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NURS 522 > nurs 522 gi and universal preoperative care > Flashcards

nurs 522 gi and universal preoperative care Flashcards

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1
Q

Colorectal Cancer: Modifiable Risks

A

+ fat/- fiber diet
- physical activity
Obesity

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2
Q

Colorectal Cancer: Non-modifiable Risks

A

50+ age
Family history of polyps or colorectal cancer
Hereditary Non-polyposis Colorectal Cancer
Lynch syndrome
Inflammatory Bowel Disease

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3
Q

Colorectal Cancer: Diagnosis

A

Biopsy w/ colonoscopy
Fecal occult blood test annually
Colonoscopy Q10 years

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4
Q

Colorectal Cancer: Sigmoid and Rectum

A

Change in bowel habits

Hematochezia

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5
Q

Colorectal Cancer: Proximal Colon

A

Subtle
Fecal occult blood (early)
Bowel obstruction symptoms (late)

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6
Q

Colorectal cancer (Adenocarcinoma): surgeries

A

Colectomy w/o stoma
Diversion w/o colon resection w/ perm. loop stoma
Low anterior resection w/ or w/o temp. stoma
Abdominoperineal resection w/ perm. sigmoid/descending colostomy

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7
Q

Low anterior resection (LAR)

A 
If tumor mid/high rectum
0 use if tumor near anus/low rectum
2 stage procedure
Temp ileostomy or transverse colostomy
Anal canal and sphincters intact
0 perm colostomy
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8
Q

Abdominoperineal resection (APR): Mile’s Procedure

A

Low rectal tumors
Complete removal of rectum/anal sphincters
Perm. sigmoid/descending colostomy
Anal opening sewn closed
Wide resection of tissue/structures
Possible damage to pudendal nerve = sex. dysfunction

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9
Q

Posterior exenteration

A

Removal of sigmoid/descending colon, rectum, uterus, cervix, ovaries, fallopian tubes, vagina
Sigmoid colostomy

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10
Q

Anterior exenteration

A 
Removal of urethra, uterus, cervix, vagina, bladder
Urinary diversion (ileal conduit, colon conduit, Indiana pouch)
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11
Q

Total pelvic exenteration

A

Resection of all anterior and posterior pelvic structures
Advanced ovarian cancer not candidates 2nd to metastasis
Urinary and fecal diversions

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12
Q

Crohn’s Disease

A

Any portion of GI tract
Develops at terminal ileum
RLQ pan/cramping, fever, malaise, - weight, bleeding, extracolonic manifestations
Affects all layers of bowel wall
Skipped areas of ulceration = hallmark sign
Strictures, FISTULAS, abscess, bowel obstruction
0 surgical cure or continence diversions

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13
Q

Ulcerative Colitis

A

Confined to colon
Develops in rectum and moves proximally
Frank bleeding w/ diarrhea, TOXIC MEGACOLON
Ulcers in mucosa, continuous and circumferential
Seen on X-ray
Cured w/ removal of colon
May need ostomy

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14
Q

Total proctocolectomy

A

Rectum and anus removed

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15
Q

Familial Polyposis Coli

A

Hereditary
Premalignant polyps appear at puberty
Polyps progress to cancer w/i 10 years
Resection of colon and rectum - risk of cancer
Extra-intestinal manifestations (cysts, osteomas, duodenal tumors = Garder’s Syndrome)

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16
Q

Diverticulosis

A

Associated w/ diet
Disease of aging
Typically asymptomatic herniations of intestinal wall

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17
Q

Diverticulitis

A

Inflammations of intestinal wall herniations
0 evidence nuts/seeds obstruct
LLQ pain, rebound tenderness, fever, N/V, change in bowel habits, dysuria

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18
Q

Diverticular disease: medical management

A 
Treat infection
Bowel rest
Liquid diet
Tylenol
Slow introduction of fiber
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19
Q

Diverticular disease: surgical management

A

Last resort
If recurrent/non-responsive diverticular disease, full perforation, fistula, obstruction
Percutaneous drainage of abscess
Resection of bowel, colorectal anastamosis w/o diverting colostomy or w/ temp. diverting ostomy (Hartmann’s pouch)

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20
Q

Radiation Enteritis

A

Iatrogenic damage = bowel mucosa damaged by radiation (diarrhea, incontinence, cramping, pain, bleeding)
Treat symptoms
Surgery to manage bowel obstruction, necrosis, strictures, perforation
Bowel resection required
Temp. stoma

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21
Q

Blunt GI trauma

A

Watch/wait over immediate surgery
Eval for organ damage
Medically manage if 0 organ damage/perforation

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22
Q

Penetrating GI trauma

A

If rectal or major colon injury, repair w/ protecting loop colostomy

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23
Q

Ischemic Colitis: Signs/symptoms

A

Left colon including splenic flexure and sigmoid colon
More common in elderly
Early: left ABD pain, distention, urgency, diarrhea
Late: hemorrhage w/ clots, frank blood
Young: acute, + bleeding, self-limiting
Diagnosis w/ s/s + endoscopy

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24
Q

Ischemic Colitis: treatment

A

Medical: 2/3 resolve w/ NPO; IV hydration; antibiotics; vitals monitoring; d/c estrogens, decongestants, crack cocaine
Surgical: if peritonitis, perforation, or co-existing co-morbidities = bowel resection w/ temp diverting stoma

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25
Intestinal Obstruction
Partial or complete High morbidity and death Mechanical: volvulous, food bolus, adhesion, tumor Non-mechanical: ileuss/s: altered bowel sounds/output, distention, discomfort
26
Intestinal Obstruction: Management
Medical: NPO, NG tube, hydration, avoid opiates | Surgical management: If + risk of perforation = bowel resection w/ diverting stoma
27
Antegrade Continent Enema (ACE) Procedure
Severe constipation (spina bifida) Pt self-administers enema at cecum = BM Appendix , ileum or colon connect bowel w/ skin Complications: leakage of stool onto skin, perforation of bowel w/ catheter insertion
28
Inperforate Anus
Absence of opening | Co-existing anomalies (VACTERL)
29
VACTERL
``` Vertebral defects Anorectal anomalies Cardiovascular anomalies (ventricular septal defect) Tracheoesophageal defects (fistula) Esophageal atresia Renal defects (hydronephrosis) Limbs (webbed fingers, missing digits) ```
30
Necrotizing Enterocolitis (NEC)
Immature GI tract Ischemia s/s: ABD distention, feeding intolerance, abnormal xray Emergent surgery and temp ostomy xray: air in bowel wall (halo sign)
31
Hirschprung's Disease
Lack of ganglion cells and hypertrophic nerves to propel stool s/s: distention, obstruction tx: resection w/ pull-through, temp ostomy
32
Antegrade Continent Enema (ACE)
For severe constipation Pt may self-administer enema at cecum = bowel contraction /evacuation Use appendix, ileum, or colon to connect bowel w. skin Complications: leakage, perforation
33
Intestinal or Multi-Organ Transplantation
For permanent intestinal failure w/ life-threatening TPN-related complications (recurring sepsis, impending loss of central access, liver failure)
34
Jejunostomy
RUQ or RLQ 2nd to Ischemic Bowel Disease, Crohn's, trauma, NEC Small bowel resection Caustic effluent
35
Ileostomy
RLQ 2nd to Crohn's, CUC, FAP, congenital anomalies, trauma, NEC, ischemic bowel cancer Types: Total proctocolectomy (TPC), temp loop ileostomy, loop stoma, or bowel resection w/ temp loop ileostomy
36
Total Proctocolectomy (TPC)
Located in distal ileum | Traditional ileostomy
37
Transverse Colostomy
``` RUQ, LUQ 2nd to Diverticulitis, colon cancer, Crohn's, perforated bowel, obstructions, Hirschprungs, imperforate anus May include colectomy Temp loop stoma No active enzymes Semi-formed stool ```
38
Descending/Sigmoid Colostomy
LLQ Colorectal cancer, trauma, bowel perforation, Crohn's, ischemic bowel Abdominoperineal resection w. perm colostomy (APR): rectum and anus removed or end colostomy w/ Hartmann's procedure Stool formed/semi-formed
39
IPAA - Ileal Pouch Anal Anastamosis (Ileoanal Reservoir)
RLQ temp ileostomy PELVIC internal pouch CUC, FAP
40
IPAA - Ileal Pouch Anal Anastamosis (Ileoanal Reservoir)Stage I
``` Colon and most rectum removed Distal rectum and anus intact Pouch constructed from ileum Pouch anastomosed to distal rectum Temp loop ileostomy high in ileum May expel mucus ```
41
IPAA - Ileal Pouch Anal Anastamosis (Ileoanal Reservoir)Stage II
When suture lines healed, ileostomy takedown Stool fills pouch Evacuation via anus
42
ACE Procedure
RLQ at cecum or in umbilicus Colonic inertia = severe constipation, neurologic disorder (spina bifida, ALS, MS, SCI)Used in addition to restorative procedures (Mitrofanoff) Small opening made in umbilicus or appendix = stoma used for colon irrigation Stool exits via anus
43
Kock Pouch
``` RLQ CUC, FAP Used if continent diversion needed but 0 rectum or anus 2nd to TPC Total proctocolectomy w/ ABD ileal pouch Perm stoma Nipple valve for continence ```
44
Risk of mucosal atrophy due to NPO
At villi Villi connected to blood vessels Atrophy reversible, but = diarrhea
45
Section of bowel w/ greatest bacteria
Distal colon
46
IPAA (ileoanal reservoir) indicated for:
Chronic Ulcerative Colitis (CUC) | Familial Adenomatous Polyposis (FAP)
47
Location for ileostomy
RLQ
48
Location for sigmoid colostomy
LLQ
49
Symptoms of CUC
Anemia Bloody stool Diarrhea
50
Symptoms of Crohn's Disease
ABD pain/cramping | Fistulas
51
Stoma maturation
Bowel everted and sutured to ABD during surgery
52
Meds for management of Crohn's
CorticosteroidsImmune suppressants | Antibiotics
53
Rectal cancer at dentate line =
Abdominoperineal resection (APR) Removes diseased rectum Wide resection of tissue and lymph nodes Requires sigmoid colostomy
54
Low Anterior Resection (LAR)
Rectal cancer in middle of rectum
55
Total Proctocolectomy (TPC) and Ileal Pouch Anal Anastomosis (IPAA or IAR)
Removal of entire colon | Not indicated if disease limited to rectum
56
Pneumatosis Intestinalis
Halo sign Indicator for impending bowel perforation Seen in Necrotizing Enterocolitis (NEC)
57
Total Proctocolectomy and sexual function
Narrow resection of rectum Low risk of damage to pudendal nerve Erections still possible
58
Cause for abdominoperineal resection
Rectal cancer (Adenocarcinoma of colon/rectum)
59
Stoma w/ most corrosive effluent
Ileostomy | Most digestive enzymes in jejunum and ilium
60
Damage to inferior mesenteric artery
Provides blood supply to descending colon, sigmoid colon, proximal portion of rectum Ileostomy may be needed
61
Stoma site location considerations
Through rectus muscle Below belt line Away from umbilicus, creases, scars At apex of infraumbilical bulge
62
Treatment for carcinoma in upper and middle third of rectum
Low Anterior Recection (LAR)
63
Diverticulitis s/s
``` LLQ pain Fever N/V Change in bowel habits Palpable mass in LLQ ```
64
Complication of Diverticulitis requiring immediate surgery
Bowel perforation
65
Intussusception s/s
ABD pain Vomiting Palpable mass in RUQ Bloody (red currant jelly) stool
66
Intussusception medical management
Air enema reductions (may re-expand bowel) | Surgery needed if reduction unsuccessful, bowel necrosis, perforation, peritonitis

NURS 522 (3 decks)

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