Lower Gastrointestinal Tract

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Lower Gastrointestinal Tract

• Continued

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Celiac Sprue

• A.k.a. gluten induced enteropathy
• Gluten A protein found in wheat and wheat
  products
• Individual cannot tolerate and it causes damage
  to the lining of the small intestines.

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Cause(s)

• Not clear
• The damage may be an immune reaction
• May be inherited
• Women are affected more than men.

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Signs and Symptoms

• Weight loss
• Flatulence
• Anorexia
• Muscle wasting
• large, greasy yellow foul smelling stools

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How to diagnose

• If you eliminate wheat from the diet and the s/s
  go away
• Orbiopsy of the intestinal villi that shows
  destruction

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Prognosis

• Good if the patient adheres to the diet.
• Small intestines can regenerate however if the
  patient is continually noncompliant, regeneration
  may not be possible.

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Duodenal Ulcer
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Appearance

• Circumscribed
• Crater-like lesion

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Causes

• H. Pylori bacteria
• Salicylates
• Increased HCL production
• Genetics
• Smoking

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Signs Symptoms

• Chronic, periodic heartburn
• May radiate to the back
• Appear 2 hours after eating

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Diagnostic Procedures

• Stool for occult blood
• Esophagogastroduodenoscopy (EGD)

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Treatment

• Avoid the cause
• Antacids
• Anticholinergics
• Antihistamines
• Vagotomy

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Prognosis

• Chronic
• Can perforate and hemorrhage
• Can be controlled if client is compliant

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Appendicitis
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Etiology

• Fecalith
• Worms
• Foreign body
• Neoplasm

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Complications

• Necrosis
• Gangrene
• Rupture
• Peritonitis
• Sepsis

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Signs Symptoms

• Abdominal pain
• Focused McBurneys Point
• Nausea, Vomiting, diarrhea OR constipation
• Fever, malaise
• Elevated WBC

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Treatment

• Only (1)appendectomy
• There is no prevention

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IBS vs. Chrons Disease

• Alternating diarrhea with constipation
• May last 1 day
• Change in motility
• Strong psychological component

• Diarrhea
• Steady RL abd. Pain
• Not linked to psychological components
• Sores, fistulas in anal area

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Crohns Disease

• Ulcerations, fistuals.
• Sigmoidoscopy, Colonoscopy
• Only definitive dx. Is thru biopsy

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Crohns Treatment

• Symptomatic Supportive
• Steroids
• Mesalamine
• Colectomy
• Ileostomy

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Ulcerative Colitis

• Differentiated from Crohns by the inflammatory
  process.
• The inflammation is uniform with NO patches of
  healthy tissue
• Only impacts the mucosal lining

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Signs Symptoms

• Bloody diarrhea
• Maybe some pus
• Abdominal pain
• Urgency to defecate

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Diagnostic Procedures

• Sigmoidoscopy will find that the tissue easily
  falls apart
• Biopsy will also be done
• Colonoscopy to determine how far the disease goes

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Treatment

• Much the same as Crohns disease
• May require excision and resection of damaged
  part of the colon.

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Diverticulitis

• Inflammation of abnormal side pockets in
  intestinesside pockets are called diverticula.
• Most commonly found in the sigmoid colon

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Cause

• Unknown
• Theory Food accumulates in a diverticulum (1)
  and forms a fecalithbacteria accumulates and
  inflammation/infection occurs.

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Signs Symptoms

• Fever
• Pain in LL abdomen
• Relieved by BM

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Diagnosis

• Sigmoidoscopy will reveal the abnormal pockets
• Hemocult
• Increased ESR

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Treatment

• High bulk diet
• Stool softeners
• Antibiotics
• Anticholinergics

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Prognosis

• The older you get the worse the prognosis
• Complications hemorrhage, perforation, sepsis,
  shock.

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Hemorrhoids

• Dilated, tortuous veins in the mucosa of the anus
  or rectum
• Two Kinds Internal/External

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Causes

• Constipation
• Sitting too much
• Infections
• Pregnancy
• Anal sex
• Old age

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Signs Symptoms

• Pain
• Itching
• Bleeding
• Visible hemorrhoids

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Treatment

• Increase roughage in diet
• Stool softeners
• Sitz baths
• Manual reduction
• Ligation
• Cryosurgery

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Colorectal cancer

• Almost always adenocarcinoma

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Cause

• Unknown however
• Higher incidence in societies with diets high in
  red meat and low in fiber
• Family history of digestive tract disease
• IBS
• Familial polyposis

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Signs Symptoms

• Rectal bleeding
• Cachexia
• Lymphadenopathy
• Hepatomegaly
• Ascites

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Treatment

• Surgery
• Chemotherapy
• Radiation
• Cure rate of 92 if caught early.
• DRE! Annually after age 40