(53) Lower GI Disorders NRS 101

Lower GI Intestinal Disorders and Cancers

Overview

• Focus on lower gastrointestinal (GI) disorders including:

  • Infections (E. coli, C. difficile)

  • Celiac disease

  • Irritable bowel syndrome (IBS)

Infections of the Intestine

Common Infections

• E. coli and C. difficile (C. diff)

  • Entry: through contaminated food/water, person-to-person contact, fecal-oral route due to poor hygiene.

E. coli

• Transmission Sources:

  • Contaminated undercooked meats

  • Contaminated produce

  • Poor food handling practices

• Symptoms:

  • Hemorrhagic colitis (bloody diarrhea, severe cramping)

  • Avoid anti-diarrheals since diarrhea helps expel toxins.

C. difficile

• Cause:

  • Antibiotic overuse leading to normal flora disruption and C. diff overgrowth.

  • Frequently associated antibiotics: clindamycin, ampicillin, amoxicillin, cephalosporins.

• Symptoms:

  • Diarrhea (may contain blood/mucus)

  • Rectal urgency, tenesmus, nausea, abdominal cramping.

  • Distinctive foul smell.

• Treatment Options:

  • Discontinue causative antibiotics, replace fluids and electrolytes.

  • Mild cases: oral metronidazole (Flagyl).

  • Severe cases: Flagyl plus vancomycin.

  • Fecal Microbial Transplantation (FMT) to restore normal flora.

Diagnostic Assessments for C. diff

• Stool cultures for blood, mucus, white blood cells.

• Blood chemistry tests to monitor fluid/electrolyte balance.

Nursing Interventions

• Assess history of exposure, fluid intake/output.

• Monitor symptoms and educate on hygiene and food preparation techniques.

Celiac Disease

• Definition:

  • Genetic autoimmune disorder triggered by gluten (in wheat, rye, barley), damaging small intestine lining.

• Symptoms:

  • Abdominal pain, diarrhea after gluten ingestion, malabsorption, nutritional deficiencies, weight loss.

  • Irritability, depression, fatigue, and vitamin deficiencies.

• Diagnosis:

  • Blood tests for antibodies while consuming gluten.

  • Potential intestinal biopsies.

• Treatment:

  • Strict gluten-free diet; dietary consultations.

  • Monitor for deficiencies managed with vitamins/supplements.

  • Usually resolves intestinal damage in 3-6 months with diet change.

Irritable Bowel Syndrome (IBS)

• Definition:

  • Functional disorder characterized by diarrhea, constipation, or alternating symptoms.

• Symptoms:

  • Abdominal pain relieved by defecation, frequent bowel movements, sensations of incomplete evacuation.

  • Symptoms can worsen with stress or anxiety.

• Diagnosis:

  • Diagnosis by exclusion using Rome III criteria.

• Management:

  • Dietary modifications, relaxation techniques, medications (anticholinergics, anti-diarrheal).

  • High fiber intake, avoid gas-producing foods, and possibly use probiotics.

  • Daily log for diet and bowel movements.

Inflammatory Bowel Diseases (IBD): Crohn's Disease and Ulcerative Colitis

• Common Characteristics:

  • Occur in young adults; periods of exacerbation and remission.

• Ulcerative Colitis:

  • Affects the colon and rectum, causes mucosal inflammation, resulting in diarrhea with pus/blood.

  • Potential complications: toxic megacolon, colon cancer.

  • Management involves anti-inflammatory medications, dietary modifications, potential surgery.

• Crohn's Disease:

  • Can affect any part of the GI tract, characterized by "cobblestone" appearance.

  • Symptoms: diarrhea, fatigue, weight loss, abdominal pain.

  • Management may require anti-inflammatories, nutritional support, and surgery for complications.

Acute Abdominal Inflammation

Appendicitis

• Definition:

  • Inflammation of the appendix, requiring surgical intervention to prevent rupture.

• Symptoms:

  • Pain at McBurney’s point, rebound tenderness, abdominal rigidity, fever.

• Diagnosis:

  • Elevated white blood cell count, CT scan.

Diverticulitis

• Definition:

  • Inflammation of diverticula, may lead to complications like perforation.

• Symptoms:

  • Lower left quadrant pain, fever, elevated white blood cell count.

• Management:

  • High fiber diet, weight management, potentially surgery depending on severity.

Peritonitis

• Definition:

  • Inflammation of the peritoneum, usually due to perforation.

• Symptoms:

  • Severe abdominal pain, rigidity, nausea, hypotension.

• Management:

  • Surgical correction and antibiotics.

Hernias

• External Hernias:

  • Protrusion of a viscous organ through an abnormal opening.

• **Common Types: **

  • Inguinal, femoral, umbilical.

• Symptoms:

  • Visible protrusion, pain based on location.

• Management:

  • May involve surgical correction; can be reducible or incarcerated.

Colorectal Cancer

• Overview:

  • Second leading cause of cancer deaths, often asymptomatic until advanced.

• Symptoms:

  • Changes in bowel habits, Rectal bleeding, abdominal pain, generalized weakness, weight loss.

• Diagnosis:

  • Fecal occult tests, colonoscopy, imaging tests.

• Management:

  • Surgery for tumor resection, followed by chemotherapy/radiation as needed.

Hemorrhoids and Anal Conditions

• Hemorrhoids:

  • Swollen veins in the rectum/anus, causing bleeding or prolapse.

• Symptoms:

  • Bright red blood during defecation, severe pain if thrombosed.

• Management:

  • Increasing fiber, topical creams, surgical options in severe cases.

• Anal Fissures and Fistulas:

  • Fissure: tear in anal skin; Fistula: tunnel from anus to skin.

• Management:

  • May require surgery if they don’t heal spontaneously.

Fecal Incontinence

• Definition:

  • Inability to control bowel movements due to various causes.

• Management:

  • Biofeedback training, bowel training programs.