Download - MY GI LEC
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IRRITABLE BOWEL SYNDROME
Functional disorder of
motility in small and large
intestines- no organic dse
AKA: Spastic colon, irritable
colon, nervous indigestion,
pylorospasm and spastic
colitis, fxnal dyspepsia,
laxative or cathartic colitis-
no ulceration present
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Cause: stress,
emotional factors
Manifestation:
result in increase motility which leadsto spasm and Chronic abdominal pain
(diffused pain) LLQ (dissipates after
passage of gas), alternating diarrhea and constipation,
pasty pencil like stools,
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Hypersecretion of mucus
Dyspeptic symptoms ( flatulence,
nausea, anprexia, belching)
Spastic contractions (small, dry, hart,
pellet-like stools)
Foul breath, sour stomach, cramps
Behavioral disturbance ( anxiety,
depression, sleep disturbance,
weakness
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Diagnostic:
Noconfirmatory dx , r/oorganic
pathology
Hx of nervousness and emotional
disturbances
Barium enema,
stool exam,
Sigmoidoscopy/ colonoscopy-
reveal spasm
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Interventions (A-IBS)
Antidiarrheals, antispasmodics
(Probanthine,
avoid fatty, irritating and gas forming
foods,
Increase fluid intake
Increase fiber in the diet diet
Bulk former ( metamucil)
Stress management,
Rest, exercise, limit responsibilities
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Risk factors
Mechanical factors
Adhesion ( most common)
Formed after abd . Sx
Hernia ( incarcerated, strangulated)
Volvolus (twisting bowel)
Causes infarction Intussusception (telescoping bowel)
Tumors (chief cause)
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Neurogenic factors
Paralytic ileus Lack of peristaltic activity after abd. Sx
Tx- aspiration of the secretion by gastric
suction until the bowel begins to fxn
Vascular fctors
Complete occlusion (mesenteric infarction)
embolus
Partial occlusion (abdominal angina)
atherosclerosis
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PATHOPHYSIOLOGY
Bowel N secrete 7-8 electrolyte rich fluid
Obstruction partially retained fluid
Distention
Increase peristalsis- ends- flaccid
Increase P and reduce absorptive ability
Increase capillary permeability/backward peristalsis
Extravasate to peritoneal cavity
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Manifestations:
abdominal distention, cramping pain,diminished or absent bowel sounds, vomiting
fecal material, constipation
Diagnostics: Abdominal US and X-ray
Interventions:
GI decompression using NGT, (Miller Abbott
tube or Cantor tube )
Bowel resection with or without anastomosis
/ colostomy
NPO, F&E replacement
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INFLAMMORY BOWEL DISEASE
(IBD)
Ulcerative colitis
Crohns disease
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Definition
Crohns dse (regionalenteritis)
Chronic relapsing dse
that may develop
discontiuously in anysegment
Most- terminal ileum
Segmnetal &
Transmural -
submucosa
Less common than UC
Ulcerativecolitis
Entire length of the colon
and involves only the
mucosa & submucosa
inflammation andulcertation that starts in the
rectosigmoid area and
spreads upward;
mucosa is edematous,
thickened with eventual
scarring; consequently colon
loses elasticity and
absorption,
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Ulcerative colitis
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etiology
Crohns dse
Unclear
Genetic basis
Consideredautoimmune in
nature
Ulcerativecolitis
Bacterial
Altered immunity
Destructive enzymeand a lack of
protective substance
Emotional
disturbance-precipitate an
exacerbation
young adults (15 to
20 years old)
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pathophysiology
Crohns dse1. Thickening and
inflammation
happens2. Healing lesions
scar tissue
formation
obstruction ofGItract
3. Diarrhea, 3-5 / day
without blood.
Ulcerative colitis1. Diffuse inflammation
of intestinal mucosa
swelling of epithelial
cells necrosis cryptformation site of
abscess ulceration >
bleeding
2. Chronic narrowingof lumen
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manifestation Crohns dse
Abdominal pain RLQ
relieve after passing a
flatus/stool
Diarrhea less severe than
UC
Stool- Soft or semi-fluid ,
foul smelling & fatty(Steatorrhea),
Weight loss, anorexia,
anemia, fatigue
Ulcerative colitis Bloody diarrhea
15-20 times daily
with or without pus
Abdominalcramping/tenderness
Colicky pain in LLQ
N/V
Fever
Anorexia, Weight loss
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Diagnostic assessment
Hct and hgb
Barium enema with air contrast
Colonoscopy
biopsy
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Medical management
Primarily aims to control the symptoms Anti inflammatory therapy (sulfasalazine),
steroids
longer for crohns dse
Antidiarrheal (Imodium, lomotil)
Antispasmodic- dec postprandial pain and
diarrhea
Fluids, electrolytes replacement
Rest during acute attack
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Monitor bowel movement
consistency, frequency and volume. Correction of nutritional deficiencies
Institute dietary management:
Low-residue, lactose-free
Elemental diet- residue free, low in fat and
digested mainly in the upper jejunum
TPN if necessary- bowel rest, more
useful in crohns
Observe for fluid and nutritional
status
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Surgical management
Commonly used to tx ulcerative colitis
Indicative for both if complication arises
(obstruction, perforation, abscess, fisula)
Total proctocolectomy with permanent
ileostomy
Restorative procedure- ileorectal
anastomosis, ileoanal reservior, a Kock
pouch
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procedure
Total proctocolectomy with permanent
ileostomy
Colon & rectum removed and anus closed Terminal ileum is brought out through
abdominal wall
Permanent ileostomy formed
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Colostomy/Ileostomy
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ComparisonCategories Colostomy Ileostomy
Definition A portion of colon is brought
thru the abdominal wall
A portion of ileum is
brouht thru
abdominal wall
Indications Inflammation or obstruction of
large bowel; congenital orobstructive process of lower
intestinal tract, sigmoid/rectal
Ca
Ulcerative, Chrons
Purpose Provide outlet for intestinal
waste products
Serve as an exit for
waste products when
colon has been
removed
Discharge Liquid to formed stools Yellow green or brown
liquid
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ostomaCare
Apply appliance
Monitor for signs of leakage
Monitor stoma for size, color, and bleeding
Stoma care and irrigation Place petroleum gauze, or moist dressing over the
stoma
Skin Care Avoid gas forming food
Emptying pouch
Diet, fluid and electrolyte balance
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HEMORRHOIDS
Perianal varicose veins
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Two Types of Hemorrhoids
Internal - sup hemorrhoidal plexus External- inf hemorrhoidal plexus
Causes Many anastomoses between plexuses
lack of valve in portal vein
Contributory factors: ( inc intra-abdominalpresure
Chronic constipation, Pregnancy, Obesity Prolonged sitting or standing
Wearing constricting clothings
Disease conditions like liver cirrhosis, CHF
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Pathophysiology
Increase intra-abdominal pressure
(straining)
Distenstion of hemorrhoidal vein
Ampula is filled with formed stool
venous obstruction (repetition)
Permanent dilatation
push outside
bleeding
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diagnostic
Ext. Hemorrhage:
Visual examination
Internal hemorrhage:
History
Digital palpation
Proctoscopy
Asking client to strain during assessment
cause the vein to dilate
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MEDICAL MANAGEMENT
Used only for small, uncomplicated with mildsymptoms Reducing presure
Relieving pain Hot Sitz bath, warm compress
Pharmacologic Bulk laxatives
Stool softener
Local anesthetic application Nupercaine
Steriod- reduce pain and itching
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Dietary management
Increasing fluid and fiber
Surgical
Sclerotherapy
Rubber band ligation Int. hem
Cryosurgery- freezing
Laser removal
Hemorrhoidectomy- vein is excised ( open &
closed)
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POSTOP CARE
Patient Teaching Clean rectal area thoroughly after each
defecation
Sitz bath at home especially after defecation
Avoid constipation: High fiber diet
High fluid intake
Regular exercise
Regular time for defecation
Use stool softener until healing is complete Notify physician for the following:
Rectal bleeding
Continued pain on defecation
Continued constipation