Lower GI problems Flashcards
Primary causes of diarrhea
infectious organisms –> usually viruses (can be bc of PPIs)
Cdif is almost always hospital aquired –> (can be bc of broad spectrum antibiotics)
Diarrhea: upper GI, lower GI, CDI
upper: large volume watery stools
lower: small volume bloody diarrhea (fever)
CDI: colitis and intestinal perforation
When shouldn’t you give antidiarrheals?
for infectious diarrhea –> you won’t get the infection out
use antibiotics instead
How to treat cdif
wash hands - no sanitizer
oral vancomycin or fidaxomicin for 10 days
stop nonessential meds
if recurrent: fecal transplant
Which drugs cause constipation and why is constipation an issue?
opioids cause it –> take narcotics with stool softeners
obstruction leads to perforation
Acute abdominal pain
Medical emergency
-could be organ damage, obstruction, bleeding, perfortation, peritonitis
**give pregnancy test, then probably x-ray
abdominal trauma
can be blunt or perforating –> blunt is usually worse
often messes up liver or spleen
Concerns: shock, peritonitis, abdominal compartment syndrome (fucks with repiration and cardiac/kidney func)
IBS
chronic abdominal pain or discomfort along with weird bowel patterns
-no known cause, but phychological stuff impacts it
IBS-C = women
IBS-D = men
Appendicitis
fecalith obstructs lumen of appendix leading to distention, venous engorement, mucu/bacteria buildup, gangrene, perforation, peritonitis
Manifestations of appendicitis
pain at McBurney’s point esp with coughing/sneezing
jump on right foot or lie still with right leg flexed
How to treat appendicitis
immediate surgery to avoid rupture and peritonitis
Preop: IV fluid/pain meds; NPO, antiemetics
Peritonitis: primary vs secondary
primary = blood borne organisms
secondary = perforation of organs that spill contents into peritoneal cavity
complications of peritonitis
hypovolemic shock, sepsis, intraabdominal abscess, paralytic ileus, ARDS
Treatment of peritonitis
-may or may not require surgery
-IV for fluid and antibiotics
-analgesia and knees flexed for pain
-rest and sedatives for anxiety
-monitor VS, I/O, and O2
-antiemetic
-NPO!!! NG tube if needed
Gastroenteris
inflammation of stomach and small intestine
often from viruses in food
you don’t really do much - it goes away on its own
IBD
Inflammation of GI tract with sporadic periods of remision and exacerbation –> autoimmune
2 types:
Ulcerative colitis = colon
Crohn’s disease = anywhere- mouth to anus
Treat with steroids
Triggers for IBD
-diet, smoking, and stress which alter flora
-high sugar or fat intake
-low fruit, veggie, omega-3, or fiber
-NSAIDs, antibiotics, oral contraceptives
-genetic factors
Characteristics of Crohn’s
-ulcers, strictures, leaks, abscesses, fistulas
-weight loss
-pain
-fever
-diarrhea/cramping
-rectal bleeding
Ulcerative colitis characteristics
-affects mucosal layer and prevents absorption
-pseudopolyps form
-bloody diarrhea (sometimes w/ protein)
-anemia
-fever, weight loss, pain, fatigue
Complications of IBD
-hemorrhage, strictures, perforation, abscess, fistula, cdif, colonic dilation
-high risk of colorectal cancer
-malabsorption, liver disease, osteoporosis
-multiple sclerosis, ankylosing spondylitits
How to treat ulcerative colitis
Total proctocolectomy with ileal pouch/ anal anastomosis or permanent ileostomy
cures the issue, but is extremely mentally traumatic
How to treat Crohn’s disease
surgeries to resect disease sections with reanastomosis
-often recurs
-can result in short bowel syndrome
strictureplasty - opens narrowed areas
NOT CURATIVE
Food for IBD
sometimes can’t be tolerated during exacerbation
may need liquid enteral feedings
then gradually introduce foods again to determine what makes it worse
IBD in old ppl
proctitis and left sided UC more common
increased risk of hospitalization and mortality
increased risk of infection and cancer
anemia, malnutrition, volume depletion
my be physically unable to get to bathroom
