LOWER GI Flashcards
(157 cards)
1
Q
Also known as surgical Abdomen
A
Acute Abdomen
2
Q
Sudden onset of abdominal pain without traumatic etiology and requires swift surgical intervention to prevent peritonitis, sepsis, and septic shock.
A
Acute Abdomen
3
Q
is the inflammation of the appendix
A
Appendicitis
4
Q
Obstruction of the appendix is caused by
A
-Fecalith
- Foreign bodies
- Infection
5
Q
Presenting symptom of appendicitis
A
Abdominal Pain
6
Q
What is the location or the localized pain of appendicitis?
A
Right Lower Quadrant
7
Q
Clinical Manifestation of Appendicitis
A
-Presenting symptom (abdominal pain that eventually becomes localized to RLQ
-Anorexia, nausea and vomiting
- Decreased or absent bowel sounds
- High grade fever: 38C-38.5C
- Rigid abdomen, guarding behavior
8
Q
Patient on left side-lying. Extended right leg is gently pulled back
A
Eliciting the Psoas Sign
9
Q
Patient is on supine. Right hip and knee flexed at 90⁰. Gently rotate thigh towards the midline
A
Eliciting the Obturator Sign
10
Q
What are the physical exam findings that indicate appendicitis?
A
(+) Mcburney’s Sign
(+) Rovsing’s sign
(+) Psoas sign
(+) Obturator sign
10
Q
rebound tenderness on RLQ
A
McBurney’s Sign
11
Q
RLQ pain upon deep palpation of LLQ
A
(+) Rovsing’s sign
12
Q
Pain on passive extension of the right thigh
A
(+) Psoas Sign
13
Q
Pain on passive internal rotation of the flexed thigh
A
(+) Obturator Sign
14
Q
-Sudden relief of abdominal pain followed by severe pain
- Abdominal rigidity
-Leukocytosis (WBC > 20,000/mm3)
A
Perforated Appendix
15
Q
-Fever
-Rigid Abdomen
- Early signs of shock (hypotension, tachycardia)
A
Peritonitis
16
Q
First Line Medical Surgical Management of Appendicitis
A
Conservative Medical management
-Antibiotic therapy, as ordered
- Decrease peristalsis to prevent rupture
-Bed rest
-Maintain NPO
-Avoid factors that increase peristalsis
- Hot compress over abdomen
-Laxatives
-Enema
17
Q
Second-line management of appendicitis
A
Surgical Management
18
Q
Surgical removal of the appendix by laparotomy or laparoscopy
A
Appendectomy
19
Q
For acute uncomplicated appendicitis
A
Laparoscopic appendectomy
20
Q
for ruptured appendicits
A
Open appendectomy
21
Q
What is the method of anesthesia for surgical management of Appendicitis?
A
Spinal
22
Q
Pre-Op of Appendectomy
A
-Facilitate signing of consent form
-Start IV line and pre-op antibiotics, as ordered
-Transport to OR ASAP
23
Q
Post-Op Nursing Care of Appendicitis
A
-Flat on bed 6 to 8 hours post op to prevent spinal headache
-Monitor return of sensation in the lower extremities
-Facilitate early ambulation (Day 0- day of surgery)
-Post op position: HIGH- FOWLERS to reduce tension on incision and abdominal organs
-DAT if bowel sounds are present
-Facilitate wound care and monitor surgical site for signs of infection
-Administer antibiotics, as ordered
24
What is the type of surgical drain when ruptured?
Penrose Drain
25
Discharge Instructions of Appendectomy
-Wound care
-Instruct to avoid heavy lifting post op, but can resume normal activity within 2 to 4 weeks
-Instruct on take home meds (i.e., antibiotics, analgesics
26
Saclike herniation of the lining of the bowel that extends through a defect in the muscle layer
Diverticulum
27
presence of multiple diverticula without inflammation or symptoms
Diverticulosis
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a diverticulum that becomes inflamed, causing perforation and potential complications
Diverticulitis
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Risk factors of Diverticular Diseases
-Increasing Age
- Low fiber Diet
- Obesity
- Family History
-Smoking
30
Clinical Manifestations of Diverticulosis
Asymptomatic
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Clinical Manifestation of Diverticulitis
C- chronic constipation
A- Anorexia
N- Nausea
A- Abdominal Pain (LLQ)
L- Low-grade Fever
32
Diagnostic in Diverticular Disease
- Screening test
- Permits visualization of the extent of diverticular disease
Colonoscopy
33
Confirmatory test of Diagnostic of Diverticular Disease
Abdominal CT Scan w/contrast
34
Localized pericolic or mesenteric abscess
Stage 1
35
Walled- off pelvic, intra-abdominal, or retroperitoneal abscess
Stage 2
36
Generalized purulent peritonitis
Stage 3
37
Generalized fecal peritonitis
Stage 4
38
-Outpatient treatment
-Rest, oral fluids, analgesic
-Clear liquid diet until inflammation subsides; then a high- fiber, low fat diet
Stage 1
39
Stage 2 in Medical-Surgical Management (Diverticular Diseases)
-May require hospitalization
-NPO
-Nasogastric decompression if with vomiting or abdominal distention
-IV fluids, as prescribed
-Broad-spectrum antibiotics, as ordered
-DOC: Ampicillin- sulbactam (Unasyn)
-Analgesics, as ordered
DOC: Oxycodone – does not cause constipation
40
Surgical resection of the colon with anastomosis
Hartmann Procedure
41
Hartmann Procedure
The inflamed area is removed and a primary end-to- end anastomosis is completed
One-stage resection
42
Used for diverticulitis with complications
Multi-stage Resection
43
Nursing Care of Patients with Diverticulosis
-Promote lifestyle modification
-High- fiber diet
-Encourage an individualized exercise program
-Smoking cessation
Prevent increase in intraabdominal pressure
-Bulk- forming laxatives, as ordered
-DOC: Psyllium fiber
-Liberal fluid intake of 2,000
mL/day
-Avoid nuts and seeds (sesame seeds, cucumber, tomatoes, popcorn)
44
exists when a blockage prevents the normal flow of intestinal contents through the intestinal tract
Intestinal Obstruction
45
Obstruction is due to narrowing of intestinal lumen
Mechanical Obstruction
46
-Most common cause: surgical adhesions
-Other causes: hernia, Chron’s disease, volvulus, tumor
Mechanical Obstruction
47
Obstruction is due to failure of the intestinal musculature to propel its contents
Functional Obstruction
48
-Most common cause: paralytic ileus
-Other causes: hypokalemia, cervical/thoracic/lumbar spinal cord injury
Functional Obstruction
49
The obstruction occurs anywhere along the small intestine
Small Bowel Obstruction (SBO)
50
Clinical Manifestations of Small Bowel Obstruction
C- Cramp-like Abdominal Pain
A- Absent flatus/stool, only mucus
R- Reflux vomiting
D- Dehydration (thirst, weakness, dry mucous membranes)
51
Medical Management of Intestinal Obstruction
-Rest the bowel
- Nasogastric decompression x 3 days
-IV fluids
-Treat reversible underlying cause
-Potassium replacement, f with hypokalemic
- Anti-inflammatory drugs, if with chron's disease
52
Herniorrhaphy
Hernia
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Adhesiolysis
Adhesions
54
Tumor Resection
Tumor
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The obstruction occurs anywhere along the large intestine
Large Bowel Obstruction
56
Clinical Manifestations of Large Bowel Obstruction
S-Slow onset of symptoms
C- Constipation
U- Unusual stool shape
B- Bleeding
A- Abdominal Distention (Late)
57
Performed to untwist and decompress the bowel
Colonoscopy
58
Surgical opening into the cecum for patients who are poor surgical risks; provides an outlet for releasing gas and a small amount of drainage
Cecostomy
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In both types of Obstruction, what we need to watch out for?
Watch out for:
-Discrepancies in I & O
- Worsening of pain or distention
-Increased NG output
60
Is the inflammation of the peritoneum (serous membrane lining the abdominal cavity)
Peritonitis
61
What causes peritonitis?
-Bacterial Etiology (E.coli, Klebsiella)
- Fungal Etiology
- External Causes:
-Abdominal Surgery
- Abdominal Trauma (Gun Shot Wound, stab wound)
62
A transparent membrane that covers the abdominal organs
Peritoneum
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Clinical Manifestations of Peritonitis
T- Temperature Elevation
A- Abdominal pain (Severe)
L- Loss of Appetite
E- Early signs of shock
R- Rigid, board-like abdomen
64
Medical Management of Peritonitis
-Oxygen supplementation
-IV fluid replacement (use large-bore IV cath)
-Isotonic Fluids: PNSS/PLR
- Broad- spectrum antibiotics, as ordered
-Decrease GI stimulation
-NPO
-Nasoenteric tube insertion and decompression
-Bed rest in semi- Fowlers
-Symptomatic treatment:
-Analgesics for pain
-Anti-emetics for n&v
-Encourage DBE to prevent respiratory complications
65
What needs to be closely monitor when patient is having a peritonitis?
Closely monitor the patient's VS as he/she may decompensate anytime
66
Vital signs must be monitored for how many minutes?
5 minutes using electrocardiac monitor
67
Diarrhea, constipation, or both may be the main manifestation
Irritable Bowel Syndrome
68
Affects women greater than men
Irritable Bowel Syndrome
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Age at time of diagnosis is less than 45 years old
Irritable Bowel Syndrome
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Diarrhea is the only main manifestation
Inflammatory Bowel Disease
71
Affects women = men
Inflammatory Bowel Disease
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Age at time of diagnosis is greater than 30 years old
Inflammatory Bowel Disease
72
Triggers of Irritable Bowel Syndrome
-Chronic Stress
-Sleep Deprivation
- Surgery
- Infections
- Diverticulitis
- Food (milk,yeast products, eggs, wheal products, red meat)
72
IBS type where main symptom is constipation
IBS- C
73
IBS type where the main symptom is diarrhea
IBS- D
74
IBS type where the main symptom is a combination of constipation and diarrhea
IBS-M
75
What is the associated symptoms of Irritable Bowel Syndrome
-Abdominal Pain which is precipitated by eating and relieved by defecation
-Bloating and distention
76
A diagnostic that is used to describe the shape and types of stool
Bristol Stool Chart
77
What are the types of bristol stool chart that cause constipation?
Type 1 and 2
78
What are the types of bristol stool chart that indicates Ideal Stool Forms
Type 3 and Type 4
79
Type of Bristol Stool Chart that indicates Diarrhea
Type 5, 6, 7
80
Irritable Bowel Syndrome
What drugs will you administer if diarrhea occurs?
- Loperamide (Diatabs)
- Alosetron (Lotronex): for severe IBS- D that persists for at least 6 months and is unresponsive to therapies
81
What are the symptoms of Irritable Bowel Syndrome
-Diarrhea
- Constipation
- Abdominal bloating and gas
- Abdominal pain
82
Irritable Bowel Syndrome
What drugs will you administer if constipation occurs?
-Psyllium fiber
83
Irritable Bowel Syndrome
What drugs will you administer if abdominal bloating and gas occurs?
-Probiotics (Lactobacillus)
84
Irritable Bowel Syndrome
What drugs will you administer if abdominal pain occurs?
-Dicyclomine
85
Nursing Management of Irritable Bowel Syndrome
Lifestyle Modification
- Emphasize and reinforce good sleep habits and good dietary habits
-Encourage to eat at regular times and to avoid food triggers
-Do not take fluid with meals as this may result to bloating
-Encourage smoking cessation and avoidance of alcoholic beverages
86
Risk factors of Inflammatory Bowel Disease (Environmental Exposures)
-Antibiotic use/abuse
- Hygiene Hypothesis
- Western Diet: highly processed/fast foods
- Cigarette smoking- increased risk for chron's
- Smoking cessation- increased risk for UC
- Oral contraceptives
- NSAIDS
-Lack of Vitamin D
- Air Pollution
- Urban Residence
- Temperate climate
87
What are the Layers of Intestinal Wall?
-Serosa
- Muscularis externa
- Submucosa
- Mucosa
88
is the subacute and chronic inflammation of the GI tract wall that extends through all the layers
Chron's Disease
89
Classifications of Chron's Disease
R- Regional Enteritis
R- Right side (Distal Ileum and ascending colon)
R- Remission and exacerbation
90
Clinical manifestations of Chron's Disease
C-Cobblestone Appearance
D- Diarrhea
RLQ Pain
-Crampy
- Occurs after meals
- Unrelieved by defecation
A- Avoidance behavior: avoids intake of food
W- Weight loss, malnutrition, anemia
S- String sign seen in barium studies
91
Indicates constriction of a segment of the intestine
String sign
92
Ulceration and inflammation of mucosal and submucosal layer
Ulcerative Colitis
93
Inflammatory changes begin in the rectum and progresses proximally into the colon
Ulcerative Colitis
94
Unpredictable periods of remission and exacerbation
Ulcerative Colities
95
Clinical Manifestations of Ulcerative Colitis
B- Bloody or purulent diarrhea
E- Elevated temperature
L- Left lower quadrant pain
A- Anorexia, weight loss, dehydration
T- Tenesmus (Intermittent)
96
Age of Onsets Jey differences of Chron's Disease and Ulcerative Colitis
Chron's Disease (20 to 29 years old)
Ulcerative Colitis (15 to 30 years)
97
Site of Onset key differences of Chron's disease and Ulcerative Colitis
Chron's Disease (Distal ileum and/or cecum)
Ulcerative Colitis (Rectum)
98
Progression Differences of Chron's Disease and Ulcerative Colitis
Chron's Disease (Distally, but some areas of the colon are skipped)
Ulcerative Colitis (Proximally and mat affect entire length of colon)
99
Layers involved differences in chron's disease and ulcerative colitis
chron's disease (transmural)- affect all parts of intestinal wall
Ulcerative Colitis (left lower quadrant)
100
Severity of Diarrhea Differences of Chron's disease and Ulcerative Colitis
Chron's Disease (Less severe, may involve steatorrhea)
Ulcerative Colitis (Severe and may be bloody)
101
What is the treatment of medication for Ulcerative Colitis?
Aminosalicylates
102
The drugs of Aminosalicylates
-Sulfasalazine (Asulfidine)
- Mesalamine (Asacol)
103
For treatment of flare ups and maintenance of remission
Aminosalicylates
104
Side effects of Aminosalicylates
Folate deficiency anemia (if it occurs, give folic acid as ordered)
105
Treatment of Medication for Chron's Disease
Corticosteroids
106
What are the corticosteroids drugs?
- Hydrocortisone (IV)
- Prednisone (PO)
- Dexamethasone (PO)
107
This kind of drugs is for acute flares only
Corticosteroids
108
Special Considerations of Corticosteroids
- Rapid Acting
- Cannot be used to maintain remission
- Dose must be tapered once remission has been induced
109
Indication of this drug is maintenance of remission
Immunomodulators
110
Special Considerations of Immunomodulators
- Slow- acting
- Should not be used to induce remission (has a 2 to 3 month lag period)
- Monitor CBC every month and LFT intermittently
111
What is the side effects of immunomodulators
Pancytopenia (Low RBC, low platelet, low WBC)
112
Inflammatory Bowel Diseases
Antibiotic Therapy Drugs of Choice
-Metronidazole (Flagyl)
- Ciprofloxacin (Ciprobay)
113
If patients develops peripheral neuropathy
Discontinue Metronidazole if patient develops peripheral neuropathy
114
# Chron's Disease
widening of a narrowed portion of the small intestine
Stricturoplasty
115
# Chron's Disease
Chron's Disease
removal of the affected portion of the colon and anastomosis of remaining parts
Bowel Resection
115
# Chron's Disease
Chron's Disease
Removal of the entire colon
Total Colectomy
116
# Chron's Disease
Chron's Disease
Removal of the entire colon and the rectum
Proctolectomy
117
Is the most common procedure to treat UC
Proctocolectomy with Ileal Pouch- Anal Anastomosis (IPAA)
118
What is the texture of ileostomy output?
Watery
119
PRE-OPERATIVE PREPARATIONS of Proctocolectomy with Ileal Pouch- Anal Anastomosis (IPAA)
Bowel Preparation
-Reduce risks of infectious complications and allow easier handling of the colon and rectum
- Enema until clear a day before surgery
-Clear liquid diet a day before surgery
- NPO on midnight before surgery
120
What kind of anesthesia is used in (IPAA)
General Anesthesia
121
What is the IntraOP position of IPAA?
Lithotomy
122
POST-OPERATIVE CARE of IPAA
-Reinforce health teaching on changes bowel patterns and stool characteristics
-Initially, expect to pass liquid stools up to 15 times a day
-Frequency will eventually slow down to three to eight per day, with a toothpaste consistency
-Drink copious amounts of fluids. Electrolyte drinks may be taken to correct electrolyte losses
Dietary modifications
-High carbohydrate diet (to thicken stool output)
-Small, frequent meals (to avoid large small- bowel loads)
-Avoid late night meals (to prevent nighttime awakenings for bowel movement)
123
occurs when the wall of a muscle weakens, and the intestine protrudes through the muscle wall of a cavity
Hernia
124
What are the risk factors of hernia?
-Multiparity
-Anything that increases abdominal
125
Clinical Manifestations of Hernia
-Bulging over herniated area which appears when patient stands or strains, and disappears when supine
-Pain (may or may not be present)
126
A portion of the intestine protrudes through the umbilicus
Umbilical Hernia
127
Occurs in the midline of the abdomen between the umbilicus and the xiphoid process
Abdominal Hernia
128
Occurs in the groin; most common
Inguinal Hernia
129
Complications of Hernia
-Incarcerated Hernia
-Strangulated Hernia
130
Hernias that do not return to the abdominal cavity with rest or manipulation and cause complete bowel obstruction
Incarcerated Hernia
131
Similar characteristic with incarcerated hernias but blood supply to hernia is cut off
Strangulated Hernia
132
A device that applies pressure to the hernia, thus keeping the intestine in the abdominal cavity.
Hernia Truss
133
Management of Hernia that involves making an incision in the abdominal wall, replacing the contents of the hernial sac, repairing the weakened tissue, and closing the opening.
Herniorrhaphy
134
Involves replacing the hernia into the abdomen and reinforcing the weakened muscle wall with wire, mesh, or fascia
Hernioplasty
135
Are dilated portions of veins in the anal canal
Hemorrhoids
136
This may be internal of external
Hemorrhoids
137
Appear outside the external sphincter
External Hemorrhoids
138
located above the internal sphincter
Internal Hemorrhoids
139
What type of degree in internal hemorrhoids that do not prolapse and protrude into anal canal
First degree
140
What type of degree in internal hemorrhoids that prolapse outside the anal canal during defecation but reduce spontaneously
Second degree
141
What type of degree in internal hemorrhoids that prolapsed to the extent that they require manual reduction
Third degree
142
What type of degree in internal hemorrhoids that prolapsed to the extent that they may not be reduced
Fourth degree
143
Causes of Hemorrhoids
-Constipation (most common)
-Pregnancy
-Obesity
-Liver Cirrhosis
-Right-sided heart failure
144
Clinical Manifestations of Hemorrhoids
-Constipation
-Anal pain
-Rectal bleeding with defecation (hematochezia)
-Anal itchiness
145
Collaborative Management of Hemorrhoids
-High- residue diet and increased oral fluid intake
-Bulk- forming laxatives, as ordered
(DOC: Psyllium)
-Cold packs to anal area followed by warm sitz bath
-Astringents, as ordered to reduce engorgement
(DOC: witch hazel)
146
The sclerosing agent is injected into the base of the hemorrhoid to cause blood vessel thrombosis, which helps prevent prolapse
Sclerotherapy
147
Sclerosing agent percent phenol in saline
5%
148
Hemorrhoid is visualized through an anoscope, and the proximal portion is grasped with an instrument
Rubber band Ligation
149
RUBBER BAND LIGATION
This band is slipped over the hemorrhoid.
Small rubber band
150
Surgical excision of hemorrhoids
Hemorrhoidectomy
151
How does hemorrhoids removed?
Hemorrhoids are removed with a clamp and cautery, or are ligated and then excised
152
Diet for patient with hemorrhoidectomy
Low residue diet to reduce bulk of feces
153
Hemorrhoidectomy Post-Operative Care
-Administer analgesics, as ordered
-Assist client to side- lying or prone position
-Apply ice packs over dressing for the first 12 hours to prevent bleeding
-Warm sitz bath 12 to 24 hours post op. Best time to do sitz bath is after every bowel movement
-Administer stool softeners, as ordered
-Encourage increase oral fluids and high- residue diet
-WOF: rectal bleeding, suppurative drainage, continued pain on defecation, continued constipation
