irritable bowel syndrome manifestation
- change in bowel pattern or type
- weight change
- fatigue/malaise
- flatulence, bloating
- nutritional history
- worsen with stress
- defecation improves symptoms
- abdomen slightly distended, round contour
- hyperactive bowel tones
- soft with tenderness
- pain
- risk for fluid and electrolyte imbalance
IBS
most common digestive disorder Types: C- constipation D - diarrhea A- alternating M- mixed c&d
factors:
- caffeine, dairy, bacterial infection
- hormonal causes so affects women more than men
- stress/anxiety
- most common women under 50
- serotonin: alters normal gut production and/or release of serotonin
IBS interventions
- avoid food triggers
- stress management
- high water intake
- high fiber diet
- probiotics
- psyllium taken at mealtimes with water - produces bulky, soft stools
IBS-C = laxatives
IBS-D - lmodium, amitriptyline
types of hernia’s
- indirect inguinal: intestine pushed into inguinal canal and pass into scrotum
- direct inguinal: intestine passes through weak point in abdominal wall
- femoral hernia: intestine passes through femoral ring
- umbilical hernia: congenital, increased intra-abdominal pressure
- incisional (ventral) hernia: occurs at site of pervious surgical incision
- reducible hernia: contents can be placed back into abdominal cavity
- irreducible or incarcerated hernia: cannot be placed back into abdominal cavity
- strangulated hernia: results when the blood supply to the herniated segment of bowel is cut off - surgical emergency
hernia
weakened abdominal muscle wall through which a segment of the bowel or abdominal structure protrudes
- abdominal weakness + increased intra abdominal pressure = hernia
hernia teaching/discharge
- avoid strenuous activity for several days
- docusate soidum 100mg every morning
- analgesics for pain
- caution operating machinery
- incision: observe redness, swelling, heat, drainage, increased pain
- avoid coughing and heavy lifting
- splint incisional area
- report difficulty voiding
- drink plenty fluids
- avoid constipation
- shower 24-48 hrs after
- can return to work 1-2 weeks
colonoscopy
- endoscopic examination of entire large bowel
- definite test for diagnosis colorectal cancer
prep:
- clear liquid diet day before
- NPO except water 4-6 hrs before procedure
- avoid aspirins, anticoagulants
- cleanse contents in bowel by taking laxatives
procedure:
- conscious sedation
- scope into colon
- 30-60 min
post-op colonoscopy
- NPO til sedation wears off & passes flatus
- vitals 15-30 min until alert
- assess for bleeding
- fullness & mild abdominal cramping are expected for several hours
- assess bowel perforation including severe abdominal pain
- assess hypovolemic shock, including dizziness, light-headedness, decreased BP
- arrange another person to drive pt
colorectal cancer (CRC)
- cancer in large intestine - usually starts as polyps then turns into cancer
- most common GI cancer in US - highly curable
- most tumors are in the rectum
- spread by invasion and through lymph and blood
- metastasis to liver, lungs, brain, bones, adrenal glands
complications:
- bowel obstruction, perforation, peritonitis, abscess or fistula, frank hemorrhage
assessment:
- change bowel habits, blood in stool, weight loss, pain
- inspect mass or distention
- tinkling sounds pr absent sounds
goal = remove tumor
CRC risk factors
- over 50
- family hx
- genetics: autosomal dominant
- crohn’s disease
- ulcerative colitis
- low fiber, high animal fat
- smoking/alcohol
- obesity and sedentary lifestyle
intestinal obstruction
- partial or complete blockage of bowel preventing passing of stool through intestine
mechanical - bowel is physically blocked –> adhesion, tumor, crohns, impaction, twisting, hernia
non-mechanical: paralytic ileus after handling bowel during surgery called pseudo-obstruction – difficulty moving
- intestinal fluid accumulates above obstruction
- distention can occur, fluid imbalance, hypovolemia
- there can be obstruction even if someone if passing stool
small vs large bowel obstruction
small - pain, sometimes visible with peristaltic waves
- upper or epigastric distension
- nausea, profuse vomiting – may contain feces
- metabolic alkalosis
- sever fluid imbalances
large bowel - lower abdominal cramping
- lower distension
- minimal or no vomiting
- no fluid or electrolyte imbalances
obstruction diagnostic
- normal or elevated WBC
- elevated H&H, BUN
- ct of abdomen
- endoscopy
obstruction interventions
- monitor vs - esp. fluid balance
- bowel sounds, distention, passing gas
- insert NG tube
- manage pain
- iv therapy or parenteral nutrition if needed
goal: relieve obstruction
- surgical approach if pain then N/V
- medical approach if n/v then pain
CRC surgical management
goal: removal of tumor
- colon resection: removal tumor and lymph nosed
- colectomy (colon removal): surgical creation of opening of the colon onto the surface of the abdomen. depending on location - may be resection of removed
colostomy management
- apply pouch over stoma
- assess color and integrity of stoma frequently
- stoma should be slightly raised above skin
- reddish pink and moist
- slight edematous and small bleeding
- producing stool in about 2-3 days
- report any dark red, purple or black color, dry, unusual bleeding, or separation from wall
diverticular diseases
diverticulosis - pouches in colon
diverticulitis - inflamed pouches on colon
assessment: - change bowel habits - occult bleeding, possibly with weakness or fatigue - low grade fever when inflamed - crampy abdomen pain N/V
tx:
- bowel rest
- iv fluids
- npo
- ng tube
- no heat on abdomen
- antibiotics
- surgery = bowel resection
appendicitis
acute inflammation of the appendix which is attached to the colon
- can occur when lumen of appendix is obstructed
- inflammation leads to infection of bacterial that invade the wall of the appendix
- can occur at any age but normally between 20-30
- sepsis can occur within 24 to 36 hrs - life threatening emergency
appendicitis assessment
- pain that shifts to right lower quad
- pain increases with cough or movement and relived by bending right hip or knees
- muscle rigidity and rebound tenderness
- normal or elevated temp
- increased WBC and increase immature WBC
- imaging with enlarged appendix
appendicitis interventions
- administer fluids
- maintain semi-fowlers position so abdomen can drain
- administer pain meds and antibiotics
- no laxatives bc can cause perforation
- no heat bc increases circulation and results increased inflammation
gastroenteritis
- inflammation of the mucous membranes of the stomach and intestinal tract mainly affecting the small bowel
- caused by viral or bacterial infection
- oral or fecal routes
- diarrhea and vomiting lasting 1-7 days
- person to person or contaminated food or water
gastroenteritis assessment
- get history of travel, foods eaten
- diarrhea, abdominal cramping or pain
- N/V
- electrolyte imbalance
- poor skin turgor
- fever
- dry mucous membranes
- orthostatic bp changes
- hypotension
- oliguria - abnormal small amounts of pee
gastroenteritis interventions
- fluid replacement
- electrolyte replacement
- allow to be excreted from body
- contact precautions - hand washing
inflammatory bowel disease
ulcerative colitis - inflammation of the colon and rectum (large intestine). lining bleeds with small erosions
crohn’s disease - inflammation of many segments GI tract. thickening bowel wall.
- liquid loose stools
- elevated wbc, c-reactive protein
- low h&h, RBC, sodium , potassium, albumin
