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Chapter 51

Unit 7: Noninflammatory bowel disease

what are the symtoms of irritable bowel syndrome? abdominal pain, constipation, diarrhea abdominal distention and bloating -belching, nausea w/ meals or passing stool, cramping
risk factors of IBS diet (fatty foods, caffeine, alcohol), stress, more common in women
diet for IBS avoid dairy eggs and wheat products, drink 2-4L of fluid, increase fiber to 30-40g/day
laboratory tests CBC, serum albumin, erythrocyte sedimentation rate (ESR), occult stools
Hydrogen breath test (Pg. 571) -special diet before? exhale into hydrogen analyzer before and after ingesting test sugar. positive=excess hydrogen in blood from bacterial overgrowth ror malabsorption *NPO 12 hrs before test
erythrocyte sedimentation rate (ESR) if elevated- tells you that there is an inflammatory response going on but it doesnt tell you what one
barium enema dye injected into large intestine to see intestine, colon, and rectum
constipation causes? meds (opioids!!), lack of exercise, diet, holding in your poop
constipation complications internal and external hemorrhoids, fistula in rectum can cause reccurent UTIs bc the bacteria (ecoli) from the colon keeps going into the bladder, can also have a rectal-vaginal fistula and have the same problem
treatment: non pharmacologic diet high in fiber and fluids, establish normal routine, respond to urge, exercise/activity
treatment: pharmacological stool softeners, laxatives
docusate sodium colace- pulls water into the stool, not gonna work if the stool is extremely compacted. More of a preventative measure
saline laxative milk of magnesium- can cause diarrhea
hyperosmotic magnesium citrate
stimulant lax magnesium citrate
bulk forming metamucil
diarrhea causes medications, metabolic disorder/endocrine disorders, infections (cdiff)
why do antibiotics cause diarrhea they destroy all bacteria- including the good bacteria in your intestines
problems from diarrhea fluid and electrolyte imbalance, dehydration, dysrhythmmias
diarrhea treatment: nonpharmacological rest, avoid irritants in diet like caffeine, dairy, milk, fats, perianal skin care
diarrhea treatment: pharmacological probiotics and antidiarrheals
alosetron 5-HT4 (serotonin) blocker- blocks serotonin receptors in gut
diphenoxylate HCl with atropine sulfate lomotil- reduces motility of stomach
narcotics? purposely give them for their constipating effects
fecal transplant from donor to get good bacteria back into gut
intestinal obstruction surgical emergency!! (mechanical or non mechanical)
mechanical causes (90%) -pain is like? adhesions, tumors, fibrosis, strictures -usually requires surgery -mild, colicky, intermittent
volvulus twisting of intestines
intususception bowel folds in on itself, *telescoping*
hernia bowel becomes trapped in weakened area of abdominal wall
non mechanical causes (decreased peristalsis) paralytics ileus, mesenteric emboli, hypokalemia, inflammatory response to peritonitis or sepsis
small bowel obstruction S/S F/E imbalance, vomiting leading to metabolic alkalosis, abdominal pain, obstipation, distention, changes in BS -profuse sudden projectile vomiting w/ fecal odor.. relieves pain
obstipation inability to pass stool even though you feel like you need to
colonic obstruction (LBO) S/S minor F/E imbalance, infrequent voiding, possible metabolic acidosis, extreme abdominal pain, obstipation, distention,
lab tests -increased hgb creatinine and hematocrit- may indicate dehydration -amylase might show pancreatic involvement -decreased sodium, chloride, potassium
diagnostic test for obstructions xray, CT scan (cause & exact location), endoscopy (determines the cause)
treatment (all IV all the time) NPO, KCL replacement, analgesics, antibiotics, NG tube
cause of obstruction: colorectal cancer most common cause of LBO
risk factors colon polys, >50 years old, african american, CRC more common in women, rectal cancer more common in men, high fat low fiber diet
gold standard for finding colorectal cancer colonoscopy
Carcinoembryonic antigen (CEA) as the body goes thru fetal development there are cells that are undifferentiated and then they become differentiated, in cancer cells they don’t differentiate and those undifferentiated cells become a protein (not very sensitive to stage 1 cancer)
colonoscopy every 10 years after you turn 50, more often if there are polyps
how do you prep a pt for a colonoscopy? bowel prep, clear liquid diet day before, NPO after midnight unless doctor orders them to take their normal meds (beta blockers)
bowel prep laxatives such as bisacodyl and polyethylene glycol
what should you educate the pt about before a colonoscopy? they're awake during procedure (versed), they will be gassy after
post procedure care monitor VS, monitor for complications like hemorrhage and perforation, they need someone to drive them home, bowel sounds
What are the group of disorders in noninflammatory bowel disorders? Hemorrhoids, cancer, hernia, irritable bowel syndrome, intestinal obstruction
What is a hernia? (Pg. 569) The displacement of the bowel through the abdominal muscle into other areas of the abdominal cavity
Where are hernia's commonly found? Groin area, umbilicus, healed incision
Non surgical hernia client actions? -Wear a ___ w/ hernia belt during ____ hrs truss pad during walking hours
Post operative hernia actions? -Avoid increased intra-abdominal pressure for _____, such as? 2-3 weeks -coughing, straining, heavy lifting
Medications for IBS: alosetron (Lotronex) IBS specific med -blocks 5-HT4 receptors which innervate the viscera *indicated for diarrhea lasting longer than 6 months
Expected result of Alosetron? Formed stool, and decreased urgency and frequency of defecation
Medications for IBS: Lubiprostone (Amitiza) IBS specific med -increases fluid secretion in the intestine to promote intestinal motility (IBS w/ constipation) not for men
What kind of pain is a non-mechanical bowel obstruction like? Vague, diffuse, constant pain w significant abdominal distention
BOTH small & large intestine obstructions give these main S/S: obstipation (can't for >8hrs even though you feel you need to), abdominal distention & high pitched BS above obstruction (borborygmi) w/ hypoactive BS below or over the area
NG tube for intestinal obstructions (Pg. 574) Why? to decompress the bowel
What med would you give for a non mechanical intestinal obstruction? Prokinetics; promote gastric motility (Octreotide (sandostatin))
Complications to bowel obstructions: Dehydration from..? Lyte imbalance from..? Metabolic alkalosis Metabolic acidosis -Vomiting (SBO) -vomiting, potassium especially (SBO) -SBO-- vomiting -acidosis; lower obstruction d/t non reabsorption of alkaline fluids
Created by: mary.scott260!