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Chapter 52
Unit 7: Inflammatory Bowel Disease
| Question | Answer |
|---|---|
| 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!
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