Week 4 Lower Gastrointestinal Flashcards
We continue our gastrointestinal series learning about lower gastrointestinal disorders such as constipation/diarrhoea, appendicitis and peritonitis, IBD, IBS, Bowel surgeries, Liver, gall bladder and pancreatic disorders.
Diarrhoea is defined as
the passage of three of more loose or liquid stools per day.
Constipation is
infrequent or incomplete bowel motions which are hard or dry that are accompanied by pain, cramps and swelling of the abdominal area.
Diarrhoea- causes
gastroenteritis caused by a virus or bacteria
food poisoning from food contamination by a virus or bacteria
anxiety or emotional stress
over consumption of alcohol
medications, including antibiotics
lactose intolerance
parasitic infections such as giardia
coeliac disease
food intolerances
irritable bowel syndrome
inflammatory bowel syndrome
a shortened bowel because of surgery
radiotherapy
Diarrhoea- signs and symptoms
nausea and vomiting
a fever
headache
loss of appetite
stomach pain or cramps
bloating
urgency
lack of energy
Diarrhoea Nursing Management
Patient history is important to identify potential causes. Recent unintentional weight loss could signal problems.
During physical assessment of your patient, look for signs and symptoms of dehydration, including thirst and dark urine. Take their vital signs and assess them for cramping, abdominal distension, borborygmus (prolonged gurgles of hyperperistalsis), fever, and anorexia.
Diagnostic testing is needed if diarrhoea lasts more than 14 days or is severe (the patient has signs and symptoms of dehydration, frank or occult blood in the stool, fever 39° C]or greater, or severe pain in her abdomen or rectum).
Managing the symptoms is important to replace lost fluids and electrolytes. Patient may need to be place on NBM or discontinue the patients oral food intake. Otherwise, oral hydration is best if your patient is otherwise healthy. Commercial rehydration preparations include Hydralyte, Pedialyte, Gastrolyte to name a few. If your patient has severe dehydration or can’t tolerate oral fluids,they may require intravenous therapy with a glucose-based electrolyte solution.
A Fluid Balance Chart (FBC) and Bowel chart may be required to monitor input and output.
Another essential component of treatment for diarrhea is diet modification. Your patient shouldn’t have dairy products because enteric viral and bacterial infections can cause a transient lactase deficiency. Food choices for someone with watery diarrhea should include easily digested foods, such as a BRAT diet of bananas, rice, applesauce, and toast.
Antimotility agents that are useful to help control symptoms in someone who doesn’t have a fever or bloody stools include opioid derivatives such as loperamide (Imodium) and diphenoxylate (Lomotil).
Antibiotic therapy may be used after careful consideration if your patient is suspected of having shigellosis, traveler’s diarrhea, or immunosuppression. Ciprofloxacin (Cipro), rifaximin (Xifaxan), and erythromycin are the drugs of choice. Metronidazole is appropriate to treat parasitic diarrhea caused by Giardia.
Constipation causes
not eating enough fibre
not drinking enough
not doing enough exercise
anxiety, depression, grief
delaying the urge to go to the toilet
using laxatives for a long period of time
the side effects of some medications
Verapamil (Dihydropyridine calcium channel blocker);
Iron supplements such as Ferrograd;
Opioid analgesics such as codeine, morphine and pethidine;
Anticholinergics such as atropine, benzhexol and benztropine;
Tricyclic antidepressants such as amitriptyline;
Drugs containing calcium (calcium supplements or antacids containing calcium carbonate).
You may also suffer constipation when you:
are pregnant
have bowel problems such as haemorrhoids, irritable bowel syndrome (IBS) and diverticulitis
have medical conditions such as parkinson’s disease, multiple sclerosis, diabetes
have slow transit bowel, which means it takes longer for the stool to travel through the bowel meaning more water is removed causing the stool the become harder to pass.
Constipation Signs and Symptoms
absent stools
hard stools
distended abdomen
chronic discomfort
haemorrhoids
straining when trying to pass a stool
Constipation Nursing management
Fluid replacement- oral/IV to prevent dehydration.
High fibre diet improves gut transit times and softens the stool
Encourage activity as this stimulates peristalsis and reduces constipation
Encourage the practice of good toilet habits - ensuring privacy, take time, don’t delay defacation, create a routine - after breakfast is often a good time.
There are a number of laxative medicines we can use to manage constipation – depending on the severity, hardness of stools, required onset (for example, a bowel evacuation is required prior to abdominal surgery), patient preference (including previously experience side effects) and what has worked successfully for them in the past. There are also a number of laxative groups: Bulk forming laxatives such as psyllium, osmotic laxatives such as lactulose or glycerol, stool softeners such as docusate and stimulant laxatives such as senna.
Appendicitis is
the inflammation of the appendix. Inflammation is mostly caused by small, hard peices of faeces getting stuck in the pouch of the appendix causing a blockage. Anyone can get appendicitis however, it is more common in older children and teenagers.
There are many variations of the symptoms of appendicitis. These may include:
pain that starts around the belly button, then moves to the right side of the abdomen
fever
localised tenderness
rebound tenderness
nausea and sometimes vomiting
loss of appetite.
Peritonitis is
an inflammation of the peritoneum (the thin tissue that lines the inner wall of the abdomen and covers most of abdominal organs).
Peritonitis is caused by
an infection. Bacteria can enter the lining of your belly from a hole in your gastrointestinal tract. This can happen if you have a hole in your colon or a burst appendix.
Symptoms of peritonitis may include:
abdominal pain
bloating
fever
nausea and vomiting
loss of appetite
diarrhoea
low urine output
thirst
Appendicitis Nursing management
NBM, pre-op checklist in preparation for OT
ice pack to RLQ
IVT and IVABs as ordered
analgesia
Peritonitis Nursing management
analgesia
IVAB’s as ordered
assess for signs of sepsis eg/fever, disorientation
Treatment for appendicitis is
surgical removal of the appendix (appendectomy) and antibiotic treatment. It can be ‘open’ surgery or ‘laparoscopic’ surgery. If left untreated, the inflamed appendix may rupture, spilling infection into the peritoneal cavity and resulting in peritonitis and possible septic shock.
Inflammatory bowel disease (IBD) is
an umbrella term used to describe a group of disorders the cause prolongs inflammations to the GI tract. These disorders are characterised by periods of excacerbation and periods of remissions.
IBD is either classified as ____ or ___
ulcerative colitis or Crohn’s disease.
Ulcerative colitis is
an inflammatory disorder of the gastrointestinal tract that affects the colorectum. It is a chronic lifelong condition that, untreated, has a relapsing and remitting course. The pathophysiology of ulcerative colitis involves defects in the epithelial barrier, immune response, leukocyte recruitment, and microflora of the colon.
Crohn’s disease, also called granulomatous colitis or regional enteritis, affects
the GI tract, and the intestinal wall becomes inflamed. The inflammation can penetrate through all layers of the GI tract and may occur at one or more locations in the GI tract, from the mouth right through to the anus, with areas of normal tissue between areas of diseased tissue.
Signs and symptoms are similar for both Crohns and Colitis and include
Abdominal pain and cramping
Diarrhoea (severe and bloody stools with colitis)
Rectal bleeding (common with colitis)
Nausea and vomiting
Diminished appetite and weight loss
Gas or flatulence
Bloating
Fever
Anaemia
Fatigue
Sores in the mouth and around anus
Irritable bowel syndrome (IBS) is a common, chronic function gastrointestinal disorder that causes
pain in the stomach, wind, diarrhoea and constipation. The cause is not well understool and diagnosis is often made based on symptoms.
It is unknown what causes IBS, although a number of factors are thought to play a role. These include:
Gut sensitivity
Altered gut motility
Bacterial- there may be a imbalance of ‘good’ and ‘bad’ bacteria in their gut.
Leaky gut- people with IBS may have a slightly inflamed or ‘leaky’ gut that is not readidly detected on usual testing
Infections- sometimes IBS starts after a gut infection such as gastroenteritis
Signs and Symptoms of IBS:
Abdominal pain or discomfort
Bowel changes- constipation, diarrhea, erratic and unpredicatble bowel habits
Bloating and distension
Excessive faltulence
Fatigue
Nursing goals have a focus on patient education. Major goals are similar to IBD, focusing on management of symptoms and improving quality of life.
Below is a list of therapies sometimes used to manage symptoms of IBS:
Low FODMAP diet
Gluten free diet
Modifying fibre intake – via dietary changes or supplements
Fat restricted diet
Coffee and caffeine restriction
Alcohol restriction
Restriction of spicy foods
Prescription medications such as antispasmodics, antidepressants, prosecretory agents, anti-diarrheal agents, antibiotics, serotonin agents
Over the counter medications, such as peppermint oil, laxatives and probiotics
Exercise
Gut directed hypnotherapy
Cognitive behavior therapy
Stress management
A bowel obstruction is
when digested material is prevented from passing normally through the GI tract.
The obstruction can occur in either the large or small intestine and it can be either partial or complete, simple or strangulated.
Depending on the type of the obstruction will depend on the treatment plan.
A partial obstruction, will generally resolve itself, whereas a complete obstruction will require surgical intervention.
Mechanical obstructions are when something physically blocks the small intestine. This can be due to:
adhesions: fibrous tissue that develops after abdominal surgery
volvulus: twisting of the intestines
intussusception: “telescoping,” or pushing of one segment of intestine into the next section
malformations of the intestine occurring in newborns
tumors within the small intestine
gallstones, which can — but rarely do — cause obstructions
swallowed objects, especially in children
hernias: a portion of the intestine that protrudes outside of the body or into another part of the body
inflammatory bowel disease, such as Crohn’s disease
