Patho Exam 2 Lower GI
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Patho Exam 2 Lower GI
IBD: Crohn's Disease and Ulcerative colitis. Other lower GI problems
IBD is bowel inflammation with manifestations resulting in...
Inflammatory chemical mediators
What is the cause of IBD and is it familial?
Unknown cause b/c its autoimmune
What are the S&S of IBD?
Are the S&S of IBD constant and how severe are they?
Remission/ exacerbation patterns (come and go)
Systemic manifestations are mild to furminating (extreme)
What are the 3 proposed causative factors of IBD?
Immune (autoimmune w/ no trigger or defective immunoregulation
Genetics (it is a familial tendency)
Infectious origin (something got into you somehow)
If there is a cause... its a 2ndary disease
Define Crohn's Disease (1 type of IBD)
An inflammation of the GI tract that extends through all layers of the intestinal wall (transmural- diff from Ulcerative colitis)
What group develops Crohn's Disease?
Young adults and adolescents
European origin or certain subcultures (some jews)
Where does Crohn's Disease occur in lower GI tract?
Most commonly is proximal colon aka "ileocecal region" where the large and small bowel meet
What precipitates a Crohn's attack?
What do Crohn's lesions look like?
Inflamed granulation tissue
Lesions surrounded by normal appearing tissue (skip pattern- red then damaged)
List clinical manifestations for Crohn's Disease
RLQ abdominal pain
Malabsorption (results in hypoalbuminemia, steatorrhea- gray fat stool, anemia)
Also- fever, weakness, F&E losses, bleeding
What are complications of Crohn Disease?
Fibrosing strictures- hardening areas altering peristalsis
Fistulas (bowel to bladder, vagina, out of body)
Abscesses (perianal or peritoneal)
Cancer (caused by dysplasia)
Define Ulcerative Colitis
Inflammatory disease of MUCOSA of rectum and colon
Unlike Crohn's b/c mucosa not transmural
What is the location of Ulcerative colitis?
Rectum or rectosigmoid
Rare- subtotal or total colon)
List the disease features of Ulcerative colitis
Continuous injury (Crohn's was cobblestone)
Epithelial cell changes cause cancer
List clinical manifestations of Ulcerative Colitis
Diarrhea- severe, bloody, mucous threads
Pain- lower abdominal (targeted end of colon)
Exacerbation and remission pattern (not constant)
Compare LGI types of Inflammation
: Granulomatous (lesions of inflammed granulated tissue)
: Ulcerative/ exudative
Compare LGI level of injury
: All layers (transmural)
Compare LGI Area of Involvement
: ileum/ proximal colon (or anywhere)
: Limited to rectum and sigmoid colon
Compare LGI rectal bleeding
: Common (rectal area is only location of colitis)
Compare LGI fistulas/ strictures
: common (transmural through tissue)
: rare (only affects mucosal layer)
Compare LGI Cancer Development
Compare LGI Fat/ Vitamin malabsorption
: Yes (in small intestines) (transmural)
: No (only damages mucosa)
State prototype drug for Antiinflammatory drug group 5-Aminosalicylates (5-ASA)
List indications for use mesalamine (Rowasa) 5-ASA
Mild to moderate IBD
1st line therapy
List delivery forms of mesalamine (Rowasa) 5-ASA
Rectal for local effect (colitis or rare crohn)
PO for small bowel (crohns)
What does 5-ASA "prodrug" mean?
Chemical makeup does nothing when broken down (no systemic effects)
Only works when it attaches to receptor sites (locally)
What does 5-ASA (Rowasa) break down into?
5-ASA (active* antiiflammatory ingredient)
Sulfapyridine (effects unknown, responsible for adverse effects)
What are the SE of 5-ASA?
Mesalamine (Rowasa) has less SE than other forms of 5-ASA
GI- abdominal discomfort, gas, nausea
Hematologic disorders (rare)
List Pt Teaching for 5-ASA mesalamine (Rowasa)
Drug is photosensitive- keep in foil container until use, will stain surfaces and material
**Report symptoms of Acute Intolerance Syndrome- cramping, acute abdominal pain, bloody diarrhea (same as disease but more severe), May be accompanied with fever, rash, & H/A
Delayed therapeutic effect- 3 to 21 days!
What is the prototype drug for Glucocorticoids?
List the uses and delivery of Glucocorticoid Budesonide
Induction of remission
Short term relief (never long term- think steroid adverse effects "olive" look)
Give PO or IV (broken down by liver- generally local)
State the prototype drug for Immunomodulator therapy
-ab = antibody
What is the MOA of infliximab (Remicade)?
Monoclonal (designer- target specific things) antibody
Binds with and inactivates TNF-alpha (proinflammatory) - Tumor necrosis factor
What is the indication for use of infliximab (Remicade)?
Mod to severe Crohn dx or ulcerative colitis
only used when conventional/ modern does not work
What is the mode of delivery of infliximab (Remicade)?
Induction regimen (intermittent for 6 weeks)
can significantly reduce exacerbation
List SE of infliximab (Remicade)
Infusion reactions (fever, chills, urticaria, cardiopulmonary rxns)
Increased risk for lymphoma
(not 1st line therapy)
List prototype immunosuppresant agents
State indications for use and delivery of Imuran and Purinethol
Induce/ maintain remission (not acute, takes 6 months)
Second-line adjunct therapy (take with mainstream drug)- (toxic, kept as backup)
not approved for IBD but commonly used
List SE of immunosuppressants Imuran and Purinethol
Bone marrow suppression
List Nsg implications for immunosuppressants (Imuran and Purinethol)
Pt teaching- S&S of infection, anemia, bleeding
Monitor CBC for bone marrow depression
Monitor pancreatic enzymes
Condition in small pouches in lining of colon that bulge outward through weak spots
State location and incidence of Diverticulosis
: Sigmoid colon
: 30% people over 60 yrs and 80% people over 80 yrs
List contributing factors of Diverticulosis
Dietary factors- not enough fiber
Physical Activity- sedentary
Bowel habits- constipation
Effects of aging- weakness
State manifestations and complications of Diverticulosis
Inflammation leads to perforation, rupture, and absesses leading to peritonitis (rare)
What causes Diverticulitis manifestations?
List common complaints and duration of Diverticulitis manifestations
Pain- severe lower abdominal
Systemic fever and chills
: days then goes away
State complications and tx of Diverticulitis
Peritonitis- e. coli
Hemorrhage- vessel bursts
Fistula formation- bursts then attaches
: broad spectrum antibiotic therapy
Inflammatory response of serous membrane that lines abdominal cavity and covers visceral organs
What is the common cause of Peritonitis?
Break in the system causing death of bowel and bacteria escaping into the peritoneum
Trauma- stab or gun shot wound
How does bacteria access peritoneal cavity causing peritonitis?
It escapes from the bowel through fissure, rupture (diverticulitis), or trauma
: common cause of death in war
What are common conditions that cause Peritonitis?
Perforated peptic ulcer
Gangrenous (dead) bowel
Pelvic inflammatory disease (PID)
Gangrenous gallbladder (dead tissue)
What are the local manifestations of Peritonitis?
Translocation of ECF (extra cellular fluid) in peritoneal cavity
Rigid "board-like" abdomen- from tense internal infection
What are the systemic manifestations of Peritonitis?
(starts to look shocky)
What are the late manifestations of Peritonitis?
Shock- inflammation causes edema causing a large shift of fluids (ECF in peritoneum) leading to shock
What are the complications of Peritonitis?
Adhesions (attaches elsewhere causes dec. peristalsis and discomfort)
Multiorgan failure (resulting from shock)