gi quiz pt 2

what are the two categories of inflammatory bowel disease (IBS)?

regional enteritis (crohn's disease) and ulcerative colitis

what are the s/s of crohn's disease

inflammation and pain in the LRQ

where does crohn's occur in the abdomen?

ileum or ascending colon

what are the lesions found in crohn's disease separated by?

normal tissue

when lesions are separated by normal tissue in crohn's disease what does this create?

a cobblestone appearance

what is the pathophysiology of crohn's disease?

- chronic inflammation of all of the gi tract occurs that extends through the layers transmural
- edema and thickening of mucosa begins
- ulcers begin to form on the inflamed mucosa

what forms as the information found in crohn's disease extends into the peritoneum?

- fistulas
- fissures
- abscesses

what are found in 50% of crohn's patients?

granulomas (nodular inflammations)

what happens to the wall of the intestines as crohn's disea progresses?

the wall thickens, fribosis and narrowing of the lumen also occurs

what happens to the bowel loops during crohn's disease?

they can stick together and develop adhesions

what is a chronic issue seen with crohn's disease?

diarrhea and steatorrhea

steatorrhea

fat in stool

what is a clinical manifestation in a patient with crohn's disease?

weight-loss, malnutrition and anemia, limited food intake leading to poor nutrition

how does scar tissue interfere with the intestine during crohn's disease?

it interferes with upper intestinal digestion leading to cramping after meals

what is the barium series diagnostic found with crohn's disease?

discontinuous lesions, narrowing of the colon, stenosis and fistulas

what is the sigmoidoscopy diagnostic found within crohn's disease?

maybe unremarkable unless perianal present

what is the colonoscopy diagnostic found in crohn's disase?

distinct ulcerations separated by normal mucosa in ascending colon

what does ulcerative colitis mean?

it is when the intestinal wall is worn down or broken through

where do we typically see ulcerative colitis?

in the rectum and descending colon

what kinds of lesions are found with ulcerative colitis?

mucosal ulcerations

what is the pathophysiology of ulcerative colitis?

superficial mucosa of the colon is characterized by multiple ulcerations, shedding of the colonic epithelium

what is a unique characteristic of the lesions found in ulcerative colitis?

the lesions are contagious, one after another abscesses form

what is a very common s/s of ulcerative colitis

bleeding and severe diarrhea

what happens during ulcerative colitis as a disease process begins?

it begins in the rectum, spreads approximately to involve the entire colon and can cause systemic complications

clinical manifestations of ulcerative colitis?

exacerbations and remission is common, diarrhea, intermittent tenesmus, rectal bleeding, may have anorexia, weight loss, fever, and committing and dehydration

what is the barium series diagnostic for ulcerative colitis

no narrowing of the colon, no mucosal edema, stenosis is rare

what is the sigmoidoscopy diagnostic for ulcerative colitis?

abnormal inflamed mucosa

what is the colonoscopy diagnostic found in the ulcerative colitis?

friable inflamed mucosa with exudate or ulcers and descending colon

where do we see pain in ulcerative colitis?

LLQ abdominal pain

what are complications of ulcerative colitis?

toxic megacolon (colectomy), perforation and intractable bleeding intestinal obstruction

what does it mean to have a toxic megacolon?

- the colon becomes distended and the abdomen is distended
- bloating
- fever
- shock

what are medications used for irritable bowel disease, crohn's, and colitis?

- sedatives
- antidiarrheals
- anti-perspirant
- amino salicylate
- abx
- corticosteroids
- immuno-dilators

what kind of surgical interventiions are used when it is necessary during IBS?

- ileostomy
- ileal pouch anal anastomosis (IPAA)
- koch pouch

what are the gi upper diagnostic tests?

- upper endoscopy/capsule endoscopy
- EGD
- barium swallow
- x-ray of upper GI
- CT scans
- CBC
- tumor markers

what is an EGD?

esophagogastroduodenoscopy

what does an EGD look at?

- it looks at the stomach esophagus and duodenum
- it's to look for the growth of abnormal cells, a form of biopsy

what CBCs are looked at in upper GI diagnostic testing?

looks for changes in RBC count to indicate possible anemia

what are the tumor markers we see in upper GI diagnostic testing?

CEA, CJ, 19-9, CA 50

what are lower GI diagnostic tests?

- x-ray
- CT scan done with contrast
- MRI
- PET scan
- barium enema
- colonoscopy
- sigmoidoscopy
- laprascopic

what is a capsule endoscopy?

it is when the patient swallows a little camera and a recorder belt

what must be done before a patient partakes in a capsule endoscopy noninvasive test?

the patient must fast

what CBCs are we looking for when doing lower GI diagnostic testing

looking for WBC with diverticulitis for indication of infection and RBCs for bleeding

what is a diverticulum?

- it is a saclike herniation of the inner bowel
- mucosa and submucosal layers
- that extends through a defect in the muscle

what is the diverticulum related to in the intestine?

high intraluminal pressure

what is the volume in a diverticulum in the colon?

there is a low volume in the colon, lack of fiber

what kind of muscle strength is found in the colon wall in a diverticula?

decreased muscle streaks in the colon wall, hypertrophy r/t the hard stools

what is diverticulosis?

multiple diverticula without inflammation

what is diverticulitis?

infection and inflammation of the diverticula

what factors increase diverticular disease?

age and a low fiber diet

how is diverticulitis diagnosis made?

usually done through colonoscopy

what do we see chronic prior to the development of diverticulosis?

chronic constipation

diverticulosis symptoms

- mild or severe pain in LLQ
- n/v
- fever
- chills
- leukocytosis

what is very common to see in diverticulosis?

common to be frequently asymptomatic and only include bowel regularities, nausea, anorexia, bloating, and abdominal distention

IBS

irritable bowel syndrome

how is IBS characterized?

recurring bowel pain r/t disorders of the bowel

one of the most common GI conditions in the US

IBS - 15% of adults in the US

in what gender is IBS more common?

women

is there a cause of IBS?

no, it is a functional disorder of intestinal mobility with no known cause

IBS associated triggers

- chronic stress
- food deprivation
- surgery
- infections
- diverticulitis
- diet

IBS manifestations

vary from mild to infrequent to severe and continuous, sometimes precipitated by eating

what must be monitored if a patient with IBS is suffering with constipation and/or diarrhea?

dehydration levels

IBS symptoms

- constipation and diarrhea (sometimes both)
- pain
- bloating
- distention

what is something that often relieves IBS pain?

defecation

what is IBSD

irritable bowel syndrome diarrhea

what is IBSC

irritable bowel syndrome constipation

what must you do first when doing an IBS assessment and diagnosis?

- CBC
- C reactive protein
- test for celiac disease
- fecal calprotectin
- stool studies
- colonoscopies

when looking at a stool study for an IBS assessment diagnosis, what should be looked at specifically?

look for parasites, like worms

why might you look at a c reactive protein for an IBS assessment and diagnosis?

c reactive protein