vagina)
Perineal abscesses
fistulas
strictures
joint swelling & pain
ankylosing spondylitid, osteoporosis, kidney stones, eye inflamation, mouth sores, skin lsesions
fever
anorexia
malaise
anal fissures
intestinal obstruction
inflammation
edema
fibrosis
scarring
malnutriton
anemia from hemorrhage
Surgical complications may include anal canal strictures, pelvic sepsis, pouch failure, fecal incontinence, pouch dysplasia/cancer, sexual dysfunction, and female infertility.
what skin care actions should you take when treating a patient with IBD?
use witch hazle compress to reduce anal irritation
do not use soap
what kind of skinc care should you have with a patient who hs IBD?
meticulous skin care at all times
what kind of disease has these manifestations?
diarrhea (often foul smelling, light in color and frothy), steatorrhea, flatulence, weight loss, and other signs of malabsorption.
fatigue and weakness
longstanding impaired absorption
severe abdominal pain
increased bleeding
manifestations are similar to irritable bowel syndrome (IBS) and lactose intolerance,
Atypical symptoms
anemia, dental enamel defects, osteoporosis, arthritis, neurological symptoms, infertility, and increased transaminases.
celiac disease
what food choises should a patient with diverculitis have?
Fiber intake
Do not eat
Seeds, corn, nuts
None
Except for clear liquid diet for 2-3 days is common when there is an active outburst
what disease has these clinical manifestations?
Abdominal pain over the sigmoid colon
Fever or leukocytosis
Palpable mass is felt over the involved area
Flatulane
Anorexia
Bloting
Distention
Diarreah
Constipation
Stools will have mucus or blood
Bleeding
Change in mental status
Confusion, falling, anorexia
Sepsis
Peritonitis
Rebound tenderness
deverculitis
what disease has this kind of treatment?
Broad spectrum antibiotics for 7-10 days
consume a clear liquid diet untill symptoms subside
antibiotics used to treat diverticulitis include:
Ciprofloxacin and metronidazole, trimethoprim-sulfamethoxazole and metronidazole, amoxicillin-clavulanate, Augmentin or Moxifloxacin.
IV fluids
NPO
Nasogastric tube
Pain medications
DO NOT GIVE LAXITIVES OR ENEMAS
devirculitis
what disease has these diatery recomendations?
fiber from raw fruits and vegetables
DO NOT increase your fiber during acute phases
diverculitis
what disease has this etiology?
Without adequate fiber intake, more water is absorbed from the stool. This slows transit time and makes it more difficult for the stool to pass through the colon. This then causes increased intraluminal pressure from constipation and straining,
diverculitis
