Intestinal Disorders

IBS Patho

does not have a specific pathophysiology since a diagnosis is typically made when other, more definitively diagnosed intestinal conditions have been ruled out

• Dysfunction in gut-brain connection or hypersensitivity of GI nerves

• IBS-C (constipation presentation)

• IBS-D (diarrhea presentation)

• IBS-M (mixed presentation)

IBS Risk Factors

• Female

• Young

• Family Hx

• Emotional distress

• Food sensitivities

• Meds

  • antidepressants, ABX, meds manufactured w/sorbitol

IBS Sx

• Violent or uncontrollable changes in bowel habits…diarrhea or constipation

• Abd. pain or cramping

• Abd. bloating

• Flatulence

• Blood or mucous stool in stool without indication of disease

must occur weekly for three months or less often for at least six months.

IBS Labs

Diagnosed by ruling out other conditions

• ROME criteria

IBS Tx

• Lifestyle modifications

  • reducing stress

  • avoid trigger foods

  • adequate exercise and sleep

  • monitor fluid intake (dehydration prevention)

• Meds

Lower GI Tract

• Jejunum • Ileum

• Caecum • Ascending colon

• Descending colon • Sigmoid

• Rectum • Anus

Crohn’s Disease Patho

inflammation of the deeper layers of structures lining the GI organs that lie anywhere between the mouth to the anus.

• Patches of inflammation followed by patches of healthy tissue.

  • transmural inflammation

Ulcerative Colitis Patho

affects the colon and rectum.

• Continuous pattern of small sores or ulcers of the superficial mucosa and submucosa that lines these specific areas of the large intestine.

Crohn’s Disease Risk Factors

• Cigarette smoking (or second-hand exposure)

• Fetal or childhood exposure to ABX

• Appendectomy or tonsillectomy early in life

• 20-30 years of age

Ulcerative Colitis Risk Factors

• Past viral or bacterial infections

• 60-79 years of age

• Smoking REDUCES risk

Crohn’s Disease Sx

• Diarrhea

• Rectal bleeding

• Abd.pain

• Decreased appetite

• Abscess formation

• Fistulas around anus

• Skin lesions or joint pain

Ulcerative Colitis Sx

• Stool urgency

• Fatigue

• Increased bowel movement

• Mucous in stool

• NOCTURNAL bowel movements

• Abd. pain

IBD Labs

• EGD

• flexible sigmoidoscopy

• Endoscopy

• Colonoscopy

• X-ray, CT, or MRI

IBD Tx

• Anti-inflammatories, immunosuppressants, or biologic medications

• ABX to address complications

• Vitamin and mineral supplements

• Smoking cessation

• Stress reduction therapy…mediation etc

Diverticulosis

Outward facing sacs along the intestinal tract that form because of areas of weakness.

Diverticulitis

diverticula can become inflamed or develop infections

Celiac Disease

Autoimmune disease causing extreme gluten sensitivity

• Over time, the inner lining of the small intestine can be damaged, and malabsorption can occur due to ingestion of this protein.

Bowel Obstruction

occurs when there is either a structural or functional issue that causes a blockage in the small or large intestine that keeps food or liquid from passing through.

Bowel Obstruction Risk Factors

• Intra-abdominal adhesions

• prior abdominal or pelvic surgery

• IBD

• Cancer

Diverticulitis Risk Factors

• increased age

• obesity

• smoking

• lack of exercise

• Low fiber diet

• Certain medications such as steroids, opioids, and NSAIDs.

Celiac Disease Risk Factors

• Family Hx

• T1DM

• Down Syndrome

• Turner Syndrome

• Autoimmune thyroid issue

• Microscopic colitis

• Addison’s disease

Bowel Obstruction Sx

• Sharp or cramping pain

• Bloating

• Distention of abdomen

• Diarrhea or inability to pass stool or gas

• Loss of appetite

• N/V

Diverticulitis Sx

• Persistent abdominal pain

• N/V

• Elevated temp

• Abd. tenderness

• Constipation or diarrhea

  • Complications may include abscess formation, bowel blockage, fistula development, or peritonitis.

Celiac Disease Sx

• Diarrhea

• Fatigue

• Weight loss

• Bloating

• Increased flatulence

• Anemia

  • Complications loss of bone density, mouth ulcers, neuropathy, joint pain, or reduced function of the spleen. 

Celiac Disease Labs

blood test called tissue transglutaminase IgA antibody (tTG-IgA) i

Colostomy Education

• Nurses should teach that the pouch should be emptied when one-third full to prevent leaks.

• The appliance should be changed every 5 to 7 days or sooner if leakage or skin irritation occurs.

• Clients should monitor the peristomal skin for redness, irritation, or breakdown and use protective barriers as needed.

• Proper hand hygiene and safe disposal of soiled materials must also be emphasized.

Bowel Obstruction Tx

• Partial bowel obstructions may be treated with laxatives to promote GI motility and dietary changes to reduce the bulk of food traveling through the intestines.

• Complete bowel obstructions need to be treated urgently. Most client will be hospitalized to receive IV fluid replacement, nasogastric tube placement to remove excess fluids, medications to decrease nausea and pain, and potential surgery to remove adhesions or scar tissue that may be causing the obstruction.

Diverticulitis Tx

• increasing dietary fiber intake

• antibiotics if infection occurs

• possible surgical intervention such as a colon resection or colectomy, for complications related to intestinal obstruction or perforation.

Celiac Disease Tx

• Strict anti-gluten diet

• Ileostomy if sx are severe