Module 8: GI

If colorectal cancer is caught early, what is the chance of survival?

90%

At what ages should people screen for colorectal cancer?

45 to 75 y/o

If there is a family hx of colorectal cancer, when should screening begin?

10 years prior to family member’s diagnosis

What are 5 colorectal cancer cues?

• change in bowel habits

• pencil-sized stool

• blood in stool

• pain

• feeling of incomplete evacuation

What does an early change in stool look like in colorectal cancer?

blood

What does a late change in stool look like in colorectal cancer? What causes it?

thinning

• d/t bowel obstruction

What are risk factors for colorectal cancer?

• age

• family or personal hx of cancer

• high alcohol intake

• cigarette smoking

• obesity

• hx of inflammatory bowel disease

Are M or F more affected by colorectal cancer?

males

Of all the risk factors for colorectal cancer, what is the #1 risk factor?

age

What kind of diet increases the risk of colorectal cancer?

high

• fat

• protein

• beef

low

• fiber

What are intestinal diverrsions?

surgical openings used to drain stool

• ex. ostomy

T/F: all of large intestine can be removed to survive

T

Describe the 2 aspects of preoperative intestinal diversion care

• placement/positioning of stoma

• education

Describe postoperative intestinal diversion care

• frequent assessment of stoma

• VS

• dressing change

• hydration & electrolyte balance

• skin & stoma care

• diet & fluid intake

• prevent complications

What is stoma expected to look like?

beefy red

What needs to be balanced during postoperative intestinal diversion care?

electrolytes

What is the most common complication after surgery?

infection

T/F: the large bowel is responsible for fluid & nutrient absorption

F

What is an ultrasonography?

visualizes the gallbladder and liver (can detect calculi in gallbladder)

What is radionuclide imaging (cholescintigraphy)?

x-ray done with contrast in the IV to visualize the bile ducts

What is an ileostomy?

surgical creation of an opening into the ileum or small intestine

What is a colostomy?

creation of the opening in the colon or large intestine

What is endoscopic retrograde cholangiopancreatography?

procedure used to diagnose diseases of the gallbladder, biliary system, and pancreas

What is cholecystitis?

gallbladder & inflammation

What is choledocholithiasis?

gallstones in common bile duct

What is cholelithiasis?

gallstones

What is cholangitis?

infection of bile ducts

What is a cholecystectomy?

gallbladder removal

What are the risk factors for cholelithiasis (gallstones)?

• female, fat, 40, fertile

• birth control, estrogen

• DM

• frequent weight changes

• multiparous

What are the 4 Fs/main cholelithiasis (gallstone) risk factors?

• female

• fat

• 40

• fertile

What are cholelithiasis cues?

• silent

  • most people will not notice

• pain

• N/V

Where is pain located in cholelithiasis?

right back

What 2 cues are present in choledocholithiasis?

• jaundice

• changes in urine & stool

What action is needed when person is experiencing cholelithiasis w/o pain?

no action needed if there is no pain

What actions are needed for cholelithiasis?

• lithotripsy

• cholecystectomy

What is a lithotripsy?

procedure where gallstones are zapped and broken up using lasers

What are 2 types of cholecystectomies?

• surgical

• laparoscopic

What is acute cholecystitis?

acute inflammation of gallbladder

What causes acute cholecystitis?

bile backs into gallbladder

• gallbladder swells

What are 90% cases of acute cholecystitis caused by?

gallstones

What is acalculous cholecystitis?

acute cholecystitis not caused by stones

What are 5 causes of acalculous cholecystitis?

• surgery

• trauma

• burns

• torsion

• cystic duct obsctruction

What are the 2 main acute cholecystitis cues?

• pain, tenderness & rigidity of URQ

• N/V

What acute cholecystitis cues are not always seen?

• fever

• chills

• elevated WBCs

What are 2 ways that acute cholecystitis can be diagnosed?

• U/S

• ERCP

What is the main method of managing acute cholecystitis?

decrease inflammation

What are the 5 different methods of decreasing inflammation in acute cholecystitis?

• iv fluids

• NGT

• a/x

• analgesia

• gut rest/NPO

What type of diet should someone w/ acute cholecystitis follow?

low fat diet

What is a laparoscopic cholecystectomy used for?

surgical management of gallbladder disease

When can a patient be discharged after a laparoscopic cholecystectomy?

day of surgery

• outpatient procedure

What is the most common complaint post laparoscopic cholecystectomy?

shoulder pain

What can be done to manage pain post laparoscopic cholecystectomy?

• sit up

• walk

• PRNs as prescribed

What are the guidelines for activity post laparoscopic cholecystectomy?

• light walking can occur immediately

• lifting restriction for a week

What education should be taught for wound care post laparoscopic cholecystectomy?

• clean w/ mild soap

• don’t remove steri-strips until they fall off

What should diet look like post laparoscopic cholecystectomy?

• resume as tolerated

• slowly introduce fats

What 5 s/sx should be reported to provider post laparoscopic cholecystectomy?

• N/V

• abd pain

• anorexia

• abdomen distention

• fever

What are 5 risk factors for esophageal cancer?

• GERD

• barrett’s esophagus

• smoking

• ETOH

• chronic exposure to hot liquids

What are the 2 types of esophageal cancer?

• squamous cell esophageal cancer

• adenocarcinoma esophageal cancer

What are esophageal cancer cues?

• dysphagia

• fullness in throat or substernal area

• regurgitation, hiccups, bad breath

• weight loss & constitutional symptoms

What are 3 ways to dx esophageal cancer?

• EGD w/ Bx

• CT

• U/S

What are 4 ways to medically manage esophageal cancer?

• surgery

• radiotherapy

• chemo

• immunotherapy

What are the 4 nursing goals for esophageal cancer?

• maintain airway

• maintain nutrition

• prevent aspiration

• promote comfort

How can the nurse maintain the airway in esophageal cancer?

• watch airway

• trach management

• NGT care

How can the nurse maintain nutrition in esophageal cancer?

• high calorie

• high protein

• liquid/soft diets

• enteral/parenteral feedings

How can the nurse prevent aspiration in esophageal cancer?

manage oral secretions

How can the nurse promote comfort in esophageal cancer?

physical & emotional support

What are diverticula?

sac-like herniations of the lining of the bowel

Where do diverticula exist?

defects in the muscle layer

What is diverticulosis?

multiple diverticula without inflammation

What does diverticulosis cause?

diverticulitis

What is diverticulitis?

infection & inflammation of diverticula

What are 3 risk factors for diverticular disease?

• increased age

• low fiber diet

• chronic constipation

What are diverticulosis cues?

often asymptomatic

When are cues present in diverticulosis?

when there is an infection

How is diverticulosis diagnosed?

colonoscopy

What does diet look like for patient w/ diverticulosis?

• high fiber

• low-fat

• hydration

What should be prevented in diverticulosis?

constipation

What are diverticulitis cues?

• cramps

• narrow stools

• constipation (d/t obstruction)

• pain, N/V, chills, fever, leukocytosis

What are 4 ways to dx diverticulitis?

• CT

• abd xray

• U/S

• CBC

When diagnosing diverticulitis via CBC, what are they looking for?

leukocytosis (inc WBC)

What are 3 medications used to treat diverticulitiss?

• abx

• acetaminophen/NSAIDs

• antispasmodics

What diet should a patient w/ diverticulitis follow initially?

NPO

When patient w/ diverticulitis begins to feel better, what can their diet consist of?

• clear foods

• low fiber

When diverticulitis is resolved what can the diet consist of?

• high fiber

• low fat

What are 3 complications of diverticulitis?

• perforated bowel

• abscess

• GI bleed

What are the 2 types of intestinal obstructions?

• mechanical

• ileus

What is a mechanical obstruction?

obstruction within the lumen of the bowel or pressure from outside the lumen

What are the 3 types of mechanical obstructions?

• intussception

• volvus

• hernias

What is an intussception?

intestine folds into self

• ex. telescope

What is a volvus?

intestine twisting around itself, becoming edematous

What is a hernia?

the intestine protrudes through an opening in the abdominal wall

Is an ileus more common in small or large bowel?

small bowel

What is an ileus?

when intestinal musculature stops working properly

What are 2 short-term causes of an ileus?

• bowel manipulation during surgery

• medication

What are 2 long-term causes for an ileus?

• narcotic abuse

• scleroderma

Do small bowel obstructions progress slowly or rapidly?

rapidly

Describe the pain in small bowel obstructions

• crampy

  • colicky (pain comes in waves)

T/F: stool & flatus are absent in small bowel obstructions

T

What are small bowel obstruction cues?

• vomiting

• dehydration

• abdominal distention

What are 4 complications caused by small bowel correction isn’t uncorrected?

• hypovolemic shock

• septic shock

• peritonitis

• death