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VN235

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Bacterial, viral, food, inflammatory disease, malabsorption, radiation, enteral tube feedings ... Anorectic abscess. Dressings, packing, sitz baths,antibiotics ... – PowerPoint PPT presentation

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Title: VN235


1
VN235
  • LOWER
  • GASTROINTESTINAL
  • DISORDERS
  • Edited by Susan Radloff, MSN, RN

2
CONSTIPATION
  • Cause
  • Rectal and metabolic conditions,
    medications,decreased fiber/fluids/mobility
  • Treatment
  • Fiber, exercise, water, Metamucil, Colace,
    suppositories, enemas

3
DIARRHEA
  • Cause
  • Bacterial, viral, food, inflammatory disease,
    malabsorption, radiation, enteral tube feedings
  • Treatment
  • Replace fluids/electrolytes, eliminate cause,
    Lomotil, Imodium

4
APPENDICITIS
  • Most common reason for emergency abdominal
    surgery
  • Inflammation and edema R/T occlusion followed by
    increase in pain in right lower quadrant

5
SIGNS AND SYMPTOMS
  • Right lower quadrant pain
  • Low grade fever
  • Anorexia, nausea, vomiting
  • Constipation or diarrhea
  • Rebound tenderness

6
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7
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

8
PERITONITIS
  • Caused by perforation of the appendix
  • Occurs 24 hours after onset of pain
  • Fever gt 100 degrees
  • Toxic appearance
  • Abdominal pain or tenderness

9
TREATMENT
  • IV fluids
  • IV antibiotics
  • Appendectomy
  • Low abdominal incision
  • Laparoscopy

10
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

11
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12
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

13
DIAGNOSTIC TESTS
  • Abdominal X-ray
  • CT scan
  • CBC and Sed Rate

14
COMPLICATIONS
  • Peritonitis abdominal pain, rigid abdomen, loss
    of bowel sounds, S/S of shock
  • Abscess tenderness, mass, fever, gtWBC
  • Hemorrhage massive rectal bleeding

15
MEDICAL MANAGEMENT
  • Clear liquids gt high fiber low fat diet
  • Antibiotics
  • Bulk-forming laxative Metamucil
  • Colace
  • Dulcolax suppository

16
MEDICAL MANAGEMENT
  • Possible hospitalization
  • NPO IV fluids
  • NG suctioning
  • Antibiotics
  • Pain control

17
SURGICAL MANAGEMENT
  • Indicated if perforation, peritonitis, abscess,
    hemorrhage of obstruction
  • Bowel resection
  • Temporary colostomy

18
HARTMAN PROCEDURE
19
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

20
CLINICAL MANIFESTATIONS
  • Insidious onset
  • Abdominal pain and diarrhea not relieved by
    defecation
  • Cramping pain after meals
  • Weight loss
  • Malnutrition
  • Secondary anemia

21
CLINICAL MANIFESTATIONS
  • Intestinal perforations
  • Fever
  • Leucocytosis
  • Abscesses, fistulas, fissures
  • Arthritis, skin lesions, conjunctivitis, oral
    ulcers
  • Remissions and exacerbations

22
DIAGNOSTIC TESTS
  • Proctosigmoidoscopy
  • Stool for occult blood and fat
  • Upper GI
  • Barium enema
  • CT scan
  • CBC
  • Sed rate

23
COMPLICATIONS
  • Intestinal obstruction
  • Fluid and electrolyte imbalance
  • Malnutrition
  • Fistulas and abscesses
  • Risk for colon cancer

24
ULCERATIVE COLITIS
  • Pathophysiology
  • Recurrent multiple ulcerations and inflammation
    of mucosal layer of colon and rectum
  • Rectal bleeding
  • Bowel narrows and thickens

25
CLINICAL MANIFESTATIONS
  • Exacerbations and remissions
  • Diarrhea
  • Abdominal pain
  • Rectal bleeding

26
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

27
DIAGNOSTIC TESTS
  • Stool for occult blood
  • lt hemoglobin hematocrit
  • gtWBC
  • ltalbumine levels
  • Electrolyte imbalance
  • Sigmoidoscopy Barium enema
  • Endoscopy

28
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

29
MEDICAL TREATMENT
  • Low residue, high-protein, high caloric diet
  • MVI and iron
  • TPN
  • IV fluid and electrolyte replacement
  • Corticosteroids
  • Antibiotics

30
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

31
SURGICAL TREATMENT
  • If no response within 24 48 hours
  • Surgical procedures include partial to total
    colectomy with or without an ileostomy

32
TOTAL PROCTOCOLECTOMY
33
LOOP ILEOSTOMY AND RESERVOIR
34
LOOP ILEOSTOMY REVERSED
35
CONTINENT ILEOSTOMYKOCK POUCH
36
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

37
IBS
  • R/O other disorders
  • Bran or Metamucil
  • Modify diet

38
ABDOMINAL HERNIAS
39
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

40
ABDOMINAL HERNIAS
  • Complication
  • Strangulation- blood/intestinal flow cut off
  • Treatment
  • Conservative truss

41
ABSORPTION DISORDERS
  • Lactose intolerance deficiency in lactase
  • Celiac disease sensitivity to gluten
  • Tropical Sprue bacterial infection

42
ABSORPTION DISORDERS
  • Signs and symptoms
  • Weight loss weakness, malaise
  • Sprue frequent loose, bulky foul stools
  • Lactose intolerance abdominal cramping,
    excessive gas, loose stools

43
TREATMENTS
  • Celiac eliminate wheat, rye, oats, barley
  • Lactose intolerance experiment Lactaid
  • Sprue folic acid, broad spectrum antibiotics,
    high calorie, high protein, low fat diet

44
SMALL BOWEL OBSTRUCTION
  • Causes
  • Adhesions
  • Hernias
  • Neoplasms
  • Intussusception
  • Volvulus (twisting)
  • Paralytic ileus

45
OBSTRUCTIONS
46
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

47
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

48
DIAGNOSTIC TESTS
  • Abdominal X-ray
  • Electrolytes
  • CBC

49
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

50
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51
SURGICAL MANAGEMENT
  • Exploratory laporotomy
  • Bowel resection and anastomosis

52
LARGE BOWEL OBSTRUCTION
  • Carcinoma
  • Diverticulitis
  • Inflammatory bowel disorders
  • Benign tumors
  • Mechanical obstructions

53
PATHOPHYSIOLOGY
  • Accumulation of intestinal contents, fluid, gas
  • Severe distention
  • Perforation
  • Intestinal strangulation and necrosis

54
CLINICAL MANIFESTATIONS
  • Slow development
  • Constipation
  • Distended abdomen
  • Crampy lower abdominal pain
  • Fecal vomiting
  • Shock

55
DIAGNOSTIC TESTS
  • Flat and upright abdominal X-rays
  • Colonoscopy
  • Rectal tube
  • IV therapy

56
SURGICAL TREATMENT
  • Segmental resection with anastomosis
  • Abdominal perineal resection with permanent
    sigmoid colostomy
  • Temporary colostomy
  • Permanent colostomy

57
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
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