UNIT 8 Irritable Bowel Syndrome (IBS), Herniation, Intestinal Obstruction CHAPTER 51 Flashcards
What is Irritable Bowel Syndrome?
Pathophysiology Review
Irritable bowel syndrome (IBS) is a functional GI disorder that causes chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating.
S/S BLOATING AND ABDOMINAL PAIN
The patient generally appears well, with a stable weight, and nutritional and fluid status is within normal ranges. Inspect and auscultate the abdomen. Bowel sounds vary but are generally within normal range. With constipation, bowel sounds may be hypoactive; with severe diarrhea, they may be hyperactive.
Risk factors for Irritable Bowel Syndrome
*Caffeine/carbonation, dairy can be cause, raw
foods
* Bacterial overgrowth
* Women more than men
* Stress or behavioral issues – depression and
anxiety relate to IBS
Symptoms of Irritable Bowel Syndrome
Symptoms:
* May be primarily diarrhea (most common), primarily
constipation, or both
* Abdominal pain (commonly LLQ); , discomfort,
constipation and/or diarrhea, and abdominal
bloating; pain is relieved by a BM.
* Typical scenario: Chronic diarrhea unamenable to tx;
diarrhea is NEVER bloody or fatty; NEVER any weight
loss or constitutional symptoms (fever, malaise, etc).
* Diarrhea will be urgent, especially post prandial(after eating).
Would you use Anti Diahreals for a patient with Irritable Bowel Syndrome?
A. Yes
B. No
A. Yes
Must completely rule out other causes
* TX:
* High fiber diet for ALL patients, 30-40gm/day
* Avoid caffeine
* Diarrhea: Loperamide, Diphenoxylate, serotonin antagonist (Alosetron-last
resort)
* Constipation: Bulking laxatives (methylcellulose, psyllium), Lubiprostone (take
with food and water)
* Other tx: Peppermint oil capsules—relaxes intestinal muscles and relieves pain;
TCA’s: IBS is also a pain and psychiatric disorder; Antispasmodics: Dicyclomine,
Hyoscyamine
Pt teaching for IBS
Dietary fiber and bulk help produce bulky, soft stools and establish regular bowel elimination habits. The patient should ingest about 30 to 40 g of fiber each day. Eating regular meals, drinking 8 to 10 glasses of water each day, and chewing food slowly help promote normal bowel function.
Stress management is also an important part of holistic care. Relaxation techniques, meditation, and/or yoga may help the patient decrease GI symptoms. If the patient has a stressful work or family situation, personal counseling may be helpful. Based on patient preference, make appropriate referrals or assist in making appointments if needed. The opportunity to discuss problems and a empt creative problem solving is often helpful. Teach the patient that regular exercise is important for managing stress and promoting regular bowel elimination.
For patients with increased intestinal bacterial overgrowth, recommend daily probiotic supplements. Probiotics have been shown to be effective for reducing bacteria and successfully alleviating GI symptoms of IBS. There is also evidence that peppermint oil capsules may be effective in reducing symptoms for patients with IBS (Currò et al., 2017).
What is a Hernia?
A hernia is a weakness in the abdominal muscle wall through which a segment of the bowel or other abdominal structure protrudes. Hernias can also penetrate through any other defect in the abdominal wall, through the diaphragm, or through other structures in the abdominal cavity.
What is an Intestinal Obstruction
Intestinal obstructions can be partial or complete and are classified as mechanical or nonmechanical. With either condition, elimination is compromised by this common and serious disorder.
The bowel is physically blocked or neuromuscularly blocked
What is Mechanical Obstruction
In mechanical obstruction, the bowel is physically blocked by problems outside the intestine (e.g., adhesions), in the bowel wall (e.g., Crohn’s disease), or in the intestinal lumen (e.g., tumors).
What is Nontechnical Obstruction
Nonmechanical obstruction (also known as paralytic ileus or functional obstruction) does not involve a physical obstruction in or outside the intestine. Instead, peristalsis is decreased or absent because of neuromuscular disturbance, resulting in a slowing of the movement or a backup of intestinal contents
What is the most common Intestional Obstruction?
A. Adhesions
B. Tumors
C. Strictures
D. Hernia
E. Volvulus
A. Adhesions
Adhesions: Most common cause; scar tissue from
previous surgeries causes fibrous bridges between
segments of the intestine
Risk Factors for Intestional Obstruction
Tumors: Large tumor leads to obstruction.
Adhesions – Most common cause; scar tissue from
previous surgeries causes fibrous bridges between
segments of the intestine.
Strictures (IBD) – narrowing
Hernia: Protrusion of intestine through abdominal
wall
Volvulus – twisting of the intestine; cecum and
sigmoid area
Intussusception – telescoping of the intestine within
itself; ileocecal valve
signs and symptoms of Nonmechanical obstruction
Non-mechanical obstruction
The intestinal musculature cannot propel the contents
along the bowel
Paralytic ileus
Common following surgery (hypokalemia, drugs)
Hypoactive to absent bowel sounds
Hiccups
N/V
Abdominal distention
Small bowel intestional obstruction Sign/ Symptoms
Abdominal discomfort or pain
with visible peristaltic waves
Upper or epigastric abdominal
distention
N/V – may contain fecal
matter.
Obstipation- severe or complete constipation, cannot pass stool
Severe fluid and electrolyte
disturbances
Metabolic alkalosis
Large Bowel Intestinal Obstruction
Intermittent lower abdominal
cramping
Lower abdominal distention
Minimal/no vomiting
Constipation or ribbon-like
stools
No major fluid and electrolyte
imbalance
Metabolic acidosis (not always
present)
What are the signs. symptoms of hypokalemia
Hypoactive bowel sounds, Irregular pulse, Dysthymias, Decreased peristalsis, Increased risk for digitalis toxicity.
