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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
causes of constipation in the elderly
missing teeth, decreased eating and drinking, low exercise, weaking abdominal muscles, meds, excessive laxative use
signs of constipation
less than 3 defecations per week, bloating, abdominal pain, feeling you still need to defecate after defecation, small stool amounts
complications of constipation
HTN, fecal impaction, fecal incontinence, hemorrhoids, anal fissure, rectal prolapse, megacolon
fecal impaction
hard stool bulge that can’t be removed. It can cause an ulcer or liquidy stool release
removal by hand or enema
treatment of fecal impaction
megacolon
dilation and atonia of the colon. It can cause perforation
constipation treatment
hydration, high fiber diet, exercise, pelvic floor strengthening, change medications, laxatives
Methycellulose
fiber laxative. It should be taken with a lot of water. IT encourages peristalsis
Magnesium Hydroxide
saline agent. Magnesium that pulls water towards it and increases peristalsis. It takes two hours to work and is for short use
AKI and CKD
contraindications of saline agents
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
Bisacodyl
stimulates nerve that increases peristalsis and secretions and decreases water reabsorption. It works in 6-8 hours. Type of laxative
stool softeners
wets the stool with effects similiar to surfactant
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
chloride channel activator
Lubiprostone. It activates chloride channels to bring sodium and water into the colon. It can’t be given during pregnancy
causes of appendicitis
stool obstructing the appencdix, lymphatic tissue, foreign objectsm inflammation, ischemia, and an abscess
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
rebound tenderness
press on the RLQ, pain is stronger when you let go
Rovsing;s sign
press on the LLQ, pain is on the right side when pressing down
diagnosis of appendicitis
leukocytosis, high CRP, CT, laproscopy
appendectomy
treatment of appendicitis
post appendectomy instructions
high fowler position, physiotherapy, early mobilization, remove stiches after 1-2 weeks, no weights for 2-4 weeks, prevent atelectasis
Diverticulosis
lots of diverticuli without inflammation, damage to the muscle layer in the intestinal wall leading to herniation of the mucosa
the sigmoid colon
most common location of diverticulosis
risk factors for diverticulosis
old age, low fiber diet, obesity, smoking, longer term use of NSAIDs and tyelonol, family history
signs of diverticulosis
chronic constipation, diarrhea, intermittently, bloating, nausea, and anorexia
colonscopy
method of diagnosis of diverticulosis
constipation prevention
treatment of diverticulosis
Diverticulitis
inflammation of minimum 1 diverticula with microperforation
stool build up in a diverticula leading to infection
cause of diverticulitis
complications of diverticullitis
obstruction, abscess, peritonitis, hemorrhage
signs of diverticulitis
acute LLQ pain, nausea, fever, large rectal bleed, non specific signs in the elderly, anemia, leukocytosis,
CT abdomen with contrast
method of diagnosis of diverticulitis
treatment of mild diverticulitis
rest, PO fluids, low fiber diet when disease is active and high fiber diet when inactive, analgesics, antibiotics
adhesions
main cause of a small bowel obstruction
tumor
main cause of colon obstruction
signs of small bowel obstruction
spasmatic abdominal pain, no gas or stool, nausea and vomit, hypokalemia, hypochloremia, metabolic acidosis, bloating
CT or Xray
methods of diagnosis of small bowel obstruction
NPO, NGT, and balance fluids and electrolytes
treatment of small bowel obstruction
signs of colon obstruction
gradual onset, constipation, GI bleed, iron deficiency anemia, spasmatic abdominal pain
CT or Xray
methods of diagnosis of a colon obstruction
NPO, NGT, balance fluids and electrolytes, colonoscopy
treatment of a colon obstruction
Cecostomy
treatment of colon obstruction if there is risk of strangulation. It is a removal of the intestine with insertion of a stoma
IBD
autoimmune inflammation of the bowel
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
signs of ulcerative colitis
10-20 liquidy,bloody stools per day; fever; abdominal pain; weight loss; ulcers in the mucosa on the biopsy
complications of ulcerative colitis
colon obstruction, hemorrhage, toxic megacolon, perforation, colorectal cancer
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
signs of Crohn’s
5-6 soft, loose, non-bloody, stools per day; fever; abdominal pain; weight loss; granulomas in the biopsy;
complications of Crohn’s
small bowel obstruction, malnutrition, fistula, colorectal cancer
treatment of IBD
lots of hydration, low fiber diet, high calories and protein, stop smoking, immunosupressants
infiliximab anti-TNF (humira)
treatment of toxic megacolon
prococolectomy and ileal pouch
surgical treatment of ulcerative colitis
partial colectomy with temporary or permanent stoma
surgical treatment of Crohn’s
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
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
colostomy
stoma that will have harder stool and works 3-6 days after surgery
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
adenocarcinoma
most common type of colorectal cancer
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
signs of colorectal cancer
change in defecations, bloody stool, iron deficiency anemia, weight loss, fatigue, and abdominal pain
complications of colorectal cancer
obstruction, perforation, peritonitis, abscess, bleeding
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
treatment of colorectal cancer
segmental or total colon resection. Hartman procedure (stoma insertion), chemo, and radiation
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
perianal abscess
obstruction of the anus by dried stool that causes an infection
Crohn’s disease and AIDs
risk factors for a perianal abscess
signs of a perianal abscess
dull pain, itchiness, pain during defecation, edema, bleeding, fever
complications of a perianal abscess
fistula, failure, to defecate, and sepsis
emergency surgery to open anus and drain the abscess
treatment of perianal abscess
anal fistula
fistula connecting the anus to skin, vagina, or bladder. Usually caused by a perianal abscess
stool or pussy secretions from the skin
sign of an anal fistula
infection
complication of an anal fistula
surgery to remove the fistula
treatment of an anal fistula
Anal Fissure
tear in the anus
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
signs of an anal fissure
pain during defecation, burning, bright red blood in the stool
treatment of an anal fissure
high fiber diet, stool softeners, laxatives, hydration, surgery if nothing else works
lateral internal sphincterectomy
surgical treatment of an anal fissure
Hemorrhoids
inflamed or dilated veins
risk factors for hemorrhoids
constipation, diarrhea, obesity, increased abdominal pressure, dehydration, hypertension
external anal veins
veins from the systemic system. Hemorrhoids here can hurt and cause thrombosis. They don’t usually bleed
internal anal veins
veins from the portal system. Hemorrhoids here don’t usually hurt, but do often bleed
hemorrhoid treatment
prevent constipation, exercise, treat pain, hemorrhoidectomy