Colorectal Diseases

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85 Terms

1
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risk factors for constipation

old age, women, African American, low socioeconomic status, immobilization, low fiber diet, low water intake, stress, pregnancy, medications

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causes of constipation in the elderly

missing teeth, decreased eating and drinking, low exercise, weaking abdominal muscles, meds, excessive laxative use

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signs of constipation

less than 3 defecations per week, bloating, abdominal pain, feeling you still need to defecate after defecation, small stool amounts

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complications of constipation

HTN, fecal impaction, fecal incontinence, hemorrhoids, anal fissure, rectal prolapse, megacolon

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fecal impaction

hard stool bulge that can’t be removed. It can cause an ulcer or liquidy stool release

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removal by hand or enema

treatment of fecal impaction

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megacolon

dilation and atonia of the colon. It can cause perforation

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constipation treatment

hydration, high fiber diet, exercise, pelvic floor strengthening, change medications, laxatives

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Methycellulose

fiber laxative. It should be taken with a lot of water. IT encourages peristalsis

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Magnesium Hydroxide

saline agent. Magnesium that pulls water towards it and increases peristalsis. It takes two hours to work and is for short use

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AKI and CKD

contraindications of saline agents

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lubricants

lubricates the colon wall and helps stool move. (paraffin and glycerin oil). Paraffin works in 6-8 hours and glycerin works in 30 minutes

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Bisacodyl

stimulates nerve that increases peristalsis and secretions and decreases water reabsorption. It works in 6-8 hours. Type of laxative

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stool softeners

wets the stool with effects similiar to surfactant

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Normolax and Avilac

osmotoc agents that quickly clean the colon and increase defecations. It needs to be drunk in large amounts and can cause nausea and bloating

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chloride channel activator

Lubiprostone. It activates chloride channels to bring sodium and water into the colon. It can’t be given during pregnancy

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causes of appendicitis

stool obstructing the appencdix, lymphatic tissue, foreign objectsm inflammation, ischemia, and an abscess

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signs of appendicitis

dull pain in the RLQ, anorexia, nausea, subfebrile pain, constipation, perforation if after 24 hours, interabdominal abscess, rebound tenderness, Rovsing’s sign

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rebound tenderness

press on the RLQ, pain is stronger when you let go

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Rovsing;s sign

press on the LLQ, pain is on the right side when pressing down

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diagnosis of appendicitis

leukocytosis, high CRP, CT, laproscopy

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appendectomy

treatment of appendicitis

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post appendectomy instructions

high fowler position, physiotherapy, early mobilization, remove stiches after 1-2 weeks, no weights for 2-4 weeks, prevent atelectasis

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Diverticulosis

lots of diverticuli without inflammation, damage to the muscle layer in the intestinal wall leading to herniation of the mucosa

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the sigmoid colon

most common location of diverticulosis

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risk factors for diverticulosis

old age, low fiber diet, obesity, smoking, longer term use of NSAIDs and tyelonol, family history

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signs of diverticulosis

chronic constipation, diarrhea, intermittently, bloating, nausea, and anorexia

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colonscopy

method of diagnosis of diverticulosis

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constipation prevention

treatment of diverticulosis

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Diverticulitis

inflammation of minimum 1 diverticula with microperforation

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stool build up in a diverticula leading to infection

cause of diverticulitis

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complications of diverticullitis

obstruction, abscess, peritonitis, hemorrhage

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signs of diverticulitis

acute LLQ pain, nausea, fever, large rectal bleed, non specific signs in the elderly, anemia, leukocytosis,

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CT abdomen with contrast

method of diagnosis of diverticulitis

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treatment of mild diverticulitis

rest, PO fluids, low fiber diet when disease is active and high fiber diet when inactive, analgesics, antibiotics

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adhesions

main cause of a small bowel obstruction

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tumor

main cause of colon obstruction

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signs of small bowel obstruction

spasmatic abdominal pain, no gas or stool, nausea and vomit, hypokalemia, hypochloremia, metabolic acidosis, bloating

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CT or Xray

methods of diagnosis of small bowel obstruction

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NPO, NGT, and balance fluids and electrolytes

treatment of small bowel obstruction

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signs of colon obstruction

gradual onset, constipation, GI bleed, iron deficiency anemia, spasmatic abdominal pain

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CT or Xray

methods of diagnosis of a colon obstruction

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NPO, NGT, balance fluids and electrolytes, colonoscopy

treatment of a colon obstruction

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Cecostomy

treatment of colon obstruction if there is risk of strangulation. It is a removal of the intestine with insertion of a stoma

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IBD

autoimmune inflammation of the bowel

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ulcerative colitis

IBD that begins in the rectum and proceeds in a continuous manner towards the cecum. There is inflammation of the mucosa and submucosa

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signs of ulcerative colitis

10-20 liquidy,bloody stools per day; fever; abdominal pain; weight loss; ulcers in the mucosa on the biopsy

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complications of ulcerative colitis

colon obstruction, hemorrhage, toxic megacolon, perforation, colorectal cancer

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Crohn’s disease

IBD that occurs in both the small and large intestines, most often in the terminal ileum. It is patchy and not continuous and involves all intestinal layers

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signs of Crohn’s

5-6 soft, loose, non-bloody, stools per day; fever; abdominal pain; weight loss; granulomas in the biopsy;

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complications of Crohn’s

small bowel obstruction, malnutrition, fistula, colorectal cancer

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treatment of IBD

lots of hydration, low fiber diet, high calories and protein, stop smoking, immunosupressants

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infiliximab anti-TNF (humira)

treatment of toxic megacolon

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prococolectomy and ileal pouch

surgical treatment of ulcerative colitis

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partial colectomy with temporary or permanent stoma

surgical treatment of Crohn’s

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ileostomy

made after IBD surgery. Stoma that will have softer stool and more malabsorption it can urinary and biliary stones, It works 24-48 hours after surgery

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instructions for an ileostomy

low fiber diet for first 6-8 weeks, avoid hard to digest foods, hydration, empty stoma every 4-6 hours, switch bag every 5-10 days

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colostomy

stoma that will have harder stool and works 3-6 days after surgery

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instructions for a colostomy

eat spinach, avoid smelly foods, hydration, high fiber diet, apple juice for constipation, empty every 4-6 hours, and switch bags every 5-10 days

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adenocarcinoma

most common type of colorectal cancer

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risk factors for colorectal cancer

age over 50, family history, IBD, alcohol, smoking, high fat and low fiber diet, obesity, HNPCC (heriditary colon cancer), FAP

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signs of colorectal cancer

change in defecations, bloody stool, iron deficiency anemia, weight loss, fatigue, and abdominal pain

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complications of colorectal cancer

obstruction, perforation, peritonitis, abscess, bleeding

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diagnosis of colorectal cancer

by secondary prevention: Fecal occult blood test once a year, DNA in stool test once every 3 years in age over 50, colonscopy once every 10 years in over 50

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treatment of colorectal cancer

segmental or total colon resection. Hartman procedure (stoma insertion), chemo, and radiation

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preop instructions for colorectal cancer

drink only clear fluids 2 days before, NPO from midnight the day of the surgery, laxatives, enema, PO neomycin to change the flora in the colon

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perianal abscess

obstruction of the anus by dried stool that causes an infection

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Crohn’s disease and AIDs

risk factors for a perianal abscess

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signs of a perianal abscess

dull pain, itchiness, pain during defecation, edema, bleeding, fever

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complications of a perianal abscess

fistula, failure, to defecate, and sepsis

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emergency surgery to open anus and drain the abscess

treatment of perianal abscess

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anal fistula

fistula connecting the anus to skin, vagina, or bladder. Usually caused by a perianal abscess

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stool or pussy secretions from the skin

sign of an anal fistula

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infection

complication of an anal fistula

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surgery to remove the fistula

treatment of an anal fistula

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Anal Fissure

tear in the anus

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causes of an anal fissure

trying to pass a hard and large stoll, constriction of the anus due to stress, birth, trauma, and anal sex

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signs of an anal fissure

pain during defecation, burning, bright red blood in the stool

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treatment of an anal fissure

high fiber diet, stool softeners, laxatives, hydration, surgery if nothing else works

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lateral internal sphincterectomy

surgical treatment of an anal fissure

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Hemorrhoids

inflamed or dilated veins

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risk factors for hemorrhoids

constipation, diarrhea, obesity, increased abdominal pressure, dehydration, hypertension

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external anal veins

veins from the systemic system. Hemorrhoids here can hurt and cause thrombosis. They don’t usually bleed

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internal anal veins

veins from the portal system. Hemorrhoids here don’t usually hurt, but do often bleed

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hemorrhoid treatment

prevent constipation, exercise, treat pain, hemorrhoidectomy