lower GI bleed
what causes lower GI bleed ?
- diverticulosis - tumors - polyps - colitis -crohn disease hemmoroids -ulcers
when a patient have a lower GI bleed what are the signs and symptoms ?
- hematochezia melena -occult in blood in stools anemia if chronic
where does ulcerative colitis usually begin ?
- in the rectum and sodas upwards towards the cecum. and the colon becomes edematous and may develop bleeding lesions and ulcers ; the ulcers may lead to perforation.
what does the lower GI consist of ?
- jejunum -iileum -colon -rectum
what are the food that trigger manifestation of colitis and crohn disease
- milk products -whole wheat grain -nuts -seeds -raw fruit -veggies -pepper -alchohol and caffeine-containing products
what is hematochezia
usually indicate lower GI bleed blood is a catharsis and moves rapidly thought the system so the stool is liquid this can indicate upper GI bleed if bleeding is massive
patient education for colitis and crohn
CLIENT EDUCATION ● Seek emergency care for indications of bowel obstruction or perforation (fever, severe abdominal pain, vomiting). ● For extreme or long exacerbations, NPO status and administration of total parenteral nutrition promotes bowel rest while providing adequate nutrition. ● Avoid caffeine and alcohol. ● Take a multivitamin that contains iron. ● Small, frequent meals can reduce the occurrence of manifestations. ● Dietary supplements that are high in protein and low in fiber (elemental and semi‐elemental products, canned nutrition beverages) can be used. ● Weigh 1 or 2 times weekly. ● Use of vitamin supplements and B12 injections, if needed.
what is ulcerative colitis ?
Edema and inflammation primarily in the rectum and rectosigmoid colon incidence of ulcerative colitis peaks at adolescence to young adulthood (more often in females) and older adulthood (more often in males).
chronic colitis (5)
causes muscular hypertrophy , fat deposit and fibrous tissue with bowel thickening, shortening and narrowing.
what is a colonoscopy ?
flexible scope that visualize the rectum sigmoid and colon - moderate IV sedation ( twilight zone)
what are the diagnosis ?
history exam colonoscopy bleeding scan angiography
what is crohn disease ? ( small intestine)
inflammation and ulceration of the gastrointestinal tract , often at the distal ileum or terminal ileum - all bowel layers can become involved: lesion are sporadic. fistula are common ● Can involve the entire GI tract from the mouth to the anus. ● Malabsorption and malnutrition can develop when the jejunum and ileum become involved. Requires supplemental vitamins and minerals, possibly including vitamin B12 injections. adolescents and young adults, but can occur at any age
what is peritonitis ?
inflammation of the peritoneum result from infection of peritoneum due to puncture ( surgery or trauma) rupture of part of the gastrointestinal tract ( diverticulitis , peptic ulcer disease , appendicitis, bowel obstruction) or infection from continuous ambulatory peritoneal dialysis.
what is diverticulitis
is the inflammation and infection of the bowel mucosa caused by bacteria , food, fecal matter trapped in one or more diverticula ( pouch like herniation in the intestinal wall) Diverticulitis is not to be confused with diverticulosis, which is the presence of many small diverticula in the colon without inflammation. Diverticula can perforate and cause peritonitis, and/or severe bleeding. Diverticulitis occurs more often in older adults and affects males more frequently than females.
what happen in severe cases of ulcerative colitis ?
it can involve the entire length of the colon. Mucosa and submucosa become hyperemic (increase in blood flow), and the colon will become edematous and reddened. It can lead to abscess formation. ● Edema and thickened bowel mucosa can cause partial bowel obstruction. Intestinal mucosal cell changes can lead to colon cancer or insufficient production of intrinsic factor, resulting in insufficient absorption of vitamin B12 (pernicious anemia). - loss the ability to absorb nutrient because scar tissue develops and causes loss of elasticity.
position for colonoscopy
left side with knee to the chest
acute ulcerative colitis result in
result in vascular congestion hemorrhage edema ulceration of the bowel mucosa
what are the treatment for GI bleed ?
sames as upper GI colonoscopy surgery if severe resection of bowel ...removal part of bowel.
signs and symptoms of colitis (Large intestine)
● Abdominal pain/cramping: often left‐lower quadrant pain ● Anorexia and weight loss ● Fever ● Diarrhea: up to 15 to 20 liquid stools/day ● Stools containing mucus, blood, or pus ●malnutrition , dehydration and electrolyte imbalance ● Abdominal distention, tenderness, and/or firmness upon palpation ● High‐pitched bowel sounds ● Rectal bleeding
what are the sign and symptoms of crohn disease?
● Abdominal pain/cramping: often right‐lower quadrant pain ● Anorexia and weight loss ● Fever ● Diarrhea: five loose stools/day with mucus or pus ● Abdominal distention, tenderness and/or firmness upon palpation ● High‐pitched bowel sounds ● Steatorrhea- the excretion of abnormal quantities of fat with the feces owing to reduced absorption of fat by the intestine
what are the signs and symptoms for diverticulitis
● Acute onset of abdominal pain often in left‐lower quadrant - pain increase with straining, coughing and or lifting ● Nausea and vomiting - blood in the stools PHYSICAL ASSESSMENT FINDINGS ● Fever ● Chills ● Tachycardia ● Abdominal distention
what are the pre procedure for colonoscopy ?
● Bowel prep ● Prep can include laxatives, such as bisacodyl and polyethylene glycol. ● Polyethylene glycol is not recommended for older adult clients because it can cause fluid and electrolyte imbalances. ● Polyethylene glycol can inhibit the absorption of some medications. Review the client's medications and consult with the provider. * blood pressure med is okay* ● Clear liquid diet (avoid red, purple, orange fluids). NPO after midnight. ● The client must avoid medications indicated by the provider (aspirin, anticoagulants, antiplatelet).
patient education fo diverticulitis
● Consume a clear liquid diet until manifestations subside. ● Progress to a low‐fiber diet once solid foods are tolerated without other manifestations. Slowly advance to a high‐fiber diet as tolerated when inflammation resolves. ● Avoid seeds or indigestible material (nuts, popcorn, seeds), which can block diverticulum. ● Avoid foods or drinks that can irritate the bowel. (Avoid alcohol. Limit fat to 30% of daily calorie intake.)
nursing intervention for diverticulitis
● For severe manifestations (severe pain, high fever), the client is hospitalized, NPO, and receives nasogastric suctioning, IV fluids, IV antibiotics, and opioid analgesics for pain. ● Instruct the client who has mild diverticulitis about self‐care at home. The client should take medications as prescribed (antibiotics, analgesics, antispasmodics) and get adequate rest. ● Provide the client with instructions to promote normal bowel function and consistency.** can take bulk-forming laxatives . drink adequate fluid 2500 to 3000 ml daily and avoid used of enema.
what is the nursing intervention for both colilitis and crohn disease?
● Monitor by colonoscopy due to the increased risk of colon cancer. ● Assist the client in identifying foods that trigger manifestations. ● Monitor for electrolyte imbalance, especially potassium. Diarrhea can cause a loss of fluids and electrolytes. ● Monitor I&O, and assess for dehydration. ● Educate the client to eat high‐protein, high‐calorie,low‐fiber foods.
post procedure
● Notify the provider of severe pain (possible perforation) or indication of hemorrhage. ● Monitor for rectal bleeding .● Monitor vital signs and respiratory status. Maintain an open airway until the client is awake .● Resume normal diet as prescribed. ● Encourage increased fluid intake. ● Instruct the client that there can be increased flatulence due to air instillation during the procedure. ● Instruct the client not to drive or use equipment for 12 to 18 hr after the procedure.