lower gi

• at least 3 loose stools/day
• chronic if longer than 30 days

• -ingesting infectious organisms
• -ecoli
• -viruses
• -age, gastric acitity

• organisms alter secretions and or absorption
• -inflamed colon and produce toxins

• -explosive and watery
• -abdominal cramp/pain
• -leukocytes, blood and mucos in stool
• -n/v

upper= large volume, watery, cramps, low grade fever

colon and distal bowel= fever and frequent bloody diarreha w/ small volume

• stool occult and culture
• cbc and electrolytes

• -AB are RARE for acute
• -antidiarehhal agents may be given short term

• -opioid and opiod derrivitives
• -bismuth subsaliciates

-decrease peristalisis so delay transit and increase absorption from stools

• immodium(loperamide)
• lomotil(diphen and atropine)

diarreha

• -decrease secretions in digestive tract which decreases inflammation
• -provide protective coat
• -mild AB

• pepto bismol
• kaopectate

Diarehha

up to 2-3 months on surfaces

• flagyl(metronidazole)
• vancomycyin

• most effective treatment for recurring cdiff
• -infuse fecal from enema, colonoscopy, or ng tube

• -100% effective
• -process poop down to bacteria only, then encapsulate
• -less invasive and covers more of GI tract

• clear liquids the day b4
• npo 8hrs
• complete colon empty

• -cramping and urge to defecate may occur
• -barium will clear in 1-3 days, calky stool

-prevent constipation

an xray exam that can detect changes in the large intestine(colon)

• -drink barium
• -q30 xray until barium reaches terminal illium

endoscopic exam of the large bowel and the distal part of the small bowel

• -same as barium
• -sedation
• -refeeredshoulder pain

• -observe for bleeding and perforation
• -abdominal distention
• -pain or feeling of need to defecate when bowels are empty

• visualization of digestive systm(small int)
• 8-12 hours of imaging

• same as barium
• clears after 2 hours
• food/meds 4 hours after

• stool
• serum electrolytes
• hemo/hct
• wbc
• esr

for prolonged diarreha

• gualac or hemmocult test
• free of red meat 24-48 hrs

decreased with diarrhea and N/V

increased with dehydration from diarrhea and N/V

increased with infection

increased with inflammation

• -distention
• -straining
• -lack of appetite
• -increased flatulance

hemmorrhoids

• laxitives
• manual disimpaction
• enemas

2 liters per day

20-30g per day

probiotics

• increase gut transit time
• increase stool freq
• softening stool

• bulk forming
• stool aoft
• stimulant

24 hours

psylilium/metamucil

• -increase bulk which stimulates peristalisis
• -must take with 8oz of water
• -best initial choice

72 hours

docusate/Colace/surfac

• lubricate gi tract
• soften stool

• -12 hours
• 15-30 min

• senna9very common)
• senokot/sennosidide
• elax, bisacodyl/ducolox

• -increase peristalisis
• -most widley abused
• -contraindicated with impaction

• -disimpaction or enema
• -bulking agents
• -high fiber
• -antidiarehhal
• kegals
• biofeed back
• bowel training

loperimide/immodium

• -gel injection into submucosa of anal canal
• -bulks up(narrows) anal canal

• diet
• defecate 30 min after breakfast
• digital stim
• ducolax or glycerine suppository 15-30 min before usual evacuation

occurs when intestinal contents can not pass through the gi tract

• large or small bowel
• small is most common
• partial or complete

6-8 to small bowel

when electrolyte rich fluids can not be absorbed

• hypovolemia
• bowel tissue ischemia/necrosis/rupture

• -n/v(bile colored, often in SBO)(rare in colon obstruction)
• -abd pain and distention
• -constipation

• mechanical
• non mechanical

• -surgical(most common)(days to years)
• -hernias

• carcinomas
• volvus
• diverticular disease

decreased or absent peristalisis

• -non mechanical
• -lack of peristalisis
• -no bowel sounds
• -post abdominal surgery
• (encourage early ambulation)

iliocecal intussception

if not resolved in 24 hours

saccular dialations or outpouchings of the mucosa that develop in the colon

inflammation of one r more diverticula resulting in perforation into perineum

having multiple non inflamed diverticula

• sigmoid colon
• elderly

high luminal pressure in colon from deficiency of dietry fiber intake

erosion of bowel wall which causes perforation

the body walls off perforation

can not be contained

• -no s/s
• -abd paint, bloat, gas or change in bowel habiti
• -NO SX of INFLAMMATION

• -acute llq pain(sigmoid colon)
• -palpable abd mass
• -n/v
• -s/s of infection: fever, increased WBC
• -older adults may be afebrile and normal WBC(chronic)

• diverticula
• inflammation

• -high fiber9fruit and veg)
• -decreased fat/red meat
• -weight
• -reduce intra abd pressure

• let colon rest and reduce inflammation
• -HOME: AB and clear liquid
• -HOSPITAL: Ab, npo, ng, iv fluid, clear liquid progressive, asses for abcess, bleeding and peritonisis

a medical emergency

inflammation/infection of the peritoneum

when infectious organisms enter the peritoneal cavity

• -blood borne
• -ascities from cirrhosis
• -genital tract

• -rupture of organ in abdomen(diverticulitis, appendicitis, perforated ulcer)
• -peritoneal dialysis
• -gunshot and knife wounds

• -abdominal pain
• -guarding abdomen
• -rebound tenderness
• -ridgitity of abdomen

• n/v
• distention
• fever
• shock

• -cbc
• -peritoneal aspiration
• -xray, ct, ultra sound
• -paritoneoscopy(laproscopy)

is indicated to locate cause, drain purulent fluid and repair damage

• -ab
• -ng
• -iv
• -o2
• -analgesic/anemetic
• -asses for shock
• -abdominal asses
• -position knees

• dialated veins around anus/lower rectum
• appear periodically

increased anal pressure and weakened anal tissue that supports hemroidal veins

• -stool softner
• -increase fiber/fluids
• -antiinflamatories
• -sitz

• excessive size
• pain
• bleeding

• most often used
• can be painful
• non surgical

• -excision of
• -donut
• -pain relief
• -first bm
• pain med before bm