Chapter 47 Lower Gastrointestinal Problems Part 1

Question 1

What are some common gastrointestinal (GI) problems?

Answer 1

Diarrhea, constipation, fecal incontinence, inflammatory bowel problems, infectious bowel problems, bowel trauma, bowel obstructions, colorectal cancer (CRC), abdominal and bowel surgery, malabsorption problems

This list covers a wide variety of GI issues that patients may experience.

Question 2

What are the conceptual problems patients often face related to GI issues?

Answer 2

Impaired elimination and nutrition

These issues can significantly affect a patient’s overall health and well-being.

Question 3

What symptoms are commonly associated with gastrointestinal problems?

Answer 3

Inflammation, pain, altered fluid and electrolyte balance

These symptoms can complicate the treatment and management of GI conditions.

Question 4

What are the common goals in managing gastrointestinal problems?

Answer 4

Promoting optimal bowel habits and nutrition

These goals are essential for improving patient outcomes and quality of life.

Question 5

Fill in the blank: Patients often have problems with impaired _______ and nutrition.

Answer 5

elimination

Impaired elimination can lead to various complications in GI health.

Question 7

What is diarrhea?

Answer 7

The passage of at least 3 loose or liquid stools per day.

Diarrhea can be classified as acute, persistent, or chronic based on duration.

Question 8

What is the duration of acute diarrhea?

Answer 8

14 days or less.

Question 9

What is the duration of persistent diarrhea?

Answer 9

Longer than 14 days.

Question 10

What is chronic diarrhea?

Answer 10

Diarrhea lasting 30 days or longer.

Question 11

What is health care-associated diarrhea?

Answer 11

Acute diarrhea in a hospitalized patient that starts after 3 days of hospitalization and was not present on admission.

It is fairly common, developing in up to one-third of patients.

Question 12

What is the primary cause of acute diarrhea?

Answer 12

Ingesting infectious organisms.

Question 13

What causes most cases of infectious diarrhea in the United States?

Answer 13

Viruses.

Question 15

What are the manifestations of Campylobacter jejuni infection?

Answer 15

Diarrhea, abdominal cramps, fever, sometimes nausea, vomiting. Lasts about 7 days.

Commonly associated with undercooked poultry.

Question 16

What type of food is Clostridioides difficile associated with?

Answer 16

Undercooked poultry and unpasteurized milk.

Most frequent in summer months.

Question 17

What are the symptoms of Clostridium perfringens infection?

Answer 17

Diarrhea, abdominal cramps, nausea, vomiting.

Occurs 6-24 hours after eating contaminated food.

Question 18

What can prolonged use of antibiotics lead to in relation to Clostridium perfringens?

Answer 18

Increased susceptibility to infection due to exposure to feces-contaminated surfaces.

Spores on hands and surfaces are hard to kill.

Question 19

What are the manifestations of Enterohemorrhagic Escherichia coli infection?

Answer 19

Severe abdominal cramping, bloody diarrhea, vomiting, low-grade fever. Can progress to life-threatening renal failure.

Lasts 5-7 days.

Question 20

What are the symptoms of Norovirus infection?

Answer 20

Fever, vomiting, profuse watery diarrhea. Lasts 3-8 days.

Most common cause of travelers’ diarrhea.

Question 21

How is Salmonella transmitted?

Answer 21

Transmitted via fecal-oral route or in food or water contaminated with infected feces.

Reservoir includes poultry, reptiles, and other animals.

Question 22

What are the symptoms of Giardia lamblia infection?

Answer 22

Diarrhea, abdominal cramping, nausea, vomiting. Lasts about 2 weeks.

May be fatal in those who are immunocompromised.

Question 23

True or False: Shigella can cause diarrhea that lasts 4-7 days.

Answer 23

True

Symptoms may include diarrhea (sometimes bloody), fever, stomach cramps.

Question 24

What is the transmission method for Cryptosporidium?

Answer 24

Transmitted in stool of infected human or animal.

Highly contagious and can contaminate recreational water.

Question 25

Fill in the blank: Enterotoxigenic E. coli can lead to _______.

Answer 25

[diarrhea, abdominal cramps, nausea, vomiting] ## Footnote Symptoms may last 3-4 days.

Question 26

What is a common symptom of Rotavirus infection?

Answer 26

Watery diarrhea. ## Footnote Lasts about 1-3 days and may cause dehydration.

Question 27

What are the symptoms associated with Staphylococcus infection?

Answer 27

Nausea, vomiting, abdominal cramps, diarrhea. Rapid onset, lasts 1-2 days. ## Footnote Usually mild but can be severe in some cases.

Question 28

What is a key characteristic of the outer shell of Cryptosporidium?

Answer 28

Allows it to live for long periods outside of the body and makes it resistant to chlorine. ## Footnote Common cause of waterborne disease.

Question 29

What type of water is Norovirus commonly found in?

Answer 29

Fresh lakes and rivers, swimming pools, water parks, and hot tubs. ## Footnote Highly contagious and transmitted mainly by fecal-oral route.

Question 30

What high-risk groups are particularly susceptible to Cryptosporidium in the United States?

Answer 30

Travelers, recent immigrants, and men who have sex with men. ## Footnote Most common in tropical areas.

Question 32

What is a common cause of bloody diarrhea in the United States?

Answer 32

Bacterial infection with Escherichia coli O157:H7 ## Footnote It is transmitted by undercooked beef or chicken contaminated with the bacteria or in fruits and vegetables exposed to contaminated manure.

Question 33

What is the most common GI parasite that causes diarrhea in the United States?

Answer 33

Giardia lamblia ## Footnote This parasite is prevalent and often associated with contaminated water.

Question 34

How do some infectious organisms attack the intestines?

Answer 34

They change the secretion and/or absorption of enterocytes or cause inflammation ## Footnote Examples include Rotavirus A, Norovirus, and G. lamblia.

Question 35

What is secretory diarrhea?

Answer 35

A result of bacterial or viral infections that causes oversecretion of water, sodium, and chloride into the bowel ## Footnote It occurs when ingested pathogens survive in the GI tract long enough to absorb into the enterocytes.

Question 36

What factors influence a person's susceptibility to gastrointestinal pathogens?

Answer 36

Age, gastric acidity, intestinal microflora, and immune status ## Footnote Older adults are particularly at risk for life-threatening diarrhea.

Question 37

What effect do proton pump inhibitors (PPIs) have on pathogen survival?

Answer 37

They increase the chance that pathogens will survive ## Footnote This is because stomach acid kills ingested pathogens.

Question 38

What is the role of normal flora in the human colon?

Answer 38

They aid in fermentation and provide a microbial barrier against pathogens ## Footnote Antibiotics can kill normal flora, increasing susceptibility to infections.

Question 39

What is C. difficile infection (CDI) associated with?

Answer 39

Most serious hospital-associated diarrhea and common cause of hospital-acquired GI illness ## Footnote Patients receiving broad-spectrum antibiotics are particularly susceptible.

Question 40

What can cause diarrhea besides infection?

Answer 40

Drugs and food intolerances ## Footnote For example, large amounts of undigested substances can lead to osmotic diarrhea.

Question 41

What are the clinical manifestations of infections attacking the upper GI tract?

Answer 41

Large-volume, watery stools, cramping, and periumbilical pain ## Footnote Patients often experience a low-grade or no fever, nausea, and vomiting.

Question 42

What diagnostic studies are typically performed for diarrhea?

Answer 42

Stool cultures, blood cultures, and measuring stool electrolytes, pH, and osmolality ## Footnote These tests help determine the cause and severity of diarrhea.

Question 43

What is the primary concern in treating acute infectious diarrhea?

Answer 43

Preventing transmission, replacing fluid and electrolytes, and protecting the skin ## Footnote Most patients tolerate oral fluids for mild diarrhea.

Question 44

What is the role of antidiarrheal drugs?

Answer 44

They have limited short-term use to coat and protect mucous membranes, absorb irritating substances, and decrease intestinal secretions ## Footnote They are not a primary treatment for infectious diarrhea.

Question 46

What are antidiarrheal drugs not recommended for?

Answer 46

Major infectious diarrheas ## Footnote They potentially prolong exposure to the organism.

Question 47

What is a major concern with fecal microbiota transplantation (FMT)?

Answer 47

Potential for transmitting infectious agents in the donor stool ## Footnote Careful screening and intimate physical contact with the recipient can minimize this risk.

Question 48

In what condition are antidiarrheal drugs used cautiously?

Answer 48

Inflammatory bowel disease (IBD) ## Footnote They can cause toxic megacolon.

Question 49

When are antibiotics used in treating acute diarrhea?

Answer 49

For certain infections or when the infected person is severely ill or immunosuppressed ## Footnote They rarely have a role otherwise.

Question 50

What two antibiotics are recommended for empiric therapy in adults with acute diarrhea?

Answer 50

* Ciprofloxacin * Azithromycin

Question 51

What is Clostridioides difficile infection (CDI)?

Answer 51

A hazardous health care-associated infection (HAI) ## Footnote Risk is highest in patients on antimicrobial, chemotherapy, gastric acid-suppressing, or immunosuppressive drugs.

Question 52

How long can C. difficile spores survive on objects?

Answer 52

Up to 70 days

Question 53

What may be used to prevent CDI or as an adjunct therapy?

Answer 53

Lactobacillus probiotics

Question 54

What is the treatment for CDI?

Answer 54

* Oral vancomycin (125 mg 4 times a day) * Fidaxomicin (200 mg twice daily) for 10 days

Question 55

What should be done with non-essential antibiotics and antidiarrheal drugs during CDI treatment?

Answer 55

They should be stopped

Question 56

What is a treatment option for patients who cannot be treated with vancomycin or fidaxomicin?

Answer 56

Metronidazole

Question 57

What are signs of severe, complicated CDI?

Answer 57

* Shock * Hypotension * Ileus * Megacolon

Question 58

What is the risk of recurrent CDI?

Answer 58

Occurs in about 20% of patients

Question 59

What is fecal microbiota transplantation (FMT) used for?

Answer 59

Recurrent CDI

Question 60

What is the process of preparing donor stool for FMT?

Answer 60

Pureed into a liquid slurry consistency using saline, water, or pasteurized cow's milk

Question 61

What clinical problems can arise from acute infectious diarrhea?

Answer 61

* Impaired bowel elimination * Fluid imbalance * Electrolyte imbalance

Question 63

What is the mechanism of action for bismuth subsalicylate (Pepto-Bismol)?

Answer 63

Decreases secretions and has weak antibacterial activity. ## Footnote Used to prevent travelers' diarrhea.

Question 64

What are the nursing considerations for bismuth subsalicylate (Pepto-Bismol)?

Answer 64

May cause tinnitus and confusion. Do not use with GI bleeding. ## Footnote Caution patient to avoid alcohol.

Question 65

What is the mechanism of action for diphenoxylate with atropine (Lomotil)?

Answer 65

Decreases peristalsis and intestinal motility. ## Footnote Opioid and anticholinergic.

Question 66

What are the nursing considerations for diphenoxylate with atropine (Lomotil)?

Answer 66

Blurred vision, dry mouth, drowsiness may occur. Take as directed. Overdose may be life-threatening. ## Footnote Caution patient to avoid alcohol.

Question 67

What is the mechanism of action for loperamide (Imodium, Pepto Diarrhea Control)?

Answer 67

Inhibits peristalsis, delays transit, increases absorption of fluid from stools. ## Footnote Taken after each stool; up to 6 doses per day.

Question 68

What are the nursing considerations for loperamide (Imodium, Pepto Diarrhea Control)?

Answer 68

May cause drowsiness. Use caution with hazardous activities. ## Footnote Take as directed.

Question 69

What is the mechanism of action for octreotide acetate (Sandostatin)?

Answer 69

Suppresses serotonin secretion, stimulates fluid absorption from GI tract, decreases intestinal motility.

Question 70

What are the nursing considerations for octreotide acetate (Sandostatin)?

Answer 70

Given subcutaneously, intramuscularly, or intravenously. May cause gall bladder or liver problems.

Question 71

What is the mechanism of action for paregoric (camphorated tincture of opium)?

Answer 71

Decreases peristalsis and intestinal motility. ## Footnote Opioid.

Question 72

What are general nursing considerations for antidiarrheal drugs?

Answer 72

Caution patient to avoid alcohol. May cause drowsiness. Use caution with hazardous activities.

Question 74

What are the overall goals for a patient with diarrhea?

Answer 74

1. Resumption of normal bowel patterns 2. Normal fluid, electrolyte, and acid-base balance 3. Normal nutrition status 4. No perianal/perineal skin breakdown ## Footnote These goals aim to restore the patient's health and prevent complications.

Question 75

What is the initial assumption regarding the cause of acute diarrhea?

Answer 75

All cases are considered infectious until the cause is known ## Footnote This approach emphasizes the need for infection control measures.

Question 76

What is essential for infection control in patients with diarrhea?

Answer 76

Strict infection control precautions ## Footnote This includes hand hygiene and isolation measures.

Question 77

What hand hygiene practice is crucial in limiting the spread of C. difficile?

Answer 77

Meticulous hand washing with soap and water ## Footnote Alcohol-based hand cleaners are ineffective against C. difficile spores.

Question 78

What should be done immediately for patients with CDI?

Answer 78

Put them in isolation ## Footnote This helps prevent the spread of infection to others.

Question 79

What personal protective equipment should visitors and providers wear for patients with CDI?

Answer 79

Gloves and gowns ## Footnote This is to protect against contamination.

Question 80

What should infected patients be provided with for their use?

Answer 80

Disposable stethoscopes and thermometers ## Footnote This prevents cross-contamination.

Question 81

How should surfaces and equipment be disinfected in the room of a CDI patient?

Answer 81

Using a 10% bleach solution or a disinfectant labeled as C. difficile sporicidal ## Footnote This ensures effective elimination of spores.

Question 82

What is fecal incontinence?

Answer 82

The involuntary loss of stool ## Footnote It occurs when the structures that maintain continence are damaged.

Question 83

What is required for voluntary defecation to occur?

Answer 83

An intact neuromuscular system ## Footnote This system enables control over bowel movements.

Question 84

True or False: Alcohol-based hand cleaners are effective against C. difficile spores.

Answer 84

False ## Footnote Only soap and water are effective for this purpose.

Question 85

What are the overall goals for a patient with diarrhea?

Answer 85

1. Resumption of normal bowel patterns 2. Normal fluid, electrolyte, and acid-base balance 3. Normal nutrition status 4. No perianal/perineal skin breakdown ## Footnote These goals aim to restore the patient's health and prevent complications.

Question 86

What is the initial assumption regarding the cause of acute diarrhea?

Answer 86

All cases are considered infectious until the cause is known ## Footnote This approach emphasizes the need for infection control measures.

Question 87

What is essential for infection control in patients with diarrhea?

Answer 87

Strict infection control precautions ## Footnote This includes hand hygiene and isolation measures.

Question 88

What hand hygiene practice is crucial in limiting the spread of C. difficile?

Answer 88

Meticulous hand washing with soap and water ## Footnote Alcohol-based hand cleaners are ineffective against C. difficile spores.

Question 89

What should be done immediately for patients with CDI?

Answer 89

Put them in isolation ## Footnote This helps prevent the spread of infection to others.

Question 90

What personal protective equipment should visitors and providers wear for patients with CDI?

Answer 90

Gloves and gowns ## Footnote This is to protect against contamination.

Question 91

What should infected patients be provided with for their use?

Answer 91

Disposable stethoscopes and thermometers ## Footnote This prevents cross-contamination.

Question 92

How should surfaces and equipment be disinfected in the room of a CDI patient?

Answer 92

Using a 10% bleach solution or a disinfectant labeled as C. difficile sporicidal ## Footnote This ensures effective elimination of spores.

Question 93

What is fecal incontinence?

Answer 93

The involuntary loss of stool ## Footnote It occurs when the structures that maintain continence are damaged.

Question 94

What is required for voluntary defecation to occur?

Answer 94

An intact neuromuscular system ## Footnote This system enables control over bowel movements.

Question 95

True or False: Alcohol-based hand cleaners are effective against C. difficile spores.

Answer 95

False ## Footnote Only soap and water are effective for this purpose.

Question 98

What subjective health information is important to consider for diarrhea assessment?

Answer 98

Recent travel, hospitalization, infections, stress, diverticulitis or malabsorption, metabolic disorders, IBD, IBS ## Footnote IBD: Inflammatory Bowel Disease, IBS: Irritable Bowel Syndrome

Question 99

Which medications are associated with diarrhea?

Answer 99

Laxatives or enemas, magnesium-containing antacids, sorbitol-containing suspensions or elixirs, antibiotics, methyldopa, digitalis, colchicine, OTC antidiarrheal drugs ## Footnote OTC: Over-The-Counter

Question 100

What functional health patterns might be observed in a patient with diarrhea?

Answer 100

* Chronic laxative use * Malaise * Ingestion of fatty and spicy foods * Food intolerances * Anorexia * Nausea * Vomiting * Weight loss * Thirst * Increased stool frequency, volume, and looseness * Change in color and character of stools * Steatorrhea * Abdominal bloating * Decreased urine output * Abdominal tenderness * Abdominal pain * Cramping * Tenesmus ## Footnote Steatorrhea: Fatty stools

Question 101

What objective data might indicate diarrhea?

Answer 101

* Lethargy * Sunken eyeballs * Fever * Malnutrition * Frequent soft to liquid stools * Altered stool color * Abdominal distention * Hyperactive bowel sounds * Pus, blood, mucus, or fat in stools * Fecal impaction * Pallor * Dry mucous membranes * Poor skin turgor * Perianal irritation * Decreased output * Concentrated urine ## Footnote Fecal impaction: A condition where stool becomes hard and lodged in the intestines

Question 102

What possible diagnostic findings are associated with diarrhea?

Answer 102

* Abnormal serum electrolyte levels * Anemia * T WBC * Eosinophilia * Hypoalbuminemia * Positive stool cultures * Ova, parasites, leukocytes, blood, or fat in stool * Abnormal sigmoidoscopy or colonoscopy findings * Abnormal lower GI series ## Footnote T WBC: Total White Blood Cell count, GI: Gastrointestinal

Question 105

What is the first nursing management action for a patient with diarrhea?

Answer 105

Ensure the patient maintains an adequate fluid intake ## Footnote This includes encouraging oral fluids containing glucose and electrolytes.

Question 106

What types of fluids should be encouraged for patients with diarrhea?

Answer 106

Oral fluids containing glucose and electrolytes ## Footnote IV fluids and electrolytes may also be administered as ordered.

Question 107

What medications may be administered to a patient with diarrhea?

Answer 107

Antidiarrheal and antibiotic drugs ## Footnote These should be given as ordered by a healthcare provider.

Question 108

What precautions should be implemented for patients with diarrhea?

Answer 108

Proper isolation and infection control precautions ## Footnote This is essential to prevent the spread of infection.

Question 109

What should be maintained to monitor a patient's condition with diarrhea?

Answer 109

Accurate intake and output records, recording weight daily ## Footnote This helps in assessing the patient's hydration status.

Question 110

What should be done to assist a patient with perianal care?

Answer 110

Assist the patient with keeping the perianal area clean ## Footnote Applying a moisturizing skin barrier cream may also be needed.

Question 111

What can be used to reduce perianal irritation and pain?

Answer 111

Dibucaine, witch hazel, or sitz baths ## Footnote These options help soothe the affected area.

Question 112

What measures can be implemented to make toileting easier for patients?

Answer 112

Call light in reach, easy-to-manage clothing, assistive devices available, and provide privacy ## Footnote Using a deodorizer can also help maintain comfort.

Question 113

What dietary recommendation should be made to a patient with diarrhea?

Answer 113

Increase high fiber foods, such as whole-grain breads and cereals, and fresh fruits and vegetables ## Footnote This is unless contraindicated.

Question 114

What should patients be taught to avoid to help manage diarrhea?

Answer 114

Foods and fluids known to worsen diarrhea ## Footnote This education is critical for symptom management.

Question 115

What is the first nursing management action for a patient with diarrhea?

Answer 115

Ensure the patient maintains an adequate fluid intake ## Footnote This includes encouraging oral fluids containing glucose and electrolytes.

Question 116

What types of fluids should be encouraged for patients with diarrhea?

Answer 116

Oral fluids containing glucose and electrolytes ## Footnote IV fluids and electrolytes may also be administered as ordered.

Question 117

What medications may be administered to a patient with diarrhea?

Answer 117

Antidiarrheal and antibiotic drugs ## Footnote These should be given as ordered by a healthcare provider.

Question 118

What precautions should be implemented for patients with diarrhea?

Answer 118

Proper isolation and infection control precautions ## Footnote This is essential to prevent the spread of infection.

Question 119

What should be maintained to monitor a patient's condition with diarrhea?

Answer 119

Accurate intake and output records, recording weight daily ## Footnote This helps in assessing the patient's hydration status.

Question 120

What should be done to assist a patient with perianal care?

Answer 120

Assist the patient with keeping the perianal area clean ## Footnote Applying a moisturizing skin barrier cream may also be needed.

Question 121

What can be used to reduce perianal irritation and pain?

Answer 121

Dibucaine, witch hazel, or sitz baths ## Footnote These options help soothe the affected area.

Question 122

What measures can be implemented to make toileting easier for patients?

Answer 122

Call light in reach, easy-to-manage clothing, assistive devices available, and provide privacy ## Footnote Using a deodorizer can also help maintain comfort.

Question 123

What dietary recommendation should be made to a patient with diarrhea?

Answer 123

Increase high fiber foods, such as whole-grain breads and cereals, and fresh fruits and vegetables ## Footnote This is unless contraindicated.

Question 124

What should patients be taught to avoid to help manage diarrhea?

Answer 124

Foods and fluids known to worsen diarrhea ## Footnote This education is critical for symptom management.

Question 127

What are the two main functions that can result in fecal incontinence when impaired?

Answer 127

Motor function and sensory function ## Footnote Motor function involves the contraction of sphincters and rectal floor muscles, while sensory function relates to the ability to perceive stool presence and the urge to defecate.

Question 128

What is the most common cause of sphincter injury in women?

Answer 128

Obstetric trauma ## Footnote Obstetric trauma can occur during childbirth and may lead to damage to the anal sphincters.

Question 129

Which factors contribute to fecal incontinence in older adults?

Answer 129

Aging, menopause, mobility problems, chronic constipation ## Footnote Mobility problems can prevent timely access to toilets, and chronic constipation may lead to fecal impaction.

Question 130

What is fecal impaction?

Answer 130

A collection of hardened feces in the rectum or sigmoid colon that cannot be expelled ## Footnote It often leads to incontinence when liquid stool seeps around the hardened feces.

Question 131

What diagnostic method can reveal reduced anal canal muscle tone?

Answer 131

Rectal examination ## Footnote A rectal examination can also detect internal prolapse, rectocele, hemorrhoids, masses, and fecal impaction.

Question 132

What dietary changes are recommended to manage fecal incontinence?

Answer 132

High-fiber diet and increased intake of caffeine-free fluids ## Footnote Fiber supplements or bulk-forming laxatives can help increase stool bulk and firm consistency.

Question 133

Which medications are useful in slowing gastrointestinal transit for fecal incontinence?

Answer 133

Antidiarrheal drugs, such as loperamide ## Footnote These medications can help manage the symptoms of fecal incontinence.

Question 134

What is the role of physical therapy in managing fecal incontinence?

Answer 134

Improves awareness of rectal sensation and strengthens external sphincter contraction ## Footnote Biofeedback training is a component of physical therapy that requires intact sensory and motor nerves.

Question 135

What is the purpose of mild electrical stimulation in fecal incontinence treatment?

Answer 135

Targets communication problems between the brain and pelvic floor muscles ## Footnote This treatment can improve quality of life and sphincter control.

Question 136

What is dextranomer/hyaluronic acid gel (Solesta) used for?

Answer 136

To treat fecal incontinence by injecting into the anal canal ## Footnote It builds up tissue in the anal area, narrowing the canal and improving muscle closure.

Question 137

When is surgery indicated for fecal incontinence?

Answer 137

When conservative treatments fail, in cases of full-thickness prolapse, or for anal sphincter repair ## Footnote A colostomy may be necessary in some cases.

Question 138

What are common triggers for diarrhea that should be reduced in the diet?

Answer 138

* Caffeine * Artificial sweeteners * Dairy products * High gas-producing vegetables * Vegetables containing insoluble fiber ## Footnote Examples of high gas-producing vegetables include broccoli, cabbage, and cauliflower.

Question 139

What should be assessed in patients with fecal incontinence?

Answer 139

Bowel patterns, current habits, stool consistency, volume, frequency, and symptoms ## Footnote Assessment should also include any pain during defecation.

Question 141

What is a common cause of anal sphincter weakness related to childbirth?

Answer 141

Childbirth injury

Question 142

Name a surgical procedure that can lead to anal sphincter weakness.

Answer 142

Anorectal surgery for hemorrhoids, fistula, fissures

Question 143

List two conditions that can cause inflammation leading to fecal incontinence.

Answer 143

* IBD * Radiation

Question 144

What type of problems can affect toileting ability in functional fecal incontinence?

Answer 144

Physical or mobility problems

Question 145

Name a neurological disease associated with fecal incontinence.

Answer 145

Multiple sclerosis

Question 146

What is one congenital abnormality that can lead to fecal incontinence?

Answer 146

Spina bifida

Question 147

Fill in the blank: Chronic _______ can contribute to fecal incontinence.

Answer 147

constipation

Question 148

True or False: Stroke can be a cause of fecal incontinence.

Answer 148

True

Question 149

What condition involves the denervation of pelvic muscles due to chronic straining?

Answer 149

Denervation of pelvic muscles from chronic straining

Question 150

List two common causes of fecal incontinence related to neurologic disease.

Answer 150

* Brain tumor * Diabetes

Question 151

What pelvic floor dysfunction can lead to fecal incontinence?

Answer 151

Rectal prolapse

Question 152

Name a condition that can cause fecal impaction.

Answer 152

Diarrhea

Question 153

What injury can lead to anal sphincter weakness apart from surgery?

Answer 153

Perineal trauma or pelvic fracture

Question 154

What is a common complication of aging that affects fecal incontinence?

Answer 154

Frail older person who cannot get to the bathroom in time

Question 155

Fill in the blank: Internal sphincter _______ can cause fecal incontinence.

Answer 155

thinning

Question 156

Name a condition that can lead to fecal incontinence due to nerve damage.

Answer 156

Neuropathy

Question 157

What type of injury can lead to anal sphincter weakness from a medical procedure?

Answer 157

Anorectal infection

Question 159

What is a common cause of anal sphincter weakness related to childbirth?

Answer 159

Childbirth injury ## Footnote Childbirth can lead to trauma affecting the anal sphincter.

Question 160

Name a physical condition that can lead to functional incontinence.

Answer 160

Physical or mobility problems ## Footnote Examples include a frail older person who cannot get to the bathroom in time.

Question 161

What are two inflammatory diseases that can cause fecal incontinence?

Answer 161

* IBD * Radiation ## Footnote Inflammatory bowel disease (IBD) and radiation exposure can lead to gastrointestinal issues.

Question 162

Which neurologic disease is characterized by brain lesions affecting bowel control?

Answer 162

Brain tumor ## Footnote Brain tumors can disrupt normal neural pathways responsible for bowel control.

Question 163

What congenital abnormalities are associated with fecal incontinence?

Answer 163

* Spina bifida * Myelomeningocele ## Footnote These conditions can affect the spinal cord and surrounding structures.

Question 164

What condition involves the weakening of the internal anal sphincter?

Answer 164

Internal sphincter thinning ## Footnote This can occur due to various factors including aging and trauma.

Question 165

List two causes of fecal incontinence related to pelvic floor dysfunction.

Answer 165

* Fistula * Rectal prolapse ## Footnote Both conditions can disrupt normal bowel function and control.

Question 166

True or False: Chronic constipation can lead to fecal incontinence.

Answer 166

True ## Footnote Chronic constipation can cause fecal impaction, leading to incontinence.

Question 167

Fill in the blank: Neuropathy is a common cause of _______ incontinence.

Answer 167

fecal ## Footnote Neuropathy can affect the nerves that control bowel function.

Question 168

Name a complication of fecal impaction.

Answer 168

Diarrhea ## Footnote Fecal impaction can lead to overflow diarrhea, causing incontinence.

Question 169

What is a potential outcome of perineal trauma or pelvic fracture?

Answer 169

Anal sphincter weakness ## Footnote Such injuries can compromise the integrity of the anal sphincter.

Question 170

What is a common cause of fecal incontinence in older adults?

Answer 170

Dementia ## Footnote Cognitive decline can impair the ability to recognize the need to use the bathroom.

Question 171

List three neurologic diseases that can result in fecal incontinence.

Answer 171

* Diabetes * Multiple sclerosis * Stroke ## Footnote These conditions can disrupt normal bowel function through various mechanisms.

Question 172

What type of surgery may lead to anal sphincter weakness?

Answer 172

Anorectal surgery for hemorrhoids, fistula, fissures ## Footnote Surgical interventions in this area can compromise sphincter function.

Question 173

Fill in the blank: Chronic straining can lead to denervation of _______ muscles.

Answer 173

pelvic ## Footnote Chronic straining may result in muscle damage affecting bowel control.

Question 175

What is the Bristol Stool Scale used for?

Answer 175

To assess stool consistency ## Footnote It provides a standardized way to describe the form of stool.

Question 176

What sensation might indicate issues with bowel evacuation?

Answer 176

Feeling of incomplete evacuation (tenesmus)

Question 177

What is fecal incontinence associated with?

Answer 177

Incontinence-associated dermatitis (IAD) ## Footnote IAD results from chemical irritants in feces causing skin damage.

Question 178

What are common symptoms of IAD?

Answer 178

* Redness * Skin loss * Rash

Question 179

Where is IAD typically located?

Answer 179

* Perianal area * Perineal area * Buttocks * Upper thighs

Question 180

What is a recommended first step in bowel training?

Answer 180

Know the patient's usual bowel pattern

Question 181

What is the best time to schedule elimination for bowel training?

Answer 181

Within 30 minutes after breakfast

Question 182

What medications can be administered to stimulate bowel evacuation?

Answer 182

* Bisacodyl * Glycerin suppository * Small phosphate enema

Question 183

What is digital stimulation used for?

Answer 183

To stimulate the anorectal reflex

Question 184

What is a stool management system?

Answer 184

A system that funnels liquid stool from the rectum into a containment system ## Footnote Examples include Flexi-Seal, DigniCare, Actiflo.

Question 185

What should be avoided when managing fecal incontinence?

Answer 185

Using a rectal tube or urinary catheter as a stool catheter

Question 186

What is essential for maintaining perineal skin integrity?

Answer 186

Fecal containment

Question 187

What are options for skin cleansing in patients with fecal incontinence?

Answer 187

* Hydrating skin cleansing foam * Incontinence clean-up cloths * Baby wipes

Question 188

What should be avoided in skin care products for sensitive skin?

Answer 188

Products that contain alcohol

Question 189

What is a common emotional factor that can contribute to constipation?

Answer 189

Anxiety, depression, and stress

Question 190

What defines constipation?

Answer 190

Fewer than 3 stools per week

Question 191

What are common risk factors for chronic constipation?

Answer 191

* Low-fiber diet * Decreased physical activity * Ignoring the defecation urge

Question 192

What can prolonged retention of feces lead to?

Answer 192

Drying of stool due to water absorption

Question 193

What is cathartic colon syndrome?

Answer 193

A condition in which the colon becomes dilated and atonic due to chronic laxative use

Question 195

What is the clinical presentation of constipation?

Answer 195

Varies from mild discomfort to severe events mimicking an 'acute abdomen'. ## Footnote May include absent or hard, dry stools, abdominal distention, bloating, increased flatus, and increased rectal pressure.

Question 196

What are hemorrhoids a common complication of?

Answer 196

Chronic constipation. ## Footnote Result from venous engorgement caused by repeated Valsalva maneuvers and venous compression from hard, impacted stool.

Question 197

What is the Valsalva maneuver?

Answer 197

A technique where the patient inspires deeply and holds the breath while contracting abdominal muscles and bearing down. ## Footnote Increases intraabdominal and intrathoracic pressures, reducing venous return to the heart.

Question 198

What serious outcomes can the Valsalva maneuver have for patients?

Answer 198

May be fatal for patients with heart failure, cerebral edema, hypertension, and coronary artery disease. ## Footnote Can lead to a transient drop in arterial pressure followed by a sudden increase when the patient relaxes.

Question 199

What complications may arise from chronic constipation?

Answer 199

Rectal mucosal ulcers, fissures, and diverticulosis. ## Footnote Colonic perforation can occur in cases of obstipation or fecal impaction.

Question 200

What are the signs of colonic perforation?

Answer 200

Abdominal pain, nausea, vomiting, fever, and a high WBC count. ## Footnote Perforation is life-threatening.

Question 201

How is constipation typically diagnosed?

Answer 201

Based on history and physical assessment, including abdominal assessment, inspection of the perianal and rectal region, and digital rectal examination (DRE). ## Footnote Concerning signs include sudden changes in bowel habits, rectal bleeding, iron deficiency anemia, weight loss, significant abdominal pain, and palpable mass.

Question 202

What diagnostic tests may be needed if concerning signs are present?

Answer 202

Abdominal x-rays, barium enema, colonoscopy, or sigmoidoscopy. ## Footnote Tests are necessary to rule out serious diseases like colorectal cancer (CRC).

Question 203

What interprofessional care strategies can prevent constipation?

Answer 203

Increasing fiber intake, fluid intake, and exercise. ## Footnote Lifestyle modifications are key to prevention.

Question 204

What are the options for treating constipation?

Answer 204

Laxatives and enemas. ## Footnote Each class of laxative works differently based on the severity and duration of constipation.

Question 205

What type of laxatives can prevent constipation?

Answer 205

Daily bulk-forming laxatives (e.g., psyllium). ## Footnote They work like dietary fiber and do not cause dependence.

Question 206

What is the next recommended treatment for chronic constipation if diet and lifestyle modifications do not work?

Answer 206

Osmotic laxatives. ## Footnote Stimulant laxatives are for patients who do not respond to osmotic laxatives.

Question 207

What precautions should be taken when using enemas?

Answer 207

Must be used cautiously, especially those containing sodium phosphate and magnesium. ## Footnote Can cause electrolyte imbalances in older adults and patients with heart and kidney problems.

Question 208

What therapies target constipation from opioid use?

Answer 208

Peripherally acting opioid receptor antagonists (methylnaltrexone, naldemedine, naloxegol). ## Footnote These do not block the analgesic effects of opioids.

Question 210

What type of drugs are associated with constipation?

Answer 210

Cardiovascular, Central nervous system, GI, Other ## Footnote This includes various drug classifications that can lead to constipation as a side effect.

Question 211

Name two categories of cardiovascular drugs associated with constipation.

Answer 211

* Antihypertensives (B-adrenergic blockers, calcium channel blockers) * Furosemide ## Footnote These drugs can affect bowel motility and lead to constipation.

Question 212

Which type of hypolipidemic drugs can cause constipation?

Answer 212

* Cholestyramine * Colestipol * Statins ## Footnote These medications help lower cholesterol levels but may also contribute to constipation.

Question 213

What are some antidepressants that are associated with constipation?

Answer 213

* Tricyclics * Selective serotonin reuptake inhibitors ## Footnote These classes of antidepressants can have gastrointestinal side effects, including constipation.

Question 214

List two antiepileptics that may lead to constipation.

Answer 214

* Carbamazepine * Phenytoin * Clonazepam ## Footnote Antiepileptic drugs can impact gut motility and contribute to constipation.

Question 215

Which antipsychotic medications are linked to constipation?

Answer 215

* Butyrophenones * Phenothiazines * Barbiturates ## Footnote These medications are used to treat psychiatric disorders and can have gastrointestinal side effects.

Question 216

What class of drugs do benzodiazepines belong to regarding constipation?

Answer 216

Central nervous system drugs ## Footnote Benzodiazepines can cause sedation and may also contribute to reduced bowel activity.

Question 217

Which antacids are known to cause constipation?

Answer 217

* Antacids containing aluminum * Antacids containing calcium ## Footnote These antacids can neutralize stomach acid but may have a constipating effect.

Question 218

Name two types of supplements that can lead to constipation.

Answer 218

* Bismuth * Calcium * Iron ## Footnote These supplements are often taken for various health benefits but can affect bowel movements.

Question 219

What type of analgesics are associated with constipation?

Answer 219

Opiates and derivatives ## Footnote These pain relievers are well-known for causing constipation as a common side effect.

Question 220

Which antitussives may cause constipation?

Answer 220

* Codeine * Dextromethorphan ## Footnote These cough suppressants can have a constipating effect as they act on the central nervous system.

Question 222

What are some colonic disorders that can cause constipation?

Answer 222

* Cancer * Diverticular disease * IBD * Intestinal stenosis * Intussusception * Luminal or extraluminal obstructing lesions * Prolapse * Rectocele ## Footnote Colonic disorders are significant contributors to constipation and involve various structural or functional abnormalities of the colon.

Question 223

Name a systemic disorder associated with collagen vascular disease that can lead to constipation.

Answer 223

* Amyloidosis * Systemic lupus erythematosus * Systemic sclerosis (scleroderma) ## Footnote Collagen vascular diseases can impact gastrointestinal motility and contribute to constipation.

Question 224

List metabolic/endocrine disorders that may cause constipation.

Answer 224

* Chronic renal failure * Diabetes * Hypercalcemia/hyperparathyroidism * Hypokalemia * Hypothyroidism * Pheochromocytoma * Pregnancy ## Footnote Metabolic and endocrine disorders can disrupt normal bowel function, leading to constipation.

Question 225

Which neurologic disorder is associated with constipation due to autonomic neuropathy?

Answer 225

Diabetes ## Footnote Autonomic neuropathy from diabetes can impair bowel motility and contribute to constipation.

Question 226

What is Hirschsprung megacolon?

Answer 226

A congenital condition causing bowel obstruction due to a lack of nerve cells in the colon ## Footnote This condition can lead to severe constipation in affected individuals.

Question 227

True or False: Parkinson disease is a neurologic disorder that can lead to constipation.

Answer 227

True ## Footnote Parkinson disease can affect gastrointestinal motility and contribute to constipation.

Question 228

Fill in the blank: Chronic renal failure can lead to _______.

Answer 228

constipation ## Footnote Chronic renal failure can cause various metabolic changes that affect bowel function.

Question 229

Name two neurologic disorders that are associated with constipation.

Answer 229

* Multiple sclerosis * Stroke ## Footnote Neurologic disorders can disrupt the normal functioning of the gastrointestinal system, leading to constipation.

Question 231

What is the mechanism of action for bulk forming laxatives?

Answer 231

Absorbs water, increases bulk, stimulating peristalsis ## Footnote Action usually occurs within 24 hours.

Question 232

Indications for bulk forming laxatives include:

Answer 232

* Acute constipation * Chronic constipation * IBS * Diverticulosis ## Footnote Examples include methylcellulose (Citrucel) and psyllium (Metamucil).

Question 233

What is the primary action of emollients?

Answer 233

Lubricate intestinal tract and soften feces ## Footnote Action: Softeners in 72 hours, lubricants in 8 hours.

Question 234

What do prosecretory drugs do?

Answer 234

Increase intestinal fluid secretion, speeding colonic transit ## Footnote Action usually occurs within 24 hours.

Question 235

What is the action of saline and osmotic solutions?

Answer 235

Cause retention of fluid in intestinal lumen, reducing stool consistency and increasing volume ## Footnote Action occurs within 15 minutes to 3 hours.

Question 236

How do stimulant laxatives work?

Answer 236

Increase peristalsis and speed colonic transit by irritating colon wall ## Footnote Action usually occurs within 12 hours.

Question 237

Indications for stimulant laxatives include:

Answer 237

* Acute constipation * Chronic constipation * Fecal impaction * Anorectal conditions * Chronic idiopathic constipation * IBS-C (women only) ## Footnote Common agents include anthraquinones (cascara sagrada, senna) and bisacodyl (Dulcolax).

Question 238

What are nursing considerations for laxative use?

Answer 238

* Do not use in patients with abdominal pain, nausea, or vomiting * Must be taken with fluids (≥8 oz) * Can block absorption of fat-soluble vitamins ## Footnote May increase bleeding risk in patients on anticoagulants.

Question 239

What is a potential side effect of stimulant laxatives?

Answer 239

Cause melanosis coli (brown or black pigmentation of colon) ## Footnote Most widely abused laxatives; should not be used in patients with impaction or obstipation.

Question 240

Fill in the blank: Emollients do not affect _______.

Answer 240

[peristalsis]

Question 241

True or False: Saline and osmotic solutions can lead to fluid and electrolyte imbalances in older adults.

Answer 241

True ## Footnote Overuse in those with renal failure can exacerbate this risk.

Question 242

What is a common example of a lubricant laxative?

Answer 242

Mineral oil (Fleet Mineral Oil Enema) ## Footnote Used to soften hard stools.

Question 243

What is the action time for stimulant laxatives?

Answer 243

Usually within 12 hours ## Footnote They work by stimulating the enteric nerves.

Question 244

What can be a result of overusing magnesium or sodium phosphates?

Answer 244

Fluid and electrolyte imbalances ## Footnote Particularly concerning in older adults or those with renal failure.

Question 245

What is the action time for prosecretory drugs?

Answer 245

Usually within 24 hours

Question 247

What condition may help patients who have constipation due to uncoordinated contraction of the anal sphincter?

Answer 247

Anismus ## Footnote Anismus refers to the inability to relax the anal sphincter during bowel movements.

Question 248

What might a patient with severe constipation related to bowel motility or mechanical disorders require?

Answer 248

More intense treatment ## Footnote This may include procedures like colostomy, ileostomy, or continent fecal diversion.

Question 249

What dietary component is key in preventing and treating constipation?

Answer 249

Fiber ## Footnote Fiber is found in fruits, vegetables, and grains.

Question 250

Which foods are especially effective in preventing and treating constipation?

Answer 250

Wheat bran and prunes ## Footnote Whole wheat and bran are high in insoluble fiber.

Question 251

How does fiber help alleviate constipation?

Answer 251

By adding to stool bulk and attracting water ## Footnote Larger, bulkier stools move through the colon more quickly.

Question 252

What is the recommended fluid intake for preventing constipation?

Answer 252

2 L/day ## Footnote This may be contraindicated in patients with heart disease or renal failure.

Question 253

What initial effect may increasing fiber intake have on patients?

Answer 253

Increased gas production ## Footnote This effect decreases over several days as the body adjusts.

Question 254

What should be assessed to manage a patient's constipation?

Answer 254

Usual defecation patterns and habits ## Footnote Assessment should include onset, duration, stool shape, consistency, and difficulty with evacuation.

Question 255

What should be taught to patients about managing constipation?

Answer 255

Role of diet, adequate fluid intake, and regular exercise ## Footnote Emphasizing a high-fiber diet is crucial.

Question 256

What should be stressed to patients regarding laxatives and enemas?

Answer 256

Use them as ordered ## Footnote Proper use of laxatives and enemas is part of effective constipation management.

Question 257

Fill in the blank: Increasing fiber intake may initially increase _______ production.

Answer 257

gas ## Footnote This is due to fermentation in the colon.

Question 259

What should patients be taught regarding defecation?

Answer 259

Establish a regular time to defecate and not suppress the urge to defecate. ## Footnote Regularity in defecation can help prevent constipation and promote bowel health.

Question 260

What position facilitates easier defecation?

Answer 260

Sitting on a commode with knees higher than hips. ## Footnote This position allows gravity to aid the process and straightens the angle between the anal canal and rectum.

Question 261

What is the purpose of using a footstool in front of the toilet?

Answer 261

To promote flexion of the hips. ## Footnote Flexed hips facilitate the defecation process.

Question 262

Why is it challenging to defecate while sitting on a bedpan?

Answer 262

The sitting position does not allow gravity to assist effectively. ## Footnote Bedpans can create discomfort and may not be conducive to natural bowel movements.

Question 263

What should be done for a patient in bed to facilitate defecation?

Answer 263

Raise the head of the bed as high as the patient can tolerate. ## Footnote This position can help mimic a sitting posture, which is beneficial for bowel movements.

Question 264

What factors can cause embarrassment during defecation?

Answer 264

Sights, odors, and sounds of defecation. ## Footnote Providing privacy and using odor eliminators can help alleviate this embarrassment.

Question 265

What is recommended to maintain abdominal muscle tone?

Answer 265

Prompt patients to contract abdominal muscles several times a day. ## Footnote Exercises like sit-ups and straight-leg raises can also improve muscle tone.

Question 266

What should be discussed with patients who have rigid beliefs about bowel function?

Answer 266

Concerns about bowel function and the adverse consequences of overuse of laxatives and enemas. ## Footnote Providing accurate information can help address misconceptions.

Question 267

What is acute abdominal pain?

Answer 267

Pain of recent onset that may signal a life-threatening problem. ## Footnote Immediate attention is required for acute abdominal pain.

Question 268

What are common causes of acute abdominal pain?

Answer 268

Damage to organs leading to inflammation, infection, obstruction, bleeding, and perforation. ## Footnote Each of these causes can lead to urgent medical conditions.

Question 269

What does perforation of the GI tract result in?

Answer 269

Irritation of the peritoneum and peritonitis. ## Footnote This condition can lead to severe complications and requires prompt medical intervention.

Question 270

What can cause hypovolemic shock in the context of acute abdominal pain?

Answer 270

Bleeding or obstruction and peritonitis. ## Footnote These conditions can lead to significant fluid loss from the vascular space.

Question 271

What is the most common symptom of an acute abdominal problem?

Answer 271

Pain. ## Footnote Other symptoms may include nausea, vomiting, diarrhea, constipation, flatulence, fatigue, fever, rebound tenderness, and bloating.

Question 272

What is the first step in diagnosing acute abdominal pain?

Answer 272

Complete history and physical assessment. ## Footnote Gathering detailed information about the pain is crucial for accurate diagnosis.

Question 273

Fill in the blank: The irritation of the peritoneum is referred to as _______.

Answer 273

peritonitis. ## Footnote Peritonitis can result from perforation of the GI tract and is a serious condition.

Question 275

What are some important health history factors to consider for constipation?

Answer 275

Colorectal disease, neurologic problems, bowel obstruction, environmental changes, cancer, IBD, diabetes ## Footnote IBD stands for Inflammatory Bowel Disease.

Question 276

What are some medications that may be relevant to constipation?

Answer 276

Refer to Table 47.7 for specific medications ## Footnote Table 47.7 is not provided here but typically includes various medications that can affect bowel function.

Question 277

What health perception issues might patients with constipation have?

Answer 277

Chronic laxative or enema use, rigid beliefs about bowel function, malaise ## Footnote These perceptions can significantly impact a patient's management of constipation.

Question 278

What nutritional changes may be relevant in assessing constipation?

Answer 278

Changes in diet or mealtime, fiber and fluid intake, anorexia, nausea ## Footnote Adequate fiber and fluid intake are crucial for preventing constipation.

Question 279

What elimination changes are indicative of constipation?

Answer 279

Change in usual bowel patterns, hard stool, decrease in stool frequency and amount, flatus, abdominal distention, straining, tenesmus, rectal pressure, fecal incontinence (if impacted) ## Footnote Tenesmus refers to the feeling of incomplete bowel evacuation.

Question 280

How might a patient's activity-exercise level relate to constipation?

Answer 280

Daily activity routine, immobility, sedentary lifestyle ## Footnote Increased physical activity is often recommended to alleviate constipation.

Question 281

What cognitive-perceptual symptoms might be present in patients with constipation?

Answer 281

Dizziness, headache, anorectal pain, abdominal pain on defecation ## Footnote These symptoms can contribute to the patient's overall discomfort and distress.

Question 282

What coping-stress tolerance factors may affect constipation?

Answer 282

Acute or chronic stress ## Footnote Stress can influence bowel habits and exacerbate constipation.

Question 283

What objective data might indicate constipation?

Answer 283

Lethargy, anorectal fissures, hemorrhoids, abscesses, abdominal distention, hypoactive or absent bowel sounds, palpable abdominal mass, fecal impaction, small hard dry stool, stool with blood ## Footnote Each of these signs can provide important clues to the patient's condition.

Question 284

What diagnostic findings may suggest constipation?

Answer 284

Guaiac-positive stools, abdominal x-ray showing stool in lower colon ## Footnote Guaiac-positive stools indicate the presence of blood in the stool, which may require further investigation.

Question 286

What is a common posture observed with peritoneal irritation?

Answer 286

Fetal posture ## Footnote This is often seen in conditions like appendicitis.

Question 287

Which symptoms indicate the need for monitoring in patients with kidney stones or gallstones?

Answer 287

Restlessness and inability to find a comfortable position

Question 288

What physical assessments are performed on patients with acute abdominal pain?

Answer 288

Assessment of the abdomen, rectum, and pelvis

Question 289

What tests are commonly done for patients with acute abdominal pain?

Answer 289

* Complete blood count (CBC) * Urinalysis * Abdominal x-ray * ECG * Ultrasound or CT scan

Question 290

What additional test might be required for women of childbearing age with acute abdominal pain?

Answer 290

Pregnancy test

Question 291

What is the primary goal of emergency management for acute abdominal pain?

Answer 291

Identify and treat the cause and monitor for complications

Question 292

Why should pain medications be used cautiously in patients with non-traumatic acute abdominal pain?

Answer 292

To provide pain relief without interfering with diagnostic accuracy

Question 293

What surgical procedures may be performed if the cause of acute abdominal pain is found?

Answer 293

* Diagnostic laparoscopy * Laparotomy

Question 294

What factors are assessed when monitoring a patient with acute abdominal pain?

Answer 294

* Vital signs * Intake and output * Skin color and temperature * Peripheral pulse strength

Question 295

What does increased pulse and decreasing BP indicate in the context of acute abdominal pain?

Answer 295

Impending shock

Question 296

What does a fever in a patient with acute abdominal pain suggest?

Answer 296

An inflammatory or infectious process

Question 297

What clinical problems are associated with acute abdominal pain?

Answer 297

* Pain * Fluid imbalance * Risk for infection

Question 298

What are the overall goals for a patient with acute abdominal pain?

Answer 298

* Relief of abdominal pain * Resolution of inflammation * Freedom from complications * Normal nutrition status

Question 299

What general care measures should be implemented for patients with acute abdominal pain?

Answer 299

Managing fluid and electrolyte imbalances, pain, and anxiety

Question 300

What should be assessed at regular intervals in patients with acute abdominal pain?

Answer 300

Quality and intensity of pain

Question 301

Fill in the blank: Patients with acute abdominal pain may experience _______ guarding and rigidity.

Answer 301

involuntary

Question 302

True or False: A laparotomy is performed when laparoscopic techniques are adequate.

Answer 302

False

Question 303

What information can be gained from assessing the abdomen in a patient with acute abdominal pain?

Answer 303

* Distention * Masses * Abnormal pulsation * Symmetry * Hernias * Rashes * Scars * Pigmentation changes

Question 305

What is the recommended daily intake of fiber to manage constipation?

Answer 305

20 to 30 g of fiber per day ## Footnote Gradually increase fiber intake over 1 to 2 weeks to promote stool evacuation.

Question 306

What foods are high in fiber?

Answer 306

* Raw vegetables and fruits * Beans * Breakfast cereals (All-Bran, oatmeal) ## Footnote Eating prunes or drinking prune juice daily can also stimulate defecation.

Question 307

What is the role of fluids in managing constipation?

Answer 307

Fluid softens hard stools; drink 2 L/day ## Footnote Recommended fluids include water and fruit juices, while caffeinated beverages should be avoided.

Question 308

How often should one exercise to help manage constipation?

Answer 308

At least 3 times per week ## Footnote Activities can include walking, swimming, or biking, and abdominal exercises can strengthen muscles.

Question 309

What is the best time to establish a regular schedule for defecation?

Answer 309

First thing in the morning or after the first meal of the day ## Footnote Many people often feel the urge to defecate during these times.

Question 310

True or False: It is advisable to delay defecation.

Answer 310

False ## Footnote Delaying defecation can lead to hard stools and decreased urge to go.

Question 311

Why is it important to record bowel elimination patterns?

Answer 311

To identify problems early ## Footnote Regular monitoring helps in maintaining bowel health.

Question 312

What should be the approach towards the use of laxatives and enemas?

Answer 312

Use as ordered; avoid overuse ## Footnote Overuse can lead to dependence and inability to have a bowel movement without them.

Question 314

What are common gynecologic problems that can cause acute abdominal pain?

Answer 314

* Pelvic inflammatory disease * Ruptured ectopic pregnancy * Ruptured ovarian cyst ## Footnote These conditions are critical to consider during assessment for acute abdominal pain.

Question 315

Name three infectious diseases associated with acute abdominal pain.

Answer 315

* Escherichia coli 0157:H7 * Giardia * Salmonella ## Footnote These pathogens can lead to gastrointestinal symptoms and abdominal discomfort.

Question 316

List at least three inflammatory conditions that can cause acute abdominal pain.

Answer 316

* Appendicitis * Cholecystitis * Diverticulitis * Gastritis * IBD * Pancreatitis * Pyelonephritis ## Footnote Inflammation of abdominal organs is a significant cause of acute pain.

Question 317

What vascular problems can lead to acute abdominal pain?

Answer 317

* Mesenteric vascular occlusion * Ruptured aortic aneurysm ## Footnote Vascular issues can result in severe abdominal pain and require immediate attention.

Question 318

What are some other causes of acute abdominal pain?

Answer 318

* Obstruction or perforation of abdominal organ * GI bleeding or ischemia * Myocardial infarction * Trauma ## Footnote These conditions may mimic abdominal pain and should not be overlooked.

Question 319

What types of abdominal pain might a patient experience?

Answer 319

* Diffuse * Localized * Dull * Burning * Sharp ## Footnote Understanding the characteristics of pain can aid in diagnosis.

Question 320

What are some assessment findings related to acute abdominal pain?

Answer 320

* Abdominal distention * Abdominal rigidity * Diarrhea * Hematemesis * Melena * Nausea and vomiting * Rebound tenderness ## Footnote These findings provide critical information for assessment.

Question 321

What are signs of hypovolemic shock in a patient with acute abdominal pain?

Answer 321

* Low blood pressure * Cool, clammy skin * Decreased level of consciousness * Tachycardia * Low urine output (<0.5 mL/kg/h) ## Footnote Recognizing hypovolemic shock is essential for timely intervention.

Question 322

What initial interventions should be taken for a patient with acute abdominal pain?

Answer 322

* Ensure patent airway * Apply oxygen via nasal cannula or nonrebreather mask * Establish IV access with large-bore catheter and infuse warm normal saline or lactated Ringer's solution * Obtain blood for CBC and electrolyte levels * Obtain blood for amylase level, pregnancy tests, clotting studies, and type and crossmatch as appropriate * Insert indwelling urinary catheter * Obtain urinalysis * Insert NG tube as needed ## Footnote These steps are crucial for stabilization and further evaluation.

Question 323

What ongoing monitoring should be conducted for a patient with acute abdominal pain?

Answer 323

* Monitor vital signs * Monitor level of consciousness * Monitor oxygen saturation * Monitor intake/output * Obtain pain assessment * Assess amount and character of emesis * Anticipate surgical intervention * Keep patient NPO ## Footnote Continuous monitoring helps in detecting any changes in the patient’s condition.

Question 325

What should be provided to a patient experiencing ingestion problems?

Answer 325

Medication and other comfort measures ## Footnote Includes maintaining a calm environment and providing information to decrease anxiety.

Question 326

What are key indicators of hypovolemic shock?

Answer 326

Vital signs, intake and output, level of consciousness ## Footnote Ongoing assessments of these indicators are crucial.

Question 327

What does postoperative care depend on?

Answer 327

The type of surgery performed ## Footnote Refer to specific nursing care plans for detailed guidance.

Question 328

After surgery, what color should the drainage from an NG tube typically be after 12 hours?

Answer 328

Light yellowish-brown or greenish tinge ## Footnote Dark brown to dark red may indicate fresh blood.

Question 329

What does 'coffee-grounds' granules in NG tube drainage indicate?

Answer 329

Blood has been changed by acidic gastric secretions ## Footnote This indicates the presence of digested blood.

Question 330

What common conditions may cause nausea and vomiting after a laparotomy?

Answer 330

Surgery, decreased peristalsis, pain medications ## Footnote Antiemetics like ondansetron may be administered.

Question 331

What can lead to abdominal distention and gas pains post-surgery?

Answer 331

Swallowed air, reduced peristalsis, manipulation of abdominal organs, anesthesia ## Footnote Early ambulation helps alleviate these symptoms.

Question 332

What should a patient start on after surgery regarding diet?

Answer 332

Clear liquids ## Footnote Gradually progresses to a regular diet if tolerated.

Question 333

What are patients often restricted from lifting after surgery?

Answer 333

Anything heavier than a few pounds ## Footnote This is to prevent complications during recovery.

Question 334

What are the expected outcomes for a patient with acute abdominal pain?

Answer 334

* Resolution of the cause of acute abdominal pain * Relief of abdominal pain and discomfort

Question 335

What are common causes of abdominal injuries?

Answer 335

* Blunt trauma * Penetrating injuries

Question 336

What can result from injuries to solid organs in the abdomen?

Answer 336

Profuse bleeding leading to hypovolemic shock ## Footnote Examples include liver and spleen injuries.

Question 337

What risks are associated with hollow organ injuries?

Answer 337

Peritonitis ## Footnote This occurs when contents spill into the peritoneal cavity.

Question 338

What is abdominal compartment syndrome?

Answer 338

Excessively high pressure in the abdomen ## Footnote It can lead to respiratory failure and renal failure.

Question 339

What are classic manifestations of abdominal trauma?

Answer 339

* Guarding and splinting of the abdominal wall * Hard, distended abdomen * Decreased or absent bowel sounds * Abrasions or bruising * Abdominal pain * Hematemesis or hematuria * Signs of hypovolemic shock

Question 340

What does bruising around the umbilicus indicate?

Answer 340

Cullen sign, suggesting retroperitoneal hemorrhage ## Footnote Bruising around the flanks is known as Grey Turner sign.

Question 341

What may be heard in the chest if the diaphragm ruptures?

Answer 341

Bowel sounds ## Footnote This is an abnormal finding and indicates a serious injury.

Question 342

What does auscultation of bruits indicate?

Answer 342

Arterial damage ## Footnote This could signify serious vascular injury.

Question 344

What are the baseline laboratory tests included in diagnostic studies for abdominal trauma?

Answer 344

CBC and urinalysis ## Footnote These tests help assess the patient's condition and detect potential issues.

Question 345

Why might a patient have normal hemoglobin and hematocrit levels even when bleeding?

Answer 345

Fluids are lost at the same rate as red blood cells ## Footnote This can mask the severity of blood loss initially.

Question 346

What laboratory work is done in anticipation of possible blood transfusions?

Answer 346

Type and crossmatch ## Footnote This is crucial for preparing for potential transfusions.

Question 347

What are the most common diagnostic methods for abdominal trauma?

Answer 347

Abdominal CT scan and focused abdominal ultrasound ## Footnote The patient must be stable to undergo a CT scan.

Question 348

What is diagnostic peritoneal lavage used for?

Answer 348

To detect blood, bile, intestinal contents, and urine in the peritoneal cavity ## Footnote This procedure helps assess internal injuries.

Question 349

What should be administered if a patient is hypotensive due to abdominal trauma?

Answer 349

Volume expanders or blood ## Footnote This is part of emergency management.

Question 350

What is the purpose of an NG tube in the management of abdominal trauma?

Answer 350

To decompress the stomach and prevent aspiration ## Footnote This is important for maintaining airway safety.

Question 351

What factors influence the decision to perform surgery in abdominal trauma cases?

Answer 351

Clinical findings, diagnostic test results, and patient response to conservative management ## Footnote These factors help determine the most appropriate intervention.

Question 352

What is the characteristic nature of chronic abdominal pain?

Answer 352

Dull, aching, or diffuse ## Footnote This type of pain can arise from various abdominal structures.

Question 353

What are common causes of chronic abdominal pain?

Answer 353

* Irritable bowel syndrome (IBS) * Peptic ulcer disease * Chronic pancreatitis * Hepatitis * Pelvic inflammatory disease * Adhesions * Vascular insufficiency ## Footnote Identifying the cause is crucial for treatment.

Question 354

What initial steps are taken to diagnose chronic abdominal pain?

Answer 354

A thorough history and description of pain characteristics ## Footnote This includes assessing severity, location, duration, and onset.

Question 355

What diagnostic tests may be performed for chronic abdominal pain?

Answer 355

* Endoscopy * CT scan * MRI * Laparoscopy * Barium studies ## Footnote These tests help visualize and assess internal conditions.

Question 356

What characterizes irritable bowel syndrome (IBS)?

Answer 356

Chronic abdominal pain and altered bowel patterns ## Footnote Symptoms may include diarrhea, constipation, or a mix of both.

Question 357

How much more often does IBS affect women compared to men?

Answer 357

2 to 2.5 times more often ## Footnote This indicates a significant gender disparity in prevalence.

Question 358

What are potential psychological stressors associated with IBS?

Answer 358

* Depression * Anxiety * Panic disorders * Posttraumatic stress disorder ## Footnote These stressors can contribute to the development and exacerbation of IBS.

Question 359

What dietary intolerances may contribute to IBS symptoms?

Answer 359

* Gluten * Fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) ## Footnote Identifying and managing these intolerances can help alleviate symptoms.

Question 360

What are examples of oligosaccharides that may affect IBS?

Answer 360

* Wheat and rye products * Some fruits and vegetables * Onions * Garlic * Legumes * Nuts ## Footnote These foods can trigger symptoms in sensitive individuals.

Question 361

What is lactose and where is it found?

Answer 361

A disaccharide found in milk and milk products ## Footnote Lactose intolerance can lead to gastrointestinal symptoms.

Question 362

What is fructose and where is it commonly found?

Answer 362

A monosaccharide found in honey, apples, pears, and high-fructose corn syrup ## Footnote Fructose can also contribute to gastrointestinal discomfort.

Question 363

What are polyols and where can they be found?

Answer 363

Found in apples, pears, stone fruits, cauliflower, mushrooms, and artificial sweeteners like sorbitol ## Footnote These compounds can exacerbate symptoms for some individuals with IBS.

Question 365

What are the causes of blunt abdominal trauma?

Answer 365

Causes include: * Assault with a blunt object * Crush injury * Explosions * Falls * Motor vehicle collisions * Pedestrian event ## Footnote Blunt trauma is often associated with non-penetrating injuries.

Question 366

What are common assessment findings for abdominal trauma?

Answer 366

Common findings include: * Abdominal distention * Abdominal pain with palpation * Abdominal rigidity * Absent or 1 bowel sounds * Hematemesis * Hematuria * Nausea and vomiting ## Footnote These findings help in diagnosing the severity and type of abdominal injury.

Question 367

What are signs of hypovolemic shock in abdominal trauma patients?

Answer 367

Signs include: * Decreased blood pressure * Increased heart rate * Decreased level of consciousness * Tachypnea ## Footnote Hypovolemic shock indicates significant blood loss and requires immediate intervention.

Question 368

What surface findings might indicate abdominal trauma?

Answer 368

Surface findings may include: * Abrasions and bruising on the abdominal wall, flank, or peritoneum * Impaled object * Open wounds: lacerations, eviscerations, puncture wounds, gunshot wounds ## Footnote These findings can help to assess the extent of injury.

Question 369

What is the initial intervention for an unresponsive patient with abdominal trauma?

Answer 369

Assess circulation, airway, and breathing ## Footnote This is a critical step in emergency management.

Question 370

What should be done if a patient with abdominal trauma is responsive?

Answer 370

Monitor airway, breathing, and circulation ## Footnote Continuous monitoring is essential to ensure patient stability.

Question 371

What is the purpose of establishing IV access in abdominal trauma management?

Answer 371

To infuse normal saline or lactated Ringer's solution ## Footnote IV access is crucial for fluid resuscitation.

Question 372

What steps should be taken regarding external bleeding in abdominal trauma?

Answer 372

Control external bleeding with: * Direct pressure * Sterile pressure dressing ## Footnote Immediate control of bleeding is vital to prevent shock.

Question 373

What should be done with an impaled object in an abdominal trauma patient?

Answer 373

Stabilize impaled objects with bulky dressing—do not remove ## Footnote Removing an impaled object can cause further injury.

Question 374

What should be covered with a sterile saline dressing in abdominal trauma?

Answer 374

Protruding organs or tissue ## Footnote This helps to prevent contamination and further injury.

Question 375

When should an indwelling urinary catheter be inserted in abdominal trauma patients?

Answer 375

If there is no blood at the meatus, pelvic fracture, or boggy prostate ## Footnote This is to assess urinary function and potential injuries.

Question 376

What is the purpose of ongoing monitoring in abdominal trauma management?

Answer 376

To monitor vital signs, level of consciousness, O2 saturation, and urine output ## Footnote Continuous monitoring is essential for detecting changes in the patient's condition.

Question 377

How can patient warmth be maintained during ongoing monitoring?

Answer 377

Using: * Blankets * Warm IV fluids * Warm humidified O2 ## Footnote Maintaining warmth is critical in trauma care to prevent hypothermia.

Question 379

What are the Rome IV criteria for diagnosing IBS?

Answer 379

Presence of abdominal pain and/or discomfort at least 1 day per week for 3 months, associated with 2 or more of the following: related to defecation, change in stool frequency, change in stool form.

Question 380

What are the categories of IBS based on stool patterns?

Answer 380

* IBS with constipation (IBS-C) * IBS with diarrhea (IBS-D) * IBS mixed * IBS unsubtyped

Question 381

What are common symptoms of IBS?

Answer 381

* Abdominal distention * Nausea * Flatulence * Bloating * Urgency * Mucus in stool * Sensation of incomplete evacuation

Question 382

What non-GI symptoms may be associated with IBS?

Answer 382

* Fatigue * Headache * Sleep problems

Question 383

What is key to diagnosing IBS?

Answer 383

A thorough history and physical assessment.

Question 384

What factors should be assessed when diagnosing IBS?

Answer 384

* Symptoms description * Health history (including psychosocial factors) * Family history * Drug and diet history * Impact of symptoms on daily activities

Question 385

What diagnostic tests are used in IBS?

Answer 385

To rule out other disorders such as CRC, IBD, endometriosis, and malabsorption disorders.

Question 386

What are the main treatment approaches for IBS?

Answer 386

* Psychologic support * Diet and lifestyle changes * Drugs to regulate stool output and reduce discomfort

Question 387

What is the benefit of keeping a diary for IBS patients?

Answer 387

To help identify factors that trigger IBS symptoms.

Question 388

What dietary approach may help IBS patients?

Answer 388

Following a low-FODMAP diet.

Question 389

What are high-FODMAP foods that should be avoided?

Answer 389

* Garlic * Onions * Wheat * Dairy

Question 390

What is recommended for patients with IBS-C?

Answer 390

A high-fiber diet to produce soft, painless bowel movements.

Question 391

What are common drug therapies for IBS?

Answer 391

* Antidepressants * Antispasmodic agents (e.g., hyoscyamine, dicyclomine) * Rifaximin * Eluxadoline * Alosetron

Question 392

What is the mechanism of action of eluxadoline?

Answer 392

Decreases colonic contractions to reduce diarrhea and pain.

Question 393

What is a significant side effect of alosetron?

Answer 393

Severe constipation and ischemic colitis.

Question 394

What is appendicitis?

Answer 394

Inflammation of the appendix.

Question 395

What is the most common reason for emergency abdominal surgery?

Answer 395

Appendicitis.

Question 396

What is the common age range for developing appendicitis?

Answer 396

10 to 30 years of age.

Question 397

What causes appendicitis?

Answer 397

Luminal obstruction leading to distention, venous engorgement, and accumulation of mucus and bacteria.

Question 398

What are the clinical manifestations of appendicitis?

Answer 398

* Dull periumbilical pain * Anorexia * Nausea * Vomiting * Persistent pain shifting to right lower quadrant

Question 399

What diagnostic signs may indicate appendicitis?

Answer 399

* Rigidity * Rebound tenderness * Muscle guarding * Positive psoas sign * Positive obturator sign * Positive Rovsing sign

Question 400

What is the typical initial pain location in appendicitis?

Answer 400

Dull periumbilical pain.

Question 401

What type of fever may develop in appendicitis?

Answer 401

Low-grade fever.

Question 402

What should patients with IBS-C consider for treatment?

Answer 402

Linaclotide (Linzess) if laxative therapy is ineffective.

Question 403

What is a contraindication for linaclotide?

Answer 403

History of mechanical obstruction or prior bowel surgery.

Question 405

What is the preferred diagnostic procedure for appendicitis?

Answer 405

CT scan ## Footnote Ultrasound and MRI are also options.

Question 406

What is the standard treatment for appendicitis?

Answer 406

Immediate appendectomy ## Footnote This is the surgical removal of the appendix.

Question 407

What should be started before surgery for appendicitis?

Answer 407

Antibiotics and fluid resuscitation ## Footnote These help prepare the patient for surgery.

Question 408

What is the purpose of IV fluids and antibiotic therapy before appendectomy in case of a ruptured appendix?

Answer 408

To prevent dehydration and sepsis ## Footnote Especially important if there is evidence of peritonitis or an abscess.

Question 409

What are the key nursing management focuses for a patient with suspected appendicitis?

Answer 409

Preventing fluid volume deficit, relieving pain, preventing complications ## Footnote Ensure the stomach is empty in case surgery is needed.

Question 410

How long do patients typically stay in the hospital after an uncomplicated laparoscopic appendectomy?

Answer 410

24 hours ## Footnote Ambulation begins a few hours after surgery.

Question 411

What is peritonitis?

Answer 411

Inflammation of the peritoneum ## Footnote It may result from contamination of the peritoneal cavity.

Question 412

What are common causes of secondary peritonitis?

Answer 412

* Ruptured appendix * Perforated ulcer * Diverticulitis * Trauma from gunshot or knife wounds ## Footnote These lead to the release of contents into the peritoneal cavity.

Question 413

What is the most common symptom of peritonitis?

Answer 413

Severe, continuous abdominal pain ## Footnote Tenderness over the involved area is a universal sign.

Question 414

What are signs of peritoneal irritation in peritonitis?

Answer 414

* Rebound tenderness * Rigidity * Spasm ## Footnote Patients may lie still and take shallow breaths due to pain.

Question 415

What complications can arise from peritonitis?

Answer 415

* Hypovolemic shock * Sepsis * Intra-abdominal abscess formation * Paralytic ileus * Acute respiratory distress syndrome ## Footnote Peritonitis can be fatal if treatment is delayed.

Question 416

What diagnostic studies are conducted for peritonitis?

Answer 416

* CBC for WBC count and hemo-concentration * Peritoneal aspiration * Abdominal x-ray * Ultrasound and CT scans * Peritoneoscopy ## Footnote These help identify the cause and severity of the condition.

Question 417

What conservative treatment is provided for milder cases of peritonitis?

Answer 417

* Antibiotics * NG suction * Analgesics * IV fluid administration ## Footnote Surgery is indicated for severe cases to locate the cause of inflammation.

Question 419

Why is assessing the patient's pain important in peritonitis?

Answer 419

It helps to determine the cause of peritonitis ## Footnote Assessing pain location and quality can provide insights into the underlying issues contributing to peritonitis.

Question 420

What are some clinical problems associated with peritonitis?

Answer 420

* Pain * Fluid imbalance * Impaired GI function * Risk for infection ## Footnote These problems can complicate the patient's condition and require careful management.

Question 421

What are the overall goals for a patient with peritonitis?

Answer 421

* Resolution of inflammation * Relief of abdominal pain * Freedom from complications * Normal nutrition status ## Footnote Achieving these goals is critical for the patient's recovery.

Question 422

What is a key implementation step for managing a patient with peritonitis?

Answer 422

Establish IV access for fluid replacement and antibiotic therapy ## Footnote IV fluids help replace lost fluids and antibiotics treat the infection.

Question 423

What positioning may increase comfort for a patient with peritonitis?

Answer 423

Knees flexed ## Footnote This position can relieve abdominal tension and discomfort.

Question 424

What is gastroenteritis?

Answer 424

An inflammation of the mucosa of the stomach and small intestine ## Footnote It often presents with symptoms like diarrhea, nausea, and vomiting.

Question 425

What are common features of acute gastroenteritis?

Answer 425

* Sudden diarrhea * Nausea * Vomiting * Fever * Abdominal cramping ## Footnote These symptoms can indicate the presence of gastroenteritis.

Question 426

What is the most common cause of gastroenteritis?

Answer 426

Viruses ## Footnote Norovirus is a leading cause of foodborne outbreaks of acute gastroenteritis.

Question 427

What should be encouraged to prevent dehydration in gastroenteritis?

Answer 427

Oral fluids containing glucose and electrolytes ## Footnote These fluids help replace lost fluids and maintain electrolyte balance.

Question 428

What is inflammatory bowel disease (IBD)?

Answer 428

A chronic inflammation of the GI tract characterized by periods of remission and exacerbation ## Footnote IBD includes conditions such as Crohn's disease and ulcerative colitis.

Question 429

How is IBD classified?

Answer 429

* Crohn's disease * Ulcerative colitis ## Footnote The classification is based on clinical manifestations and the affected areas of the GI tract.

Question 430

What is the typical onset age for IBD?

Answer 430

Teenage years and early adulthood ## Footnote IBD can also have a second peak in the 6th decade of life.

Question 431

What is the suspected etiology of IBD?

Answer 431

An autoimmune disease involving an immune reaction to the intestinal tract ## Footnote The exact cause of IBD is still not fully understood.

Question 433

What does IBD stand for?

Answer 433

Inflammatory Bowel Disease ## Footnote IBD encompasses conditions like Crohn's disease and ulcerative colitis.

Question 434

What type of response is associated with IBD?

Answer 434

Inappropriate or sustained immune response ## Footnote This response is triggered by environmental and bacterial factors in genetically susceptible individuals.

Question 435

Where are the highest rates of IBD found?

Answer 435

Northern Hemisphere and industrialized nations ## Footnote The incidence varies based on geographic location and racial or ethnic background.

Question 436

What is the strongest risk factor for developing IBD?

Answer 436

Family history ## Footnote Many individuals with IBD have a family member who also has the condition.

Question 437

How do lifestyle factors influence IBD?

Answer 437

They increase susceptibility by changing the GI microbial flora ## Footnote Factors include diet, smoking, and stress.

Question 438

What dietary factors are thought to contribute to IBD?

Answer 438

High intake of refined sugar, total fats, PUFA, and omega-6 fatty acids ## Footnote Conversely, consuming more raw fruits, vegetables, omega-3-rich foods, and fiber decreases risk.

Question 439

Name some medications that increase the risk of IBD.

Answer 439

NSAIDs, antibiotics, and oral contraceptives ## Footnote These medications can alter gut health and immune responses.

Question 440

What genetic link is associated with IBD?

Answer 440

IBD occurs more often in family members of affected individuals ## Footnote This includes a higher incidence in monozygotic twins.

Question 441

How many genes associated with IBD have been identified?

Answer 441

Over 200 genes ## Footnote These genes may contribute to different forms of IBD, such as Crohn's disease and ulcerative colitis.

Question 442

Which major genes are related to Crohn's disease?

Answer 442

NOD2, ATG16L1, IL23R, and IRGM ## Footnote These genes are involved in immune system function.

Question 443

What is the pattern of inflammation in Crohn's disease?

Answer 443

Can occur anywhere in the GI tract, often involves the distal ileum and proximal colon ## Footnote It features skip lesions and inflammation through all layers of the bowel wall.

Question 444

What type of inflammation is characteristic of ulcerative colitis?

Answer 444

Mucosal layer inflammation in the colon and rectum ## Footnote It typically begins in the rectum and moves continuously toward the cecum.

Question 445

True or False: Fistulas are common in ulcerative colitis.

Answer 445

False ## Footnote Fistulas and abscesses are rare in UC since inflammation does not extend through all bowel wall layers.

Question 446

What are 'skip' lesions?

Answer 446

Segments of normal bowel between diseased portions ## Footnote These are characteristic of Crohn's disease.

Question 447

What complications can arise from Crohn's disease?

Answer 447

Bowel obstruction, abscesses, and peritonitis ## Footnote These complications occur due to deep inflammation and microscopic leaks.

Question 449

What is the usual age at onset for Ulcerative Colitis?

Answer 449

Teens to mid-30s; after 60

Question 450

What type of abdominal pain is commonly associated with Ulcerative Colitis?

Answer 450

Common, severe constant

Question 451

Is diarrhea common in Ulcerative Colitis?

Answer 451

Common

Question 452

What is the incidence of malabsorption in Ulcerative Colitis?

Answer 452

Minimal incidence

Question 453

What is the usual age at onset for Crohn's Disease?

Answer 453

Teens to mid-30s; after 60

Question 454

What type of abdominal pain is commonly associated with Crohn's Disease?

Answer 454

Common, cramping

Question 455

Is diarrhea common in Crohn's Disease?

Answer 455

Common

Question 456

What is the incidence of fever during acute attacks in Ulcerative Colitis?

Answer 456

During acute attacks

Question 457

What is the incidence of rectal bleeding in Ulcerative Colitis?

Answer 457

Common

Question 458

What is the incidence of tenesmus in Ulcerative Colitis?

Answer 458

Common

Question 459

What is the weight loss incidence in Ulcerative Colitis?

Answer 459

Rare

Question 460

What is the weight loss incidence in Crohn's Disease?

Answer 460

Common, may be severe

Question 461

Where does Ulcerative Colitis usually start?

Answer 461

Usually starts in rectum and spreads in a continuous pattern up the colon

Question 462

What is the pathologic depth of involvement in Ulcerative Colitis?

Answer 462

Mucosa

Question 463

What is the distribution pattern of inflammation in Ulcerative Colitis?

Answer 463

Continuous areas of inflammation

Question 464

Is small bowel involvement common in Ulcerative Colitis?

Answer 464

Rare

Question 465

Where can Crohn's Disease occur along the GI tract?

Answer 465

Occurs anywhere along GI tract. Most common site is distal ileum

Question 466

What is the pathologic depth of involvement in Crohn's Disease?

Answer 466

Entire thickness of bowel wall (transmural)

Question 467

What is a characteristic feature of Crohn's Disease?

Answer 467

Healthy tissue interspersed with areas of inflammation (skip lesions)

Question 468

What is the incidence of cancer in Ulcerative Colitis after 10 years of disease?

Answer 468

Common (because of toxic megacolon)

Question 469

What is the incidence of C. difficile infection in Ulcerative Colitis?

Answer 469

Rare

Question 470

What complication is more common in Crohn's Disease?

Answer 470

Perianal abscess and fistulas

Question 471

What is the incidence of strictures in Crohn's Disease?

Answer 471

Common

Question 472

What is a complication associated with Ulcerative Colitis?

Answer 472

Toxic megacolon

Question 473

What is the incidence of small intestinal cancer in Crohn's Disease?

Answer 473

Common

Question 474

What is the incidence of colorectal cancer (CRC) in Crohn's Disease compared to Ulcerative Colitis?

Answer 474

T Incidence of CRC but less than with ulcerative colitis

Question 475

Is the incidence of complications in Ulcerative Colitis severe?

Answer 475

Common (because inflammation involves entire bowel wall)

Question 476

True or False: Malabsorption is common in Crohn's Disease.

Answer 476

True