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Chapter 51
Unit 7: Noninflammatory bowel disease
| Question | Answer |
|---|---|
| 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!
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