management of a patient w/ a lower GI disorder pt 1

what is the appendix?

tube like pouch

attached to cecum of LI, just below ileocecal valve

function not fully understood, may serve as reservoir for beneficial intestinal bacteria

empties inefficiently and lumen is small

what is the incidence of appendicitis?

most common cause of abdominal pain

increase chance in young and old

more likely in males

what is the patho of appendicitis?

destruction of appendicile lumen, not always sure why it happens

sometimes a fecilitle (small hard piece of stool) gets stuck in the lumen

what are the manifestations of appendicitis?

pain starts around the umbilicus and migrates to the right lower quadrant (mcburney point)

nausea and vomiting

increase temp

rebound tenderness

how is appendicitis diagnosed?

increased WBCs

a diameter greater than 6 mm on ultrasound

occluded lumen and wall thickening on CT scan

what are the interventions for appendicitis?

immediate surgery, normally laparoscopic

pre-op interventions: NPO, monitor lytes, nothing to stimulate the bowels

post-op: IV fluids, NPO, antibiotics, pain assessment, incentive spirometer, monitor for complications

what is peritonitis?

acute inflammation of the peritoneum, leads to access formation and adhesions

list the cause of peritonitis

primary: abdominal trauma/wounds

secondary: perforated ulcer, appendix, diverticulum, gallbladder

what are the manifestations of peritonitis?

pain, fever, abdominal distention (board like abdomen), diminished or absent bowel sounds, N/V, hypovolemia and shock, hiccups

what tests are done to diagnosis peritonitis?

WBC, blood cultures, liver and renal function studies, serum lytes, abdominal CT, paracentesis (pull out fluid from abdomen, see if high in protein and WBCs)

describe treatment for peritonitis

goals: prevent extension of inflammation, correct fluid and lytes, minimize bowel obstruction

NPO and NG normally, IV fluids, control pain, semi-fowler

what complications can occur from peritonitis?

access formation, septicemia, septic shock, hypovolemic shock, adhesions

what is diverticular disease?

diverticulum: small bulging sac pushing outward from colon wall

more than one is diverticula

occur throughout intestinal tract, but most common in sigmoid colon

what is the etiology of diverticular disease?

risk factors: low fiber diet, age, constipation, decreased physical activity, laxative abuse

what are symptoms and interventions for diverticulosis?

symptoms: most asymptomatic, episodic pain, constipation or diarrhea, ribbon like stools

interventions: high fiber diet, bowel movement everyday, avoid laxatives, increase fluid intake, increase physical activity

what is the difference between diverticulosis and diverticulitis?

diverticulosis: multiple diverticula are present without inflammation

diverticulitis: diverticula become inflamed

list the symptoms of diverticulitis

LLQ pain

constipation or increased deification

N/V

low grade fever

increase WBC

possible blood in stool

how is diverticulitis diagnosed?

WBC, hem occult testing of stool, colonoscopy, CT, abdominal x ray

how does someone prepare for a colonoscopy?

clear liquids the day before, NPO, no red or purple liquids

take medication to empty bowel

what are interventions for diverticulitis?

non-surgical: antibiotics, bowel rest, hydration, pain relief (no morphine), no laxatives, antispasmodics, diet

surgical: peritonitis, abscess, failure to respond to medical treatment, hemorrhage

what are complications of diverticulitis?

perforation, peritonitis, abscess/fistula formation, bowel obstruction, urethral obstruction, bleeding