Chapter 52 Word Scramble
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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) |
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