Lower GI-Lecture #2

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Lower GI-Lecture #2
2013-12-04 18:39:57
N172 Lower GI

N172 Lower GI
Show Answers:

  1. When does a person usually get an appendicitis?
  2. Complication of appendicitis
    • Perforation
    • Peritonitis
    • Abscesses
  3. Clinical Manifestations of Appendicitis
    • Pain RLQ
    • Anorexia
    • N/V
    • Rebound Tenderness
    • Muscle Guarding
  4. Common causes of Peritonitis
    • ruptured appendix
    • perforated gastric/duodenal ulcer
    • severely inflamed gallbladder
    • abdominal trauma-GSW/knife wound
  5. Diseases that can cause peritonitis
    • pancreatitis
    • ascites
    • peritoneal dialysis
  6. Clinical Manifestations of peritonitis
    • abdominal pain
    • rebound tenderness
    • muscular rigidity
    • abdominal distention
    • ascites
    • fever
    • tachycardia/tachypnea
    • n/v
  7. Why don't you give a person with an appendicitis laxatives or an enema?
    increases peristalsis and can cause perforation
  8. After a person has had surgery/been NPO when do you advance their diet?
    Once you hear bowel sounds
  9. How do you treat peritonitis?
    • NPO
    • fluid & electrolyte replacement
    • antibiotics/antiemetics
    • NG Tube with suction
    • semi fowlers
    • pain management
  10. Name 2 inflammatory bowel diseases
    Ulcerative Colitis and Crohn's
  11. What's IBD?
    chronic recurrent inflammation of the intestinal tract
  12. Who's most likely to get IBD's?
    Jewish white people....who have it in their family.  Inherited
  13. Where do Ulcerative Colitis usually occur?
    starts in the rectum and sigmoid colon and spreads up the colon in a CONITNUOUS pattern of inflammation and ulceration of the mucosal layer
  14. Why are F&E lost with ulcerative colitis?
    cuz there is a decreased mucosal area for absorption of F&E
  15. Clinical Manifestations of Ulcerative Colitis
    • bloody diarrhea (4/5xday)
    • abdominal pain
    • fever
    • malaise
    • anorexia
  16. Sever Ulcerative Colitis presents itself as....
    • 10-20 stools per day
    • mucous and blood in stools
    • fever
    • weight loss
    • anemia
    • tachy
    • symptoms of dehydration
  17. Complications of Ulcerative Colitis
    • Toxic Megacolon
    • Perforation
    • Hemorrhage causing anemia
    • Increased risk of colorectal cancer
  18. Systemic complications from Ulcerative colitis
    • arthritis
    • eye inflammation
    • skin lesions
    • thromboembolism
    • kidney stones
    • sclerosing cholangitis
  19. Lab studies for ulcerative colitis/Crohns and why you do those studies
    • CBC-iron deficiency anemia
    • WBC count-megacolon/perforation
    • Serum Protein-hypoalbuminemia
    • Stool testing-OB and C&S
  20. Dx studies for ulcerative colitis and Crohns
    • colonoscopy
    • pillcam
    • barium enema
  21. Planning goals for a person with ulcerative colitis and Crohns
    • decreased # of stools/day
    • soft formed stools
    • keep food in and maintain wt
    • no anxiety
  22. Interventions with ulcerative colitis/Crohns
    • IV fluids and electrolytes
    • monitor # stools and appearance
    • meticulous peri care
  23. Most effective  exacerbation medications for ulcerative colitis/Crohns (2)...what does it do?
    • Pentasa
    • Colazal

    it's a retention enema that is an anti inflammatory
  24. Severe anti inflammatory medications for ulcerative colitis/Crohns
    • Prednisone PO
    • Solumedrol IV
  25. Maintenance medication for ulcerative colitis
  26. Surgical procedure for Ulcerative Colitis
    total l colectomy with rectal mucosal stripping and ileal reservoir

  27. After colorectal surgery for ulcerative colitis...how much fluid may you see in the stoma bag?
    1500-2000ml/24 hrs!!!

    change bag frequently
  28. Foods to encourage and discourage with Ulcerative Colitis
    Encourage-high calorie, high protein low residue diet w/vitamins and iron supplements

    Discourage-cold foods, high residue foods (wheat bread, cereal with bran, nuts, raw fruit) smoking
  29. Describe Crohn's disease
    • discontinuous inflammation involving all layers of the bowel
    • most common in the terminal ileum and colon
  30. Clinical Manifestations of Crohn's
    • diarrhea
    • abdominal pain
    • fever
    • fatigue
    • wt loss/malnutrition
    • dehydration
    • anemia
    • v. deficiency
    • electrolyte imbalance
  31. Ultimate problem with Crohns disease
    • will need surgery, but it wont cure the problem
    • due to multiple surgeries...they will ultimately have short bowel syndrome
  32. short bowel syndrome causes
    severe malabsorption
  33. Oral diet for a person with Crohns
    • high calorie
    • high nitrogen (replace protein loss)
    • fat free
    • no residue
  34. With Crohns if there is malabsorption at the terminal ileum what will my patient need?
    v. B12 shots monthly
  35. Gerontologic considerations for Crohns and Ulcerative colitis
    • Second peak occurs at 70
    • riskier to have surgery
    • hard to control F&E issues
  36. Mechanical Neurogenic bowel obstruction
    caused by an occlusion of the lumen of the intestinal tract (usually small) from adhesions post op
  37. Most common mechanical obstruction of the large intestine
  38. Nom mechanical neurogenic bowel obstruction
    • paralytic ileus (lack of peristalsis)
    • vascular obstruction (emboli/atherosclerosis)
    • Hernia
    • Neoplasms
  39. What is a neurogenic bowel obstruction
    when the bowel cant tell that brain that it is full, and the brain cant tell the bowel to empty completely or at an appropriate time
  40. Patho of neurogenic bowel obstructions
    • obstruction causes distention and stimulates intestinal secretions
    • increased pressure causes capillary permeability and fluids shift in to the peritoneal cavity
  41. Systemic problems from neurogenic bowel obstructions
    • hypotension
    • hypovolemia
    • F&E imbalances
  42. Clinical Manifestations of neurogenic bowel obstructions
    • N/V
    • abdominal pain/distention
    • constipation
    • Pain
    • Fever
  43. DX studies for neurogenic bowel obstructions
    • CT
    • Abdominal X ray (gas/fluids)
    • CBC/Serum Chesistries
    • Stool for OB
    • Sigmoidoscopy/Colonoscopy with biopsy
  44. High intestinal obstructions vs. low intestinal obstructions you will see.....Metabolic
    • high-alkalosis
    • low-acidosis
  45. Nursing management for a person with a neurogenic bowel obstruction
    • watch for fluid and electrolyte imbalances
    • replace potassium?
    • NPO
    • Manage NG tube
  46. What are diverticula
    saccular dilations or outpouching of the mucosa thru the smooth muscle of the intestinal wall
  47. Where do diverticula mainly occur?
    sigmoid colon
  48. What is thought to be the cause of diverticula?
    Who gets it the most?
    lack of fiber and high carb diet

    US Americans get it the most
  49. What is the result of diverticula?
    transit time slows and more water is absorbed from the stool making it more difficult to pass thru the lumen
  50. What causes diverticulitis?
    retention of stool and bacteria in the diverticula causing inflammation, abscesses and small perforations
  51. Common symptoms of diverticulitis
    • LLQ abdominal pain
    • fever
    • leukocytosis
  52. Compolications of diverticulitis
    • Perforation with peritonitis
    • abscess and fistula formation
    • bowel and ureteral obstruction
    • bleeding
  53. What kind of a diet does a person with diverticulitis eat?
    • High fiber...fruits and vegetables
    • increased fluids

    Avoid bending, heavy lifting and tight clothes
  54. Reducible hernia
    go back in to place by manipulation or when the patient lies down
  55. Irreducible hernias
    cant be placed back in to the abdominal cavity and may become strangulated.
  56. Inguanal Hernia
    Most common hernia and most common in men

    Pushes through inguinal ring
  57. Femoral Hernia
    Occurs most in women

    pushes thru the femoral ring in to the femoral canal
  58. Umbillical Hernia
    occur when the rectus muscle is weak or the umbilical opening fails to close after birth
  59. Ventral/Incisional Hernia
    occur due to a weakness in the abdominal wall at the site of a previous incision
  60. Hernias are most common in people who are.....
    • obese
    • have had multiple surgeries in the same area
    • inadequate wound healing
  61. Clinical Manifestations of Hernias
    • Protrusion
    • Severe pain if strangulated
  62. Herniorraphy
    surgical repair of a hernia...done laparoscopically
  63. Hernioplasty
    reinforcement of a weakened area around a hernia
  64. If strangulation of the intestines occur due to a hernia what will happen....
    • necrosis/gangrene
    • bowel resection with temporary colostomy
  65. After Herniorraphy or Hernioplasty....tell the patient
    • don't sneeze/cough
    • don't lift heavy things for 6-8 weeks
  66. Cirrhosis
    chronic, progressive degeneration and destruction of liver cells
  67. With cirrhosis destroyed liver cells are replaced by scar tissue....what's the result?
    • inadequate blood flow
    • poor cellular nutrition/hypoxia

    further decreases fxn of liver
  68. What causes cirrhosis
    • Alcoholism
    • Chronic Hepatitis
    • Biliary cirrhosis
    • Cardiac problems
  69. Which Hepatitis cause Cirrhosis?
  70. How does heart disease cause cirrhosis?
    caused by long standing Rt. sided heart failure causing venous flow to back up in to the liver
  71. Early symptoms of cirrhosis
    • GI Distress
    • Anorexia
    • Dyspepsia
    • Flatulence
    • N/V
    • Diarrhea/Constipation
  72. Later symptoms of Cirrhosis
    • Jaundice
    • Peripheral Edema
    • Ascites
    • Skin lesions
    • Endocrine disturbances
    • Peripheral Neuropathies
  73. Hematologic problems seen with cirrhosis
    • Thrombocytopenia
    • Leukopenia
    • Anemia
  74. Complications of Cirrhosis
    • Portal HTN
    • Esophageal Varices
    • Ascites
    • Peripheral Edema
    • Hepatic Encephalopathy
    • Hepatorenal Syndrome
  75. What's esophageal Varices?
    large torturous veins at the lower end of the esophagus as a result of portal hypertension causing high pressure and they are weak so they may hemorrhage.

    Vericose veins of the esophagus
  76. What causes Hepatic Encephalopathy?
    the liver doesn't metabolize the ammonia in the body so it accumulates and crosses over the blood brain barrier causing neurologic changes
  77. S/S of encephalopathy
    lethargy to coma
  78. Hepatorenal Syndrome
    occurs with cirrhosis....renal failure with azotemia and is a result of portal hypertension
  79. Persons with Cirrhosis are at risk for....
    • Excess fluid volume
    • Imbalanced nutrition
    • impaired skin integrity
    • bleeding
    • acute confusion
  80. Interventions for a person with cirrhosis
    • reduce/eliminate risk factors for alcoholism
    • rest to decrease metabolic demand on liver
    • Banana Bag-B complex vitamins
    • Assess for F&E imbalances
    • Address skin
  81. Nutritional therapy for a person with cirrhosis
    • High calories/carbs
    • Low fat/protein
  82. Person with ascites is treated with....
    • diuretics
    • sodium restrictions
    • paracentesis
    • peritoneal shunt
  83. How do you treat a patient with Esophageal Varices
    • Goal is to reduce risk of bleeding....
    • Give Beta Blockers to reduce BP
    • TIPS-Transjugular Intrahepatic Portosystemic Shunt
    • Vitamin K
  84. Why is a person with Cirrhosis given V. K?
    to correct clotting abnormalities
  85. How is ammonia removed to prevent encephalopathy? (2)
    • it is going to be removed via the intestines with Lactulose 3-4x/day
    • Antibiotics impair bacterial action on protein in the feces to decrease ammonia production.
  86. Clinical manifestation of pancreatitis
    • LUQ abdominal pain
    • N/V
    • Leukocytosis
    • Hypotension
    • Tachycardia
    • Jaundice
  87. What aggravates pancreatitis
  88. Greys Turner's Sign
    • seen in pt. with pancreatitis
    • bluish discoloration of the blank areas
  89. Cullen's Sign
    • seen with Pancreatitis
    • Bluish periumbilical discoloration resulting from seepage of blood stained exudates from the pancreas
  90. Chronic pancreatitis will cause....
    • weight loss
    • constipation
    • mild jaundice
    • dark urine
    • steatorrhea
    • DM
  91. Steatorrhea
    fat in stool
  92. Systemic complications of pancreatitis
    • pleural effusion
    • atelectasis
    • pneumonia
    • hypotension
    • thrombi
    • bleeding
  93. Key management issues for a person with Pancreatitis
    • NPO
    • NGT with suction
    • F&E balance
    • Monitor infections
    • Nutritional therapy
  94. Cholelithiasis
    gall stones
  95. Cholecystitis
    inflammation of the gallbladder
  96. What causes cholelithiasis?
    increased precipitation of cholesterol, bile salts and calcium.  Infection and disturbances of cholesterol metabolism create an environment for gallstones to form
  97. Gallstones are most commonly made from
  98. How does cholelithiasis cause cholecystitis?
    stones from the gallbladder migrate to the cystic/bile duct causing a blockage.  There will be a blockage of bile from the gallbladder causing stasis and cholecystitis?
  99. Clinical Manifestations of Cholecystitis
    • RUQ pain
    • N/V
    • Fever
    • Leukocytosis
    • Jaundice
  100. Patients with  Cholecystitis will complain of....
    • fat intolerance
    • dyspepsia
    • heartburn
    • flatulence
  101. How do you manage cholecystitis?
    • pain management
    • antibiotic for infections
    • F&E balance per labs
    • NGT tube with suction
  102. How do you manage cholelithiasis?
    ERCP-stone removal
  103. After a cholecystectomy why may the person have should pain?
    cuz carbon dioxide wasn't released or absorbed by the body
  104. What is given to a person with cholecystitis to help with spasms?
  105. Fat soluable vitamins given to a person with cholecystitis
  106. What kind of diet should a person eat with cholecystitis?
    low fat
  107. What's toxic megacolon?
    • a condition seen in people with UC and Crohns.  Inflammation and infection cause a widening of the colon:
    • abdominal pain/distention/tenderness
    • fever
    • tachy
    • SHOCK!!