LOWER GASTROINTESTINAL PROBLEMS

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LOWER GASTROINTESTINAL PROBLEMS

• Alteration in Elimination
• Madeline Gervase RN,MSN,CCRN,FNP

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Diarrhea

• Not a disease
• Symptom
• ? in stool frequency
• ? in stool volume
• ? in looseness of stool
• ? fluid absorption
• ? fluid secretion
• motility disturbances?

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Diagnostic Studies and Treatment

• History
• travel
• med use
• previous surgery
• contacts
• physical exam
• labs
• stools/cultures
• Tx based on cause

• Meds
• Demulcent
• Anticholinergic
• Antisecretory
• Narcotic
• Nursing Diagnosis
• Altered elimination
• Fluid volume deficit
• Impaired skin integrity
• Risk for infection transmission

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Fecal Incontinence

• Involuntary passage of stool
• Causes
• Traumatic
• Inflammatory
• Neurologic
• Other

• Diagnosis
• rectal exam
• sigmoidoscopy
• colonoscopy
• Biofeedback
• Surgery
• Diet

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Constipation

• ? stool frequency
• hard, difficult-to-pass stools
• ? stool volume
• retention of feces in rectum

• Causes
• ? dietary fiber
• inadequate fluid intake
• med use
• lack of exercise
• beliefs
• ignoring urge to defecate
• laxative abuse
• multiple organic causes

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• Colonic disorders
• Drug Induced
• Systemic Disorders
• metabolic/endocrine
• collagen vascular disease
• neurogenic disorders

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• Complications
• Hemorrhoids
• Cardiac (bradys)
• Diverticulosis
• Obstipation (fecal
• impaction)

• Treatment
• Diet
• Medications
• Knowledge re
• bowel
• function

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• Bulk forming
• Metamucil
• Fibercon
• Stimulants
• Cascara
• Exlax
• Dulcolax

• Stool softeners
• mineral oil
• colace
• peri-colace
• Saline and Osmotic
• Mg salts
• Mg citrate
• MOM
• Fleets enema
• Lactulose

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Acute Abdomen

• Causes
• trauma
• ischemic bowel
• obstruction
• cholecystitis
• crohns disease
• diverticulitis
• gastritis
• gastroenteritis
• pancreatitis
• PID

• PUD
• performation
• uterine rupture
• volvulus
• peritonitis
• Ruptured abd aneurysm
• ectopic pregnancy
• ovarian cyst
• ulcerative colitis

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Diagnosis and treatment

• H P
• CBC, U/A, Xray, ECG, electrolytes, amylase, PT,
  PTT,
• type and cross, pregnancy test
• Airway/oxygen
• IV access
• foley catheter

• N/G tube prn
• VS, LOC, pulse ox, I O
• Assess and treat pain
• assess and measure emesis
• NPO
• Prepare for OR

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Abdominal Trauma

• Blunt
• Penetrating
• Organ damage
• Massive blood loss
• Hypovolemic shock
• Peritonitis
• hematemesis, hematuria
• shock

• SS
• Board-like, distended
• abdomen
• ? or absent BS
• Contusions, abrasions, bruising (Cullens
  sign)
• PAIN
• Scapula pain

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Types

• Mechanical
• occlusion of lumen
• 90
• Adhesions-50
• hernias
• neoplasms

• Nonmechanical
• neuromuscular or vascular
• paralytic ileus
• pesudoobstruction
• vascular
• interference in blood supply
• emboli

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Symptoms(based on location of obstruction)

• Fluid, gas, and intestinal contents accumulate
  proximal ? Distention ?? absorption ? ?fluids ?
  ?pressure ? ?capillary permeability and FE
  extravasate into peritoneal cavity.
• ? circulating blood volume
• hypotension shock
• FE imbalance

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• Small bowel
• rapid dehydration
• Large bowel
• dehydration and electrolyte imbalances are much
  later
• fecal vomiting
• Distention
• absent in high, small bowel
• ? lower, large bowel

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Diagnosis

• HP
• Abdominal xrays (air/fluid levels)
• Barium enemas (not in perforation)
• Lower GI
• Sigmoidoscopy
• Colonoscopy
• Labs
• CBC, lytes, amylase, BUN

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Treatment

• Decompress intestine - NG tubes
• Intravenous fluids
• Surgical - mechanical obstruction
• Pain management
• Nursing Dx
• Pain
• Fluid volume deficit
• Altered nutrition

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Diverticulosis and Diverticulitis

• 50 by age 80
• Men women
• Men complications
• Smooth muscle becomes thickened
• ? intraluminal pressures
• litis retention of stool and bacteria in
  culum - hardened mass ? inflammation and small
  perforations

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• None
• Crampy, abdominal pain LLQ
• constipation/diarrhea/constipation
• palpable LLW mass
• Fever, chills, nausea, anorexia, leukocytosis
• hematochezia (maroon stools)
• Elderly
• afebrile, normal WBC, no tenderness

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• Complications
• perforation, peritonitis, abscess, fistula
  formation, obstruction, ureteral obstruction,
  bleeding
• Management
• High-fiber diet
• Laxatives

• Anticholinergic drugs
• dicyclomine (Bentyl)
• Donnatal
• Increased fluids
• Weight reduction
• Reduce intraabdominal pressure
• Acute
• NPO
• Bowel resection, colostomy

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• Symptoms vary depending on location
• N/V, pain, distention, no flatus, obstipation
• High - projective bile vomitus
• Distal small bowel-gradual
• Large bowel-no emesis

• Pain
• persistent, colicky (lower)
• peristaltic pain
• ileus -constant, generalized
• strangulation-severe, rapid onset
• Bowel signs
• High pitched above obstruction
• audible borborygmi

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Acute Pancreatitis

• PAIN
• LUQ or mid-epigastrium -radiates to back
• aggravated by eating
• occurs when lying down
• sudden onset
• flushing, cyanosis, dyspnea

• Acute inflammatory process
• Men women
• Biliary tract disease and alcoholism
• Autodigestion of pancreas
• N/V, low-grade fever
• leukocytosis, hypotension, tachycardia, jaundice

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• Dx tests
• amylase, lipase, urinary amylase
• glucose, lipids, calcium
• ERCP
• Management
• Pain relief (Meperidine)
• Antispasmodic
• NPO
• IV fluids
• N/G tube prn

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Cholecystitis and cholelithiasis

• Diagnosis
• ultrasound
• PCT (percutaneous transhepatic cholangiography)
• ERCP
• Labs
• Management
• Analgesic, antibiotics, FE
• Surgery (open/closed)

• inflammation
• Stones
• remain in GB or migrate
• pain
• obstruction (duct)
• Indigestion, pain/tenderness RUQ
• Moderate to severe pain, fever, jaundice
• Complications
• abscess, pancreatitis, rupture

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Thank you!

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