Lower GI disorders

CHOLELITHIASIS (stones) & CHOLECYSTITIS (infection): Risk factors

- 75% High cholesterol - Hyperlipidemia - Pigment stone - Pregnancy - Diet - Rapid weight loss - Obesity - Long fasting periods - Prolonged TPN - Diabetes - female

Complications of Diverticulitis

- Abscess formation. - Peritonitis. - Fistulas (e.g., colovesicular or colovaginal). - Hemorrhage. - Strictures or bowel obstruction from scar tissue.

What are the symptoms of Diverticulitis

- Acute LLQ cramping pain. - Constipation or obstipation. - Fever, nausea, and leukocytosis.

What is celiac disease?

- Autoimmune malabsorption disorder triggered by gluten (found in wheat, barley, rye, and related products like malt and brewer's yeast). - Genetic component: common in first-degree relatives.

The nurse instructs the patient to exercise caution and carefully read labels on foods, a particularly before consuming the following:

- Candies (gluten-free candy list is available on Celiac Disease Foundation site) - Caramel-colored foods - Cornflakes and puffed rice cereals (these often contain malt flavoring or extract, which contains gluten) - Oat products not specifically labeled as produced in gluten-free facilities - Processed lunch meats and "shaped" foods (e.g., cheese sticks) - Salad dressings, condiments, soy sauce, seasonings - Sauces (wheat is often used as thickening agent) - Soft drinks

What is IBS?

- Chronic functional disorder characterized by recurrent abdominal pain and disordered bowel movements (diarrhea, constipation, or both) without an identifiable cause. - spastic bowel contractility - small intestine & colon hyper-reactivity in response to food, hormonal influx and stress

Medical management for diverticulitis

- Clear liquid diet during acute phase, advancing to high-fiber, low-fat diet. - Analgesics for pain - IV fluids, bowel rest (NPO). - Broad-spectrum IV antibiotics (e.g., ampicillin/sulbactam). - NG suction for vomiting or distention. - Gradual reintroduction of oral intake as symptoms subside.

Medical management for lg bm obstruction

- Correction of Electrolyte Abnormalities - IV fluids - NG Aspiration and Decompression - rectal tube or colonic stent to decompress - surgical resection, colostomy, anastomosis

Manifestations of large bm obstruction

- Develops and progresses slowly, unlike small bowel obstruction. - constipation - Stool may become thin or ribbon-like as it passes through a narrowing obstruction. - pain (colicky, deep cramping) - blood in stool - abdominal distention - may have diarrhea around the blockage - high-pitched sounds - localized tenderness - pressure will keep expanding can get perforated and peritonitis - atelectasis from not being able to breathe from pressure - pressure on SVC

Postoperative Nursing Management for a ostomy

- Encourage early ambulation to promote recovery. - stoma needs to be Pink to bright red and shiny. - Ileostomy drainage: Begins within 24-48 hours; drainage is continuous and liquid. - Colostomy drainage: Begins within 3-6 days; stool consistency varies: - Observe for signs of complications (e.g., skin irritation around the stoma, changes in stoma color or output). - Educate the patient on how to empty and care for the ostomy appliance and manage output.

What is a mechanical obstructions

- Extrinsic lesions from outside the intestines or intrinsic lesions within the intestines can obstruct flow. - tumor (if cant remove = fatal) - inflammatory bowel disease - fecal impaction - adhesions (scarring) - strangulated hernia (if blood supply is cut off = necrosis, if necrosis can lead to purfuration = sepsis and death from infection)

Foods that are naturally gluten-free

- Fresh fruits and vegetables - Meat and poultry - Fish and seafood - Dairy - Beans, legumes, and nuts - Corn, rice, soy, quinoa, and potato

Nursing management of diverticulitis

- High-fiber diet with adequate fluid intake (2 L/day). - Avoid triggers (e.g., nuts, popcorn) if identified. - Establish regular bowel habits to prevent stool retention. - Monitor for signs of complications (abscess, perforation, peritonitis). - Administer IV fluids and antibiotics as prescribed. - Rest bowel through NPO status and NG suction if necessary. - Ostomy care if required

management of anal fissure

- Increase fiber intake with supplements. - Use stool softeners and bulk-forming agents. - increase water intake - Soaking the anal area to relieve discomfort and promote healing. (sitz bath) - Topical therapies - if all fails = surgery

IBS nutrition

- Increase soluble fiber (e.g., psyllium). - water - educated about food on fiber - gas forming foods - caffeine

Patho of ulcerative colitis

- Inflammation begins in the rectum and progresses proximally through the colon. - Over time, the bowel narrows, shortens, and thickens due to muscular hypertrophy and fat deposits. - Non-transmural inflammation (does not affect deeper layers) means complications like abscesses and fistulas are rare.

What is appendicitis?

- Inflammation of the appendix, a wormlike appendage about 8-10 cm long, attached to the cecum.

Large bowel obstructions

- Most occur in the sigmoid colon. - most common causes are cancer, diverticular disease, and volvulus - others are: benign tumors, strictures, and obstipation or fecal impactions

CHOLELITHIASIS (stones) & CHOLECYSTITIS (infection): manifestations

- Pain after eating - Pain in right shoulder or back - Nausea and vomiting - rapid wt loss - feeling of fullness - Pain RUQ

symptoms of anal fissures

- Painful defecation. - Burning sensation during bowel movements. - Bright red bleeding, often visible on toilet tissue after defecation.

IBS stress reduction

- Relaxation techniques, cognitive-behavioral therapy, yoga. - identification of emotional triggers

causes of anal fissures

- Trauma from passing large, firm stools. - Persistent anal canal tightening due to stress and anxiety, leading to constipation. - Childbirth, trauma, and anal intercourse.

Medical management for celiac disease

- Treatment: Lifelong avoidance of gluten in food and nonfood products. - Symptoms may take time to resolve. - Anemia: Supplementation (folate, iron, B12). - Osteopenia: Osteoporosis treatment.

What are the manifestations of appendicitis?

- Vague, dull periumbilical pain (visceral pain). - Pain localizes to the right lower quadrant (RLQ) (sharp, discrete, and localized). - Anorexia, nausea, low-grade fever. - McBurney's Point tenderness (RLQ pain). - Rebound tenderness: increased pain upon release of pressure. - Rovsing's Sign: RLQ pain elicited by palpation of the left lower quadrant. - advanced: Signs of peritonitis (abdominal distention, paralytic ileus) if perforation occurs.

Food that contain gluten

- Wheat (wheat-free does not mean gluten-free), barley, bran, durum, spelt, faro, rye, bulgur, graham, semolina, farina, emmer, and triticale; these are generally used in: - Cakes, pastries, cookies - Breads, pastas, rolls, pizza, crackers - Brewer's yeast; this generally includes beer, ale, and porter - Malt, malt extract, and malt flavoring - Modified food starch made from wheat (commonly contained in sour cream)

Nursing care for sm bowel obstruction

- abdominal assessment - enema: depends if a complete or not, dont wanna give a stimulant as it will cause the obstruction to move and purf - monitor I/O - monitor VS - fluid volume replacement - NG Tube Management: (Maintain NG tube functionality. Regularly assess and measure NG output.) - Signs of Resolution: (Return of normal bowel sounds. Decreased abdominal distention. Improvement in abdominal pain and tenderness. Passage of flatus or stool.) - Close monitoring for complications like strangulation or necrosis is essential to determine the need for surgical intervention.

IBS manifestations

- abdominal pain or discomfort relieved with defecation (colicky pain, prolonged intense pain can be spasmpatic - N/V - gas or burping - abdominal bloating - tender palpation over sigmoid colon - dx by ruling out other causes

Small bowel obstructions

- adhesions, hernia and tumor account for most of the obstructions here - others is Crohn's disease, intussusception, volvulus, and paralytic ileus.

Management for inflammatory bowel disease (crohns and ulcerative)

- aimed at inducing disease remission, using a management process called induction therapy, and preventing flare-ups of the disease process while maximizing quality of life, using a management process called maintenance therapy

Symptoms of celiac disease in child

- anemia - refusal to eat - anorexia - smelly poop - celiac crisis

IBS medications

- antidiarrhieas - SSRIS: helps with emotional triggers - bulk forming lax: helps reduce bowel spasms - anticholergnic - probiotics - Loperamide, Alosetron, Rifaximin

Diagnostic study findings for ulcerative colitis

- barium studies, sigmoidoscopy, colonscopy - no narrowing of colon, no mucosal edema - abnormal inflamed mucosa - friable mucosa with ulcers

What is an intestinal obstruction?

- blockage prevents the normal flow of intestinal contents through the intestinal tract. - most common is in the sm bowel - two kinds: functional or mechanical

Inflammatory bowel disease

- both are inflammatory - ulcerative colitis - crohn's disease

Therapeutic management of ulcerative colitis

- corticosteriods - immunomodulators - antibiotics - proctocolectomy with ileostomy

Patho of crohn's

- course if prolonged and variable - begins with crypt inflammation and abscesses, which develop into small, focal ulcers. - creates a cobblestone affect in bowel

Ulcerative Colitis

- course is exacerbations and remissions - Chronic but with flare ups - Rectum - Bleeding is common - 5 bloody stools = admission - Give steroids

If appendicitis ruptures..

- decreased output - decreased pain - can get abscences

T-tube

- don't clamp - no knicks or twists - teach s/s of infection

Manifestations of crohn's

- found in ileum - some bleeding occurs - fistulas and diarrhea are common - significant wt loss can occur secondary to malnutrition - diarrhea - RLQ pain - secondary anemia - Steatorrhea: Excessive fat in feces due to malabsorption. - Fever and leukocytosis: Signs of systemic inflammation.

Manifestations of ulcerative colitis

- found in rectum - descending colon - bleeding is common and severe - fistulas are rare - diarrhea is severe: Often with mucus, pus, or blood. - LLQ pain - Passage of 6+ liquid stools per day. - Cramping. - Weight loss, anorexia, dehydration, and fever. - Hypoalbuminemia: Indicative of malabsorption. - Symptoms typically include bloody diarrhea, abdominal pain, and systemic effects like anemia.

Patho of celiac disease?

- genetic predisposition - Autoimmune response triggered by gluten ingestion.

Assessment and diagnostic of sm bowel obstruction

- high pitched sounds or hyperactive = an attempt pass obstruction - later hypoactive - changes in pattern may be indicative of strangulation or ischemic bowel - Abd xray and CT - lab studies (dehydrations, loss of volume and possible infection)

Sm bowel obstructions complications

- hypovolemia (s/s = hypotension, tachycardia, elevated temp, decreased output) - hypovolemic shock (s/s cool pale clammy, tachycardia, and tachypnea, from dehydration) - electrolyte imbalances (due to vomiting and loss of potassium)

Sm bowel obstructions manifestations

- main in abd (colicky, crampy, wavelike, increasing in pain it blockage cant move) - tenderness - N/V (blood, poop, bile) - blood and mucus in vomit or poop - complete = projectal vomiting (think electroyltes) - BM will be high pitched at first and later on will be absent - distended abdomen - when was last BM, and are they passing gas?

What is a functional obstruction

- paralytic ileus (parastalsisis stops), can be from surgery - The intestinal musculature cannot propel the contents along the bowel either due to interruption of innervation or vascular supply to the bowel

Nursing care for lg bowel obstructions

- resp assessment: check for ateleticis - NG assessment: understand why they are getting this - activity/ repo (bedrest) - antibioticcs - prepare for surgery (can decompress not very common and the need to be NPO) - Observe for symptoms of worsening or resolving obstruction

acute attack of gallbladder

- rest/NPO - non fatty diet - if no improvement = surgery

What is the patho of appendicitis?

- simple: inflammed - gangrenous - purfurated - Blockage increases intraluminal pressure, leading to ischemia, bacterial overgrowth, and inflammation. - Untreated obstruction can result in gangrene, perforation, or abscess formation.

systemic complications for crohn's

- small bowel obstructions - colon cancer - cholelithiasis - malabsorption

Crohn's disease

- subacute and chronic inflammation of the GI tract wall that extends through all layers - most commonly occurs in the distal ileum and the ascending colon - Significant weight loss - Monitoring albumin

Complications for ulcerative colitis

- toxic megacolon - perforation - hemorrhage - colon cancer

Pharm treatment for IBD (crohns and ulcerative colitis)

1. Antibiotics: Metronidazole, ciprofloxacin. 2. Corticosteroids: for acute exacerbations; Prednisone (oral), hydrocortisone (IV), budesonide (rectal 3. Immunomodulators: Azathioprine, mercaptopurine, methotrexate, cyclosporine.

Cholecystectomy nursing care

1. Gallbladder rest - no fat diet - if its not better need surgery 2. Pain management - Pain after surgery - carbon dioxide - move them (ambulation) 3. Respiratory assessment - More prone to having respiratory complications - Turn cough deep breath - Incentive spirometer - Ambulation 4. Biliary drainage - T-tube - Teaching signs of infection 5. Patient teaching - Monitor for infections

Nutrition for IBD (crohns and ulcerative colitis)

1. Induction Therapy: - Low-residue, high-protein, high-calorie diet. - Supplemental vitamins and iron to address deficiencies. - Avoid: Cold foods and smoking (increase motility). 2. Maintenance: - Avoid trigger foods. - Probiotics for ulcerative colitis. - Fiber is generally not restricted once remission is achieved. 3. Malnutrition Management: - Intensive nutrition therapy for patients - Preference for oral or enteral nutrition over parenteral nutrition unless indicated.

Nursing management of celiac disease

1. Patient Education: - Emphasize adherence to a gluten-free diet. - Teach about hidden gluten sources: Cross-contaminated oats. Shared preparation areas in restaurants or homes (e.g., toasters). Non-food items (toothpaste, medications, cosmetics, modeling clay). - Label vigilance: 2. Dining and Food Preparation: - Ask about preparation methods when eating out. - Avoid cross-contamination in shared kitchen tools. 3. Lifestyle Adjustments: - Provide strategies for reading food and product labels. - Educate on managing quality of life, including coping with persistent symptoms despite diet adherence.

Nursing management of IBS

1. Patient Education: - Use a bowel habit diary (e.g., Bristol Stool Form Scale). - Maintain regular eating schedules and avoid trigger foods. - Adequate fluid intake (but not during meals to prevent distention). - Avoid alcohol and smoking. 2. Stress and Lifestyle Guidance: - Encourage stress management techniques (relaxation, exercise). - Educate on sleep hygiene and cognitive-behavioral approaches. 3. Dietary Guidance: - Encourage low-FODMAP diets or gradual reintroduction of irritant foods. - Reinforce importance of adequate nutrition while avoiding triggers.

Preoperative Nursing Management for ostomy

1. Preparation and Stabilization: - Replace fluids, blood, and protein as necessary before surgery. - Administer antibiotics as prescribed. 2. Dietary Measures: Provide a low-residue diet in frequent, small feedings to minimize bowel contents 3. patient education

Anal fissure

A longitudinal tear or ulceration in the lining of the anal canal, typically just distal to the dentate line.

What is botulism?

A rare, serious paralytic illness caused by the toxin of Clostridium botulinum. Types: - Food-borne botulism: From ingesting food contaminated with botulinum toxin. - Wound botulism: From wounds infected with C. botulinum. - Infant botulism (most common in the U.S.): From ingestion of spores (e.g., environmental dust or raw honey).

A nurse is caring for a client in the primary care office who has a recent diagnosis of a hiatal hernia. Which of the following new information will be beneficial for the nurse to relay to the client? A. "A hiatal hernia might increase your risk for GERD." B. "A hiatal hernia might increase your risk for intestinal cancer." C. "A hiatal hernia might increase your risk for stomach cancer." D. "A hiatal hernia might increase your risk for lung disease."

A. "A hiatal hernia might increase your risk for GERD."

A nurse is educating a client about the risk factors for GERD (gastroesophageal reflux disease). Which of the following statements should the nurse include? A. "There is no casual link between lying down after eating and increased onset of GERD." B. "You should avoid or cut down on alcohol and caffeine, which can aggravate GERD." C. "It is okay to take aspirin with GERD." D. "You should avoid possible mercury-containing foods such as seafood because of the risk of GERD."

B. "You should avoid or cut down on alcohol and caffeine, which can aggravate GERD."

A nurse is completing dietary teaching on consuming a low fiber diet with a client who has ulcerative colitis. Which of the following foods should be eliminated in the client's diet? A. Cooked Cabbage B. Dried Apricots C. Ripe Bananas D. Ice Cream

B. Dried Apricots

A nurse is caring for a client who states their parent died from complications of a GI bleed. Which of the following statements from the nurse will help the client decrease their risk of developing a peptic ulcer? A. "Avoid using hormone replacement therapy as this can increase your risk for peptic ulcer." B. "Avoid foods that have been fried." C. "Avoid consuming undercooked foods." D. "Avoid using decongestants for seasonal allergies/colds due to their positive link to developing a peptic ulcer."

C. "Avoid consuming undercooked foods."

A nurse is preparing dietary instructions for a client who has episodes of biliary colic from chronic cholecystitis. Which of the following instructions should the nurse include in the teaching plan? A. Include foods high in starch and proteins B. Include foods high in fiber C. Avoid foods high in fat D. Avoid foods high in sodium

C. Avoid foods high in fat

A nurse is caring for a client who came to the emergency department with abdominal distention and is now on the medical-surgical unit with an NG tube in place to low gastric suction. The client is reporting anxiety, discomfort, and a feeling of bloating. Which of the following actions is the nurse's priority? A. Request a prescription to help ease the client's anxiety. B. Irrigate the NG tube with sterile water. C. Remove and reinsert the NG Tube. D. Check to see if the suction equipment is working.

D. Check to see if the suction equipment is working.

A nurse is caring for a client who has a postoperative ileus and an NG tube that has drained 2,500 mL in the past 6 hr. Which of the following electrolyte imbalances should the nurse monitor the client for? A. Elevated sodium level B. Decreased calcium level C. Elevated magnesium level D. Decreased potassium level

D. Decreased potassium level

A nurse is assessing a client who has peptic ulcer disease. Which of the following findings should the nurse identify as the priority? A. Epigastric discomfort B. Dyspepsia C. Constipation D. Hematemesis

D. Hematemesis

A nurse is reviewing the medication list for a client who has a new diagnosis of a small bowel obstruction. The nurse should withhold which of the following medications? A. Ibuprofen B. Omeprazole C. Zolpidem D. Senna

D. Senna

A nurse is caring for client who just returned from the PACU with an IV fluid infusion and an NG tube in place following abdominal surgery. Which of the following data is the priority for the nurse to assess? A. The coping ability of the client B. The client's bowel sounds C. The patency of the NG tube D. The surgical dressing

D. The surgical dressing

A nurse is caring for a client who receives intermittent enteral feedings through an NG tube. Before administering a feeding, the nurse should measure the gastric residual for which of the following purposes? A. To confirm the placement of the NG Tube B. To remove gastric acid that might cause dyspepsia C. To determine the client's electrolyte balance D. To identify delayed gastric emptying.

D. To identify delayed gastric emptying.

What is diverticulosis?

Diverticulum: Saclike herniation of the bowel lining extending through a defect in the muscle layer. Diverticulitis: Inflammation or infection of one or more diverticula.

What are the manifestations of celiac disease?

Gastrointestinal (common in children): - Diarrhea, steatorrhea (fatty stools), abdominal pain, distention, flatulence, weight loss. Non-Gastrointestinal (common in adults): - Fatigue, malaise, depression, hypothyroidism, migraines. - Osteopenia, anemia, seizures, paresthesias (hands and feet). - Oral changes: shiny red tongue, dental enamel defects. - Dermatitis herpetiformis: Clusters of itchy erythematous macules, papules, vesicles on forearms, elbows, knees, face, buttocks.

botulism assessment

History: - Onset of symptoms after ingestion of contaminated food or spores. - Environmental exposure or feeding of raw honey in infants. Physical Examination: - Diminished gag reflex. - Weakness or paralysis. Diagnostic Tests: - Stool and serum cultures. - Diagnostic studies to rule out other neuromuscular diseases (e.g., Guillain-Barré syndrome, stroke, myasthenia gravis).

surgical management for IBD (crohns and ulcerative colitis)

Indications: - Ulcerative Colitis:Colon cancer, megacolon, severe bleeding, or perforation. - Crohn's Disease:Small bowel obstruction, abscess, perforation, fistulas, or hemorrhage. Procedures: - Strictureplasty: Widening narrowed sections of the bowel. - Small Bowel Resection: Removal of diseased segments with anastomosis. - Colectomy: May include ileostomy.

botulism symptoms

Infants: - Constipation. - Poor feeding. - Listlessness. - Generalized weakness. - Weak cry. Older Children: - Double vision. - Blurred vision. - Drooping eyelids. - Difficulty swallowing. - Slurred speech. - Muscle weakness.

Assessment and diagnosis of diverticulitis

Lab Tests: - CBC: Elevated WBC, possible anemia if bleeding. - Urinalysis: Check for colovesicular fistulas. Imaging: - CT scan with contrast: Preferred for diagnosing diverticulitis, abscesses, and perforation. - Abdominal x-ray: May show free air under diaphragm (perforation).

Assessment and diagnostic for appendicitis

Laboratory Tests: - Elevated WBC count - Neutrophilia - Elevated C-reactive protein (CRP) within the first 12 hours.

What is the patho of Diverticulitis?

Likely caused by fecal or food particle trapping in diverticula, leading to: - Bacterial overgrowth. - Inflammation, distention, vascular compromise, and micro-/macroperforation.

Complications of appendicitis

Major Complications: - Perforation: Leads to peritonitis, typically within 6-24 hours after symptom onset. - Abscess Formation: Older Adults: - Symptoms may be vague or absent, leading to delayed diagnosis and increased risk of complications.

intestinal complications for crohn's

Obstruction or strictures. Perianal disease: Abscesses or fistulas. Fistulas:Most common: Enterocutaneous fistula (small bowel to skin). Abscess formation: Due to internal fistulas leading to fluid accumulation and infection.

Nursing interventions for appendicitis

Preoperative Care: - IV fluids to restore hydration. - Antibiotic therapy to prevent infection. - Pain management (analgesics, no laxatives or enemas). Postoperative Care: - Position patient in high Fowler's position: Reduces tension on incision, promotes lung expansion, and decreases risk of atelectasis. - Encourage incentive spirometry every 2 hours. - Manage pain with parenteral opioids, transitioning to oral as tolerated. - Monitor for return of bowel sounds, passing of flatus, and normal urine output. - Gradually advance oral intake as tolerated. - ambulation to get bowels moving Discharge Planning: - Educate patient on incision care and activity restrictions. - Avoid heavy lifting; normal activity usually resumes in 2-4 weeks. - Patients with gangrenous or perforated appendicitis may require longer hospitalization and additional wound care. - Provide instructions for monitoring signs of infection (fever, increased pain, swelling, discharge).

Assessment of IBS

Recurrent abdominal pain at least once daily in the last 3 months, associated with at least two of the following: - Pain related to defecation. - Pain associated with a change in stool frequency. - Pain associated with a change in stool form/appearance.

Nursing management of botulism

Respiratory Support: - Monitor respiratory effort and administer oxygen as needed. - Be prepared for mechanical ventilation if respiratory failure occurs. Nutritional Support: Monitor feeding ability and ensure adequate nutrition. Preventive Education: - Advise against feeding honey to infants under 1 year of age. - Emphasize proper food preservation techniques, especially for home-canned foods.

Diagnosis

Upper endoscopy with biopsy: - Confirms diagnosis with small intestine (proximal) tissue samples. - Gluten consumption must continue during testing to avoid false negatives.

Diagnostic study of crohn's disease

barium studies, sigmoidoscopy and colonscopy - narrowing of colon, thickening of bowel wall, mucosal edema - may be unremarkable - distinct ulcerations CBC: - Decreased hematocrit and hemoglobin (anemia). - Elevated WBC count (infection or inflammation). Elevated ESR: Indicates inflammation. Decreased albumin and protein levels: Reflects malnutrition.

Therapeutic management for crohn's

corticosteriods, immunomodulators, antibiotics, parenteral nutrition, partial or complete colectomy

What is ileostomy?

created with part of small intestine (the entire large intestine or colon has been removed)

What is cholecystitis?

inflammation/infection of the gallbladder

What is cholelithiasis?

stones in the gallbladder

What is a proctocolectomy?

surgical removal of the rectum and all or part of the colon