Part 2: Lower GI and Bowel Disorders

Chapter 20: Bowel Elimination

Part 2: Lower GI and Bowel Disorders

Appendicitis

Peritonitis

Inflammatory Bowel Disease (IBD)

Intestinal Obstruction

Pre-Nursing Program | Delaware State University

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Learning Objectives - Part 2

By the end of this lecture, you will be able to:

Define appendicitis, peritonitis, IBD, and intestinal obstruction

Identify the etiology and risk factors for each bowel disorder

Recognize key clinical manifestations and symptoms

Describe common diagnostic tests and laboratory findings

Explain non-pharmacological treatment management strategies

Understand the importance of patient education

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Appendicitis

Definition

An inflammation of the vermiform appendix, a small, finger-like pouch attached to the cecum of the large intestine.

Key Facts

Most common cause of emergency abdominal surgery

Peak incidence between ages 10-30

If untreated, can lead to rupture (perforation) and peritonitis within 24-48 hours

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Appendicitis: Etiology and Risk Factors

Etiology (Causes)

The primary cause is obstruction of the appendiceal lumen (opening).

Causes of Obstruction:

Fecaliths (hardened pieces of stool) - most common

Lymphoid hyperplasia (swelling of lymph tissue)

Foreign bodies

Parasites or tumors

Risk Factors:

Age: More common in adolescents and young adults

Gender: Slightly higher risk in males

Diet: Low-fiber, high-carbohydrate diets

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Appendicitis: Clinical Manifestations

The Progression of Pain

Starts: Vague, periumbilical pain (around the belly button)

Shifts: To the Right Lower Quadrant (RLQ)

Key Signs:

McBurney’s Point Tenderness: Intense pain at the site of the appendix

Rebound Tenderness: Pain when pressure is released from the abdomen

Rovsing’s Sign: Pain in RLQ when palpating the Left Lower Quadrant (LLQ)

Low-grade Fever

Nausea, Vomiting, and Anorexia (loss of appetite)

Patient Position: Often lies still with right leg flexed

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Appendicitis: Diagnosis and Management

Diagnostic Tests

Labs: Elevated WBC count (Leukocytosis)

Imaging: CT scan (Gold Standard), Ultrasound (often used in children/pregnant women)

Non-Pharmacological Management

NPO Status: (Nothing By Mouth) in preparation for surgery

Positioning: Semi-Fowler’s position to localize any potential drainage

Comfort: NO HEAT to the abdomen (can cause rupture!). Use ice packs if needed.

Avoid Laxatives/Enemas: These increase pressure and can cause rupture.

Surgery: Appendectomy is the definitive treatment.

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Peritonitis

Definition

Inflammation and infection of the peritoneum, the thin membrane that lines the abdominal wall and covers the abdominal organs. This is a LIFE-THREATENING EMERGENCY.

Etiology (Causes)

Primary: Spontaneous bacterial infection (often linked to liver disease)

Secondary (Most Common): Perforation of an abdominal organ (Ruptured appendix, perforated ulcer, diverticulitis, trauma)

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Peritonitis: Clinical Manifestations

The Hallmark Sign

Rigid, Board-Like Abdomen: The abdominal muscles go into spasm to protect the inflamed area.

Other Symptoms:

Severe, generalized abdominal pain (worse with movement)

Rebound tenderness

High Fever and chills

Tachycardia (fast heart rate)

Nausea and Vomiting

Abdominal Distention (bloating)

Diminished or absent bowel sounds

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Peritonitis: Diagnosis and Management

Diagnostic Tests

Labs: Massive elevation in WBCs, Blood cultures (rule out sepsis)

Imaging: X-ray (may show "free air" in the abdomen), CT scan

Paracentesis: Testing the abdominal fluid for infection

Non-Pharmacological Management

Strict NPO Status

NG Tube: To decompress the stomach and intestines

IV Fluids: To maintain blood pressure and hydration

Semi-Fowler’s Position: To facilitate breathing and localize infection

Oxygen Therapy: If needed due to abdominal pressure on diaphragm

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Inflammatory Bowel Disease (IBD)

Definition

A group of chronic, autoimmune disorders characterized by inflammation of the digestive tract. It involves periods of exacerbation (flare-ups) and remission.

Two Main Types

Crohn’s Disease

Ulcerative Colitis (UC)

Etiology:

Exact cause unknown. Likely a combination of genetics, immune system overreaction, and environmental triggers.