Intestinal Problems Student Flashcards

Question

Colorectal Cancer

Answer 1

third leading cause of cancer related deaths Hereditary Nonpolyposis Colorectal Cancer (HNPCC) or Lynch Syndrome: - autosomal dominant disorder - DNA testing available to detect gene mutations - increased risk of other organ cancers - need annual colonoscopy

Answer 2

no single risk factor highest risk: first degree relatives w/ CRC and people with IBD -family hx of CRC or familial adenomatous polyposis (FAP) -hereditary form -Abnormal KRAS gene (oncogene) other: obesity, smoking, more than 7 servings red meat/wk, more than 4 alcohol drinks/wk, diabetes

Answer 3

sx do not usually appear until disease is in advanced stages - common: iron-deficiency anemia, rectal bleeding, abdominal pain, change in bowel habits - early: none or nonspecific; fatigue, weight loss - advanced: abdominal tenderness, palpable mass, hepatomegaly ascites

Answer 4

regular screening for polyps and cancer from ages 45-75 years of age by one of the following exams: - flexible sigmoidoscopy every 5 years - colonoscopy every 10 years - double-contrast barium enema every 5 years - CT colonography every 5 years annual screening primarily for cancer - high sensitivity fecal occult blood test (FOBT) or - fecal immunochemical test (FIT): test for blood in the stool, must be done frequently to catch intermittent bleeding common with tumors stool DNA every 3 years - DNA mutations colonoscopy = gold standard - entire colon is examine; biopsy specimens - polyps removed and sent to lab - every 10 years starting at 45 - every 5 years starting at 40 if higher risk (1º relative w/ CRC) or 10 years earlier than when youngest relative diagnosed

Answer 5

correlates w/ pathologic staging of disease surgery: - resect tumor - remove lymph nodes that drain that area non-resectable tumors or metastasis: - surgery is palliative, relieves obstruction or controls bleeding - chemo and radiation, control the spread and provide pain relief

Answer 6

- remove cancer - repair perforation, fistula, or traumatic injury - relieve obstruction or stricture - treat an abscess, inflammatory disease (Diverticulitis) or hemorrhage

Answer 7

- total proctocolectomy with IPAA - proctocolectomy w/ permanent ileostomy - right or left hemicolectomy - anterior rectosigmoid resection - abdominal-perineal resection - low anterior resection

Answer 8

surgically created opening (stoma) on the abdomen for fecal elimination named for location ileum-ileostomy (involuntary drainage) -may be temporary or permanent

Answer 9

End stoma: - distal bowel removed (permanent stoma) - distal bowel oversewn (possible reanastomosis and stoma closed) ``` Loop stoma (usually temporary): - loop of bowel to abdominal surface; anterior wall opened for fecal diversion; distal opening to drain mucus; plastic rod in place 7 to 10 days ``` Double-barrel stoma: - bowel divided; two stomas created; both proximal and distal ends though abdominal wall * proximal: fecal diversion * distal: mucus fistula - usually temporary

Answer 10

delayed wound healing hemorrhage fistulas infection normal ostomy: pink-red, mild swelling, small amount of blood

Answer 11

Colostomy function: - record volume, color, consistency of drainage - excess gas common for 2 weeks (temporary) Ileostomy function: - 24-48 hours - minmal - peristalsis returns - 1500-1800 ml/day - monitor fluid and electrolyte (Na+, K+) balance - bowels adapts and increases absorption - feces thickens and volume decreases to 500ml/day IPAA: - 4-6 stools/day - adapt in 3-6 months - anal sphincter controls defecation Anal canal: - transient incontinence of mucus - kegel exercise after 4 weeks - perianal skin care - phantom rectal pain

Answer 12

diet: balanced w/ adequate fluids; avoid odor, gas, and diarrhea-producing foods resume ADLs 4 to 6 weeks empty when 1/3 full to prevent pulling and leaks change failed pouch immediately charcoal filters - deodorize and release flatus

Answer 13

secure pouching - stool is caustic to skin best pouch = open ended and drainable fluid intake = at least 2-3 L/day - teach about fluid and electrolyte imbalance; esp Na+ - increased risk of obstruction: narrowed lumen - chew thoroughly; especially nuts, raisins, popcorn, coconut, mushrooms, olives, stringy vegetables, foods with skins, dried fruis, and meats with casings

Answer 14

passage of 3 or more loose stools/day - acute: 14 days or less - persistent: more than 14 days - chronic: more than 30 days primary cause: infectious organisms alter intestines by - alter secretions and/or absorption of enterocytes in small intestines; no inflammation - impair absorption by destroying cells, causing inflammation in the colon, and producing toxins

Answer 15

- age (older adults more susceptible) - gastric acidity (proton pump inhibitors decrease stomach acid; organisms survive) - intestinal microflora (microbial barrier altered by antibiotics) - immune status (immunocompromised d/t disease or jejunal enteral feedings)

Answer 16

upper GI tract: large volume, water stools, cramping, periumbilical pain, preceding n/v, low grade or no fever lower GI tract: small volume bloody diarrhea, fever stool may contain leukocytes; blood, or mucus severe diarrhea: dehydration (life-threatening), electrolyte imbalances (K+), and acid-base imbalances (metabolic acidosis)

Answer 17

- stool cultures (blood, mucus, WBCs, infectious organisms) - Blood cultures (sepsis or immunocompromised) - WBCs - Anemia from iron and folate deficiencies - BUN, creatinine, electrolytes, pH, osmolality - stool fat, protein - GI hormones (polypeptide and gastrin may be elevated)

Answer 18

depends on cause prevent transmission replace fluid and electrolytes (oral or IV) protect the skin antidiarrheals (CI: prolonged exposure; IBD can result in toxic megacolon) antibiotics: fluoroquinolone and azithromycin

Answer 19

Clostridium difficile Infection -health care associated infection Tx: oral vancomycin or fidaxomicin for 10 days -stop nonessential antibiotics, stool softeners, laxatives, and antidiarrheals for recurrent: fecal microbiota transplantation (FMT) - donor feces administered via enema, nasoenteral tube or colonoscopy - concern = transmission of infection

Answer 20

inflammation of mucosa of stomach and small intestine features: sudden diarrhea, n/v, fever, abdominal cramping common foodborne cause (norovirus) Dx: lab tet for virus Tx: self-limiting (oral or IV fluids)

Answer 21

involuntary passage of stool related to motor and/or sensory dysfunction

Answer 22

rectal exam | anorectal: manometry, u/s, or electromyography

Answer 23

depends on cause - bowel management program (regular defecation, high-fiber diet, increased fluids, elimination 30 min after breakfast) * if ineffective, administer bisacodyl, glycerin suppository, or small enema to stimulate anorectal reflex until pattern established. Digital stimulation, tap water irrigation. - fiber supplements - reduce irritating, diarrhea-producing foods - remove fecal impaction - antidiarrheal agents - mild electrical stimulation - dextranomer/hyaluronic gel (narrows anal canal) - surgery (sphincter repair or colostomy)

Answer 24

- difficult or infrequent bowel movements - may require excessive exertion to defecate - feeling of incomplete evacuation - sx, not a disease - acute = less than 1 week - chronic = greater than 3 months

Answer 25

- low fiber diet - decreased physical activity - ignoring urge to defecate (prolonged retention desensitizes muscles and mucosa, stool dries as water absorbed > difficult to expel) - emotions, anxiety, depression - diseases that slow GI transit - drug-induced (opiods) - cathartic colon syndrome (chronic laxative use results in dilated, atonic colon)

Answer 26

discomfort absent or hard, dry stools (difficult to pass) abdominal distention, bloating, increased flatulence, increased rectal pressure hemorrhoids rectal mucosal ulcers; diverticulosis -obstipation, fecal impaction, perforation

Answer 27

- exam of abdomen, perianal, and rectal areas - sudden, persistent change in bowel habits (greater than 6 wks), rectal bleeding or bloody stool, anemia, weight loss, pain, personal or family hx of CR or IBD, and palpable mass - abdominal x-rays - barium enema - colonoscopy or sigmoidoscopy - anorectal manometry - GI transit studies - defecography

Answer 28

``` increase dietary fiber, fluids, and exercise laxatives enemas dietary fiber: vegetables, fruits, and grains adequate fluid-2 L/day probiotics proper defecation position provide privacy ```

Answer 29

inflammation of the peritoneum causes: - primary = blood-borne organisms - secondary = perforation of organs that spill contents into peritoneal cavity pathophysiology: initial chemical peritonitis progresses to bacterial causing fluid shifts and adhesion

Answer 30

- abdominal pain - most common - universal sign = tenderness over area involved - rebound tenderness, muscular rigidity, and spasm -peritoneal irritation - other: abdominal distention, fever, tachycardia, n/v, altered bowel habits complications: hypovolemic shock, sepsis, intraabdominal abscess, paralytic ileus

Answer 31

``` H&P CBC, electrolytes Peritoneal aspiration Abdominal x-ray, US, or CT scan Peritoneoscopy ```

Answer 32

preoperative/mild cases or poor surgical risk: -NPO, NG suction, IV fluids, antibiotics, analgesia, antiemetics surgery - locate source, drain purulent fluid, repair damaged organ postoperative care: NPO, IV fluid, NG suction, blood, parenteral nutrition, antibiotics, sedatives, opioids, antiemetics

Answer 33

- IV access: fluids and antibiotics - Pain management: analgesia and positioning (knees flexed) - relieve anxiety; promote rest: sedative - monitor VS, I&O, O2 - antiemetics for n/v - NPO; NG tube, if needed - drain care

Answer 34

abnormal tract between two hollow organs or a hollow organ and the skin - complication: increased morbidity and mortality, extended length of stay, and increased costs - simple: 1 short direct tract - complex: multiple organs, abscess, open into base of wound - output: low less than 200 ml/day - moderate: 200-500 ml/day - high: greater than 500 ml/day early signs = fever and abdominal pain

Answer 35

Fistula management: - identify tract - maintain fluid and electrolytes (IV replacement) - control infection - protect surrounding skin: WOCN consult - manage output: monitor I&O drainage - nutritional support: dietician; high-calorie, high-protein enteral or parenteral nutrition most heal spontaneously, some require surgery

Answer 36

protrusion of intestine through an opening or weakened area in the cavity wall -most occur in abdomen reducible - easy to return to abdominal cavity irreducible or incarcerated - cannot be placed back into abdominal cavity; abdominal contents are trapped - strangulated: blood supply compromised - results in intestinal obstruction; gangrene and necrosis are concerns

Answer 37

inguinal umbilical femoral incisional

Answer 38

- pain, increases w/ activities that increase intraabdominal pressure - may be visible - strangulated: severe pain, vomiting, cramping, abdominal pain, distention

Answer 39

H&P | imaging: u/s, CT, MRI

Answer 40

- herniorrhaphy: surgical repair; laparoscopic - hernioplasty: reinforce weak area w/ wire, fascia or mesh - strangulated: emergency surgery; temporary colostomy

Answer 41

- monitor voiding; I&O - scrotal edema - ice and elevation - encourage deep breathing - splinting - cough or sneeze w/ open mouth - no heavy lifting (greater than 10 pounds) 6 to 8 weeks

Answer 42

Dilated hemorrhoidal veins: - internal - above internal sphincter - external - outside external sphincter Etiology and pathophysiology: - increased anal pressure and weakened connective tissue results in downward displacement, which results in dilation - RF: pregnancy, constipation, straining, diarrhea, heavy lifting, prolonged standing and sitting, obesity, and ascites

Answer 43

internal: bleeding w/ defecation; pain, prolapse (pressure, protruding mass) external: reddish blue color; itching, burning, edema - thrombosis: bluish-purple, palpable; pain and inflammation; bleeding w/ defecation

Answer 44

external: inspection and digital examination internal: digital examination, anoscopy, sigmoidoscopy

Answer 45

- high-fiber diet, increased fluids (prevent constipation and reduce straining) - ointments, creams, suppositories, impregnated pads, astringents, anesthetics, stool softeners external: conservative unless thrombosed internal: rubber band ligation, infrared coagulation, sclerotherapy, laser treatment Hemorrhoidectomy: surgical excision -done w/ prolapse or thrombosis

Answer 46

perianal collection of pus d/t obstruction of anal glands results in infection which results in abscess

Answer 47

local severe pain and swelling, foul-smelling drainage, tenderness, fever; sepsis

Answer 48

rectal examination

Answer 49

surgical drainage; antibiotics

Answer 50

moist heat, positioning, low-fiber diet Education: wound care, perianal hygiene, follow-up care

Answer 51

abnormal tunnel from anus or rectum to skin, vagina, or buttocks - precedes or d/t abscess or complication from Crohn's disease - drainage; bloody, purulent, or fecal Tx: surgery (fistulotomy), complex (ligation of the intersphincteric fistula tract (LIFT), fibrin glue injections

Intestinal Problems Student Flashcards

(75 cards)