Lower Gastrointestinal Problems - Study Guide

Lower Gastrointestinal Problems - Study Guide

Diarrhea

• Etiology and Pathophysiology

• Caused by infectious organisms (bacteria, parasites, viruses).

• A healthy colon features short-chain fatty acids and beneficial bacteria aiding digestion.

• Antibiotics disrupt normal flora, increasing infection susceptibility.

• Risk Factors

• Immunocompromised individuals.

• Tube feedings.

• Certain medications.

• Food intolerances.

• Laxative use.

• Underlying diseases.

• Clinical Manifestations

• Upper GI Infection: Large volume of watery stools, cramping, periumbilical pain, low-grade or normal temperature, nausea and vomiting before diarrhea.

• Lower GI Infection: Fever, bloody diarrhea, small, frequent stool amounts.

• Severe Diarrhea: Life-threatening dehydration, electrolyte disturbances, acid-base imbalance.

• Diagnostics

• Stool cultures for severe cases with fever or bloody stool.

• Stool specimen exam for blood, mucus, WBCs.

• Multi-pathogen tests for viral, bacterial, or parasitic causes.

• Lab tests (CBC, BUN, Creatinine).

• Chronic diarrhea tests for electrolyte, pH, osmolality, fat, and undigested muscle fiber.

• Interprofessional Care

• Management depends on severity/cause:

  • Acute Care: Prevent transmission, replace fluids/electrolytes, protect skin.

  • Severe Cases: IV fluids/electrolytes/vitamins, total parenteral nutrition (TPN).

  • Avoid trigger foods/medications; psyllium fiber may help thicken stool; short-term anti-diarrheal medications (not for infectious diarrhea); antibiotics for severely ill/immunocompromised.

Clostridium Difficile Infection (CDI)

• Overview

• A highly hazardous healthcare-associated infection (HAI).

• Risk Factors

• Antimicrobial use, chemotherapy, immunosuppressants.

• ICU stay, prolonged hospitalization, recent surgeries, acid-suppressing medications.

• Prevention & Treatment

• Spores survive up to 70 days on surfaces.

• Handwashing with soap/water is essential (not alcohol-based rubs).

• Use of contact isolation (gown and gloves).

• Clean surfaces with 10% bleach wipes.

• Treatment options: Oral vancomycin, fidaxomicin, metronidazole, and fecal microbial transplant (FMT) for recurrent cases.

Fecal Incontinence

• Etiology and Pathophysiology

• Motor Function Issues: Impaired rectal sphincter or weak rectal floor muscles (due to trauma/surgery).

• Sensory Function Issues: Inability to sense need for defecation (related to stroke, MS, spinal injury).

• Fecal Impaction: Hardened feces causing liquid stool to seep around; treatment includes digital de-impaction or cleansing enema.

• Diagnostics & Care

• Health history, physical exam, abdominal imaging (X-ray, CT scan, colonoscopy).

• Treatment focuses on identifying/addressing causes and dietary adjustments (fiber, fluids).

• Options include anti-diarrheal medications, Kegels, biofeedback therapy, electrostimulation, Solesta gel injection, and possibly surgery.

• Nursing management: Bowel training, frequent toileting, skin care with barrier creams.

Constipation

• Etiology and Pathophysiology

• Hard, dry stools; difficulty passing.

• Common causes: Low fiber intake, dehydration, inactivity, voluntary stool withholding, certain medications (e.g., opioids).

• Overuse of laxatives may lead to cathartic colon syndrome.

• Clinical Manifestations

• Abdominal discomfort, bloating, rectal pressure.

• Complications like hemorrhoids (from straining), obstructive bowel movement, fecal impaction.

• Diagnostics & Care

• Diagnosed via history, physical exams, imaging (X-ray, colonoscopy).

• Treatment strategies include dietary fiber increase, hydration, exercise, possible laxatives.

• Nursing management: Encourage bowel regularity, proper positioning during defecation, privacy.

Acute Abdominal Pain

• Etiology & Causes

• Sudden onset requiring urgent attention; possible causes include gynecologic conditions, infections, vascular issues, obstructions, and trauma.

• Potential complications: peritonitis, shock (hypovolemic, septic).

• Clinical Manifestations & Diagnostics

• Symptoms may include nausea, vomiting, diarrhea, constipation, fever, bloating, rebound tenderness.

• Diagnostics include CBC, urinalysis, imaging (X-ray, CT, ultrasound), ECG and pregnancy tests.

• Interprofessional Care

• Emergency management: Identify cause, monitor complications, manage pain.

• Possible emergency surgery, with pre-op management being NPO and Hibiclens bath; post-op care includes treating nausea/vomiting, early ambulation, and monitoring.

Irritable Bowel Syndrome (IBS)

• Definition & Pathophysiology

• Characterized by chronic abdominal pain and altered bowel patterns (diarrhea/constipation).

• Linked to psychological stressors, GI infections, food intolerances.

• Clinical Manifestations

• Abdominal pain at least 1 day/week for 3 months.

• Symptoms include bloating, nausea, flatulence, urgency, mucus in stool, fatigue, sleep issues.

• Diagnostics & Care

• Based on symptom history.

• Treatment: Stress management, dietary changes (low FODMAP diet), medications as needed, and keeping a symptom diary.

Appendicitis

• Etiology and Pathophysiology

• Inflammation of the appendix due to obstruction (fecalith).

• Leads to venous engorgement and possibly gangrene, perforation, peritonitis.

• Clinical Manifestations

• Symptoms include dull periumbilical pain, anorexia, nausea, vomiting; pain shifts to right lower quadrant (RLQ).

• Low-grade fever and signs like rebound tenderness, muscle guarding.

• Diagnostics

• Physical examination, laboratory tests (WBC, UA), CT scan preferred for imaging.

• Nursing Management

• Including hydration, pain management, and preventing complications:

  • NPO, antiemetics, monitoring vital signs, ongoing patient assessment, post-operative care (ambulation and dietary advancement).

Peritonitis

• Etiology and Pathophysiology

• Inflammation of the peritoneum from primary or secondary causes (like appendicitis, trauma, or perforated viscus).

• Clinical Manifestations

• Abdominal pain, tenderness, rebound tenderness, muscular rigidity.

• Symptoms include shallow breathing due to pain, distention, fever, elevated heart rate.

• Diagnostics

• Patient assessment, history, CBC, peritoneal aspiration if necessary. Imaging includes X-ray, CT, ultrasound.

• Interprofessional Care

• Conservative care for mild cases with IV fluids/antibiotics; surgical options for locating causes, draining purulent fluid, and repairing damage.

Inflammatory Bowel Disease (IBD)

• Overview

• Chronic GI tract inflammation characterized by periods of remission and exacerbation. Includes Ulcerative Colitis (UC) and Crohn’s Disease (CD).

• Etiology and Pathophysiology

• Autoimmune reactions and environmental triggers, with genetic and immune function alterations.

• Crohn's Disease: Can affect the entire GI tract; involves all bowel wall layers, leads to deep ulcers and obstructions.

• Ulcerative Colitis: Limited to the colon, primarily affects mucosal layer with potential complications.

• Clinical Manifestations

• Both IBD conditions manifest as diarrhea, weight loss, abdominal pain, fever, and fatigue, with variations in stool features.

• Diagnostics and Care

• Aimed at ruling out other diseases with lab tests and imaging studies.

• Treatment includes drug therapy (aminosalicylates, antimicrobials, corticosteroids) and surgical therapy.

Intestinal Obstruction

• Overview

• Occurs when intestinal contents cannot pass through the GI tract. May be partial or complete, mechanical or non-mechanical.

• Etiology and Causes

• Mechanical obstructions often in the small intestine (adhesions, hernias, cancers), while non-mechanical are due to reduced peristalsis or neuromuscular issues.

• Clinical Manifestations

• 4 hallmark signs: abdominal pain, vomiting, distention, and constipation.

• Diagnostics

• History, imaging (CT, X-ray), lab tests.

• Interprofessional Care

• Management based on severity, with non-surgical measures (NG tube, IV fluids) or surgical interventions (resection, colostomy).

Colorectal Cancer (CRC)

• Risk Factors

• Family history, personal history of IBD or CRC, obesity, high red meat consumption, smoking.

• Clinical Manifestations

• Early signs like fatigue and weight loss; late signs show rectal bleeding, abdominal pain, changes in bowel habits.

• Diagnostics

• Colonoscopy for screenings and tissue biopsy starting at age 50 (earlier for high-risk individuals).

• Treatment

• Surgery (tumor resection), chemotherapy, radiation therapy, with palliative care as needed.

Diverticulosis & Diverticulitis

• Overview

• Diverticulosis: Non-inflamed diverticula.

• Diverticulitis: Inflammation causing infection, potentially leading to perforation.

• Causes & Risk Factors

• Often arises from a low-fiber diet, with increased risk from obesity, smoking, and immunosuppression.

• Clinical Manifestations

• Mild symptoms include bloating; severe cases can have nausea, vomiting, and LLQ pain.

• Diagnostics & Management

• Imaging and dietary management with a high-fiber diet during the diverticulosis stage, bowel rest, and antibiotics for diverticulitis.

Other GI Disorders

• Hernias

• Types include inguinal, umbilical, femoral, and ventral/incisional; management includes surgical repairs and observation for strangulation symptoms.

• Celiac Disease

• Autoimmune reaction to gluten; management involves a strict gluten-free diet.

• Lactose Intolerance

• Caused by a deficiency in lactase; symptoms managed with lactose-free diets and supplements.

• Short Bowel Syndrome

• Results from Crohn’s disease or surgical resection; management includes fluid and nutritional support.

Nursing Care and Education for Clients with Ostomies

• Stoma Care

• Emphasize pouch emptying when two-thirds full and hydration to prevent dehydration.

• Client Education

• Address emotional distress around body image, proper cleaning techniques, diet modifications for gas control, and recognizing stoma complications.

Symptoms and Nursing Treatment for Diarrhea, Constipation, and Related Conditions

• General Management

• For diarrhea, prioritize hydration and electrolyte balance; teach dietary management.

• For constipation, recommend fiber and hydration, along with monitoring for potential complications.

• Clinical Practice Scenarios

• Recognize the signs requiring more comprehensive evaluation and intervention for patients with gastrointestinal ailments.

These notes should serve as a comprehensive guide for lower GI problems, addressing key aspects needed for exam preparation and clinical understanding.