Unit 19 - Lower GI Flashcards
Irritable Bowel Syndrome IBS
§Non-inflammatory, functional disorder of intestinal motility
§Pain/discomfort from visceral hypersensitivity
§ Stool or gas in GI tract stimulates visceral afferent fibers
§Changes in peristaltic waves and fecal movement at specific
segments in the colon
IBS Contributing Factors
Smoking Gas producing foods Female hormones Alochol Caffeine Aspirin Heredity High fat diet Gluten intolerance (wheat, rye, barley) Lactose intolerance Carbonated beverages Anxiety Psych stress Depression
IBS S/S
§Diarrhea or constipation or both §Abdominal pain §Abdominal distention §Excessive flatulence §Defecation urgency §Sensation of incomplete evacuation
IBS Dx
Standardized Symptom based criteria (Rome III)
Recurrent abdominal pain or discomfort** at least days/month in the last
months associated with two or more of the following:
. Improvement with defecation
. Onset associated with a change in frequency of stool
. Onset associated with a change in form (appearance) of stool
Constipation Pharma
Bulk forming laxatives: polyethylene glycol
Psyllium
Stool Softener: docusate sodium
Laxative for women w/ chronic constipation: Tegasorb - off market in 2007 - severe diarrhea w/ dizziness and hypotension, deadly CV events
Diarrhea Pharma
Antidiarrheal : Loperamide
Anticholinergic / Antispasmodic: pro-pantheline
Additional: Antidepressants
Probiotics
IBS Mgmt
§ Nutrition management: contributing factor chart
§ Food diary
§ Chew food slowly & thoroughly
§ Fluids between meals not with meals
§ Consult with R.D.
§ Stress management & relaxation techniques
§ Alternative therapies
§ Acupuncture, hypnosis, cognitive-behavioral therapy
§ Symptoms to report
§ Follow up care
§ A trusting relationship with the care provider is essential
§ Goals: Relieve abdominal pain, control symptoms & stress
Inflammatory Bowel Disease IBD
Refers to Regional enteritis (Crohn’s) and ulcerative colitis (UC)
Characterized by chronic, reccurrent inflammation of the intestinal tract
Periods of remission and exacerbation
UC Manifestations
§ Inflammation of the mucosal and submucosal layers of the colon and rectum § Multiple ulcerations § shedding of the colonic epithelium, causing bleeding § LLQ pain, descending colon § toxic megacolon, perforation, bleeding, severe diarrhea, hemorrhage, tenesmus § Total colectomy curative § Often accompanied by skin & eye lesions, joint abnormalities and liver disease
Crohns Manifestations
§ Inflammation extends all layers of the bowel: granulomas, skip lesions &cobble stoning appearance on colonoscopy § Mouth to anus: distal ileum, ascending colon, most common § R LQ pain unrelieved with defecation § Crampy pain after meals § Weight loss, malnutrition, secondary anemia, chronic diarrhea, small bowel obstruction, fistulas, steatorrhea, stomatitis § Thin and emaciated § Narrowing of the colon
IBD Dx
CBC WBC ESR Albumin Sigmoid/colonoscopy Barium enema: String sign Stool for occult blood (OB)
Bowel Prep
§ Laxatives and enemas until clear § 1 gal polyethylene (GoLYTELY, Colyte) § Clear liquid diet then NPO § Explain procedure: barium by enema or use of a flexible scope and sedation will be used § Post Barium enema: § Fluids & laxatives to expel barium § Post colonoscopy § abdominal cramping § Assessment for rectal bleeding and signs of perforation
IBD Nsg Dx
Diarrhea Imbalanced nutrition < body reqs Anxiety Ineffective coping ineffective self-health mgmt
IBD Goals of Tx
§Decrease inflammation §Correct malnutrition and fluid deficits §Bowel rest § Improve quality of life §Suppress immune response §Achieve and maintain remission
IBD Pharma - Aminosalicylates
§ sulfasalazine
§mesalamine – sulfa-free
§Decrease mild-moderate inflammation
§Maintain remission, suppress immune response
§SE’s: turn urine orange in color, photosensitivity (sulfasalazine),
decreased urine output and flu-like symptoms
IBD Pharma - Abx and CS
§*** DO NOT maintain remission
§Antibiotic
§ metronidazole
§Treats secondary infections: abscesses, perforation, peritonitis
§Corticosteroids §Prednisone : oral §Hydrocortisone (): IV, hospitalized pt. §budesonide : rectal enema §Assists in reduction of inflammation
IBD Pharma - Immunosuppressant and Biologic Therapy
Immunosuppressant:
§6-mercaptopurine
§azathioprine
§methotrexate
§Biologic
§natizumab
§ infliximab: IV
Maintain Remission
IBD Nutritional Considerations
§ Iron supplementation
§Vitamins
§B12, zinc, folate, calcium, vit. D, vit. C
§Parenteral nutrition acute exacerbation
§Nutritional supplementation
§Adequate fluids
§Balanced diet: High-calorie, high protein, low-residue
IBD Evaluation
Evaluation § Fewer, firmer stools § Decreased anxiety § Use of effective coping strategies § Maintenance of body weight § No evidence of skin breakdown § Use of community resources § Understands and follows therapeutic regimen
IBD Teaching
Importance of rest and diet management §Action and side effects of drugs §Symptoms of recurrence §When to seek medical care §Use of diversional activities to reduce stress
Surgery
Ileostomy or Colostomy
Diverticulosis
presence of diverticula in intestine, common in middle age
Diverticulitis
§ Inflamed diverticula
§ Increased luminal pressure
§ Erosion into bowel wall
§ Potential for Peritoneal perforation from erosion of the bowel wall
Diverticulitis Clinical Manifestations
Sx Specific to sigmoid colon MOST COMMON LLQ abd paion Fever Leukocytosis Palpable abdominal mass N/V
Complications of Diverticulitis
§ Perforation: “Popped balloon” § Peritonitis § Abscess: body walls off the area of perforation § Obstruction § Fistula § Bleeding
Appendicitis
Obstruction Inflamed Most prevalent in young R sided epigastric, periumbilical pain Low grade fever Can lead to rupture or perforation Sx may differ in elderly
Mcburneys point
Locate umbilicus and anterior superior iliac spine. Draw line between two. 2/3 downwards on pt right side - mcburney point appendix site. Point tenderness = appendicitis
Appendicitis Tx
§ No laxatives in acute phase § Surgery § IV fluids § Antibiotics § Pain management § Post-operative care § If rupture, more intense care as seen in peritonitis
Peritonitis
§ Leakage of contents from abdominal organs into the abdominal cavity
§ Edema in tissues and development of exudate
§ Protein, WBC’s, cellular debris & blood
§ Paralytic ileus
Peritonitis Clinical Manifestations
“Acute abdomen”
§ Tenderness over the involved area (universal sign)
§ Muscle rigidity: Board-like
§ Increased temp & pulse rate, decreased BP
§ The patient lies very still R/T severe pain on movement
Collab Care - peritionitis
§ Fluid resuscitation § Oxygen via NC § NGT § Pain management § Surgery § Post operative care
Peritonitis Elderly Considerations
High risk
May have little to no tenderness
Less likely to report sx
Peritonitis Dx
H&P CT w/ oral contrast Barium Enema Colon/sigmoidoscopy Blood cultures
Goals of Peritonitis Acute Care
§ Decrease inflammation and infection § rest § Antibiotic therapy § Clear liquid diet or NPO § Clear liquid high-fiber, low-fat diet
§ Surgery if indicated:
§ Severe complications
§ Resection and or temporary colostomy
Peritonitis Disease Mgmt
§ High fiber diet: fruits and vegetables
§ Exercise regularly
§ Weight reduction: Decrease intra-abdominal pressure
§ No evidence regarding avoidance of seeds and nuts
Peritonitis Med Mgmt
§ Stool softeners § Mineral oil § Bulk Laxatives § Fiber supplements § NSAID’s increase risk of perforation
