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Lower GI and Accessory System Alterations

Lower GI and Accessory System Alterations. Yolanda Chandler, MSN,RN. Diarrhea. Increased frequency of BM Increased amount of stool Altered consistency All acute diarrhea considered infectious until cause known Viral Bacterial Parasitic . Diarrhea. Antidiarrheal Drugs Demulcent

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Lower GI and Accessory System Alterations

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  1. Lower GI and Accessory System Alterations Yolanda Chandler, MSN,RN

  2. Diarrhea • Increased frequency of BM • Increased amount of stool • Altered consistency • All acute diarrhea considered infectious until cause known • Viral • Bacterial • Parasitic

  3. Diarrhea • Antidiarrheal Drugs • Demulcent • Soothes, coats, protects mucous membranes • Pepto-Bismol • Anticholinergic • Inhibits GI motility • Lomotil/Imodium • Antisecretory • Prolongs intestinal transit time • Sandostatin • Opiod • Decreases CNS stimulation of GI tract motility & secretion-directly inhibits GI motility • Paregoric

  4. Fecal Incontinence • Involuntary passage of stool • Risk factors: • Constipation • Diarrhea • Obstetric trauma • Fecal impaction • Other • Prevention/tx may be managed by bowel training program

  5. Constipation • Decrease in frequency of BM from pt. “normal” • Hard, difficult-to-pass stools • Decrease in stool volume • Retention of feces in rectum • Goals: • Increase intake of fiber/fluids • Increase physical activity • Have soft, formed stools • No complications

  6. Constipation • Drug Therapy • Bulk forming • Metamucil • Stool softeners • Colace • Lubricants • Oil retention enema • Saline and osmotic solutions • MOM, GoLYTELY, Fleet enema • Stimulants • Cascara, Dulcolax • Selective chloride channel activator • Amitiza • Serotonin type 4 receptor partial agonist • Zelnorm

  7. Irritable Bowel Syndrome • Intermittent & recurrent abd. pain and stool pattern irregularities-classified as: • IBS w/diarrhea • IBS w/constipation • IBS w/diarrhea & constipation

  8. Irritable Bowel Syndrome • Management

  9. Appendicitis • Most common causes • Obstruction of lumen by fecalith (accumulated feces) • Foreign bodies • Tumor of cecum or appendix • Intramural thickening from excessive growth of lymphoid tissue • Clinical manifestations • Persistent/continuous pain beginning in peri umbilical area eventually shifting to right lower quadrant (McBurney’s point) • Anorexia • Nausea/vomiting • Localized/rebound tenderness • Muscle guarding • May or may not have low grade fever • Rovsing’s sign

  10. Appendicitis • Diagnostic Studies • Complete history/physical • WBC count • UA • *Ultrasound • *CT • Management • Appendectomy • Preoperative • Postoperative

  11. Peritonitis • Etiology/pathophysiology • Clinical Manifestations • Abdominal pain-most common symptom • Tenderness over involved area-universal sign • Rebound tenderness • Muscle rigidity/Spasm • Lie still/shallow respirations • Abd distention/ascites • Fever 100-101 • Tachycardia • Tachypnea • N/V • Altered bowel habits

  12. Peritonitis • Complications • Diagnostics • Management

  13. Inflammatory Bowel Disease • Crohn’s Disease • Ulcerative Colitis

  14. Inflammatory Bowel Disease-Crohn’s • Pathophysiology • Clinical Manifestations • Assessment/Diagnostic Findings • Complications

  15. Inflammatory Bowel Disease-Ulcerative Colitis • Pathophysiology • Clinical Manifestations • Assessment/Diagnostic Findings • Complications

  16. Inflammatory Bowel Disease • Management • Nutritional Therapy • Pharmacologic Therapy • Surgical Management

  17. Intestinal Obstruction • May occur in small intestine/colon • May be partial/complete • Mechanical • Functional

  18. Intestinal Obstruction • Small Bowel • Pathophysiology • Clinical Manifestations • Assessment/Diagnostic • Management

  19. Intestinal Obstruction • Large Bowel • Pathophysiology • Manifestations • Assessment/diagnostic • Management

  20. Polyps • Neoplastic • Non –neoplastic • Manifestations • Diagnosis

  21. Colorectal Cancer • Pathophysiology • Manifestations • Assessment/Diagnostic Findings • Complications • Management

  22. Ostomies • Ostomy • Surgical procedure that allows intestinal contents to pass from bowel through opening in skin on abdomen • Used when normal elimination route no longer possible • Described according to location and type • Ileostomy • ostomy in ileum • Sigmoid colostomy • ostomy in sigmoid colon • Transverse colostomy • ostomy in transverse colon, etc.

  23. Ostomies • Major types • End stoma • Loop stoma • Double barreled ostomy

  24. Ostomies • Ostomy surgery • Pre-op • Selection of op site • Assess • Physical • Psychological • Social • Cultural • Educational • Bowel prep • Prophylactic antibiotics • Post-op • Assess • Stoma /surrounding tissue/pouching system • Teach • Ostomy care

  25. Ostomies • Colostomy care • Ascending/transverse colon • Semiliquid stools • Sigmoid/descending colon • Semiformed/formed stools • Dietary modifications to decrease gas/odor • Irrigations • Ileostomy care • Liquid stool • Stoma protrusion of 1-1.5 cm makes care easier • Pouch at all times • Always use skin barrier • Monitor for fluid/electrolyte imbalances • Increase fluid to 2-3Liters daily (include sports drinks) • Low fiber initially-reintroduce fiber gradually • Stoma may bleed easily

  26. Ostomies • Adaptation to ostomy • Grief reaction • ADLs resumed 6-8 weeks-avoid heavy lifting • Sexual dysfunction • Pelvic surgery • Radiation • Chemo • Meds • Fatigue • Body image

  27. Diverticular Disease • Pathophysiology • Clinical Manifestations • Assessment/Diagnostics • Complications • Management

  28. Hernias • May be: • Reducible • Irreducible/incarcerated • Strangulated • Types

  29. Hernias • Clinical Manifestations • Management

  30. Conditions of Malabsorption • Pathophysiology • Clinical Manifestations • Assessment/Diagnostic • Management

  31. Hemorrhoids • Dilated veins of anal canal • Rectal bleeding w/defecation-bright red • Pruritis • Prolapse • Pain • Burning

  32. Hemorrhoids • Nursing Management

  33. Anorectal Abscess • Collections of perianal pus • Secondary to: • Anal fissures • Trauma • Inflammatory Bowel disease • Immunosuppressive (AIDS) • Diagnosed by • Rectal exam • Surgical therapy • I&D • Possible packing • Teaching

  34. Anal Fistula • Abnormal tunnel leading from anus or rectum • Complication of Crohn’s • Feces may enter fistula causing infection • Surgical Therapy

  35. Pilonidal Sinus • Hairs penetrate into epithelium/SQ tissue • No symptoms unless infected • Abscess requires I&D • Pack wounds • Sitz baths

  36. Jaundice • Yellowish discoloration of body tissues • Results when concentration of bilirubin in blood becomes abnormally increased • A symptom rather than a disease • Usually 1st detected in sclera and skin • Types • Hemolytic • Hepatocellular • Obstructive

  37. Viral Hepatitis

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