Unit 19 Bowel Disease of The Lower GI Tract Flashcards
What is Irritable Bowel Syndrome (IBS)?
-Non-inflammatory, FUNCTIONAL disorder of intestinal mobility
-Pain/discomfort from visceral hypersensitive (organ pain)
> Changes in peristaltic waves and fecal movement
at specific segments in the colon
What are contributing factors to IBS?
Smoking Gas-producing foods Female Reproductive Hormones Alcohol High fat diet Anxiety** Depression** Psychological stress** Aspirin Caffeine Gluten Intolerance
What are signs and symptoms of IBS?
- Diarrhea or constipation or both
- Abdominal pain
- Abdominal distention
- Excessive flatulence
- Defecation urgency
- Sensation of incomplete evacuation
What is the diagnostic for IBS?
No real diagnosis test needed, based on symptoms
1st Pain relieved by deification
2nd- Change in frequency
3rd- Change in appearance
What are the medications for constipation?
Bulk forming laxatives
- polyethylene glycol
- psyllium
Stool softener
-docustate sodium
What are medications for diarrhea?
Antidiarrheal
-loperamide
Anticholinergic/Antispasmodic
-pro-pantheline
- Antidepressants
- Probiotics
What is the management for IBS?
- Nutrition management
- Food diary
- Diet change
- Chew foods slowly & thoroughly
- Fluids between meals not with meals
- Stress management & relaxation techniques
- Alternative therapies (hypnosis, acupuncture)
- Follow up care trusting relationship with care provider is essential
What are the goals for IBS?
relieve abdominal pain
control symptoms & stress
Describe Inflammatory Bowel Disease (IBD).
- Refers to two chronic inflammatory GI disorders: -Regional enteritis (Crohn’s Disease) and Ulcerative colitis (UC)
- Autoimmune
- Characterized by chronic, recurrent inflammation of the intestinal tract
- Periods of remission interspread with periods of exacerbation
Describe Ulcerative Colitis, where the pain is located usually, and what is a way to cure it.
- Inflammation of the mucosal and submucosal layers of the descending colon and rectum
- Multiple ulcerations
- LLQ pain, descending colon***
- Severe diarrhea, bright red hemorrhage, toxic megacolon, perforation
- Total colectomy is curative for it
- auto-immune
- often accompanied by skin and eye lesions, joint abnormalities and liver disease
Describe Crohn’s Disease/Regional Enteritis.
- RLQ pain unrelieved with defecation***
- Mouth to anus, distal ilium, ascending colon most common
- Crampy pains after meals
- Weight loss, malnutrition, small bowel obstruction
- Thin and emaciated
- Inflammation extends all layers of the bowel: granulomas, skip lesions, and cobble stoning appearance on colonoscopy
What are the diagnostics for IBD?
CBC WBC (would be elevated) ESR (elevated) Albumin/pre-albumin Sigmoid/colonoscopy Barium enema: strong sign (specific for Crohn's Disease) Stool of occult blood (needs bowel prep)
What are examples of what needs a bowel prep?
Colonoscopy
Barium enema
Describe the aspects of a bowel prep.
-Laxative and enemas until clear
1 gal. polyethylene
- 24 hr clear liquid diet
- Explain procedure: barium by enema or use of a flexible scope and sedation will be used
What are the goals of IBD treatment?
- Decrease inflammation
- Bowel rest
- Correct malnutrition deficits
- Improve QOL
- Suppress immune response
- Achieve and maintain remission
What are the 5 major classes of medications for IBD?
Aminosalicylates
Antibiotics
Corticosteroids
Immunosuppressant
Biologics
What prefix of drugs have photosensitivity allergies?
Sulfa drugs
Name and describe the aminosalicylates used to treat IBD.
- sulfasalazine
- mesalamine
Decreases inflammation
Maintains remission, suppresses immune response
SE: turns urine orange in color, photosensitivity, decreased urine output and flu-like symptoms
Name and describe the antibiotic and corticosteroids used to treat IBD.
THEY DO NOT MAINTAIN REMISSION
- metronidazole (antibiotic)
- treats secondary infections: abscesses, perforation, peritonitis
- prednisone (corticosteroid) oral
- hydrocortisone IV
- budesonide rectal enema
- Assists in reduction of inflammation, pain, and for comfort
Name and describe the immunosuppressants and biological therapies used to treat IBD.
- azathiopine (immunosuppressant)
- methotrexate (immunosuppressant)
- natizumab (biologic)
- infliximab (biologic)
they maintain remission
What are nutritional considerations for IBD?
think why? PT has diarrhea, losing electrolytes-malabsorption, bleeding
- Iron supplementation
- Vitamins B12, Zinc, Folate, calcium, Vit D, Vit C
- Parenteral nutrition
- Nutritional supplementation
- Adequate fluids
- Balanced diet: High in calorie, high protein, low residue
What are teaching points for PTs with IBD?
- Importance of rest and diet management
- Action and side effects of drugs
- Symptoms of recurrence
- When to seek medical care (signs of infection)
- Must stay on medication
What is Diverticulosis?
- Part of bowel where muscle gets weak and causes pouches
- Disease/Condition in which small, bulging pouches develop in the digestive tract
What is Diverticulitis?
- Inflammation or infection in one or more small pouches in the digestive tract.
- Potential for Peritoneal perforation from erosion of the bowel wall
