diverticulitis, obstructions, polyps

diverticulum

single pouch of mucosa sticking out in the GI tract

where is diverticulitis most commonly found

L descending sigmoid colon

what is diverticulitis

inflammation of diverticula caused by retention of stool and bacteria in pouches

diverticula can tear causing infection

surrounding area becomes inflammed and edematous

what are the sx of diverticulitis

asymptomatic

how is diverticulitis discovered

sigmoidoscopy and colonoscopy

what would a pt with diverticulitis complain of

abd pain

bloating

flatus

changes in bowel habits

what are the complications of diverticulitis

hematochezia-bleeding

perforation

abcess formation

peritonitis

what are the sx of a complication of diverticulitis

LLQ pain

palpable abdominal mass

fever and chills

cramping constipation and N/V

what is the test of choice for dx diverticulitis complication

CT scan with contrast

what should not be done on someone that has diverticulitis

scope procedures

what are the causes of diverticulitis

unknown but associated with a low fiber diet

high refined carb diet

slow transit time dt low fiber and high refined carbs

high pressure in the lumen of intestine which pushes out the pockets of mucosa

what are the preventions

normal elimination pattern

avoid constipation

high fiber diet

increased fluids

dec fat intake

dec red meat

lose weight

increase physical activity

what meds are used to prevent it

metamucil

anticholinergics

what are the interventions

bed rest

bowel rest

treat infection

possible surgery- colectomy, colostomy, abcess removal

what are the interventions for the acute phase

NPO

treat infection with IV antibiotics

NG suction

what are the interventions for the recovery phase

clear liquid diet then semi-solid foods

po antibiotics to treat the infection

colectomy

remove part of the bowel

colostomy

temporary or permanent

what are the kinds of obstructions

mechanical

non-mechanical- absent or reduced peristalsis

mechanical obstruction

the lumen is occluded

what causes the lumen be occluded

adhesion- most common

infections/abcesses

tumor/polyp

volvulus- loop of intestine loops around itself

intussusception- part of the bowel slides into another adjacent bowel

barium

stool

what is a non-mechanical obstruction

absent or reduced peristalsis

what is a non-mechanical obstruction caused by

paralytic ileus- muscles of the bowel do not function dt neuromuscular problems

mesenteric occlusion- lack of bloodflow

which intestines are affected by a non-mechanical obstruction

small and large intestine

what are the sx of an obstruction

abdominal pain

distention

N/V

constipation/obstipation

what causes abdominal pain of an obstruction

intestinal stretching

what is the abdominal pain of an obstruction feel like

described as “colicky”

what does the abdominal pain of a mechanical obstruction feel like?

wave-like

what does the abdominal pain of a non-mechanical obstruction feel like?

constant and generalized

what are the bowel sounds like with an obstruction

borborygmi

what kind of obstruction does nausea and vomiting provide relief for?

high obstruction

what do the VS look like with an obstruction

either pain- tachycardia and high BP

or

hypovalemia- low BP, fatigue, tachycardia

what happens to the proximal and distal area of the obstruction?

fluid, gas, and intestinal content increases proximal to the obstruction and the distal portion collapses

what does the proximal obstruction look like

increased distention

pressure

leaking fluids

electrolytes into the peritoneum

what are the major things that happen with a bowel obstruction

hypotension

hypovalemia

ischemia

what does the location of the obstruction determine

the severity of fluid and electrolyte loss and acid-base imbalance

what happens with a high obstruction

metabolic alkalosis dt vomiting and NG suctioning

what happens in a small bowel obstruction

dehyrdation occurs more rapidly

what happens in a large bowel obstruction

feces accumulates creating more discomfort but does not create significant FE issues

what are the hallmark signs of an obstruction

distention

abd pain

N/V

constipation

where does distention increase with an obstruction

the lower bowel

what kind of obstruction does nasuea provide relief for?

high obstructions

what do the VS look like for an obstruction

reflect pain or hypovalemia

what does a high obstruction cause

metabolic alkalosis dt vomiting and NG suctioning

what happens with a small bowel obstruction

electrolyte imbalance dt dehydration

what happens with a large bowel obstruction

feces accumulation creating discomfort but does not create an electrolyte imbalance

what are the dx tests for obstructions

X-ray

CT

MRI

barium

colonoscopy

sigmoidoscopy

what should the nurse do after giving barium

increase intake of fluids to flush it out

what labs should be checked if an obstruction is suspected

CBC

electrolytes

renal function

liver function

ABG

what are the interventions of a bowel obstruction

decompress the stomach using an NG

NPO

TPN if prolonged

surgery if no resolution

colostomy

colectomy

what is a colectomy

removing a part of the bowel

diverticulosis

hollow sac cavities throughout the intestine walls

a lot of out pouching areas

diverticula

one singular out pouching area

diverticulum

what causes diverticula

constipation and straining that makes the walls herniate

what can happen to the arteries in the intestines from diverticulitis

the arteries can burst dt the thinning intestine leading to painless blood in the stool

if an inflammed divericulum ruptures what happens

peritonitis or sepsis

what causes the inflammation of the pouches

stool getting stuck in them

where is the abdominal pain in diverticulitis

LLQ

what are the interventions for the initial/acute phase of diverticulitis

NPO

IV antibiotics

assess for peritonitis

what is the biggest sign of peritonitis

a worsening fever and increased bloating

what are the interventions for the recovery phase

clear liquid diet

low fiber diet

probiotics

metamucil, anticholinergics

what is a polyp

mass of tissue that protrudes into the bowel

what are the sx of a polyp

asymptomatic

what is a hyperplastic polyp

low risk of cancer

benign

adenomatous-neoplastic polyp

more concerning

linked to colorectal cancer