Lecture 3 Intestinal Disorders

Question 1

what are the components of the small intestine?

Answer 1

duodenum
jejunum
ileum

Question 2

what is the function of the small intestine?

Answer 2

absorb nutrients

Question 3

what are the components of the large intestine?

Answer 3

cecum
ascending colon
transverse colon
descending colon
sigmoid colon
rectum
anus

Question 4

what is the function of the large intestine?

Answer 4

absorb water and electrolytes

Question 5

what is IBS?

Answer 5

chronic changes in bowel function without evidence of tissue changes or inflammation

Question 6

risk factors for IBS

Answer 6

female sex
stress
diet - alcohol and caffeine

Question 7

clinical manifestations of IBS

Answer 7

constipation
diarrhea
abdominal pain, bloating, distention

Question 8

management of IBS

Answer 8

stress reduction
adequate sleep
exercise
restrict irritating foods

Question 9

medications for IBS

Answer 9

psyllium for fiber and dicyclomine for both types
loperamide and alosetron for IBS D
lubiprostone for IBS C

Question 10

dietary management of IBS

Answer 10

30-40 grams of fiber per day
food and bowel habit diary
avoid trigger foods
adequate fluid intake
avoid alcohol and smoking
probiotics

Question 11

what is primary peritonitis?

Answer 11

spontaneous bacterial peritonitis
usually see in people with liver disease and ascites

Question 12

what is secondary peritonitis?

Answer 12

related to perforation of abdominal organs and spillage of contents into abdominal caviity

Question 13

clinical presentation of peritonitis

Answer 13

diffuse abdominal pain or intense localized pain
pain worse with movement
rebound tenderness
rigid, distended abdomen
anorexia, N/V
paralytic ileus

Question 14

how is peritonitis diagnosed?

Answer 14

aspiration and culture of fluid
X ray
CT scan

Question 15

medications for peritonitis

Answer 15

analgesia
anti emetics
IV antibiotics

Question 16

treating peritonitis

Answer 16

drainage - pericentesis
surgery

Question 17

diverticulum

Answer 17

sac like herniation of bowel lining

Question 18

diverticulosis

Answer 18

existence of diverticula, asymptomatic

Question 19

diverticulitis

Answer 19

inflammation and infection of diverticula

Question 20

risk factors for diverticulitis

Answer 20

older age
low fiber diet
NSAIDs
family history

Question 21

complications of diverticulitis

Answer 21

fistulas
abscesses
perforation
hemorrhage
obstruction
peritonitis

Question 22

clinical manifestations of diverticulosis

Answer 22

chronic constipation

Question 23

clinical manifestations of diverticulitis

Answer 23

LLQ cramping, acute onset
constipation
bloating
nausea
fever
bleeding

Question 24

diagnosing diverticulitis

Answer 24

CBC for leukocytosis, decreased H&H
abd CT scan with contrast

Question 25

provider orders to anticipate for diverticulitis

Answer 25

electrolyte test NPO - bowel rest and potential surgery IV medications and fluid if NPO H&H pain meds, antiemetics if N/V

Question 26

nursing priorities for diverticulitis

Answer 26

s/s of electrolyte imbalances pain control s/s of infection

Question 27

uncomplicated diverticulitis management at home

Answer 27

clear liquid diet rest advance slowly to high fiber low fat diet maybe pain meds and antibiotics

Question 28

Hospital management of complicated diverticulitis

Answer 28

NPO IV fluids NG suction if vomiting and distention present antibiotics potentially opioid analgesia

Question 29

surgical interventions for diverticulitis

Answer 29

one-stage resection - anastomosis of intestine hartmann's procedure

Question 30

hartmann's procedure

Answer 30

proctosigmoidectomy - colon and rectum separated colostomy is created colostomy may be reversed at later time

Question 31

what is IBD?

Answer 31

inflammatory bowel disease inflammation or ulceration of bowel Crohn's or UC

Question 32

risk factor's for IBD

Answer 32

age race/ethnicity family history smoking use of NSAIDs viral illness

Question 33

what causes IBD?

Answer 33

immune response that causes inflammatory changes

Question 34

where does crohn's disease occur?

Answer 34

can affect all the layers of the bowel and can occur anywhere in GI tract most common is distal ileum and ascending colon

Question 35

long term bowel change from crohn's disease

Answer 35

bowel thickening and fibrosis can cause narrowing of intestinal lumen

Question 36

complications of Crohn's disease

Answer 36

intestinal obstruction malnutrition/malabsorption fistulas abscesses increased risk of colon cancer

Question 37

clinical manifestations of Crohn's

Answer 37

crampy abdominal pain worse after eating diarrhea and steatorrhea anorexia weight loss, anemia fever, leukocytosis

Question 38

how does diseased tissue of Crohn's differ from diseased tissue of UC?

Answer 38

crohn's - ulcers and edematous patches UC - desquamation, shedding of epithelium causes bleeding and diffuse lesions

Question 39

where does UC occur?

Answer 39

superficial - mucosal and submucosal layers affects rectum and colon

Question 40

long term bowel changes from UC

Answer 40

bowel shortens, narrows, and thickens

Question 41

clinical manifestations of UC

Answer 41

diarrhea with mucus, pus, blood LLQ pain cramping anorexia vomiting

Question 42

diagnosing UC

Answer 42

colonoscopy fecal occult blood test CBC stool studies to rule out other causes barium enema CT scan or MRI

Question 43

complications of UC

Answer 43

perforation bleeding toxic megacolon

Question 44

signs and symptoms of toxic megacolon

Answer 44

fever vomiting abdominal pain and distention

Question 45

treatment for toxic megacolon

Answer 45

NG suction IV fluids, electrolytes, antibiotics, corticosteroids surgery

Question 46

course of Crohn's vs UC

Answer 46

crohn's - prolonged and variable, may have exacerbations and remissions UC - exacerbations and remissions

Question 47

frecquence of bleeding Crohn's vs UC

Answer 47

Crohn's - bleeding is rare UC - bleeding is common

Question 48

skin and pouch care for ostomy

Answer 48

pouch should be worn at all times, with proper fit of wafter to avoid skin contact with stool inspect skin and check for seal empty regularly to avoid leaking or bursting

Question 49

diet after ostomy placement