Diseases Of The Intestines

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A complex of disorders characterized by problems in intestinal absorption of nutrients (fat, carbohydrates, proteins, vitamins, calcium, and iron)

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Malabsorption syndrome

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Cause(s) of malabsorption syndrome

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Gastric or small bowel resection (short-gut syndrome)
Cystic fibrosis
Celiac disease
Crohn's disease
Chronic pancreatitis
pernicious anemia
Drug-induced (NSAID gastroenteritis)

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Contributing factors of malabsorption syndrome

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Deficiencies of enzymes (pancreatic lipase)

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Symptoms of Malabsorption syndrome

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Anorexia
Weight loss
Abdominal bloating
pain and cramps
indigestion
steatorrhea (abnormal amounts of fat in feces)
Diarrhea (can be chronic and explosive)

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Red flags for malabsortion syndrome

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Iron-deficiency anemia
Easy bruising and bleeding due to lack of Vit. K
Muscle weakness and fatigue duw to lack of protein, iron, folic acid, and Vit. B
Bone loss, pain, and predisposition to develop fractures from lack of Ca, Phosphate, and Vit. D
Neuropathy including tetany, paresthesias, numbness, and tingling from lack of Ca, Vit. B and D, Mg, K.
Muscle spasms from electrolyte imbalance and lack of Ca.
Peripheral anemia

Front 6

This results in inflammation of the bowel and is characterized by remission and exacerbation

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Inflammatory Bowel Disease (IBD)

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Types of IBD

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Crohn's disease (CD)
Ulcerative Colitis (UC)

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Symptoms of IBD

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Abdominal pain
Frequent attacks of diarrhea
Fecal urgency
Weight loss

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Red flags of IBD

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Joint pain (reactive arthritis) and skin rashes. Pain can be referred to low back
Complications can include intestinal obstruction and corticosteroid toxicity (low bone density, increased fracture risk)
Intestinal absorption is disrupted and nutritional deficiencies are common
Chronic IBD can lead to anxiety and depression

Front 10

This involves a granulomatous type of inflammation that can occur anywhere in the GI tract

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Crohn's disease

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Areas of adjacent normal tissue in Crohn's disease

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Skip lesions

Front 12

This involves an ulcerative and exudative inflammation od the large interstin and rectum.

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Ulcerative Colitis

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Characteristics of UC

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Varying amounts of bloody diarrhea
Mucus
Pus
No skip lesions

Front 14

Characteristics of IBS

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Abnormally increased motility of the small and large intestines

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IBS is also known as

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Spastic colon, nervous, or irritable colon

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Factors associated with IBS

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Stress
Certain foods (high in fat content or roughage, lactose intolance)

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Symptoms of IBS

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Persistent or recurrent abdominal pain that is relieved by defacation
Constipation or diarrhea
bloating
abdominal cramps
flatulence
Nausea
Anorexia

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Treatment(s) of IBS

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Stress reduction and Medications to reduce anxiety or depression
Regular physical activity

Front 19

Characteristics of Diverticular disease

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Pouch-like herniations (diverticula) of the mucosal layer of the colon through the muscularis layer

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Refers to pouch-like herniations of the colon, especially the sigmoid colon

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Diverticulosis

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Contributing factors of Diverticulosis

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Dietary factors (lack of dietary fiber)
Lack of physical activity
Poor bowel habits

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T or F: Symptoms of Diverticulosis are minimal but can include rectal bleeding

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True

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T or F: Diverticulosis can lead to diverticulitis

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True

Front 24

This refers to inflammation of one or more diverticula

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Diverticulitis

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How does diverticulitis develop?

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Fecal matter penetrates diverticula and causes inflammation and abscess

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Symptoms of diverticulitis

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Pain and cramping in the lower left quadrant
Nausea and vomiting
Slight fever
Elevated WBC

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Complications of Diverticulitis

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Bowel obstruction
Perforation with peritonitis and hemorrhage

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Red flag of diverticulitis

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Patients may complain of back pain

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T or F: Regular exercise is an important component of diverticulitits treatment

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True

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It is an inflammation of vermiform appendix

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Appendicitis

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Characteristics of inflamed appendix

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Swollen
Gangrenous
Perforated

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T or F: Perforation of appendix can be lofe threatening and can lead to the development of peritonitis

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True

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Characteristics of pain in appendicitis

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Abrupt at onset
localized to epigastric or periumbilical area
Increased in intensity over time

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Also known as rebound tenderness found in patient with appenficitis

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Blumberg's sign

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Site of appendix where point tenderness is located

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McBurney's point (located 1-1/2 to 2 in. above the ASIS in the right lower quadrant)

Front 36

T or F: Immediate medical attention is required if appendicitis is suspected.

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True

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Indication of perforation in appendicitis

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Elevation in WBC count (>20,000/mm3)

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T or F: Surgery is indicated if perforation occurs in patient with appendicitis.

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True

Front 39

It is the serous membrane lining the walls of the abdominal cavity.

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Peritoneum

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Inflammation of the peritoneum

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Peritonitis

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Cause(s) of peritonitis

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Bacterial invasion and infection of the peritoneum

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Common agents causing peritonitis

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E. coli
Bacteroides
Fusobacterium
Streptococci

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Factors that can introduce infecting agents causing peritonitis

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Penetrating wounds
Surgery
Perforated peptic ulcer
Ruptured appendix
Perforated diverticulum
Gangrenous bowel
Pelvic inflammatory disease
Gangrenous gallbladder

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Symptoms of peritonitis

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Abdominal distention
Severe abdominal pain
Rigidity from reflex guarding
Rebound tenderness
Decreased or absent bowel sounds
Nausea and vomiting
Tachycardia
Elevated WBC count
Fever
Electrolyte imbalance
Hypotension

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Peritonitis can lead to which conditions?

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Toxemia and shock
Circulatory failure
Respiratory distress

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Treatment for peritonitis

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Inflammation and infection control
Fluid and electrolyte balance restoration

Front 47

It is a tear or ulceration of the lining of the anal canal

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Rectal fissure

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Contributing factors of rectal fissure

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Constipation and large, hard stools

Front 49

It is varicosities in the lower rectum or anus

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Hemorrhoids (piles)

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Cause of hemorrhoids

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Congestion of the veins in the hemorrhoidal plexus

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Types of hemorrhoids

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Internal
External (protruding from the anus)

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Symptoms of hemorrhoids

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Local irritation
Pain
Rectal itching

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T or F: Prolonged bleeding in patients with hemorrhoids can result in anemia

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True

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Factors that contribute to discomfort in patients with hemorrhoids

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Straining with defecation
Constipation
Prolonged sitting

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T or F: Pregnancy increases the risk of hemorrhoids

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True

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Treatment for hemorrhoids

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Topical medications to shrink the hemorrhoids
dietary changes
sitz bath
local hot or cold compresses
ligation or surgical excision