Exam 6 (GU) Flashcards
(169 cards)
1
Q
long continuous 4-layer tract from mouth to anus
A
- mucosa (innermost layer)
- submucosa
- muscle
- serosa
2
Q
GI organs
A
mouth
esophagus
stomach
intestines (large & small)
rectum
anus
3
Q
GI-associated organs
A
liver
gall bladder
pancreas
peritoneum - mesentery & omentum
4
Q
autonomic
A
parasympathetic response
sympathetic response
5
Q
parasympathetic response
A
increased peristalsis (excitatory)
6
Q
sympathetic response
A
decrease peristalsis (inhibitory)
7
Q
enteric
A
meissner (submucosal) plexus
auerbach (myenteric) plexus
8
Q
meissner (submucosal) plexus
A
secretions, sensations
9
Q
auerbach (myenteric) plexus
A
GI motility
10
Q
What percentage of CO does the GI tract receive?
A
25-35%
25% at rest
35% right before digesting food
11
Q
Vessels involved in the GI tract
A
celiac artery
superior mesenteric artery (SMA)
inferior mesenteric artery (IMA)
empties into the portal vein
12
Q
Where does the celiac artery go?
A
stomach & duodenum
13
Q
where does the superior mesenteric artery (SMA) go?
A
small intestine and mid-large intestine
14
Q
where does the inferior mesenteric artery (IMA) go?
A
distal large intestine to anus
15
Q
where is the portal vein?
A
liver
16
Q
upper GI consists of
A
mouth
pharynx
esophagus
stomach
small intestines
17
Q
mouth consists of
A
lips (speech)
oral cavity (teeth, mastication)
tongue (chewing, talking, taste, speech)
salivary glands (lubricate food) –> parotid, submaxillary, sublingual (these are glands - salivary amylase is released and breaks down food)
18
Q
pharynx consists of
A
naso-, oro-, & laryngeal
initiate swallowing reflex
19
Q
esophagus consists of
A
hollow tube with striated skeletal muscle and smooth muscle
2 sphincters
20
Q
stomach consists of
A
(LUQ)
fundus
body
antrum/pylorus (& sphincter)
4-layer wall
21
Q
function of the stomach
A
store food
mix with gastric secretions
empty into small intestine
chyme
22
Q
stomach secretions
A
pepsinogen –> protien
HCl –> converts pepsinogen to pepsin
lipase –> fats
intrinsic factor –> contribute to vit B12 absorption
23
Q
small intestine consists of
A
coiled tube from the pylorus to the ileocecal valve
alkaline
microvilli
covered by the visceral peritoneum
24
Q
what are the sections of the small intestine?
A
duodenum
jejunum
ileum
intestinal villi & microvilli
25
what is the function of the small intestine?
digestion & absorption
26
lower GI consists of
large intestines
27
large intestines consist of
less coiled hollow tube
slower peristaltic movement
28
what are the sections of the large intestine?
ascending
transverse
descending
sigmoid colon
microorgansims
29
what is the function of the large intestine?
fecal formation & reservoir
water & electrolyte absorption
30
what does the mucosa do?
protects from acidic contents
produces bicarb that neutralizes and protects the GI tract
31
what is the submucosa connective tissue made up of?
connective tissue
glands
blood vessels
lymph nodes
32
what is the function of the peritoneum?
lines and covers the organs
visceral side to the organs
parietal side to the abdominal walls
33
mesentery
covers small intestines and large intestine
attaches to abdominal wall
contains blood vessels and lymph nodes
34
omentum
apron like portion that covers stomach to intestines
includes fat and lymph nodes
35
what is the function of the upper esophageal sphincter?
preventing vomit
(between mouth and the esophagus)
36
what is the function of the lower esophageal sphincter?
prevent acid from the stomach back into the esophagus - typically closed unless burping, vomiting, or swallowing
(between the stomach and the esophagus)
37
chyme
broken down chunk of food when it first comes down
38
how long does it take for the stomach to empty out food?
2-3 hours
39
what is the function of the pyloric sphincter?
help to prevent chyme from regurgitating back from small intestine or acid from coming and making it too acidic in the duodenum
40
what is the function of the ridges in the mucosa?
ridges and bumps to give the stomach more surface area
also has glands to secrete pepsinogen, HCl acid and water to help with food breakdown
41
what is the function of the ileocecal valve?
prevent waste from regurgitation into the small intestine
42
what is the function of the intestinal villi and microvilli?
increases surface area of intestine
43
what are carbs, fats, and proteins digested into?
carbs --> simple sugars, monosaccarides
fats --> glycerol, fatty acids
protein --> amino acids
44
what is the purpose of microorganisms?
health bacteria that should be there
produce vit K and vit B
deamination of amino acids to ammonia carried to liver to turn to urea and excreted as urine
byproduct is gas
45
ingestion organs
mouth
salivary glands
oropharynx
esophagus
epiglottis
(Issues with any of these may result in problems with consumption and absorption)
46
ingestions process
deglutination (swallowing) + mastication (chewing)
47
what influences ingestion?
appetite, glucose levels, temp, and stomach contents
48
ghrelin hormone
stimulate appetite
49
leptin hormone
inhibit appetite
50
digestive organs
mouth
stomach
small intestines
51
What is digestion?
physical and chemical breakdown of food into absorbable substances
52
DIGESTION digestive secretions
gastric enzymes (HCl acid, pepsinogen, intrinsic factor- helps absorb cobalamin)
pancreatic enzymes (amylase, lipase)
liver & gallbladder enzymes (bile)
53
what is absorption?
triggered by the movement of chyme past the pyloric sphincter
uptake of nutrients from the gut into the bloodstream
54
ABSORPTION digestive secretions
amylase
lipase
bile
(these are pancreas, gall bladder, and liver enzymes to further break food down)
55
What is elimination?
final absorption and defecation
produces: feces, some vit, urea, gas
happens in the large intestine
56
what is the process of defecation?
vagal stimulation!
stim by parasympathetic response
feces and rectum pressing against vagus nerve
75% water 25% bacteria, epithelial cells, undigested food
57
what is the valsalva maneuver?
vagal stimulation --> too hard --> hypotensive --> increased intraabdominal pressure
not good for patients with head trauma, eye injury, cardiac disease, hemorrhoids, portal HTN with liver cirrhosis, abd surgery
58
subjective assessment
change in appetite
dysphagia
food intolerance
abd pain
N/V
bowel habits
changes in weight
last bowel movement
nutritional assessment
medication regimen
59
order of objective assessment
inspection
auscultation
percussion
palpation
60
RUQ
liver
stomach
gall bladder
duodenum
right kidney
pancreas
transverse colon
right adrenal gland
small intestine
61
LUQ
liver
left adrenal gland
stomach
left kidney
pancreas
spleen
transverse colon
small intestine
62
RLQ
large intestine
cecum
appendix
right ureter
right reproductive organs
63
LLQ
small intestine
large intestine
left ureter
sigmoid colon
left reproductive organs
64
radiology studies
Upper: assessing for stricture, hiatal hernias, foreign body in the upper portion
Lower: assessing colon - polyps, tumors, lesions, see the barium going through the colon
Nursing responsibility: assess for dye allergy, NPO status, let them know they should pass barium with stool it will be gray or white color, which is normal
65
endoscopy
Types:
ERCP --> gall bladder and pancreas
EGD --> esophagus, stomach, upper duodenum
capsule endoscopy --> radiographic pill is taken - belt will take images of pill as It moves through body
Nursing responsibility: sedation, NPO status, consent, education of procedure, bowel prep, good vitals pre and post op, endoscopy return of gag reflex, assess for bleeds or perforation, let pt know what type of pain to expect
66
colonoscopy or sigmoidoscopy
Nursing responsibility: lower GI study - same as other
67
what blood work will be taken in an objective assessment?
liver function studies
68
purpose of liver biopsy?
assess for CA, cirrhosis, liver disease
69
what labs would be drawn in an objective assessment?
CBC - signs of infection or anemia
CMP - will give electrolytes, kidney function, and liver function
Amylase or lipase - see if they're elevated
GI labs
fecal samples
70
changes in GI with aging
xerostomia - decreased saliva production
decreased appetite & taste buds
delayed emptying of esophagus
decreased HCl acid secretion
decreased liver size
gallbladder disease
risk for decreased food intake >85 yr
constipation
71
enteral feeding
Supplemental formulated nutrition administered directly into the GI system
increases nutrients & calories & easy to absorb
72
what indicates a need for enteral feeding or "tube feeding"?
decreased oral nutrition
unsafe for PO nutrition
73
types of enteral feeding
NG/OG/Naso-ingestinal tube
gastrostomy (G-tube) or jejunostomy (J-tube)
PEF tube (g or j, or combo put in using radiography)
74
NG/OG/Naso-ingestinal tube
short term use (<4 weeks)
they are called transpyloric feedings - tube is placed past the pyloric sphincter, smaller lumen, is harder to check for residual, is more prone to occlusion, dislodged easily if severe coughing or vomiting
75
gastrostomy (G-tube) or jejunostomy (J-tube)
extended feedings
can be a combined tube or an individual tube
placed endoscopically (PEG tube) = less risk) or surgally (infection risk) IV sedation, IV anbx if open procedure, decreased risk for aspiration, used in 4-24 hrs depending on how they were places, needs to be confirmed with imaging, pts can have J tube by itself (chronic reflux helps to decompress)
76
complications of enteral feedings
constipations
dehydration
diarrhea, vomiting - common elderly with glucose intolerance
aspiration - common in elderly
77
enteral therapy nursing responsibilities
aspiration risk - HOB 30-45%
tube position - KUB confirmation
site care
patency - flush with 30mL
connections
residuals
continuous feed, if possible
oral suctioning & oral care
78
Parenteral nutritional therapy
nutrients directly to blood through vein
mixture of vits, dextrose, protein & electrolytes
- 1g/kg/day
79
limitations & contradictions of Parenteral Nutrition
contradictions: hyperlipidemia (already have trouble metabolizing fats and giving them something that is already high in fats), pts with egg and soy allergies because there are egg phospholipids
limitations: not as good as the enteral feeding because its going through blood and not being absorbed in the GI tract, used in pts who can't use GI tract
80
types of parenteral nutrition
peripheral parenteral nutrition (PPN)
Central parenteral nutrition (CPN)
81
peripheral parenteral nutrition (PPN)
short term use
fewer nutrients, less hypertonic
increase risk for phlebitis
use subclavian or ithe nner brachial vein
larger gauge IV
** Careful with parenteral nutrition - it looks just like IV fluid - wrong connections
82
Central parenteral nutrition (CPN)
long-term use
high protein, high calorie, high glucose
hypertonic solution
subclavian or peripheral vein access
83
complications of parenteral therapy
hypo or hyper glycemia
weight changes
infection
84
pertinent medications for GERD & Gasritis
PPIs (-azole)
H2 receptor blockers (-idine)
antacids
prokinetics
cytoprotective
NSAIDs
Vitamin B12
85
PPIs (-azole) function
reduce the production of HCl
long-term use concern: magnesium & vit B deficiency causing cardiac arrhythmias, kidney disase, decrease bone density, risk for demetia
used to treat H. pylori, coupled with Abx (bleed, ulcer)
86
PPIs (-azole) medications
omeprazole
esomeprazole
pantoprazole
prilosec
87
H2 receptor blockers (-idine)
also reduce acid
50% efficacy
best response to a combo of H2 receptor blocker and PPI
both possible SE: abdominal pain
88
Antacids function
neutralize HCl
concern: can cause imbalances electrolytes, use caution is people with cardiac issues and renal failure (can't filter), the elderly
Ineffective for severe or frequent symptoms
decreases absorption or enhances effects of many meds pt take (benzos, diazapens, thyroid med)
take 1-3 hours before eating for after meal or at bedtime
89
Antacid medications
aluminum hydroxide
calcium carbonate
sodium bicarbonate
sodium citrate
Maalox, Mylanta
90
prokinetics function
increase the LES (lower esophageal sphincter) pressure & gastric emptying
decrease reflux
used for patients who have delayed gastric emptying
91
prokinetics medications
metoclopramide (reglan)
baclofen
92
cytoprotective function
sucralfate - form a protective mucosal layer, protect the esophagus, stomach, duodenum
misoprostal - decrease HCl production, increase mucosal bicarb to neutralize HCl, slows down an prevents further disruption of clotting factors, for people with ruined barriers
93
cytoprotective medication
sucralfate
SE: diarrhea, caution in pregnancy
Misoprostol (synthetic prostaglandin)
SE: diarrhea
94
concern when using NSAIDs
used for pain but increases the risk for GI bleed
95
vitamin B12 function
helps with RBC production & nervous system
*pt loses cobalamin - need it to help with B12 production
96
gastroesophageal disease
not a disease but a symptom of repeated mucosal damage
reflux of gastric acid into the lower esophagus
most common GI order
97
gastroesophageal disease risk factors
weak (incompetent) LES
obesity
smoking
hiatal hernia
drugs, alcohol, spicy foods
98
GERD clinical manifestations
pyrosis (heart burn - if >40, tx like angine, heart attack unless ruled out)
dyspepsia (abdominal pain)
regurgitation
dyspnea, cough, wheezing
hoarseness
nocturnal discomfort or disturbances
sore throat or globus sensation (lump in throat)
99
complications of esophagitis
irritation of esophagus leading to inflammation
can ulcerate
100
complications of esophageal metaplasia
Barrett's esophagus (non-cancerous change in cells, damage to lower portion (below sphincter)
precancerous lesions
101
respiratory complications
acid irritates upper airway
bronchospams, laryngospasms, circospasms, wheezing
102
oral complications
dental erosion due to acid sitting in the mouth
103
GERD diagnostic testing
based on symtoms & repsonse to med therapy
endoscopy - assess lower esophageal sphincter, looks for stricture and scars
biopsy & cytology - looking for cancer
motility studies - assess LES, esophageal function
readionuclide studies - asses the rate of esophageal reflux and clearance of gastric content
104
GERD treatment
lifestyle modifications - eating, weight, smoking
drug therapy - PPIs, H2 blocker, antacids, cytoprotective, prokinetics
nutritional therapy - avoid irritants, reduce acid producing foods
surgical therapy - fundoplication (nissan & toupet), LINX reflux management system
105
Gastritis
gastric mucosal inflammation
caused by the breakdown of the mucosal barrier HCl & pepsin
leads to tissue edema and hemorrhage - stomach cancer
106
gastritis risk factors
drugs - NSAIDS, aspirin, corticosteroids (decrease prostaglandin production which protect mucosal lining), most common in women, >60 years, most common reason for ulcers, anticoag
diet
microorganisms - H. pylori most common cause
environment - smoking
bile or pancreatic acid reflux - dt incompetent pyloric sphincter, may have acid go back into the stomach or duodenum
Procedures (NG, endoscopy, stress) - interfere with sphincter
diseases/disorders - autoimmune gastritis (attacks the parietal cells and decrease intrinsic factor and decrease hydrochloric acid --> decreased digestion food backs up, decreased absorption)
107
gastritis clinical manifestations
anorexia
N/V
epigastric pain
feeling full/bloated
hemorrhage
pernicious anemia (chronic) - dt intrinsic factor being damaged, no absorption of B12
108
acute gastritis
mucosa can repair
eliminating cause & avoiding trigger
109
chronic gastritis
poor mucosal repair, if at all
eliminating cause & medications
110
gastritis diagnostics
symptoms & history (alcohol/drug use)
endoscopy or colonoscopy
biopsy - assess for cancer)
CBC - assess for anemia
occult stool
H. pylori test
111
gastritis treatment
goal is to eliminate cause, avoid further irritation, supportive care
N/V --> NPO (clear liquid diet), IV fluids, antiemetics
vitals & I&O
H2-blockers & PPIs
antibiotics (treat H. pylori)
vitamin B12 (anemia)
NG tube
112
pertinent medications for GI bleeds & ulcers
PPIs (-azole)
H2 receptor blockers (-idine)
antancids
prokinetics
NSAIDS
cytoprotective
Anti-infectives
Anti-microbial
113
anti-infective function
clarithromycin - prevents H. pylori growth
amoxacillin - bactericidal (kills bacteria)
114
anti-infectice medication
clarithromycin SE: C diff, cardiac arrhythmias, hepatotoxicity
amoxicillin SE: C diff, seizures
115
anti-microbial function
kill bacteria while coating the stomach
116
anti-microbial medication
bismuth (pepto-bismal)
metronidozole (flagyl)
117
upper GI bleed
sudden onset, occult bleeding
severity depends on the vessel involved
medical emergency
once they've have a GI bleed their most likely to have another, the severity of it depends on vessels involved (arterial = more)
brown blood - old blood (coffee ground emesis)
melena - dark tarry (make sure they don't take iron it could be dt that)
118
upper GI bleeds types
occult: small amount
obvious: hematemesis (vomiting lots of blood) & melena (blood in stool)
119
upper GI bleed causes (esophageal)
chronin esophagitis - GERD, smoking, alcohol, drugs
esophageal varices - cough--> vessel burst --> bleed out
mallory-weiss tear - where esophagus meets the stomach --> severe vomiting (causing tear in vessels they're open and they bleed out, chronic alcoholic, chronic hyperemesis gravidarium - pregnant)
119
upper GI bleed causes (stomach & duodenal)
peptic ulcers (h. pylori) - most common
drugs (corticosteroids, low-dose aspirin, NSAIDs, chemo)
gastritis
polyps
stress-induced mucosal disease (physiologic stress ulcer)
stomach cancer
120
upper GI bleed diagnosis
labs
occult blood (guaiac) if blue - blood
endoscopy (cauterize, clip, inject meds)
angiography (if no endoscopy)
120
Labs to be drawn for upper GI bleed
CBC - anemia, blood loss
electrolytes - imbalances and shift
liver enzymes - protein breakdown and function
type & cross - anticipate transfusing patient
BUN - better tool! - can see protein breakdown
PT/PTT
ABG - metabolic acidosis
121
upper GI bleed treatment
goal is to stop bleeding, restore normal hemodynamic state, identify and treat causes, reduce anxiety and pain
122
abdominal rigidity is a sign of what?
peritonitis or perforation
123
hemorrhage over how many mL is concerning?
1500mL
body cannot replace easily
124
what are the symptoms of shock?
hypotension
weak and thready pulse
cool, clammy skin
restlessness
increased thirst
125
upper GI bleed intervention
1. IV x 2 (large bore) 18 gauge bilateral
EKG
urinary cath
supp O2
NG - contents out of the stomach
NPO
2. endoscopy within 24 hr
3. drugs (decrease HCl secretion, decrease bleeding, neutralize present HCl)
4. surgical therapy - monitor for continued blood loss
126
upper GI bleed patient teaching
disease process, avoid gastric irritants, home testing of vomit/stool, early treatment of upper respiratory infections
127
peptic ucler disease
erosion of the GI mucosa d/t HCl & pepsin
*can occur in an acidic environment OR a less acidic (neutralized) environment
neutralized = less acidic than it should be people eat foods they shouldnt and the body still tries to trigger Hcl to breakdown food but then the acid destroys the cell itself - don't need to know but know it can be both
128
peptic ulcer disease risk factors
h. pylori - 80% gastric ulcer, 90% duodenum ulcer, most common AFA, Hispanic American, >50 years
medications - NSAIDS/aspirin
smoking, alcohol, coffee
Zollinger-Ellison syndrome - a condition with increased acid secretion
129
peptic ulcer disease types
based on the duration of symptoms and location
acute - superficial erosion; resolves quickly
chronic - mucosal erosion with possible fibroid (lasts longer and doesn't have to be consistent)
gastric (stomach, antrum) - women, >50yrs, higher mortality, Sx: upper epigastric pain 1-2 hrs after meal, "gaseous or burning"
duodenal - most common, 34-45 yres, co-morbidities (COPD, pancreatitis, hyperparathyroidism), chronic in nature & penetrating, Sx: mid-epigastric or back pain 3-5 hrs after meal, "cramp-like"
130
peptic ulcer disease symptoms
dyspepsia
upper abdominal pain
(if GI bleed) --> nausea, hematemesis, melena
131
peptic ulcer disease complications
1. hemorrhage - duodenal> gastric
2. perforation (most lethal) - gastric > duodenal since population older, Sx: sudden severe abdominal pain d/t leakage of foods, gas, fluids, absent bowel sounds, RIGID ABDOMEN
3. gastric outlet obstruction - d/t edema, inflammation, pylorospasm, or fibrous scar tissue, pt will say they have more pain at the end of the day, the only relief is vomiting or burping, may need surgery
132
peptic ulcer disease diagnosis
labs: CBC, liver enzymes, amylase, stool
endoscopy
biopsy
barium radiology (if not endoscopy)
133
peptic ulcer disease treatment
goal is to decrease gastric acidity, enhance mucosal defense, and treat h. pylori (if cause)
1. conservative therapy
2. acute uncompromised therapy
3. acute complicated therapy
4. surgical therapy
134
1. conservative therapy
diagnostics
rest - small, frequent meals, reduce snacks, serial endoscopy to watch progression
drug therapy - stop NSAIDs/aspirin
lifestyle modifications - don't eat before bed, reduce alcohol, sit upright after eating
follow-up
135
2. acute uncomplicated therapy
NOP
NG suction
IV fluid
drugs
frequent vitals
136
3. acute complicated therapy (PUD + 1/3 things - hemorrhage, perforation, obstruction)
IV PPI, fluids, pain meds
treat complication - (hemorrhage = stop bleed and give back blood products this is why we did the H&H, they also might need albumin
perforation = leaking gastric fluid into the peritoneum at risk for peritonitis - rigid abdomen and decreased bowel sounds
obstruction = have NG tube, probably need endoscopy to figure out where it's a,t and they will repair it, monitor electrolyte because depending onthe location of obstruction, there isn't any absorption, pt needs bed rest)
bed rest
137
4. surgical therapy
A. partial gastrectomy - removal of distal 2/3 of the stomach, anastomosis of gastric stump to duodenum (gastroduodenostomy), anastomosis of gastric stump to jejunum (gastrojejunostomy), absorption rate is decreased when a part is removed: short bowel syndrome, slower motility, malnutrition
B. vagotomy - sever the vagal nerve to decrease gastric acid secretion, SNS response may not turn off, trouble with pooping
C. pyloroplasty - surgical reinforcement of the pyloric sphincter to ease passage, bile acids coming from the liver & pancreas can shoot back to the stomach if the sphincter is not working
138
Peptic ucler disease surgical treatmetn complications
post op bleed
sumping syndrome
postprandial hypoglycemia
bile reflux gastritis
139
dumping syndrome
everything dumps into the stomach and doesn't get broken down, causing them to feel weak and lightheaded
140
postprandial hypoglycemia
eat food --> body will produce too much insulin in response to not being able to break down food - shakey, weak, and dizzy - give glucose
141
bile reflux gastritis
reflux after eating bile back into stomach Tx is cholestyramin
142
peptic ulcer disease post op nursing cares
NG tube - monitor how much you aspirate off of it - bright red is ok after surgery but if it stays that way there is a bleed, also report if you are aspirating more than 200 - puts them at risk for hypovolemic shock
Assess bowel sounds
I & O
pain control
cough & deep breathing (splint abd)
patient teaching: nutritional therapy, vitamin supp (absorption may be altered d/t removal & anastomosis), reduce meal size, mod protein & fat
143
pertinent medications for inflammatory bowel disease
anti-microbial
aminosalicylates
corticsteroids
immunosuppressants
biologics
144
aminosalicylates medications
meslamine
5-ASA, most effective
least harmful on system
145
corticosteroid medication
methylprednisolone
146
immunosuppressant medication
methotrexate
147
biologics medications
adalimumab
SE: UTI, URI, TB, hepatitis
harshest - very severe sx if taking this
148
Inflammatory bowel disease
autoimmune disorder characterized by chronic inflammation
149
Inflammatory bowel disease population
caucasion
rural
women
<40 years and >60 years
jewish
family history
cause is unknown
150
IBD: Ulcerative colitis location
colon & rectum
151
IBD: Crohn's location
entire GI tract
152
factors that contribute to inflammatory bowel disease exacerbations
smoking
diet & stress
meds
genetic disorders
153
Inflammatory bowel disease clinical manifestations
diarrhea & malabsorption --> wt loss
abdominal cramping/pain
liver disease
fever & fatigue
154
Inflammatory bowel disease complications
cancer - d/t changing cell structure
strictures, fissures
perforation or abscesses
osteoporosis - malnutrition/malabsorption
ankylosing spondylitis - changes in spine, malabsorption
C. diff
proctitis & left-sided UC (elderly)
155
Inflammatory bowel disease: crohn's
chronic inflammatory disease involving al layers of the GI tract : RLQ, most common ascending & descending color or the terminal ileum, "gut to butt"
genetic mutations: inflammation simulates leukocytes trigger release of prostaglandin, proteases, nitric-oxide, causing further damage and further inflammation - that's what causes the micro leaks
"SKIP-LESIONS"
"cobblestone" appearance
156
Inflammatory bowel disease: crohns complications
fissures, deep ulcers, granulomas
abscesses
strictures
possible obstruction
small intestine CA
inflammation --> peritonitis d/t microscopic leaks
157
Inflammatory bowel disease: crohn's symptoms
non-bloody small volume (ratio of water to stool - there is less water) diarrhea
if there is blood in it they have fissures or tears at anus
can cause tons of cramping, urgency, and frequency, low-grade fever, depending on the severity of inflammation, abdominal pain, distension, RLQ pain, tachycardia
anemia is due to malabsorption of cobalamin
osteoporosis is due to malabsorption of vit D and calcium
158
Inflammatory bowel disease: ulcerative colitis
colorectal inflammation: from the rectum to the cecum, ulcers in the mucosal layer, and pseudopolyps develop in the lumen
159
Inflammatory bowel disease: ulcerative colitis classifications
mild = <4 semi-formed stools per day
moderate = 5-10 semi-formed stools per day - may cause hemorrhoids, tears, bleeding, dehydration, and turn to systemic symptoms like fatigue
severe = 10-20 stools per day - bloody mucosal diarrhea -will have fever, wt loss, anemia, dehydration, tachycardia
160
Inflammatory bowel disease: ulcerative colitis complications
fissures
toxic megacolon (chronic leaking) requires emergency colectomy
colorectal cancer
C. diff
161
Inflammatory bowel disease: ulcerative colitis symptoms
bloody diarrhea with large fluid loss since water and electrolytes aren't being absorbed
increased risk for perianal abscesses
constant urge to pass stool, fatigue, wt loss, pain when pooping, anemia, fever
162
Inflammatory bowel disease diagnostics
Labs: CBC & CMP (difficult in Na, K, mag, bicard, Cl), ESR & CRP, stool
Imaging: barium enema, small bowel series, transabdominal UD, CT, MRI, colonoscopy
163
Inflammatory bowel disease treatment
bowel rest
treat infection
symptom release
control inflammation & decrease exacerbations
correct malnutrition & restore fluid & electrolyte balance
improve quality of life
164
Inflammatory bowel disease acute phase treatment
exacerbation
pain control
hemodynamic stability
nutrition
electrolyte imbalances
monitoring I&O
any hematemesis or rectal bleeding
165
Inflammatory bowel disease ambulatory phase treatment
how to manage oneself at home
rest and diet management
perianal care - fissures
self hygiene
what symptoms will look like when they happen and when to seek treatment
tx is palliative, not a cure
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inflammatory bowel disease drug therapy treatment
promote remission
a. aminosalicylates
b. antimicrobials
c. corticosteroids
d. immunosuppressants
e. biologics
(least to most harmful)
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inflammatory bowel disease surgical treatment
done if pt has abd abscess or perforations, poor response to drug therapy, obstructions, anal rectal disease, a hemorrhage, or pt has had to stay on corticosteroids for too long
UC: total proctolectomy with ileal puch/anal anastomosis or with permanent ileostomy (curative)
Crohn's: address complications - remove inflamed sections, may lead to short bowel syndrome, stricture-plasty
