final GI II

• stool culture
• -gross examination
• -microspoic exam
• -occult bld
• -ova and parasites

care= collection and let Doc know if pt in on period

s= barium swallow followed all the way through GI

b=Only see sigmoid

• care= low risidue diet or clear liquid diet 24-48 hours proir
• =enema or cathartic (laxative) prior
• = NPO 8hrs

post care= constipation

• care= informed consent b/c of concious sedation
• NPO
• bowel preps

nl= hyperactive BS, loose water stools, flatus

abnl= abd pain, fever, chills, bleeding

perforation

• THIS IS A SYMPTOM, NOT A DISORDER
• acute chronic

A= < 1 week and d/t infectious agent

C= > 3-4 weeks, d/t inflamm bowel disorders

• stool culture
• sigmoidoscopy
• labs=
• -e/lytes
• -osmolality
• -ABG

• h2o and e.lyte loss
• vascular collapse and hypovolemia shock
• dec K, dec Mag
• metabolic acidosis

NOT USED UNTIL cause of dia is ID'd

• -absorbants and protectants
• -opium and opium derivitives (slows transient time of stool thru bowel to absorb h2o out)
• -anticholinergics

• monitor and record I&O, vs, wt
• listen for hyperactive BS
• fluid and e.lyte replacement
• infectious control
• skin integrity
• ready access to bathroom, bed comode, bedpan

can be a primary problem OR a symptom

• avtivity
• dietary
• drugs
• lg intestine issues= tumores, obstructions
• psychogenic= American Pie "Shit Break"
• system= parkinsons, MS, prego
• chronic use of laxatives or enemas can build dependency

• dec BM
• abd discomfort
• straining
• hard, dry stool
• fecal impaction
•  =palpate hard mass of feces in rectum
•  =water mucous or liquid stool can pass in scant amounts

• bulk forming agents
• wetting agents
• irritant or stimulant laxatives

• like metamucil
• mix agent w/ full glass of cool liquid
• NOT for those w/ impaction of obstruction

• stool softeners
• Docusate
• ensure fluid intake
• not w/n 1hr of PO meds
• do not crush
• short term use

• Castor oil
• assess for contraindications (obstructions)
• give on empty stomach
• do not crush
• use < 1 week

• monitor stools
• encourage fluids and activity
• educate about BM routine, dietary fiber, use of laxatices

inflamm of appendix

obstruction -> distention -> inc pressure -> inpaired bld supply -> inflam, edema, ulceration, infection

• simple= inlfamm but intact
• gangrenous
• perforated

• continuous abd pain
• upper abd pain -> RLQ pain
• aggravated by moving, walking, coughing
• rebound tenderness
• low grade temp
• anorexia
• N/V

• abd ultrasound, x-ray
• CBC
• inc WBC
• inc bands

• Tx:
• -appendectomy
• IV fluids
• Abx
• pain control

• perforation
• abcess
• peritonitis

• inflamm of peritoneum
•  -double layered serous membrane
•  -space b/w parietal and vicseral layers

• sterile peritoneal cavity contaminated
•  -chemical= usually from upper perforation (acidity
•  -Bacterial= from lower perforation

• acute abd:
•  -severe pain
•  -rigid abd
•  -dim or absent BS

• systemic:
•  -fever
•  -inc HR and RR

• WBC > 20,000
• abd x-ray
• paracentesis

• Tx= meds
• IV
• bedrest in fowlers
• NG
• surgery
•  -laparotomy (open)
•  -peritoneal lavage -rinse it out

• abcess
• septicemia -> sepsis
• hypovolemic shock
• inc'd mortatilty rate

• chrones
• ulcerative colitis

• etiology unknown
• age; adolescents and young adults
• Diseases of remission and exacerbations

• LLQ pain
• continuous movement from rectum up
• granular, fraible, thin, blds easy tissue
• 2-30 stools/day

acute comp= toxic megacolon

• RLQ pain
• patchy and skips around in bowel
• cobblestone, ulcers and fissures
• frequent stools

acute comp= obstruction, fistula

• endoscopies
• upper and lower barium
• stool exam and culture
• CBC for anemia
• Sed rate= blood test. If inc. rate, there is an immune response somewhere in the body
• Serum albumin= malnutrition

• primary Tx = Anti-inflammatories
• corticoid steroids, only during exacerbation
• immunosurpressants
• immune response modulators
• antibio therapy
• antidiarrheal agents cautiously, if at all

• high kilocalorie and protein
• low fat, fiber, and residue
• bland
• avoid: raw veggie, whole grain bread, spicy

• toxic megacolon
• hemorrhage
• perforation

• -acute motor paralysis and diliation of colon
•  -triggered by laxative, meds, HyopK 
• -Sx= fever, inc HR, dec BP, dehydration

• intestinal obstruction - rest the bowel
• fistula - abscess, chills, fever, abd mass, UTI

• resection of affected bowel
• -cholectomy
• -ostomy
• -inc risk of fistula formation

• UC is CURED with colectomy
• Chrone's recurs after surgery b/c it is patchy

• mech= palpable
• outside intestine - tumor pressing on intestine
• within the intestine

• fcnt= nothing stuck, just parastalsis fails
• paralytic illeus

simple= 1 section of lumen obstructed (adhesions)

closed loop= 2 sections of lumen (incarcerated hernia (sm bowel pushed through ulcer)

stragulated= closed loop that is cutting off own blood supply

• abd pain
• vomit- look for fecal matter in vomit
• borbygmus
• absent BS
• Hypovolemia
• HypoK

• hypovolemic shock
• gangrene
• perforation

• Tx= fluid and Elyte status
• NG suction
• NPO
• laparotomy

• 1 of the small outpouching in colon
• most common in sigmoid

• presence of diverticulas
• mostly asymptomatic
• episodic, left sided pain

comps= hemoorhage, diverticulitis

• inflam and bacterial proliferation w/n a diverticula
• left sided pain, N/V, low greade fever
• abd distended and tender

comps= peritonitis, abcess formation, bowel obstruction, fistula formations, hemorrhage

barium swallow, scopes, heme is stool, WBC shift left

T= antibios, pain control, inc fiber diet, NPO for -itis, possibly surgery