Intestinal/Rectal Disorders Flashcards
(79 cards)
1
Q
Constipation
A
- infrequent/irregular stools
- abnormal hardening of the stool
- decrease in volume of stool
- retention of stool for prolonged time
2
Q
What are some causes of constipation?
A
- meds
- physical condition
- endocrine disorders
- poor diet
- age/lifestyle
3
Q
S/S of Constipation
A
- < 3 bowel movements/week
- abdominal pain/distention
- anorexia
- straining w/ BM
- small, hard, dry stool
- hemorrhoids
- anal fissures
- hypoactive bowel sounds
4
Q
What can you do to help patient poop?
A
- increase fiber/fluid
- laxatives
- discontinue meds causing prob
- do not ignore urge
- relieve anxiety
- bowel training
5
Q
What to do with Bowel Training?
A
- improve consistency w/ stool
- establish regular time for elimination
- stimulate emptying on routine basis
6
Q
Complications from Constipation
A
- impaction
- hemorrhoids
- anal fissures
- megacolon
- straining
7
Q
How to treat an impaction and what to watch for?
A
- care w/ digital removal
- watch for Vagal Response
8
Q
What does the vagal response cause?
A
- bradycardia
- hypotension
- syncope
9
Q
How can hemorrhoids be treated?
A
sitz bath
analgesic ointment
creams
good hygiene
10
Q
What does straining cause?
A
- initially lowers BP
- secondary reaction is a rapid increase in BP above normal
- if patient strains too long may ultimately lead to vasovagal response
11
Q
Diarrhea
A
- increased frequency of BM
- increased amount of stool
- liquid/watery stool
12
Q
Acute Diarrhea
A
- < 2 weeks
- usually infectious
13
Q
Chronic Diarrhea
A
- > 4 weeks
- physiological conditions
14
Q
Risks for Diarrhea
A
- meds
- enteral feeding
- physiologic disorder
- infections
- food intolerance/allergies
- traveler’s diarrhea
15
Q
S/S of Diarrhea
A
- frequent, watery stool
- abdominal distention
- cramps
- intestinal rumbling
- hyperactive bowel sounds
- excessive thirst
- anorexia
- incontinence
16
Q
What can be done to treat diarrhea?
A
- treat underlying process
- control symptoms
- hydration
- low fiber/bulking diet
- avoid caffeine/carbonated beverages
- avoid milk, high fat foods, fresh fruits/veggies
17
Q
What meds can be taken to reduce number of stools?
A
Lomotil or Imodium
18
Q
What complications can occur from diarrhea?
A
- dehydration
- electrolyte imbalance-may cause Dig toxicity for those taking Digoxin
- skin breakdown
19
Q
What is the most common GI disorder?
A
irritable bowel syndrome
20
Q
Irritable Bowel Syndrome (IBS)
A
- colon becomes hypersensitive
- overreacts to stimulation
- instead of slow rhythmic muscle movements you have muscle spasms
21
Q
S/S of IBS
A
- diarrhea/constipation (separate or mixed)
- pain brought on by eating and improved with defecation
- abdominal distention
22
Q
Treatment for IBS
A
- relieve pain
- control symptoms
- learn triggers
- high fiber/increase fluids
- antidepressants/antispasmodics
- smoking/alcohol cessation
- small, frequent meals
- reduce stress
23
Q
Malabsorption
A
-inability to absorb major vitamins, minerals, and nutrients
24
Q
What are some causes of malabsorption?
A
- celiac sprue
- Zollinger-Ellison Syndrome
- gastric/intestinal surgeries
- lactose intolerance
- inhibited bacterial growth in bowel
25
S/S of Malabsorption
- loose, bulky stools/diarrhea
- gray color/yellow
- fatty/oily stool, foul smelling stool
- abdominal distention/pain
- fatigue/malaise
- weight loss/malnutrition
- easy bruising
- osteoporosis
- vision probs
26
Treatment for Malabsorption
- supplementation of vitamins, minerals, nutrients
- management for primary disease state
- anti-diarrheal
- oral/IV fluid
- monitor/treat complications
27
Appendicitis
inflammation of the appendix leading to increased pressure w/in the appendage
28
What is the most common reason for emergency abdominal surgery?
Appendicitis
29
S/S of Appendicitis
- vague/dull pain in the periumbilical area that progresses to RLQ as sharp pain
- low grade fever
- nausea w/w/o vomiting
- loss of appetite
- rebound tenderness
- constipation or diarrhea
30
How can appendicitis be diagnosed?
- physical exam
- symptoms
- labs-CBC (elevated WBC's)
- diagnostic imaging- abdominal x-ray/CT scan
31
Treatment for Appendicitis
- surgery usually immediate
- prophylactic antibiotics
- IV fluids
- NPO
32
Perforation of Appendix
rupture of appendix
- peritonitis
- abscess
33
What happens with pain and perforation of appendix?
Pain may be relieved initially w/ perforation but wide spread intense pain quickly returns
34
Treatment for Perforation
- abdominal cavity lavage
- JP drain 5-7 days post op-drainage will be increased b/c of washout, clear to pus colored
- NG tube until BS return
35
What does A-P-P-E-N-D-I-X stand for?
```
A-abdominal pain
P-point of McBurney's = most pain
P-poor appetite
E-elevated temp
N-nausea w/ or w/o vomiting
I-increase WBC's, inability to pass gas or BM
X-experiences rebound tenderness
```
36
Diverticulosis
weakening of intestinal muscle wall leads to herniation of the mucosa
-sac like pouch forms that collects bowel contents = diverticulitis
37
S/S of Diverticulosis/Diverticulitis
```
Losis
-vague GI symptoms
Litis
-acute onset of pain
-constant, mild, severe, most often LLQ
-fever, increased WBC's
-N/V
```
38
Colonoscopy Management
- clears liquids day before
- laxative prep afternoon/night before
- patent IV
- vital signs
- monitor for severe, acute pain, N/V, fever/chills, abdominal distention
39
Laxative Prep for Colonoscopy
- mix w/ something flavored
- keep chilled
- follow w/ chaser
- causes frequent forceful diarrhea
- bloating, cramping
- N/V
40
Treatment for Diverticulitis Outpatient
- clear liquid diet until symptoms are gone, then high fiber/low fat
- antibiotics 7-10 days (cipro & flagyl)
- OTC pain reliever (avoid NSAIDS)
- antispasmodics (bentyl & levsin)
41
Treatment for Diverticulosis Inpatient
- IV fluids/NPO
- NG tube to suction
- IV antibiotics
- Dilaudid for pain
42
Surgical Treatment for Diverticulosis
- Abscess-CT guided percutaneous drainage
- Resection (colectomy) w/ anastomosis
- Colectomy w/ double barreled colostomy
43
CT Guided Percutaneous Drainage
imaging guidance used to place a needle or catheter through skin into the abscess to remove or drain infected fluid
-offers faster recovery
44
Resection w/ Anastomosis
area of diverticulitis removed and two remaining ends are rejoined
45
What are some complications from Diverticulosis Surgery?
DVT
pneumonia
infection
hemorrhage
46
Complications of Diverticulitis
- peritonitis
- abscess
- perforation
47
Peritonitis (Hot Abdomen)
inflammation of the lining of abdominal cavity and lining of organs w/in (peritoneum)
48
S/S of Acute Abdomen (Early) Peritonitis
- generalized pain aggravated by movement
- N/V
- low grade fever
- diminished BS
49
S/S of Late Stage Peritonitis
- constant, localized at site of infection
- rigid abdomen/distention
- rebound tenderness
- tachypnea, tachycardia, hypotension, dyspnea
- leukocytosis
50
Treatment for Peritonitis
- IV fluid Bolus-treat hypovolemia
- pain meds/antiemetics
- NG tube for decompression
- respiratory assistance
- high dose, broad spectrum antibiotics
- surgery to treat cause
51
Crohn's Disease
inflammatory bowel disease that leads to chronic inflammation w/ development of scattered ulcerations on the mucosa
52
S/S of Crohn's Disease
- comes on gradually
- pain (RLQ) unrelieved by defecation
- fatigue
- diarrhea/intense cramping especially after eating
- weight loss/malnutrition/anemia
- electrolyte imbalances
53
Complications from Crohn's Disease
- perforation
- anal fissures
- anal fistulas
54
Anal Fissure
tear
55
Anal fistula
tunnel that develops between the skin and anus
56
Intestinal Symptoms of Crohn's Disease
- arthritis
- tender, red nodules
- eye disorders
- oral ulcers
57
Ulcerative Colitis
chronic disease of the colon in which the lining of the colon becomes inflamed and develops ulcerations that are continuous in nature
58
S/S of Ulcerative Colitis
- bloody mucous diarrhea/+ guaiac
- abdominal pain
- urgency/constant feeling of need to defecate
- fever/fatigue
- anorexia/weight loss/malnutrition
- N/V, dehydration
59
Complications of Ulcerative Colitis
- hypovolemic shock
- perforation
- kidney stones
- colon cancer
- hemorrhage
- toxic mega colon
60
Toxic Megacolon
- chronic distention of the colon
- abdominal pain
- distention
- tachycardia
- fever/diarrhea
- if not responsive to treatment w/in 72 hrs surgery is necessary
61
What part of the colon does Crohn's disease effect?
Ascending, transverse, and descending
62
What part of the colon does Ulcerative Colitis effect?
Descending into the anus
63
Daily Treatment for Inflammatory Bowel Disease
- increase oral fluids
- low residue/high protein/ high calorie
- vitamin supplements
- avoid smoking, caffeine, alcohol, excessive dairy
- NSAID's will reduce likely bleeding
- methotrexate/Imuran/remicade (immunosuppressants)
64
Treatment for Flare-Ups of IBD
- NPO/IV fluids
- systemic corticosteroids
- IV antibiotics
- TPN for long term inability to tolerate PO
- antidiarrheal/bulking agent
- pain meds
- surgery
65
Polyps
- usually no symptoms (maybe bleeding)
- usually benign
- removal during colonoscopy
66
Colo-Rectal Cancer
- 3rd most common site for cancer
- 2nd common cause of death men 40-79
- early diagnosis w/ prompt treatment is best cure
- asymptomatic until late stages
67
When do screenings for Colo-rectal cancer begin?
age 50
68
How often are screens for Colo-rectal caner performed?
- NO fam hx q 10 years
| - Fam hx or findings q 5 yrs
69
Intestinal Obstructions
a blockage prevents the normal flow of digestive contents through the intestines
70
Small Bowel Obstructions
Most Common
- intussusception (telescoping)
- twisting of the bowel
- tumors/hernias
- adhesions
71
Large Bowel Obstructions
- tumors
- diverticulitis
- inflammatory bowel disease
72
Small Bowel Obstruction S/S
- acute symptoms
- colicky, wavelike, cramping pain
- blood/mucous may pass
- no stool
- vomiting of stomach contents, then bile, then feces
- abdominal distention
- diminished bowel sounds
73
Large Bowel Obstruction S/S
- progress slowly
- constipation
- melena
- stool becomes smaller in size
- abdominal distention
- weight loss/anorexia
- crampy lower abdominal pain
- fecal vomiting
74
Treatment for SBO
- NG tube for decompression
- NPO/IV fluids
- surgery to correct cause
75
Treatment for LBO
- colonoscopy for decompression and correction
- surgery to correct cause
- rectal tube for decompression
76
Pilonidal Cyst
- thought to be the result of a hair that grows into the subQ tissue
- may be congenital secondary to abnormal epithelial skin growth
77
Where do pilonidal cysts usually develop?
lower sacral area
78
S/S of Pilonidal Cyst
- asymptomatic until inflammation/infection
- redness
- swelling
- drainage at site
79
Treatment fir Pilonidal Cyst
- oral or IV antibiotics
- incision and drainage
- surgery if abscess forms
