Beg Med Surg: Non Inflammatory Bowel Disease

Front 1

IBS

Back 1

Irritable bowel Syndrome, GI disorder causes recurrent diarrhea, constipation, and/or abd pain. Comes with flare ups whenever pt exposed to causative agents. No actual pathophysiologic bowel changes.

Front 2

IBS also called...

Back 2

spastic colon
mucous colon
nervous colon

Front 3

What may cause IBS?

Back 3

Cause unknown!
Probably a genetic makeup to it... also Hx of sexual or physical abuse, stress, psychiatric disorder

Front 4

What is the most common digestive disorder?

Back 4

IBS

Front 5

Which is more prevalent, colon cancer or breast cancer?

Back 5

colon cancer

Front 6

What OTC med treats diarrhea?

Back 6

immodium

Front 7

What OTC med treats constipation?

Back 7

laxatives

Front 8

What are some causes of lower GI bleeds?

Back 8

Ulcerative colitis
Polyps
Colon cancer
Hemorrhoids

Front 9

Manning criteria for IBS?

Back 9

Abdominal pain relieved by defecation or falling asleep
Abdominal pain associated with changes in stool frequency or consistency
Abdominal distention
The sense of incomplete evacuation of stool
The presence of mucus with stool passage

Front 10

When does IBS appear?

Back 10

early adulthood

Front 11

IBS is an impairment of the ____ or _____ function of the GI tract

Back 11

motor or sensory

Front 12

The most common symptom of IBS is pain in the...

Back 12

LLQ of abdomen

Front 13

what foods irritate IBS, and should be avoided?

Back 13

caffeine, alcohol, egg, wheat products, beverages that contain sorbitol or fructose, and other gastric irritants.

Milk and milk products should be avoided if lactose intolerance is suspected.

Front 14

How to treat IBS

Back 14

relieve symptoms and look to see what causes exacerbations

Front 15

Drug therapy for IBS

Back 15

metamucil, citrucel- used as prevention to keep pt from getting constipated

Front 16

___ is the most common digestive disorder seen in clinical practice

Back 16

IBS

Front 17

Citrucel should never be given to pts when they are...

Back 17

constipated

Front 18

What is a hernia

Back 18

Weakness in the abdominal muscle wall through which a segment of bowel or other abdominal structure protrudes

Front 19

Indirect inguinal hernia

Back 19

a sac formed from the peritoneum that contains a portion of the intestine or omentum. Hernia pushes downward at an angle into the inguinal canal. In males, these can become large and often descend into the scrotum.

Front 20

Direct inguinal hernia

Back 20

in contrast pass through a weak point in the abdominal wall

Front 21

Femoral hernia

Back 21

protrude through a femoral ring. A plug of fat in the femoral canal enlarges and eventually pulls the peritoneum and often the urinary bladder into the sac

Front 22

Umbilical hernia

Back 22

are congenital or acquired. Congenital appear in infancy. Acquired directly result from increased intra-abdominal pressure. Most common in obese people.

Front 23

Incisional or ventral hernia

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Occur at the site of a previous surgical incision. Result from inadequate healing of incision site.

Front 24

A hernia is reducible when...

Back 24

the contents of the hernial sac can be placed back into the abdominal cavity by gentle pressure

Front 25

A hernia is irreducible when...

Back 25

when it cannot be reduced or placed back into the abdominal cavity

Front 26

A hernia is strangulated when...

Back 26

the blood supply to the herniated segment of the bowel is cut off by pressure from the hernial ring. This causes ischemia and obstruction of the bowel loop

Front 27

Ischemia

Back 27

A decrease in the blood supply to a bodily organ, tissue, or part caused by constriction or obstruction of the blood vessels.

Front 28

Risk factors for hernias?

Back 28

Obesity
Heavy Lifting
Straining
Chronic coughing (cystic fibrosis)
Intra abdominal pressure (pregnancy)

Front 29

Non surgical management of hernias

Back 29

Truss

Front 30

What is a truss?

Back 30

A pad made with firm material, like an abdominal binder.

Front 31

herniorrhaphy

Back 31

surgical hernia repair through laparoscopy

aka minimally invasive inguinal hernia repair (MIIHR)

Front 32

Hernioplasty

Back 32

surgeon reinforces the weakened outside abdominal muscle wall with a mesh patch

Front 33

How long to heal after hernia repair?

Back 33

About 6 weeks

Front 34

What are signs of strangulation?

Back 34

abdominal distintion
nausea
vomiting
pain
fever
and tachycardia

Front 35

Absent bowel sounds may indicate...

Back 35

obstruction and strangulation, which is a medical emergency

Front 36

Should a hernia be forcibly reduced?

Back 36

No, this maneuver can cause strangulation and intestinal rupture

Front 37

What is important post op teaching for hernia repair?

Back 37

Avoid coughing!

Front 38

How to promote lung expansion after hernia surgery?

Back 38

deep breathing and ambulation

Front 39

Do we give pts meds before surgery?

Back 39

No po meds! Pt is NPO.

Front 40

Do we give insulin before surgery?

Back 40

Ask Dr, and ask how much.

Front 41

After indirect inguinal hernia repair, scrotum....

Back 41

a scrotal support and use of ice bags to the scrotum may be used to prevent swelling. Elevation of the scrotum on a soft pillow helps prevent and control swelling.

Front 42

Colorectal refers to the colon and the rectum, which together make up the ____ _____.

Back 42

large intestine

Front 43

CRC

Back 43

Colorectal Cancer

Front 44

Most CRCs are ________.

Back 44

adenocarcinomas

Front 45

adenocarcinomas

Back 45

Tumors that arise form the glandular epithelial tissue of the colon. Polyps that turn into malignant tumors.

Front 46

Complications of increasing CRC tumor growth?

Back 46

Bowel obstruction or perforation resulting in peritonitis
Fistula formation to the urinary bladder or the vagina
Complete blockage of bowel lumen

Front 47

Ways to help prevent Colon cancer

Back 47

High Fiber Foods (raw fruits/veggies)
Whole wheat bread
Low fat foods
High doses of aspirin

Front 48

Risk factors for Colon Cancer

Back 48

> 50 y/o, genetic predisposition, personal or family cancer hx, Familial adenomatous polyposis, high fat/carb/fried foods, red meats, grilled foods, inflammatory bowel diseases

Front 49

How to screen for colon cancer?

Back 49

People with family Hx can have Genetic testing for FAP and HNPCC
Fecal occult blood test, a take home test
Colonoscopy
Double contrast barium enema

Front 50

Who should have a CRC screening?

Back 50

50+ y/o w/out family hx- colonoscopy and FOBT q 10 yrs

W/ family hx: screen earlier and more frequently

Front 51

Health promotion to avoid CRC?

Back 51

Modify diet
high aspirin therapy (but causes GI bleeds!)

Front 52

Colostomy irrigation

Back 52

like an enema

Front 53

What to clean stoma with?

Back 53

gentle soap and water, no soaps with lubricants (keeps adhesives from sticking to stoma)

Front 54

Most common sign of CRC?

Back 54

rectal bleeding, anemia, and a change in stool

Front 55

hematochezia

Back 55

passage of red blood via the rectum

Front 56

What labs to assess for CRC?

Back 56

H & H (decreased)
Fecal Occult blood test
elevated CEA- carcinoembryonic antigen

Front 57

What is the definitive test for CRC?

Back 57

colonoscopy

Front 58

Stage I tumor

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tumor invades up to muscle layer

Front 59

Stage II tumor

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tumor invades up to other organs or perforates peritoneum

Front 60

Stage III Tumor

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any level of tumor invasion and up to 4 regional lymph nodes

Front 61

Stage IV tumor

Back 61

any level of tumor invasion; many lymph nodes affected with distant metastasis

Front 62

Do we want to do surgeries for colon cancers?

Back 62

Yes always want to remove

Front 63

Non surgical management of CRC?

Back 63

Staging,
Radiation,
Drug Therapy (chemotherapy)

Front 64

Chemotherapy needed for stages...

Back 64

II and III

Front 65

Chemotherapy drug of choice for CRC?

Back 65

IV 5-flourouracil (5-FU)

Front 66

What are the effects of 5-FU therapy?

Back 66

diarrhea
mucositis
leukopenia
mouth ulcers
peripheral neuropathy

Front 67

mucositis

Back 67

occurs when cancer treatments break down the rapidly divided epithelial cells lining the gastro-intestinal tract (which goes from the mouth to the anus), leaving the mucosal tissue open to ulceration and infection

Front 68

leukopenia

Back 68

decrease in the number of white blood cells (WBC) in blood

Front 69

Surgical management for CRC

Back 69

Colon resection
Colectomy
Abdominoperineal (AP) resection
Colostomy
Minimally invasive surgery

Front 70

Colon resection

Back 70

removal of tumor and regional lymph nodes with reanastamosis

Front 71

Colectomy

Back 71

colon removal with colostomy (temporary or permanent) or iliostomy/ilioanal pull-through

Front 72

Abdominoperineal (AP) resection

Back 72

surgery that removes the lower colon and rectum.
Close the rectum, massive surgery
LOTS OF DRAINAGE

Front 73

Colostomy

Back 73

surgical creation of an opening of the colon onto the surface of the abdomen

Front 74

Why is CRC surgery so invasive?

Back 74

Want to open patient all the way up so they can be sure to see and get everything

Front 75

When does NG tube come out after abd surgery?

Back 75

When peristalsis occurs

Front 76

How to make peristalsis happen faster?

Back 76

ambulation!

Front 77

What diet after abd surgery?

Back 77

liquids then to solids as tolerated

Front 78

How much urine output per hour do we want?

Back 78

30 mL/hr

Front 79

How to prepare pt for bowel surgery?

Back 79

Bowel prep/cleaning with clindamycin or golytely
Insert NG tube and IV

Front 80

Patient teaching after bowel surgery

Back 80

Avoid heavy lifting or straining
stool softener to prevent straining
observe character of stools
watch for and report s/s obstruction (cramping, abd pain, N/V)
Avoid gas producing foods and carbonated beverages
If open surgery may not be able to drive for 4-6 wks

Front 81

3 types of intestinal obstruction

Back 81

Mechanical obstruction
Nonmechanical obstruction
Strangulated obstruction

Front 82

Mechanical obstruction

Back 82

the bowel is physically blocked by problems outside the intestine (adhesions), in the bowel wall (strictures d/t Crohn's disease), or in the intestinal lumen (tumors)

Front 83

What are adhesions?

Back 83

Scar tissue from surgeries or pathology

Front 84

intussusception

Back 84

telescoping of segment of intestine within itself, mechanical obstruction

Front 85

volvulus

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twisting of the intestine

Front 86

Nonmechanical obstruction, also known as paralytic ileus or adynamic ileus

Back 86

Does not involve a physical obstruction in or outside the intestine. Instead, peristalsis is decreased or absent as a result of neuromuscular disturbance which causes slowing of movement or a backup of intestinal contents

Front 87

Strangulated obstruction

Back 87

Obstruction with compromised blood flow, can result in peritonitis and septic shock with major blood loss

Front 88

Strangulated obstruction can be caused by

Back 88

Resulting from tumors, hernias, fecal impactions, strictures, intussusception, volvulus, fibrosis, vascular disorder, and adhesions

Front 89

Clinical Manifestations of Mechanical Obstruction

Back 89

Midabdominal pain or cramping
Vomiting
Obstipation
Diarrhea
Alteration in bowel pattern and stool
Abdominal distention
Borborygmi
Abdominal tenderness

Front 90

1st biggest sign of obstruction?

Back 90

abd distention

Front 91

Partial obstruction will have what kinds of sounds?

Back 91

high pitched

Front 92

Clinical Manifestations of Nonmechanical Obstruction

Back 92

Constant, diffuse discomfort
Abdominal distention
Decreased to absent bowel sounds
Vomiting
Obstipation

Front 93

Obstipation

Back 93

decreased or absent bowel sounds

Front 94

What is the most common cause of paralytic ileus/nonmechanical obstruction?

Back 94

caused by handling of the intestines during abdominal surgery. Intestinal function lost for hours or days

Front 95

Assessment questions for bowel obstruction?

Back 95

recent N/V and color emesis
Pain
Passage of flatus
Last BM
blood on stool
Family hx CRC

Front 96

Diet for pts with obstruction?

Back 96

NPO

Front 97

Do pts with obstruction have singultus?

Back 97

Yes. (hiccups)

Front 98

Physical assessment pts with obstruction?

Back 98

Pain
Vomit (with bile or mucous orbrown and foul smelling)
No stool/flatus
diarrhea (partial obst)
Abd distention
auscultate for high pitched sounds or absent sounds
and tenderness rigidity

Front 99

Labs to assess with obstruction

Back 99

WBC (higher with strangulation)
H & H, Creat, BUN (higher with dehydration)
Na, Cl, K reduced d/t loss of F &E

Front 100

Nonsurgical Management for Obstruction

Back 100

Nothing by mouth
Nasogastric tube placement (suction to decompress)
Nasointestinal tubes
IV fluid replacement and maintenance (K drops d/t NG tube, replace via IV)

Front 101

Surgical Management for obstruction

Back 101

Exploratory laparotomy

Front 102

What is the number one reason we see young people in the hospital for abdominal problems?

Back 102

seatbelt injuries- abdominal trauma

Front 103

Abdominal trauma defined as

Back 103

Injury to the structures located between the diaphragm and the pelvis, which occurs when the abdomen is subjected to blunt or penetrating forces

Front 104

Organs that can be affected by abd trauma?

Back 104

large or small bowel, liver, spleen, duodenum, pancreas, kidneys, and urinary bladder

Front 105

Biggest concern with abd trauma?

Back 105

Hypovolemic shock- Decreased BP, Increased HR, pain, cold clammy, change in LOC

Front 106

Cullen's sign

Back 106

Ecchymosis around unbilicus r/t abd trauma

Front 107

Turner’s sign

Back 107

Ecchymosis around wither flank d/t abd trauma, may indicate retroperitoneal bleeding into the abdominal wall

Front 108

Ballance’s sign

Back 108

When percussing, left flank dullness and resonance over right flank when pt lying on left side. This is found with RUPTURED SPLEEN

Front 109

Kehr’s sign

Back 109

Lt shoulder pain resulting from diaphragmatic irritation, may be present in splenic injury

Front 110

Polyps are...

Back 110

Small growths in the intestinal tract that are covered with mucosa and are attached to the surface of the intestine

Front 111

What is an adenoma?

Back 111

a benign tumor that forms from glandular cells

Front 112

Familial adenomatous polyposis

Back 112

an inherited condition that primarily affects the gastrointestinal tract. This disorder leads to hundreds or thousands of polyps inside the colon and rectum. Unless treated, CRC inevitably occurs

Front 113

What symptoms come with polyps?

Back 113

Usually asymptomatic, but can cause gross rectal bleeding, intestinal obstruction, and intussusception

Front 114

What are Hemorrhoids?

Back 114

Unnaturally swollen or distended veins in the anorectal region

Front 115

Internal hemorrhoids

Back 115

Cannot be seen on inspection of the perineal area, lie above the anal sphincter

Front 116

External hemorrhoids

Back 116

Lie below the anal sphincter and can be seen on inspeection of the anal region

Front 117

Health Prevention for hemorrhoids

Back 117

Prevention of constipation is #1! (high fiber- graint fruites and veggies, lots of water)

Avoid straining
Maintain healthy weight
Regular exercise

Front 118

Non surgical management for hemorrhoids

Back 118

Local treatment and nutrition therapy
Cold packs, sitz baths,
local anesthetics
High fiber diets
Stool softeners

Front 119

Surgical Management of hemorrhoids

Back 119

hemorrhoidectomy- resection of the hemorrhoid, cases more pain than other procedures

First post/op BM may be very painful!

Front 120

Malabsorption Syndrome

Back 120

Syndrome associated with a variety of disorders and intestinal surgical procedures

Front 121

What are the Primary clinical manifestations of malabsorption?

Back 121

#1Chronic diarrhea
and #2 steatorrhea

Front 122

Diarrhea occurs as...

Back 122

a result of unabsorbed nutrients, which ass to the bulk of the stool, and unabsorbed fat

Front 123

Steatorrhea

Back 123

Greater than normal amounts of fat in the feces

Front 124

Complications of diarrhea

Back 124

Skin breakdown!
Malabsorption
Fluid loss, electrolyte embalance

Front 125

Treatments for constipation

Back 125

Increase fiber in diet (raw fruits/veggies, whole grains)
Drink plenty of water
Stool softeners
Metamucil/citrucil

Front 126

What is a priority nursing intervention in the care of a
patient with chronic diarrhea?

A. Keep the skin clean and dry.
B. Use medicated wipes rather than washcloths to clean the perineal area.
C. Consult a nutritionist for suggested fibers to add to the diet.
D. Review the patient’s medications that may be exacerbating the diarrhea.

Back 126

A. Keep the skin clean and dry.