Lower GI problems Flashcards
what is gastroenteritis
inflammation of the mucosa of the stomach and small intestine
manifestations include nausea, vomiting, diarrhea, abdominal cramping, and distension
-fever, increased WBC
-blood or mucous may present in stool
-most cases self limiting
-pt may be NPO until emesis is stopped
-if dehydration has occurred, IV replacement may be necessary
what is inflammatory bowel disease?
-an autoimmune disease that currently refers to two disorders of the GI tract
what are the two disease of inflammatory bowel disease
Crohns disease and ulcerative colitis
- both commonly occur during teen and adulthood
- both diseases can be debilitating
what is ulcerative colitis?
- Inflammation involves the mucosa ONLY
- The disease begins in the rectum and spreads proximally along the colon in a continuous fashion
- multiple abscesses develop in the intestinal glands
what happens as ulcerative colitis advances?
- as the disease advances, the abscesses break into the submucosa, leaving ulceration
- these ulcerations also destroy the mucosal epithelium, causing bleeding and diarrhea
what are some clinical manifestations of ulcerative colitis?
- abdominal pain and bloody diarrhea
- mild disease, diarrhea may consist of one or two semi formed stools containing small amounts of blood per day
- in severe cases, diarrhea is bloody, contains mucus and occurs 10-20 times a day
- in addition, fever and weight loss, anemia, tachycardia, and dehydration are present
complications of ulcerative colitis?
- toxic megacolon (extensive dilation and paralysis of colon)
- bleeding, and fulminant colitis are the most common complications
- perforation is most often associated with toxic megacolon by may occur alone
A patient who has had ulcerative colitis for more than 10 years has an increased risk for what?
colorectal cancer
-pt should be screened regularly with colonoscopy
Diagnostic tests for ulcerative colitis?
- colonoscopy with biopsy
- other tests which can supplement diagnosis (barium enema, fecal sample, complete blood count (CBC), C-reactive protein (CRP), sedimentation rate (ESR)
(blood test, electroylte tests, protein levels)
What will a CBC test show for ulcerative colitis?
-shows iron-deficiency anemia from blood loss through stool
what will other diagnostic tests for ulcerative colitis show?
- decreased sodium, potassium, chloride, bicarc, and magnesium are caused by fluid & electroyle losses from diarrhea
- hypoalbuminemia is present with severe disease and results from protein loss from bowel
why is a stool culture collected for diagnostic examination for ulcerative colitis?
-stool cultures should be obtained to rule out infectious causes of inflammation
what drug therapy is available for ulcerative colitis?
- Sulphasalazine is effective
- oral prednisone (effective in tx of mild to moderate disease without systemic manifestations)
what drug has been used in severe cases of ulcerative colitis when a pt failed wo respond to the usual drugs (before surgery is considered)
-immunosuppressive drugs (cyclosporine)
what surgical therapy is available for ulcerative colitis?
Approx 80-85% of pts go into remission with help of therapy
15-20% will require surgery
-surgery is indicated for when:
-the pt doesnt response to tx
-exacerbations are frequent and debilitating
-massive bleeding, strictures, or obstruction
-carcinoma develops
Nutritional therapy for ulcerative colitis?
- the dietitian is important member of the team
- a high calorie, high protein, low residue diet with vitamin and iron supplements is frequently prescribed
- often, enteral supplements are parental nutrition are often necessary
what foods to avoid when have ulcerative colitis?
-cold foods, high residual foods (whole wheat bread, cereal with brain, nuts, raw fruit) and smoking increase GI motility and should be avoided
what is attention focused to during the acute phase of UC?
-focused on hemodynamic stability, pain control, fluid and electroyle balance, and nutritional supports
nursing implementations for UC?
- accurate intake and output records must be maintained
- the # and characteristcs of stools monitored
- teaching related to tx, drugs, diet, diagnosis tests, and disease and its managment is important
- rest is important in managing UC
What will any person who has 10-20 bowel movements a day with rectal discomfort have?
-they may present anxious, frustrated, discouraged, and depressed
what is Crohns disease?
- a chronic disease of unknown origin that can affect any part of the GI tract from mouth to anus
- often occurs between ages 15-30
- characterised by inflammation of segments of the Gi tract, most often in the terminal ileum and colon
- areas of involvement are usually discontinuous with skip lesions, with segments of normal bowel occurring between diseased portions
- the areas of inflammation can extend through all layers of the bowel walls
- care of crohns disease pt is similar to pt with UC
Onset of Crohns?
- usually comes with nonspecific complains such as diarrhea, fatigue, abdominal pain, weight loss, and fever
- diarrhea is usually NON bloody
what occurs when Crohns disease progresses?
-there is weight loss malnutrition dehydration electroyle imbalances anemia increased peristalsis pain around umbilicus and right lower quadrant possible perianal disease
Complications of Crohns?
- scar tissue from the inflammation and ulceration narrows the lumen of the intestine- may cause strictures and obstructions
- fistulas are an cardinal feature and may develop between segments of bowel
- fat malabsorption causes deficiency in the fat-soluble vitamins (A,D,E,K)
- the pt may have an intolerance to gluten
