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NURS 2514 > Week 6 - Lower GI Inflammatory Disorders > Flashcards

Week 6 - Lower GI Inflammatory Disorders Flashcards

1
Q

list 3 inflammatory disorders of the lower GI system

A
  • appendicitis
  • peritonitis
  • gastroenteritis
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2
Q

what is appendicitis

A
  • inflammation of the vermiform appendix
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3
Q

what is the appendix

A
  • narrow tube-like structure emerging from the cecum (beginning of the large intestine)
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4
Q

what commonly causes appendicitis (2)

A
  • obstruction of the appendix by fecalith or foreign material (bc it is a hollow tube)
  • twisting of the appendix
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5
Q

what is fecalith

A
  • stone or hard piece of feces
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6
Q

what does obstruction or twisting of the appendix & inflammation lead to? (5)

A
  • now the mucus being released from the intestinal lumen is trapped
  • trapped bacteria
  • increased pressure –> compresses the blood vessels –> ischemia –> necrosis
  • increased pressure may also cause the appendix to perforate or rupture = generalized peritonitis
  • compresses nerves = pain
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7
Q

how does inflammation effect the permeability of the appendix? what does this cause?

A
  • increases the permeability = intestinal bacteria leaks into the peritoneal cavity
    = localized peritonitis
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8
Q

list the manifestations of appendicitis (6)

A
  • pain
  • NV
  • fever
  • leukocytosis
  • general signs & symptoms of peritonitis
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9
Q

what kind of pain is associated with appendicitis? what causes it?

A
  • starts periumbilical
  • followed by localized lower right quadrant pain as the appendix becomes permeable and localized peritonitis occurs
  • if the appendix ruptures, get generalized peritonitis = whole abdomen tender
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10
Q

what is peritonitis

A
  • inflammation of the peritoneal membranes
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11
Q

what can cause peritonitis (2)

A
  • chemical irritation

- bacterial infection

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12
Q

peritonitis due to chemical irritation can cause _____, leading to…

A
  • inflammation = increased permeability of the intestinal wall
  • this leads to bacteria leaking into the peritoneal cavity & bacterial peritonitis
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13
Q

how long could it take for chemical peritontits to become bacterial peritonitis

A
  • can occur in a # of hours
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14
Q

list common causes of peritonitis (7)

A
  • perforated ulcer
  • ruptured gallbladder
  • pancreatitis
  • ruptured spleen
  • hemorrhage
  • perforated appendix
  • intestinal obstruction
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15
Q

list manifestations of peritonitis (9)

A
  • generalized abdominal pain
  • NV (due to inflammation)
  • rigid abdomen
  • rebound tenderness
  • septicemia
  • hypovolemic shock with tachy
  • paralytic ileus
  • fever
  • leukocytosis
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16
Q

what is meant by rebound tenderness

A
  • pain when let go from palpating
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17
Q

what causes hypovolemic shock with peritonitis

A
  • the inflammation causes formation of exudate
  • inflammation = increased permeability of vessels = causes fluid shift from peritoneal and intestinal blood vessels = 3rd spacing
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18
Q

how does paralytic ileus effect bowel sounds?

A
  • causes absent bowel sounds
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19
Q

what causes fever & leukocytosis during peritonitis

A
  • sign of inflammation & infection (from the bacteria)
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20
Q

what causes a rigid abdomen in peritonitis

A
  • the pain leads to reflex contraction of abdominal muscle
21
Q

what causes paralytic ileus during peritonitis

A
  • inflammation of the peritoneal membrane = impaired nerve transmission
  • this causes decreased peristalsis
    = paralytic ileus (obstruction)
22
Q

what are 2 types of inflammatory bowel disease

A
  • crohn’s disease

- ulcerative colitis (UC)

23
Q

what type of diseases are crohn’s disease and UC?

A
  • chronic inflammatory bowel disorders

- autoimmune in nature

24
Q

what % of pts have both crohn’s and UC

A
  • 10%
25
Q

where does crohn’s effect?

A
  • can effect anywhere along the GI tract

- but most commonly effects the ileum

26
Q

what is crohn’s characterized by?

A
  • ulcerative “skip lesions” that involve the entire thickness of the GI wall
  • creation of nodules or a “cobblestone” appearance to the mucosa
27
Q

what is meant by skip lesions

A
  • distribution of affected segments alternating with normal segments of bowel
28
Q

what contributes to the development of crohn’s

A
  • strong family history & genetic component
29
Q

when does crohn’s disease often develop

A
  • childhood or adolescence
30
Q

list manifestations of crohn’s (6)

A
  • right lower quad pain & distension
  • diarrhea
  • fistulas
  • intestinal obstruction
  • exacerbations & remissions
  • weight loss
31
Q

what causes intestinal obstruction in crohn’s

A
  • the inflammation leads to fibrosis which affects all layers of the GI tract
  • this leads to a thick, rigid wall (stricture) which predisposes to obstruction
32
Q

what causes diarrhea in crohn’s (2)

A
  • damage to the mucosa prevent absorption

- inflammation can increase motility

33
Q

what is a fistula

A
  • an abnormal connection between 2 hollow spaces
34
Q

what causes fistulas in crohn’s

A
  • inflammation of the affected bowel can create ulcers may penetrate the GI wall to create an abcess or fistula between adjacent structures
35
Q

what are the characteristics of exacerbations in crohn’s

A
  • diarrhea
  • cramping
  • melena
36
Q

what can induce remissions of crohn’s

A
  • anti inflammatory drugs
37
Q

list indications for surgical therapy of crohn’s

A
  • drainage of abdominal abscess
  • failure to respond to conservative therapy (such as corticosteroids)
  • fistulas
  • inability to decrease corticosteroids
  • intestinal osbtruction
  • massive hemorrhage
  • perforation
  • secondary hydronephrosis
  • severe anorectal disease
  • suspicion of carcinoma
38
Q

where does ulcerative colitis effect?

A
  • begins at the rectum and progresses proximally thru the large intestine
39
Q

what layers of the GI tract does ulcerative colitis effect?

A
  • mucosa & submucosa
40
Q

describe the onset of ulcerative colitis

A
  • adulthood
41
Q

describe epidemiology of ulcerative colitis

A
  • similar to crohn’s

- family history & genetic components involved

42
Q

describe manifestations of ulcerative colitis (5)

A
  • rectal bleeding
  • blood loss
  • diarrhea
  • tenemus –> painful spasms of the rectal sphincter = LLQ pain
  • colon obstruction & dilation
43
Q

what causes rectal bleeding in ulceratitive colitis

A
  • the submucosa contains blood vessels

- ulceration is more continuous

44
Q

what can rectal bleeding result in?

A
  • blood loss anemia
45
Q

what causes diarrhea in ulceratitive colitis

A
  • tissue destruction interferes w absorption in the large

= small volume diarrhea

46
Q

what is diarrhea often accompanied by in UC

A
  • tenesmus
47
Q

what is tenesmus

A
  • painful spasms of the rectal sphincter
48
Q

what causes colon obstruction & dilation in ulcerative colitis

A
  • inflammation impairs peristalsis = functional obstruction & filation
    = toxic megacolon
49
Q

outline the main differences between crohn’s and ulcerative colitis

A
  • crohn’s = skip lesions & UC = starts in rectum and is continuous
  • crohn’s = all 4 layers & UC = only mucosa & submucosa
  • crohn’s first systemic effect = weight loss & UC = anemia
  • differences in S&S

NURS 2514 (75 decks)

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