Chp. 49 Gastrointestinal Health Issues

Keratinitis Overview

• Definition: Keratinitis refers to the inflammation of the cornea.

• Relation to Duodenal Ulcers: Discussed earlier as causing erosion in the duodenum and gastric areas, potentially leading to complications like peritonitis.

Peritonitis

General Introduction

• Definition: Inflammation of the peritoneum (the tissue lining the abdominal wall and covering the abdominal organs).

• Causes: Typically caused by erosion or perforation in the gastrointestinal tract.

  • Example: Erosion from duodenal ulcers leading to gastric contents leaking into the abdomen.

Primary Peritonitis

• Rarity: Primary peritonitis is relatively rare compared to secondary peritonitis.

• Definition: Characterized by inflammation and infection of visceral and parietal tissues without a secondary cause.

  • Generally occurs due to a bloodstream infection.

Signs and Symptoms

• Cardinal Signs:

  • Abdominal pain (sharp and severe).

  • Abdominal tenderness.

  • Abdominal distension.

  • Rigid abdomen indicative of inflammation.

• Associated Symptoms: Nausea, vomiting, hypoactive bowel sounds.

• Location of Pain: Pain that radiates to the shoulder (Kerr sign) and patients often assume fetal position for relief.

Laboratory Tests

• CBC is conducted to determine white blood cell count, typically greater than 20,000 cells/mm³.

• Blood culture to identify the infecting organism.

• BMP to check for electrolyte imbalances.

Common Pathogens

• Bacterial Causes:

  • Escherichia coli (E. coli).

  • Streptococcus (strep).

  • Staphylococcus (staph).

• Potential causes from body fluids (e.g., leaky pancreatitis causing enzyme leaks into intestinal tract).

Treatment Approach

Non-Surgical Management

• Antibiotics to treat bloodstream infection.

• IV fluids to maintain hydration and electrolyte balance.

• NG tube insertion for gastric decompression; patients remain NPO (nothing by mouth).

• Pain control medications for severe discomfort.

Surgical Management

• Indicated for cases requiring irrigation of the bowel:

  • Irrigation of the peritoneum with antibiotic solution until effluent is clear.

  • Post-operative care entails monitoring for signs of infections and wound care.

Post-Operative Care

1. Monitor bowel movements.

2. Assess incision sites for increased pain or signs of infection.

3. Maintain normal positioning (semi-Fowler’s) for respiratory comfort.

Appendicitis

Overview

• Definition: Inflammation of the appendix, commonly affecting younger adults.

• Possible Complications: If untreated, may lead to gangrene and perforation.

Diagnosis

• Guidelines: Avoid abdominal palpation to prevent further perforation.

• McBurney's Point:

  • A point located midway between umbilicus and right iliac crest; tenderness when releasing pressure indicates appendicitis.

  • Rebound tenderness noted during examination.

• Symptoms: Nausea, vomiting, fever, anorexia; diffuse abdominal pain indicates possible perforation.

Laboratory Tests and Imaging

• CBC to check for signs of infection.

• UA to rule out UTI, and pregnancy tests if applicable.

• Imaging: Ultrasound or CT scan to confirm diagnosis.

Treatment Approach

Non-Surgical Management

• Monitoring in non-complicated cases, with trials of NPO and assessing for electrolyte balance.

• Administer pain management and antibiotics to reduce inflammation.

Surgical Management

• Laparoscopic appendectomy: standard treatment method for appendicitis.

• Post-operative protocols similar to general abdominal surgeries.

Gastroenteritis

Definition

• Inflammation of the stomach and intestines often resulting in vomiting and diarrhea.

Common Causes

• Norovirus is the most common cause, transmitted via fecal-oral route and can also be airborne through vomiting.

Assessment Considerations

• Recent travel history or consumption of contaminated food should be queried to identify sources of infection.

• Patient education on personal hygiene to prevent transmission.

Treatment

• Focus on dehydration, electrolytes, and nutrition. Watch for prolonged symptoms exceeding three days.

• Avoid anti-diarrheals to allow for the elimination of pathogens.

Inflammatory Bowel Diseases (IBD)

Ulcerative Colitis

• Definition: Chronic inflammation causing ulcers in the colon, primarily affecting the rectum and sigmoid colon.

• Complications: High risk for bleeding, infection, and electrolyte imbalances.

• Family history and prior C. diff infection link to development.

Diagnostic Indicators

• Elevated CRP and ESR signify inflammation.

• Consider dietary modifications to avoid exacerbation.

Treatment

• Medications: Aminosalicylates, glucocorticoids, antidiarrheals.

• Surgical options include restorative procedures or total colectomy.

Crohn's Disease

• Definition: Chronic inflammation that can affect any portion of the GI tract and presents with fissures, ulcerations, and strictures.

• Distinction from Ulcerative Colitis: Crohn’s often does not present with bloody stools.

Care and Management

• Multidisciplinary approach involving disease management during exacerbations and consideration of nutritional therapy and resection if necessary.

• Monitoring vital signs for hydration, electrolytes, and possible malabsorption.

Diverticular Disease

Overview

• Definition: Diverticular disease refers to the formation of small pouches (diverticula) in the intestinal wall.

• Issue: Diverticula can cause inflammation if they become obstructed.

Management

• Often managed with dietary changes, high fiber diet to prevent complications.

• Hospitalization with IV antibiotics may be necessary for acute diverticulitis.

Celiac Disease

Definition

• An autoimmune disorder causing inflammation in response to gluten, leading to possible serious long-term health risks.

• Estimated at 1 in 250 individuals are affected.

Symptoms and Diagnosis

• Symptoms include severe GI reactions.

• Diagnosis involves serological testing and potentially an endoscopy.

Treatment

• Life-long adherence to a strict gluten-free diet is essential.