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Chapter 52

Unit 7: Inflammatory Bowel Disease

QuestionAnswer
Inflammatory Bowel Disease (acute & chronic) What is appendicitis? (Pg. 580) inflammation of appendix related to obstruction- most common reason for abdominal surgery
who is most at risk for appendicitis? 10-30 years
appendicitis S/S abdominal pain (belly button), nausea vomiting, RLQ pain, rebound tenderness,
Mcburneys point when you palpate RLQ there is pain
Rovsings sign left side is palpated and the pain is felt on the right bc the pressure increases on the right
lab testing for appendicitis CBC with differential, electrolytes, pregnancy test (make sure its not an ectopic pregnancy), UA
what will the CBC show EXTREMELY high leukocytes
diagnostic tests? CT of abdomen, xray, ultrasound (least helpful)
Peritonitis; What causes peritonitis? Inflammation of the peritoneum -Infection due to puncture (surgery/trauma), septicemia, or rupture of part of GI tract
what is the hallmark sign? very rigid and hard abdomen!!
other S/S? nausea/vomiting, fever, tachycardia, rebound tenderness (pain after palpating)
what are surgical interventions for acute IBS? appendectomy (laparoscopic, laparotomy)
nursing care for acute IBS IV antibiotics, analgesics, monitor VS, NG tube?, pt ed
what is crohns disease (regional enteritis)? Sub-acute, chronic inflammation of distal ileum and ascending colon predominantly (but can be noted elsewhere) with remissions and exacerbations
what causes it? Genetic predisposition with an environmental trigger that causes over activity of the immune system
S/S? race, family family members who have it, white, jewish, smoker, adolescent/young adult
the colon/illeum becomes thick, mucosal, cobblestone appearance, fissures, fistulas, abscesses, granulomas, narrowing
common S/S for crohns abdominal pain/cramping RLQ, wt loss, fever, diarrhea w/ mucus and pus, abd distention, high pitched BS, steatorrhea
what is steatorrhea fat in poop
what is ulcerative colitis? Recurrent ulcerative inflammatory condition of the larger colon and rectum (edema & inflammation) -may abscess
what are the risk factors for UC? caucasian, jewish, family history, males, adults
pathophysiology of UC: starts ___ and spreads ____ rectally, proximally
both the ___ and ____ can be involved and abscess mucosa and submucosa
S/S of UC fever, severe diarrhea (15-20 liquid stools/day) with mucus and blood, abdomial distention, high pitched BS, rectal bleeding, tenesmus
where would pain be located for UC LLQ
what is tenesmus constant feeling of having to poop
what would labs show for UC hypocalcemia and maybe anemia
other lab tests CBC w/ differential, >ESR, >CRP, <albumin, <platelet, <electrolytes
what is CRP c-reactive protein released by liver to show inflammation
pANCA Perinuclear Anti-Neutrophil Cytoplasmic Antibodies, will be elevated in UC
other diagnostic tests xray, CT, MRI, barium enema, colonoscopy
treatment for IBD: non pharmacological low fiber, high protein, high calorie, avoid caffeine, smoking, alcohol, vit supplements, increase fluids
treatment for IBD: pharmacological 5-ASA: (sulfasalazine, mesalamine), Corticosteroids, Immunosuppressant, Immunomodulators
sulfasalazine azulfidine which is a sulfonamides- anti inflammatory
mesalamine (asacol, pentasa, rowasa) anti inflammatory that is a non-sulfonamides
methotrexate rheumatrex- immunosuppressant
infliximab remicade- immunomodulator
examples of corticosteroids? predisone, hydrocortisone enema
what are two surgical options? Ileal Pouch Anal Anastomosis (IPAA), Kock pouch
what is an IPAA creation of a pouch of small intestine to recreate the removed rectum. Two or more loops of intestine are sutured or stapled together to form a reservoir for stool. This reservoir is then attached to the anus for reestablishment of anal fecal flow
what is a kock pouch like an ostomy but instead of it draining by itself, they stitch the intestine to make it so you have to insert a catheter to drain the contents
what is diverticular disease Mucosal and sub-mucosal herniation through the colonic muscular wall
this herniation is secondary to (3 things) Increased intraluminal pressure Decreased stool fiber Decreased muscle strength
risk factors age, male, obesity, low fiber diet
what is diverticulum? the “out-pouching” herniation
what is diverticulosis the presence of multiple diverticula (pouches in the colon).. may or may not have diverticulitis
what is diverticulitis inflammation of the diverticula; diverticula are pouches in the intestine
diverticulosis treatment- diet, lax, exercise high fiber 20-30g/day, low fat, bulk forming laxative (Psyllium, Bisacodyl) routine exercise, prompt attention to urge to defacate
diverticulitis tx- diet, meds bowel rest-- NPO then progressing, IV antibiotics, IVF with KCL, IV analgesics, NG tube?
surgical option? Hartmanns procedure
what is hartmanns procedure? removal of rectosigmoid colon with closure of the rectum resulting in a colostomy
What are acute incidences of IBD? Appendicitis, peritonitis, gastroenteritis
What are chronic IBD incidences? Ulcerative colitis, Crohn's disease & diverticulitis
What is chronic IBD characterized by? Diarrhea (up to 20 stools during acute), crampy abdominal pain, and exacerbations (flare-ups/remission)
Created by: mary.scott260!