Chapter 41

Irritable Bowel Syndrome (IBS)

  • Chronic functional disorder with recurrent abdominal pain and disordered bowel movements (diarrhea/constipation).

  • Affects 15% of adults in the U.S., more common in women.

  • Common triggers: chronic stress, sleep deprivation, infections, certain foods.

Pathophysiology

  • IBS is characterized by disturbances in gut motility and increased sensitivity in the intestinal tract.

Signs and Symptoms

  • Altered bowel patterns, pain, bloating, abdominal distention.

Diagnostic Tests

  • Stool studies, contrast radiography, proctoscopy, barium enema, colonoscopy, manometry, electromyography.

Treatment

  • Medication management, dietary changes (bland, low-residue, high-protein), food diary, hydration, avoid alcohol/smoking, relaxation techniques.

Nursing Management

  • Provide education regarding dietary modifications and medication adherence. Monitor patient for symptom relief and exacerbation signs.

Patient Teaching

  • Encourage keeping a food diary, emphasize the importance of hydration, and advise on stress management techniques.

Peritonitis

  • Inflammation of peritoneum, usually bacterial infection, can result from GI disorders, trauma, or dialysis.

Pathophysiology

  • Common bacteria: E. coli, Klebsiella, Proteus, Pseudomonas, Streptococcus.

  • Types: Primary (SBP), Secondary (perforation of organs), Tertiary (superinfection).

Signs and Symptoms

  • Abdominal pain (diffuse to localized), distension, rigidity, rebound tenderness, nausea, vomiting, fever.

Diagnostic Tests

  • Blood tests (elevated WBC, low hemoglobin), imaging (abdominal X-ray, ultrasound, CT, MRI), peritoneal aspiration.

Treatment

  • Fluid replacement, pain management, GI support, antibiotic therapy (broad-spectrum initially, specific later).

Nursing Management

  • Monitor vital signs & abdominal assessment, fluid/nutrition management, complication prevention, patient education.

Appendicitis

  • Most frequent cause of acute abdomen in the U.S., usually due to obstruction (fecalith, hyperplasia).

Pathophysiology

  • Leads to ischemia, possible gangrene or perforation.

Signs and Symptoms

  • Abdominal pain, especially in the right lower quadrant, nausea, fever.

Diagnostic Tests

  • Clinical assessment, imaging (CT, ultrasound).

Treatment

  • Surgical intervention (appendectomy).

Nursing Management

  • Goals: relieve pain, prevent fluid deficit, reduce anxiety, prevent infection, optimal nutrition.

Diverticular Disease

  • Sac-like herniation in the bowel lining (diverticulum).

Pathophysiology

  • Diverticulosis (without inflammation), diverticulitis (infection/inflammation), linked to low-fiber diet.

Signs and Symptoms

  • Symptoms vary from asymptomatic to abdominal pain, fever, and changes in bowel habits.

Diagnostic Tests

  • Imaging studies (CT scan), clinical evaluation.

Treatment

  • Increase fluid intake, soft foods with fiber, antibiotics for diverticulitis.

Nursing Management

  • Increase fluid intake, educate on dietary modifications, monitor for complications.

Intestinal Obstruction

  • Blockage preventing normal flow through the intestinal tract.

Pathophysiology

  • Two types: mechanical (obstruction pressure) and functional (musculature inability to propel contents).

Signs and Symptoms

  • Cramping abdominal pain, vomiting, constipation, abdominal distention.

Diagnostic Tests

  • Abdominal X-ray, CT scan.

Treatment

  • Depending on type: may require surgery or conservative management.

Nursing Management

  • Assess nasogastric tube function, monitor fluid/electrolyte balance, track nutritional status.

Inflammatory Bowel Disease (IBD)

  • Includes Crohn's disease (transmural, any GI tract section) and ulcerative colitis (localized to colon/rectum).

Pathophysiology

  • Chronic inflammation leading to mucosal damage.

Signs and Symptoms

  • Diarrhea, abdominal pain, weight loss, fatigue.

Diagnostic Tests

  • Crohn's: CT, MRI, colonoscopy; Ulcerative Colitis: colonoscopy.

Treatment

  • Anti-inflammatory drugs, immunosuppressants, dietary management; surgery may be needed.

Nursing Management

  • Monitor for complications, provide education on disease management.

Colorectal Cancer

  • Third most common cancer, manifestations include changes in bowel habits, blood in stool, pain.

Pathophysiology

  • Malignant growth in the colon or rectum.

Signs and Symptoms

  • Change in bowel habits, blood in stool, unexplained weight loss.

Diagnostic Tests

  • Colonoscopy, imaging studies.

Treatment

  • Depending on stage: surgery, chemotherapy, radiation.

Nursing Management

  • Health history assessment, maintain nutritional care, monitor elimination patterns.

Cholelithiasis

  • Gallstones, more frequent in women, risk increases with age.

Pathophysiology

  • Types: pigment stones (10-25%), cholesterol stones (75%).

Signs and Symptoms

  • Silent (asymptomatic) or symptomatic (RUQ pain, nausea).

Diagnostic Tests

  • Abdominal X-Ray, ultrasound (preferred), ERCP for visualization.

Treatment

  • Non-surgical: dietary changes, pharmacological treatment; Surgical: laparoscopic/open cholecystectomy.

Nursing Management

  • Preoperative/postoperative care, pain management, patient education on lifestyle changes.

Cholecystitis

  • Inflammation of the gallbladder, can be acute or chronic; symptoms include severe abdominal pain and tenderness.