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Which lower GI dz is highest in young adults?
What is the cause of appendicitis?
Caused by obstruction of feces in the lumen
What lower GI dz do these symptoms show:
- localizes to McBurney's point
- Aggrevated by rt hip extension/laying, relieved by flexion (knee to chest)
- Lower gd fever, higher grade = increase perforation
What is the immediate tx of appendicitis?
Immediate appendectomy and abx
What are contraindications of appendicitis?
- Laxatives and enemas
- Heat application
What are causes of peritonitis?
Intestinal and bacterial contents irritating the sterile peritoneum
What is the position of comfort of peritonitis?
T or F: fluids that leak into the peritoneum can be corrected with diuretics
Diagnostics with Peritinitis?
CT, abd scan, CBC with WBC differential
Tx and interventions for peritinitis? 4
- parenteral fluids IV
- NG suctioning
how long can cdiff spores last around patient and equipment?
What is CDAD?
C-diff associated disease
Where does c-diff infection come from?
- Inactive form: normal colon flora
- Active form: use of abx kills normal flora and makes c.dff active.
Associated with abx: clindo, cephalo, fluoro, amp.
State whether this symptom is CDAD or Colitis:
1. Non-bloody, watery diarrhea (5-10/day)
2. Profuse watery diarrhea (10-15/day)
3. High fever >38.5
4. Low fever
5. Severe abdominal cramping
6. Abdominal cramping and nausea
8. Death in 6-30% of cases
Match reason for why stools would have these in it:
2. mucus, wbc
4. stool elect
a. osmolality, pH
b. ulcerative dz
d. inflammatory dz
e. from travel
f. ID for bacteria
What is tx for cdiff? what drug will use to treat mild cdiff? severe?
- d/c current abx
- replace fluids/lytes
- protect skin
- Metronidazole (flagyl) for milder
- Vanco for severe
- Probiotcs for pts on abx
State if this will be Ulerative colitis of Crohn's disease:
1. Most common in ileo-cecal area
2. Worst in sigmoid and rectum
3. Mucosa affected predominantly
4. Transmural -> fistulas common
5. Increased risk terminal ileum cancer
6. Colon cancer incidence significantly increased after 10 years
7. No cure - surgical tx are palliative
8. Colectomy curative
What are s/s of IBD mild/severe?
- Abd. pain can be mild to severe
- Bloody diarrhea
- - Mild: 1-2/day
- - Severe: 10/20 mucousy/bloody
- Anorexia/wt loss
What is toxic megacolon?
A potentally lethal condition, where colonic dilation larger than 6cm and signs of systemic toxicity
Sulfasalazine (Azulfadine) is an antiinflammatory used to treat what?
IBD: mild to moderate colitis
Mesalamine is an antiinflammatory used to treat what?
Mild to moderate colitis
What is used to treat severe cases of IBD: colitis. What are its main s/e?
Prednisone: increases BG and interferes with sleep
What can ADRs to treat IBD ause to muscles as a s/e?
Muscle wasting of arms and legs
Can long term use of prednisone cause hypo or hyertension and when is it used for GI dz?
Cyclosporine works quickly to reduce inflammation for what GI dz?
IBD: ulcerative colitis
A pt. dx with IBS tells the nurse, "the doc told me that he ordered an electrolyte panel. Can you tell me why?"
A. to monitor K+ levels since she has had diarrhea.
B. diet modifications will control symptoms, and labs show this
C. to ID the specific cause of her dz
D. the new medications will affect her fluid levels
(this multiple choice question has been scrambled)
What is the most common manifistation of diverticulitis?
Fever and LLQ pain
What is tx for diverticulitis? Which oral abx is usually used?
- Clear liquid diet for 1-several days
- low fiber diet while healing
- Flagyll usually used.
2. Strangulated hernia
3. Mesentric infarct
5. Paralytic ileus
a. no peristalsis
b. pinches off blood supply
d. scarring that form inward(can be postop)
What tests and screening will help detect both polyps and colon cancers?
- Flexible sigmoidoscopy
- CT colonography
Fecal occult blood testing - yearly
AFter an ileostomy, will patient have a low or high fiber diet?
- Goal is to eventually return to normal diet