Infection and Inflammation of the Bowels
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| What is the most common route entry of intestinal infection? | through the mouth by contaminated food or water
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| What is the most common clinical sign of intestinal infections? | Diarrhea
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| What may be present if the intestinal mucosa is directly invaded by infection? | Blood and mucus in the stool.
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| What is the primary diagnostic test for intestinal infections? | Stool culture
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| In the case of intestinal infections, why may anti-diarrheals b contraindicated? | They may prolong the contact of the infection in the intestines
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| What is the most common symptom of irritable bowel syndrome? | abdominal pain associated with a change in bowel habits
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| List 4 symptoms of IBS | *Pain *Distension *Excessive flatulence *Urge to defacate *Sensation of incomplete evacuation
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| In IBS, what is present in the stool? | Mucus
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| What should be added to the diet of a PT with IBS? | At least 20g/day of dietary fiber
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| If PT with IBS cannot get enough dietary fiber from food, what can be used? | Metamucil
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| What characterzes Ulcerative Colitis? | Inflammation and ulceration of the colon and rectum.
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| True or False: With Ulcerative Colitis, the PT suffers from the ulcers chronically. | False. There are alternating periods of exacerbation and remission
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| In a PT with Ulcerative Colitis, what produces purulent drainage sloughing of the mucosa and subsequent ulceration? | Abcesses
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| What does Ulcerative Colitis cause? | Bleeding capillaries that cause diarrhea containing pus and blood, as well as the formation of possibly cancerous Pseudopolyps.
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| What are the major symptoms of Ulcerative Colitis? | Bloody diarrhea and abdominal pain.
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| How many stools a day would a PT with active Ulcerative colitis have? | 10 to 20 liquid stools a day, containing blood, mucus and pus
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| What occurs in 5% of PTs with Ulcerative Colitis? | Toxic megacolon
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| What is Toxic Megacolon? | dilation of the large bowel in which the bowel can perforate
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| Chronic Ulcerative Colitis lasting 10 -15 years can lead to what in what percentage of PTs? | carcinoma of the colon in 50% of the cases
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| List 3 S/Sx of Ulcerative Colitis? | *Weight loss *Abdominal distension *Tachycardia *Fever *Leukocytosis *Bloody stools
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| What percentage of cases of Ulcerative Colitis require surgery? | 15% to 20%
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| What is a Total Proctocolectomy? | Construction of an internal reservoir and valve (Kock pouch).
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| Why is emotional support especially important for a PT with Ulcerative Colitis? | because these patients have a tendency to be insecure, dependent and sensitive
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| What is Crohns disease associated with? | altered immune mechanisms
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| What is Crohns disease characterized by? | by inflammation of segments of the GI tract
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| Where dose most inflammation from Crohns disease appear? | mostly seen in the ileum
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| How do ulcers form in Crohns disease? | vertically and longitudinally in specific areas along the colon creating a cobblestone appearance.
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| What is the age range for Crohns disease? | 15 to 30 yrs
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| After the first occurence of Crohns, when does it reach its second peak? | In the 6th decade
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| What is the major problem with Crohns disease in the small intestine? | Malabsorption
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| What may result from malabsorption of Vitamin b12? | Megaloblastic (pernicious) anemia
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| What are the principal symptoms of Crohns disease? | Abdominal pain and non-bloody diarrhea.
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| In the PT with Crohns, what do you assess the stools for? | Assess stools for mucus and pus (this disease does not cause blood in the stools).
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| True or False: Anal fissures are common in Crohns disease. | True.
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| What are complications of Crohns to be aware of? | Fever and anemia
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| What is the most definative test for Crohns disease? | Colonoscopy with multiple biopsies of the colon and terminal ileum
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| What first line drugs are indicated for mild to moderate cases of Crohns? | Anti-inflammatory drugs such as sulfasalazine
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| What first line drugs are administered for more severe cases of Crohn's disease | Corticosteroids such as Prednisone
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| What are the second line drugs for Crohns? | *Immunosuppressive agents such as Imuran *Multivitamins and b12 injections
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| What is the only medication specifically indicated for the treatment of Crohn’s disease? | Infliximab
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| What are eliminated form the diet of the PT with Crohns? | Foods that can cause increased diarrhea
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| What dieta have shown to induce remission in 90% of patients with Crohn’s disease and why? | Elemental diets like Criticare because they require minimal digestion and reduce stool volume
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| When do you hold anti-anxiety medication and notify the physician? | If systolic b/p drops 20mmHg
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| What do you check prior to administration of antianxiety drugs? | Blood pressure
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| What may be masked by corticosteroid medications? What are S/Sx you'll assess for? | Infection. Fever and sore throat
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| What do you monitor for in a PT on Corticosteroids? | *Infection *Adrenal insufficiency
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| What are the S/Sx of adrenal insufficiency? | *Lethargy *Nausea *Anorexia
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| True or False: Check the blood glucose level on a regular basis for ALL patients receiving corticosteroids | True
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| In a PT taking corticosteroids, what adverse reactions should you notify the physician of? | *Dizziness *Severe Headaches *SoB
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| What drugs slow intestinal motility and propulsion? | *Diphenoxylate/atropine *difenoxin/atropine *loperamide
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| What drugs affect fluid content of the stool? | Kaolin/pectin and bismuth subsalicylate
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| What drug acts as an antidiarrheal by taking on water within the bowel lumen to create a formed stool? | Polycarbophil
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| What drug can be used to treat both constipation and diarrhea? | Polycarbophil
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| What drug is used specifically for diarrhea associated with GI endocrine tumors? | Octreotide
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| List 3 adverse effects of anti-diarrheals? | *Angioneurotic edema *paralytic ileus *toxic megacolon constipation *nausea *abdominal pain
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| Taking digoxin with an absorbent such as Pepto-Bismol may result in what? | decreased absorption of the digoxin.
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| Tarchycardia due to thyrotoxicosis or cardiac insufficiency Myasthenia gravis is the contraindication for what drug? | Trimethobenzamide
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| How does trimethobenzamide affect the absorption of other drugs? | May alter GI absorption of other drugs by inhibiting GI motility and increasing transit time.
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| Constipations may become a problem with what drug group? | Anticholenergics
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| What is the action/purpose of Anticholinergics? | to Reduce motility and decrease the amount of acid secreted by the stomach
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| What drug for GI issues is also good for motion sickness? | Anticholinergics
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