Lower GI

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What is the primary function of the small intestine: absorption of nutrients
Primary function of Large intestine: absorption of water and electrolytes
Assessment of GI Labs: CBC, albumin, pre-albumin, fuaic, stool cultures, ANCA
Assessment of GI diagnostics: x-ray ultrasound
Cat/mri
Barium studies
endoscopic
colonoscopy
camera capsule
When would a barium study be contraindicated: diverticlitis
active inflammation/fistula/perforation suspected
CONSTIPATION Risk factors: medications;narcotics, calcium channel blockers,iron,diuertics,anticonvulsants,anti-parkinson drugs
Nutrition;lack of fiber
decreased fluid intake
lack of activity
develepmental ocnsiderations
CONSTIPATION what are the desired outcomes: indentify risk fctors
demonstrate behavior patterns to maintain normal elimination
CONSTIPATION management: diet and exercise
medications
nutrition;high fiber
increased activity
fluid volume/hydration status
CONSTIPATION Types of meds used: Bulk-forming agents(metamucil) take w/ full glass water
lubricants(mineral oil)-greases stool for easy pass
laxatives-ducolax, stimulant
stool softeners Colace
Osmotic agents (golytely)-can induce diarrhea, used as a prep for colonoscopy
DIARRHEA Risk factors: infection-c.diff E.coli
Medications-abx
malabsoption disorders (cystic fibrosis)
Overuse of laxative stool softeners
Nutritional therapy (tube feeding)
DIARRHEA Complications: fluid and electrolyte imbalances
K deficiency
DIARRHEA Outcomes: Identify risk factors
lifestyle changes to maintain normal elimination
DIARRHEA Management: meds-lomotil, imodium
nutrition-low fiber diet as tolerted
fluid status-check weight, s/s dehydration
skincare!
DIARRHEA When would use of lomitil be contraindicated: if you suspect a bacterial organism.
APPENDICITIS Definition: finger-like extension attached to cecum and gets i nflamed. more common in men and younger ages
APPENDICITIS What is the prime complication: perforation and peritonitis
APPENDICITIS clinical manifestations: periumbilical pain followed by nauses RLQ 50-60% vomit
tenderness at mcburney's point
rebound tenderness
low-grade fever
present atypically with flank pain and URQ pain
APPENDICITIS labs and diagnostics: CBC-WBC elevated
high C-reactive protein level
ulatrasound/CT
Rovsings sign
APPENDICITIS what is rovsings sign McBurneys point: palpating LLQ wil result in pain in RLQ + sign

midway b/w umbilicus and anterior-superior iliac spine
APPENDICITIS Outcomes: relieve pain-TC&DB, splinting, meds, HOB elevated(relieves incisional pressure
Eliminate infection-IV ABX
prevent FVD-IV therapy until BS then ice chips then adv.
optomize nutrition-watch BS
prevent anxiety
DIVERTICULITIS define: pouches or sacs within intestinal mucosa that are imflammed
DIVERTICULITIS What are the causes: incresed luminal pressure
chronic constipation
age
bowel ireegularity
DIVERTICULITIS clinical manifestations: low grade fever
anorexia
bloating, distenstion,cramping
weakness/fatigue
Inflammation LL abd pain common
DIVERTICULITIS Complication if untreated: perforation can lead to peritonitis, abscess and eventually septicemia, infection
DIVERTICULITIS diagnostics: CT
barium endema
DIVERTICULITIS GOALS: decrease amt of abnormal bacterial flora in the intestines and soften stools to facilitate movement
DIVERTICULITIS Ways to reach goal: clear liquid during acute phase
high fiber, low fat (avoid high fiber if infection is present)
ABX
bulk-froming laxatives
DIVERTICULITIS Inpatient treatment: prevent FVD
pain management
surgery may be needed
DIVERTICULITIS Teaching: increase fluid to 10 glassess/day
increase activity
increase fiber up to 25gm
DIVERTICULITIS Goal of teaching: maintain normal fluid and electrolyte blaance
promote nutrition
promote elimination
DIVERTICULITIS WHAT to AVOID: nuts, popcorn, pumpkin seeds smaller seeds are OK
COMPLICATIONS OF ACUTE IBD: bleeding
obstruction
abscess
peritonits
fisula formation
CHROHNS etiology: idiopathic, chronic inflammation affected any part of GI, but most common in TERMINAL ileum or COLON
CHROHNS patho: tranmural thicking
deep penetrating granuloma
CHROHNS clinical manifestations: location: ileum, right colon
bleeding; rare but may occur
perianal involvement;common
fistulas;common
rectal involvement; 20%
diarrhea;less severe
CHROHNS Diagnostic and labs: radiography;regional, skip lesions, narrowing of colon, thickening of bowel wall, mucosal edema, stenosis, fistulas
SIGMOIDOSCOPY-m/b unremarkable unless have fistulas
COLONOSCOPY; distinct ulcerations seperated by normal mucosa in R colon
+ASCS and ELEV SED RATE
CHROHNS Management: coricosteroids
sulfonamides
ABX
parenteral nutrition
partial/complete colectomy
(ileostomy/anastomosis)
rectum can be perserved in some pts
recurrnace common
CHROHNS complications: small bowel obstruction
right-side hydronephrosis
cholelithiasis
arthritis
terinitis
erythema nodosum
COLITIS Patho: Mucosal ulceration
mucosal minute ulceration
COLITIS clinical manisfestations: location;rectum L colon
Bleeding; common-severe
Perianal invol; rare-mild
Fistulas-rare
rectal invol: almost 100%
diarrhea; severe
COLITIS diagnostic findings/labs: radiography; diffuse involvement no narrowing of colon, no mucosal edema, stenosis rare, shortening of colon
SIGMOIDOSCOPY- abnormal inflamed mucosa
COLONOSCOPY- friable mucosa w/pseudoployps in L colon
COLITIS Management: corticosteroids
sulfonamides-useful in preventing recurrence
bulk hydrophilic agents
ABX
proctocolectomy with ileostomy
rectum preserved in only a few pts
cured by colectomy
COLITIS Systemic complications: toxic mega colon
pperforation
hemorrhagemalignant neoplasms
pyelonephritis
management goals for IBD: remission
maintain remission
improve QOL
heal mucosa-thru nutrition and meds
decrease hospitalization/surgery
decrease complications
colonoscopy/CT
Interventions: NUTRITIONAL THERAPY-bowel rest, modify diet to decrease GI symptoms and maintain nurtitional intake.
prone to osteoporosis from Ca deficiency, HIGH PROTEIN, HIGH CAL, LOW FIBER/RESIDUE diet
PHARMACOLOGICAL THERAPY
SURGERY
COMMON MEDS: AMINOSALICYLATES (5ASA)- first line of defense, benefits are odsed related, MED NEEDS TO BE IN DIRECT CONTACT
CORTICOSTEROIDS-short burst
IMMUNOMODULATORY-steroid sparring, use when steroids are not working
ABX-decrease acute symptoms
BIOLOGICAL THERAPIES-stop tissue necrosis factoer
SURGICAL PROCEDURE: stricturplasty-sm ballon, where obstruction a cut is made lengthwise. done endoscopically only as far as scope goes
COLECTOMY-total/subtotal
Ileostomy
Ileoanal anastamosis-temp ileostomy until J pouch is healed.
3 types of colectomy: total ileoanastomis-viable rectum w/ an end to end anastomsis
total with traditional ileostom
total with content ileostomy-done through Koch pouch
CARE OF CLIENT WITH ILEOSTOMY: skin care
ostomy care
nutrition
meds-post op only for chrons
psych support

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