VN235

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VN235

• LOWER
• GASTROINTESTINAL
• DISORDERS
• Edited by Susan Radloff, MSN, RN

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CONSTIPATION

• Cause
• Rectal and metabolic conditions,
  medications,decreased fiber/fluids/mobility
• Treatment
• Fiber, exercise, water, Metamucil, Colace,
  suppositories, enemas

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DIARRHEA

• Cause
• Bacterial, viral, food, inflammatory disease,
  malabsorption, radiation, enteral tube feedings
• Treatment
• Replace fluids/electrolytes, eliminate cause,
  Lomotil, Imodium

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APPENDICITIS

• Most common reason for emergency abdominal
  surgery
• Inflammation and edema R/T occlusion followed by
  increase in pain in right lower quadrant

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SIGNS AND SYMPTOMS

• Right lower quadrant pain
• Low grade fever
• Anorexia, nausea, vomiting
• Constipation or diarrhea
• Rebound tenderness

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DIAGNOSTIC FINDINGS

• Elevated WBC count
• Leukocytes gt 10,000
• Neutrophils gt 75
• Abdomial X-ray shows density or distention of
  bowel
• US or CT enlargement in the area of the cecum

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PERITONITIS

• Caused by perforation of the appendix
• Occurs 24 hours after onset of pain
• Fever gt 100 degrees
• Toxic appearance
• Abdominal pain or tenderness

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TREATMENT

• IV fluids
• IV antibiotics
• Appendectomy
• Low abdominal incision
• Laparoscopy

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DIVERTICULAR DISORDER

• Occurrence increases with age
• Sac-like out pouching of the lining of the bowel
  that extends through a defect in the muscle layer
• Food and bacteria trapped in a diverticulum cause
  inflammation and infection
• May abscess

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CLINICAL MANIFESTATIONS

• Chronic constipation
• Bowel irregularity and intervals of diarrhea
• Abrupt onset of cramp-like pain in LLQ
• Anorexia and nausea
• Abdominal distention
• Weakness fatigue
• Eventually leads to septicemia

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DIAGNOSTIC TESTS

• Abdominal X-ray
• CT scan
• CBC and Sed Rate

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COMPLICATIONS

• Peritonitis abdominal pain, rigid abdomen, loss
  of bowel sounds, S/S of shock
• Abscess tenderness, mass, fever, gtWBC
• Hemorrhage massive rectal bleeding

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MEDICAL MANAGEMENT

• Clear liquids gt high fiber low fat diet
• Antibiotics
• Bulk-forming laxative Metamucil
• Colace
• Dulcolax suppository

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MEDICAL MANAGEMENT

• Possible hospitalization
• NPO IV fluids
• NG suctioning
• Antibiotics
• Pain control

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SURGICAL MANAGEMENT

• Indicated if perforation, peritonitis, abscess,
  hemorrhage of obstruction
• Bowel resection
• Temporary colostomy

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HARTMAN PROCEDURE
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CROHNS DISEASE

• Pathophysiology
• Distal ileum or colon
• Sub acute and chronic inflammation of all layers
  of bowel wall
• Fistulas, fissures, abscesses
• Progresses to thickened narrow bowel with fibrosis

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CLINICAL MANIFESTATIONS

• Insidious onset
• Abdominal pain and diarrhea not relieved by
  defecation
• Cramping pain after meals
• Weight loss
• Malnutrition
• Secondary anemia

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CLINICAL MANIFESTATIONS

• Intestinal perforations
• Fever
• Leucocytosis
• Abscesses, fistulas, fissures
• Arthritis, skin lesions, conjunctivitis, oral
  ulcers
• Remissions and exacerbations

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DIAGNOSTIC TESTS

• Proctosigmoidoscopy
• Stool for occult blood and fat
• Upper GI
• Barium enema
• CT scan
• CBC
• Sed rate

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COMPLICATIONS

• Intestinal obstruction
• Fluid and electrolyte imbalance
• Malnutrition
• Fistulas and abscesses
• Risk for colon cancer

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ULCERATIVE COLITIS

• Pathophysiology
• Recurrent multiple ulcerations and inflammation
  of mucosal layer of colon and rectum
• Rectal bleeding
• Bowel narrows and thickens

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CLINICAL MANIFESTATIONS

• Exacerbations and remissions
• Diarrhea
• Abdominal pain
• Rectal bleeding

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CLINICAL MANIFESTATIONS

• Anorexia vomiting cramping
• Weight loss fever
• Dehydration
• Urge to defecate
• 10 20 liquid stools a day
• Hypocalcemia anemia
• Rebound tenderness in RLQ
• Erythema, eye lesions, arthritis, liver disease

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DIAGNOSTIC TESTS

• Stool for occult blood
• lt hemoglobin hematocrit
• gtWBC
• ltalbumine levels
• Electrolyte imbalance
• Sigmoidoscopy Barium enema
• Endoscopy

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COMPLICATIONS

• Toxic megacolon, perforation and hemorrhage
• R/T ulceration, vascular engorgement, vascular
  granulation tissue
• Loss of muscular ability to contract results in
  colonic distention
• Peritonitis

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MEDICAL TREATMENT

• Low residue, high-protein, high caloric diet
• MVI and iron
• TPN
• IV fluid and electrolyte replacement
• Corticosteroids
• Antibiotics

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NURSING DIAGNOSES

• Diarrhea R/T
• Pain R/T
• Fluid volume deficit R/T
• Altered nutrition, lt than body requirements
• Activity intolerance R/T
• Risk for impaired skin integrity R/T
• Risk for ineffective management of therapeutic
  regimen R/T

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SURGICAL TREATMENT

• If no response within 24 48 hours
• Surgical procedures include partial to total
  colectomy with or without an ileostomy

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TOTAL PROCTOCOLECTOMY
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LOOP ILEOSTOMY AND RESERVOIR
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LOOP ILEOSTOMY REVERSED
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CONTINENT ILEOSTOMYKOCK POUCH
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IRRITABLE BOWEL SYNDROME

• Altered intestinal motility
• Increased sensitivity to visceral sensation
• Flatus, bloating, constipation, diarrhea, passage
  of mucous, feeling of incomplete evacuation
• Abdominal pain relieved by defecation

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IBS

• R/O other disorders
• Bran or Metamucil
• Modify diet

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ABDOMINAL HERNIAS
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ABDOMINAL HERNIAS

• Hernia protrusion or projection of an organ or
  part of an organ through the wall of the cavity
  that normally contains it
• Coughing, straining, lifting, obesity, pregnancy,
  poor wound healing

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ABDOMINAL HERNIAS

• Complication
• Strangulation- blood/intestinal flow cut off
• Treatment
• Conservative truss

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ABSORPTION DISORDERS

• Lactose intolerance deficiency in lactase
• Celiac disease sensitivity to gluten
• Tropical Sprue bacterial infection

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ABSORPTION DISORDERS

• Signs and symptoms
• Weight loss weakness, malaise
• Sprue frequent loose, bulky foul stools
• Lactose intolerance abdominal cramping,
  excessive gas, loose stools

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TREATMENTS

• Celiac eliminate wheat, rye, oats, barley
• Lactose intolerance experiment Lactaid
• Sprue folic acid, broad spectrum antibiotics,
  high calorie, high protein, low fat diet

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SMALL BOWEL OBSTRUCTION

• Causes
• Adhesions
• Hernias
• Neoplasms
• Intussusception
• Volvulus (twisting)
• Paralytic ileus

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OBSTRUCTIONS
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PATHOPHYSIOLOGY

• Accumulation of intestinal contents, fluid and
  gas
• Abdominal distention and retention of fluid
  reduce absorption of fluids and stimulate gastric
  secretion
• Pressure within lumen increases, causing decrease
  in venous and capillary pressure
• Edema, congestion, necrosis, perforation,
  peritonitis

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CLINICAL MANIFESTATIONS

• Wave like abdominal pain
• Passing of blood and mucous
• Reflux vomiting from reverse peristalsis bile
  and feces
• High pitched tingling bowel sounds
• Dehydration
• Shock

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DIAGNOSTIC TESTS

• Abdominal X-ray
• Electrolytes
• CBC

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MEDICAL MANAGEMENT

• Miller-Abbott tube 10 ft. long
• Double lumen mercury and suction
• Harris tube 6 ft.
• Mercury weighted bag
• Cantor tube 10 ft. long
• Mercury bag
• Flouroscopy

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SURGICAL MANAGEMENT

• Exploratory laporotomy
• Bowel resection and anastomosis

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LARGE BOWEL OBSTRUCTION

• Carcinoma
• Diverticulitis
• Inflammatory bowel disorders
• Benign tumors
• Mechanical obstructions

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PATHOPHYSIOLOGY

• Accumulation of intestinal contents, fluid, gas
• Severe distention
• Perforation
• Intestinal strangulation and necrosis

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CLINICAL MANIFESTATIONS

• Slow development
• Constipation
• Distended abdomen
• Crampy lower abdominal pain
• Fecal vomiting
• Shock

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DIAGNOSTIC TESTS

• Flat and upright abdominal X-rays
• Colonoscopy
• Rectal tube
• IV therapy

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SURGICAL TREATMENT

• Segmental resection with anastomosis
• Abdominal perineal resection with permanent
  sigmoid colostomy
• Temporary colostomy
• Permanent colostomy

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ANORECTAL PROBLEMS

• Hemorrhoids swollen varicosities
• Astringents, Sitz baths, stool softeners, ice
• Anal fissures cracks or ulcers
• Stool softeners, Sitz baths, anesthetic
  suppositories
• Anorectic abscess
• Dressings, packing, sitz baths,antibiotics