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

nurs 522 gi and universal preoperative care Flashcards

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
Q

Intestinal Obstruction

A

Partial or complete
High morbidity and death
Mechanical: volvulous, food bolus, adhesion, tumor
Non-mechanical: ileuss/s: altered bowel sounds/output, distention, discomfort

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26
Q

Intestinal Obstruction: Management

A

Medical: NPO, NG tube, hydration, avoid opiates

Surgical management: If + risk of perforation = bowel resection w/ diverting stoma

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27
Q

Antegrade Continent Enema (ACE) Procedure

A

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
Q

Inperforate Anus

A

Absence of opening

Co-existing anomalies (VACTERL)

29
Q

VACTERL

A 
Vertebral defects
Anorectal anomalies
Cardiovascular anomalies (ventricular septal defect)
Tracheoesophageal defects (fistula)
Esophageal atresia
Renal defects (hydronephrosis)
Limbs (webbed fingers, missing digits)
30
Q

Necrotizing Enterocolitis (NEC)

A

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
Q

Hirschprung’s Disease

A

Lack of ganglion cells and hypertrophic nerves to propel stool
s/s: distention, obstruction
tx: resection w/ pull-through, temp ostomy

32
Q

Antegrade Continent Enema (ACE)

A

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
Q

Intestinal or Multi-Organ Transplantation

A

For permanent intestinal failure w/ life-threatening TPN-related complications (recurring sepsis, impending loss of central access, liver failure)

34
Q

Jejunostomy

A

RUQ or RLQ
2nd to Ischemic Bowel Disease, Crohn’s, trauma, NEC
Small bowel resection
Caustic effluent

35
Q

Ileostomy

A

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
Q

Total Proctocolectomy (TPC)

A

Located in distal ileum

Traditional ileostomy

37
Q

Transverse Colostomy

A 
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
Q

Descending/Sigmoid Colostomy

A

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
Q

IPAA - Ileal Pouch Anal Anastamosis (Ileoanal Reservoir)

A

RLQ
temp ileostomy
PELVIC internal pouch
CUC, FAP

40
Q

IPAA - Ileal Pouch Anal Anastamosis (Ileoanal Reservoir)Stage I

A 
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
Q

IPAA - Ileal Pouch Anal Anastamosis (Ileoanal Reservoir)Stage II

A

When suture lines healed, ileostomy takedown
Stool fills pouch
Evacuation via anus

42
Q

ACE Procedure

A

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
Q

Kock Pouch

A 
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
Q

Risk of mucosal atrophy due to NPO

A

At villi
Villi connected to blood vessels
Atrophy reversible, but = diarrhea

45
Q

Section of bowel w/ greatest bacteria

A

Distal colon

46
Q

IPAA (ileoanal reservoir) indicated for:

A

Chronic Ulcerative Colitis (CUC)

Familial Adenomatous Polyposis (FAP)

47
Q

Location for ileostomy

A

RLQ

48
Q

Location for sigmoid colostomy

A

LLQ

49
Q

Symptoms of CUC

A

Anemia
Bloody stool
Diarrhea

50
Q

Symptoms of Crohn’s Disease

A

ABD pain/cramping

Fistulas

51
Q

Stoma maturation

A

Bowel everted and sutured to ABD during surgery

52
Q

Meds for management of Crohn’s

A

CorticosteroidsImmune suppressants

Antibiotics

53
Q

Rectal cancer at dentate line =

A

Abdominoperineal resection (APR)
Removes diseased rectum
Wide resection of tissue and lymph nodes
Requires sigmoid colostomy

54
Q

Low Anterior Resection (LAR)

A

Rectal cancer in middle of rectum

55
Q

Total Proctocolectomy (TPC) and Ileal Pouch Anal Anastomosis (IPAA or IAR)

A

Removal of entire colon

Not indicated if disease limited to rectum

56
Q

Pneumatosis Intestinalis

A

Halo sign
Indicator for impending bowel perforation
Seen in Necrotizing Enterocolitis (NEC)

57
Q

Total Proctocolectomy and sexual function

A

Narrow resection of rectum
Low risk of damage to pudendal nerve
Erections still possible

58
Q

Cause for abdominoperineal resection

A

Rectal cancer (Adenocarcinoma of colon/rectum)

59
Q

Stoma w/ most corrosive effluent

A

Ileostomy

Most digestive enzymes in jejunum and ilium

60
Q

Damage to inferior mesenteric artery

A

Provides blood supply to descending colon, sigmoid colon, proximal portion of rectum
Ileostomy may be needed

61
Q

Stoma site location considerations

A

Through rectus muscle
Below belt line
Away from umbilicus, creases, scars
At apex of infraumbilical bulge

62
Q

Treatment for carcinoma in upper and middle third of rectum

A

Low Anterior Recection (LAR)

63
Q

Diverticulitis s/s

A 
LLQ pain
Fever
N/V
Change in bowel habits
Palpable mass in LLQ
64
Q

Complication of Diverticulitis requiring immediate surgery

A

Bowel perforation

65
Q

Intussusception s/s

A

ABD pain
Vomiting
Palpable mass in RUQ
Bloody (red currant jelly) stool

66
Q

Intussusception medical management

A

Air enema reductions (may re-expand bowel)

Surgery needed if reduction unsuccessful, bowel necrosis, perforation, peritonitis

NURS 522 (3 decks)

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