Non-Inflammatory Bowel

Disorders
1. Irritable 3.
Bowel
Syndrome

2. Irritable
Bowel
Syndrome As-
sessment:

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 Non-Inflammatory Bowel
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•Functional GI Nutrition History:
disorder that • Caffeinated beverages
causes chronic or • Sorbitol or Fructose sweetened beverages
recurrent diarrhea, • Bowel Sounds
constipation, • Drug Therapy
and/or abdominal
pain and bloating Patients often report:
- Belching
•Most common - Gas
digestive disorder - Anorexia
- Bloating
•Disease exacerbates - Labs normal;
with exposure to
causative agents

•Unknown etiology

•Mainly affects
women

•Evidence relates
the role of stress
and mental illness
to IBS, especially
with depression
and anxiety

Assessment:
• History of weight
change
• Fatigue

• Abdominal pain
- LLQ
• Usual bowel
elimination pattern

• Medical History
- GI infections

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 Non-Inflammatory Bowel
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Irritable Bowel • Abdominal pain relieved with defecation or falling asleep
Syndrome Clin-
ical Manifesta- • Changes in stool frequency or consistency
tions: • Abdominal distension

• Sensation of incomplete stool evacuation

• Mucus with stool passage

• Nausea

• Belching, gas, anorexia, and bloating

4. Irritable Bowel • CBC
Syndrome
Diag- nostics: • ESR

• Stools for occult blood

• Hydrogen breath test

- Excess produced with small intestinal bacterial over-
growth or malabsorption
- Must be NPO for 12 hours
5. Irritable Bowel • Symptom journal
Syndrome • Health teaching
Inter- ventions: • Nutrition
• Increased dietary fiber
• 30-40 g of fiber daily
• Adequate hydration
• Chew food slowly

Avoid GI stimulants: caffeine, alcohol, and dairy

Drug Therapy-dependent on symptoms of IBS:

- Bulk forming or antidiarrheal agents

- Probiotics

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 Non-Inflammatory Bowel
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• Stress management
• Regular exercise, yoga, meditation
6. Herniation: - Weakness or defect in the abdominal muscle wall
through which a segment of the bowel or other abdominal
structures protrude

• Most common types: indirect, direct, femoral, umbilical,

and incisional

• Classified as: reducible, irreducible, or strangulated

• Any hernia that is not reducible requires immediate sur-

gical
evaluation

• Strangulated hernias can cause ischemia and bowel

obstruction

• Necrosis and possible bowel perforation

S/S:

- Abdominal distention
- N/V
- Pain
- Fever
- Tachycardia

7. Indirect/ Direct Indirect:

Inguinal Hernia:
- Sac form from peritoneum that contains portion of intes-
tine/omentum; Pushes downward at an angle into inguinal
canal and in males descends into scrotum
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 Non-Inflammatory Bowel
Disorders

- Goes through inguinal Ring

Direct:

- Passes through a weak point in the abdomen

8. Femoral Hernia: - Protrudes through femoral ring- plug of fat in femoral

canal and enlarges eventually pulling peritoneum, urinary
bladder into sac

9. Umbilical Hernia: - Congenital or acquired (intra-abdominal pressure)

- Most common in those who are obese

10. Incisional or - Occurs at previous surgical site; results from inadequate

Ven- tral Hernia: healing (Post-Op Infection, Obesity, Inadequate Nutrition)

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 Non-Inflammatory Bowel
Disorders
11. Reducible - Is a hernia in which the contents of the hernial sac can be
Her- nia: returned to their normal position.
12. Irreducible - Cannot be reduced and requires surgical evaluation.
Her- nia:

13. Strangulated - Blood supply to hernia is cut off and can lead to necrosis of
Hernia: the bowel and possible perforation

S&S:
- Abdominal Distention
- N&V
- Pain
- Fever
- Increased HR

14. Herniation As- Assessment/Clinical Manifestations:

sessment:
• "Lump"

• Inspection performed while lying and standing

• Auscultate BS

•Absent BS indicate obstruction and strangulation-MED-

ICAL
EMERGENCY

• Palpate inguinal hernia

•Hernia never forcibly reduced: could cause strangulated

intestine to rupture
15. Herniation Inter- Interventions:
ventions:

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 Non-Inflammatory Bowel
Disorders
• Based upon age, type, and severity

Nonsurgical:
• Truss
• Firm pad held over hernia with belt to keep abdominal
contents from protruding
• Educate to assess skin daily and protect with light layer of
powder

Surgical:
• Herniorrhaphy- Several small incisions are made, identify
defect, place contents back

• Traditional vs. MIS

• Teach to avoid strenuous activity for several seats before
resuming normal routine
• Stool softener
• No operation of heavy machinery with opioids
• Observe incision for S/S of infection
• Avoid coughing
• Inguinal hernia
• Scrotal support, ice bags, scrotal elevation
• Difficult with 1st postop void
• Hernioplasty- Surgeon reinforces the weakened outside
abdominal muscle wall with a mesh patch

16. Why is a Because it could cause a strangulated intestine or cause it to

hernia NEVER rupture.
forcibly
reduced?
- Monitor vitals, especially BP to indicate Internal bleeding
17. Post-Op Care
for a Hernia: Pg. - Assess & manage incisional pain with oral analgesics; report
1148 Chart 56-1 and document severe pain that doesn't respond to drug therapy
immediately

- Encourage deep breathing; but avoid excessive cough- ing

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 Non-Inflammatory Bowel
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- Encourage early ambulation with assistance (Possible
within a few hours)

- Apply ice packs as prescribed

- Assist the patient to void by standing the first time after

surgery

Teach patients at discharge:

- Rest for several days

- Observe the incision for redness or drainage and report these

findings

- Shower after 24-36 hours after removing any bandage (DO

NOT remove steri-strips_ and be aware that the steri-strips
will fall off in about a week

- Monitor temp & report any occurrence of fever

- Do not lift more than 10lbs

- Avoid constipation by eating high-fiber & drinking extra

fluids

- Return to work when allowed usually in 1-2 weeks

18. Colorectal Can- • Cancer of colon or rectum; Highly curable

cer:
• One of the most prevalent malignancies

• Most are adenocarcinomas, arising from glandular ep-

ithelial tissue of the
colon

• Adenomatous polyps

• Can metastasize by direct extension or through the blood or

lymph; Most commonly metastasizes in liver

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 Non-Inflammatory Bowel
Disorders

Complications that may occur:

- Bowel obstruction/perforation
- Abscess formation
- Fistula (Bladder or Vagina)

• No known predisposing cause, age, previous history and

family hx are risk factors

• Major risk factors: >50 years, genetic predisposition,

personal or family hx of CA, disease state that predispose to
CA: Crohn's and UC;
High-fat diet (especially fat from red meats)

• Regular screening recommended for those of average risk

and over 50 without a family history of FOBT and
colonoscopy every 10 years or double contrast BE every 5
years; indicative risk screening earlier and more frequent- ly.
19. What are some GI - H. pylori, Streptococcus bovis, John Cunningham Virus,
Cancers thought & HPV
to be related to?

20. Screening Procedure: Choice of one of the following & Interval of time
Recommenda- after screening initiated at age 50:
tions for Men &
Women Ages 50 FOBT & Sigmoidoscopy
years and older - Every 5 years
at Average Risk
for Colorectal OR
Cancer: Pg. Double-Contrast Barium Enema
1150 Chart 56-2 - Every 5 years

OR
Colonoscopy
- Every 10 years

FOBT Procedure: Two or three samples from three con-

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 Non-Inflammatory Bowel
Disorders
secutive bowel movements are obtained at home and then
tested

21. Colorectal Can- Assessment:

cer • Family History
Assessment: • Medical History
• Bowel Elimination Changes
• Abdominal Fullness/Pain
• Unintentional Weight Loss

Physical Assessment/Clinical Manifestations:

• Most common: rectal bleeding, anemia, change in stool
consistency and shape
• Gas pains
• Cramping
• Incomplete evacuation
• Hematochezia (red blood via the rectum)
• Mahogany (Dark)
• Frank (Bright)
• Abdominal distension
• Visible peristaltic waves
• Digital rectal examination
• Psychosocial Assessment

Diagnostics:
22. Colorectoral FOBT: (Fecal Occult Blood Test)
Cancer • False + with certain vitamins or drugs
Diagnostics:
• Avoid ASA, Vitamin C and red meat 48 hours prior to
specimen collection

• Any NSAIDS? Discontinue prior to testing

• 2-3 separate stool samples on 3 consecutive days

• - result doesn't R/O CRC

• CEA- Carcinoembryonic Antigen

- usually elevated in people with CRC

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 Non-Inflammatory Bowel
Disorders

• Double contrast BE-

- Gives better visualization of polyps and small lesions

• CT
• MRI
- Confirms the existence of a mass, extent of disease, and
location of distant metasases

• Sigmoidoscopy
• Colonoscopy
- Definitive test for dx. of CRC

Labs:
- Hemoglobin & hematocrit values are often decreased

23. Colorectal Can- Interventions:

cer Interven-
tions: • Depends upon pathologic staging of disease

•Nonsurgical Management

• Preoperative radiation therapy

• Adjuvant Chemotherapy

•Surgical Management

• Surgical removal of tumor with clear margins

•Colon resection

•Colectomy

•Abdominoperineal resection

24. What do visiable Partial Bowel Obstruction

peristaltic
waves
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 Non-Inflammatory Bowel
Disorders
accompanied by
high-pitched or
"tinkling" bowel
sounds
indicate?
- After primary surgery it is recommended for patients with
25. Adjuvant stage II or III to interrupt the DNA production of cells and
Chemotherapy: destroy them

- Drugs of choice are IV 5-Fluorouracil with leucovorin (LV)

(Folinic Acid)- 5-FU/LV

- Capecitabine (Xeloda) or a combo of drugs referred to as

FOLFOX4

- Most frequently used is FOLFOX4 combo for metastatic

CRC is fluorouracil (5-FU), leucovorin (LV, and oxaliplatin
(Eloxatin)- Platinium Analog

Preoperative:
26. Colorectal • CWOCN
Surgery: • Postoperative sexual dysfunction and urinary inconti-
nence
• PCA education
• Bowel Prep
• NGT

Operative:
• Colon resection w/w/o colostomy
• Temporary vs. Permanent
• Total colectomy

Postoperative:
• PCA
• NGT
• Progression of diet
• Colostomy function in 2-3 days
• Stool dependent upon stoma location

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 Non-Inflammatory Bowel
Disorders
27. Surgical Proce- *Right-Sided Colon Tumors:*
dures for Col- - Right hemicolectomy for smaller lesions
orectal Cancers
in Various - Right ascending colostomy or ileostomy for large, wide-
Loca- tions: Pg. spread
1152 Table 56-1
- Cecostomy (Opening of cecum with intubation or decom-
press the bowel)

*Left-Sided Colon Tumors:*

- Left hemicolectomy for smaller lesions

- Left descending colostomy for larger lesions

*Sigmoid Colon Tumors:*

- Sigmoid colectomy for smaller lesions

- Sigmoid colostomy for larger lesions

- Abdominoperineal resection for large, low sigmoid tu- mors

(near the anus) with colostomy (the rectum and the anus are
completely removed, leaving a perineal wound)

Rectal Tumors:
- Resection with anastomosis or pull-through procedure
(Preserves anal sphincter and normal elimination pattern)

- Colon resection with permanent colostomy

- Abdominoperineal resection with colostomy

28. Ascending - Done for right-sided tumors
Colostomy:
- Stool consistency is usually liquid

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 Non-Inflammatory Bowel
Disorders

29. Descending - Done for left-sided tumors

Colostomy:
- Stool consistency is more formed

30. Transverse - Often used in such emergencies as intestinal obstruction or

(Double-Barrel) perforation because it can be created quickly.
Colostomy:
- There are two stomas.

Proximal stoma, closest to he small intestine- drains feces

Distal stoma- drains mucus

- Stool consistency is pasty

31. Sigmoid Colosto- - Done for rectal tumors

my:
- Stool consistency is more formed
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 Non-Inflammatory Bowel
Disorders

32. Colostomy Assess for and report:

Man- agement: • Signs of ischemia and necrosis
• Unusual bleeding
• Mucocutaneous separation

Condition of peristomal skin:

•Pouch system for proper fit and signs of leakage •Skin-in-
tact, smooth, w/o redness or excoriation

• Irrigation
• Emptying
33. Wound • JP drain management
Manage- ment:
• Phantom rectal sensations

• Sympathetic innervation not interrupted

• Rectal pain and itching

• Interventions

• Antipruritic drugs

• Warm compress

• Sitz bath

• Analgesics

• Foam pads to sit

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 Non-Inflammatory Bowel
Disorders
related

34. Perineal
Wound Care:
Pg. 1154 Chart
56-3

35. Critical Alert:

Re- port any of
these problems
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 Non-Inflammatory Bowel
Disorders
• Assess for signs whenever in sitting position
of infection,
abscess, fluid and - Avoid the use of air rings or donut devices
elec- trolyte
imbalance Prevention of Complications:
- Maintain fluid and electrolyte balance by monitoring in-
Wound Care: take and output and by monitoring output from perineal
• Place an absorbent wound
dressing
- Observe incision integrity, and monitor wound drains,
Instruct the patient that watch for erythema, edema, bleeding, drainage, unusual odor,
he or she may: and excessive pain
- Use a feminent napkin
as a dressing - Signs of ischemia and necrosis (Dark red, Purplish, or
- Wear a jockey-type black color; dry)
shorts rather than
boxers

Comfort Measures:
- If prescribed,
soak the wound
area in a sitz bath
for 10-20mins 3-4
times a day or use
warm/hot compress

- Administer pain
medication as
prescribed and
assess effectiveness

Instruct the patient of

permissible activities.
The patient should:
- Assume a side-lying
position in bed, avoid
sitting for long periods

- Use foam pads or

soft pillow to sit on
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 Non-Inflammatory Bowel
Disorders
to the colostomy - Unusual Bleeding
to the surgeon:
- Mucocutaneous seperation (Breakdown of suture line
securing the stoma to the abdominal wall)

Assess condition of the peristomal skin and frequently check the

pouch system for proper fit and signs of leak- age.

Skin should be:

- Intact
- Smooth
- Without redness or excoriation
36. Critical Care - Stool softener may be prescribed to keep stools soft
Alert With Colon
Resections: - Teach patients to note the frequency, amount, and char-
acter of stools

- Teach those with colon resections to watch for and report

clinical manifestations of intestinal obstruction and perfo-
ration

- Advise patient to avoid gas-producing foods and carbon-

ated beverages

- 4-6 weeks may be required to establish the effects of

certain foods on bowel patterns

37. Action Alert for - Teach patient to apply a skin sealant (preferably without
Colostomy alcohol) and allow it to dry before applying
Skin Care:
- If skin becomes raw, stoma powder or paste may be used

- The paste or other filler cream is also used to fill in crevices to

create a flat surface

38.

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 Non-Inflammatory Bowel
Disorders
The Patient with Assess GI Status:
a Colostomy: - Dietary and fluid intake
Pg. 1156 Chart - Presence of absence of N&V
56-4 - Weight gain or loss
- Bowel elimination pattern & character of stool
- Bowel sounds

Assess stoma:
- Location, size, protrusion, color, and integrity
- Signs of ischemia such as dull coloring or dark or purplish
bruising

Assess Peristomal Skin:

- Presence of absence of excoriated skin, leakage under- neath
- Fit of appliance & effectiveness of skin barrier

Assess Patient's Coping:

- Self-Care abilities
- Acknowledgment of body changes
- Sense of loss

39. Intestinal Ob- • Common and serious disorder cause by a variety of

struction: conditions

• Associated with significant morbidity

• Partial or complete

• Classified as mechanical or non-mechanical

40. Mechanical In- - Bowel is physically blocked by problems outside the

testinal Obstruc- intestine, in the bowel wall, or in the intestinal lumen.
tion:
- Crohn's
- Adhesions
- Tumors
41. AKA "Paralytic Ileus" or
"Adynamic Ileus"

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 Non-Inflammatory Bowel
Disorders
Non-Mechanical
Intestinal - Does not involve a physical obstruction in or outside the
Obstruction: intestine.

- Peristalsis is decreased or absent as a result of neuro-

muscular disturbance, resulting in slowing of the move- ment
or a backup of intestinal contents
42. Intestinal Ob- History:
structions As- • Medical History
sessment: • Family History of CRC
• Pain Assessment
• Passage of flatus and BM
• Singultus (hiccups)

Physical Assessment/Clinical Manifestations:

• Elevated temperature, tachycardia, hypotension, in- creasing

abdominal pain, abdominal rigidity, or change in skin tone
overlying the
abdomen should be reported immediately!!

• Strangulated obstruction
• Abdominal distention
• Auscultate BS
43. Telescoping
of bowel:

44. Volvulus of
Bow- el:

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 Non-Inflammatory Bowel
Disorders
45. Small-Bowel Small-Bowel Obstructions:
and Large- - Abdominal discomfort or pain possibly accompanied by
Bowel Ob- peristaltic waves in upper and middle abdomen
structions: Pg.
1159 Chart 56-5 - Upper or epigastric abdominal distention

- Nausea & early, profuse vomiting (May contain fecal

matter)

- Obstipation

- Severe F/E imbalances

- Metabolic alkalosis Large-

Bowel Obstructions:

- Intermittent lower abdominal cramping

- Lower abdominal distention

- Minimal or no vomiting

- Obstipation or ribbon like stools

- No major F/E imbalances

- Metabolic acidosis (not always present)

• No definitive laboratory test to confirm dx.

46. Intestinal Ob- • WBC elevated with strangulated obstruction
struction • Electrolyte panel
Diag- nostics: • CBC
• Abdominal CT scan

• Small intestine-Distension with fluid and gas in the small

intestine with the absence of gas in the colon

• Large intestine-Gas distension of the colon and free air

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 Non-Inflammatory Bowel
Disorders
indicates a perforated intestine

• Abdominal U/S
• Endoscopy
• Sigmoidoscopy or colonoscopy
• Barium Enema

Labs:
- WBC counts are normal unless there's a strangulated
obstruction

- Hemoglobin, hematocrit, creatinine, and BUN values are

often elevated indicating dehydration

- Sodium, Chloride, and Potassium are decreased

- Elevations in serum amylase levels may be found with

strangulating obstructions- can damage pancreas

47. Intestinal Nonsurgical Management:

Obstruction • Partial and non-strangulating
Non-Surgical • NPO
Interventions: • NGT to LIS (Low Intermittent Suction)

• Assess every four hours for placement, patency and

output

• Turn off to auscultate BS

• IV fluid replacement (2-4L of NSS or LR with K+ added)

• Monitor VS and fluid status

• Abdominal distension

• Opioid analgesics- May be temporarily held so that clinical

manifestations or perforation or peritonitis aren't masked

• Semi-Fowlers position- Alleviates abdominal pressure

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 Non-Inflammatory Bowel
Disorders
and helps with comfort and promotion of thoracic excur-
sion to facilitate breathing

• Broad spectrum antibiotic therapy- If strangulation is

thought to be present

• Gastric motility enhancer

- Octreotide acetate
- Alvimopoan

48. Intestinal Ob- Surgical:

struction Sur-
gical Interven- • Complete mechanical and incomplete mechanical ob-
tions: struction
• Strangulated obstruction

Preoperative:
• Patient teaching
• Family/significant other

Intraoperative:

• MIS vs. open approach

- Exploratory laparatomy

• Lysed adhesions

• Colon resection
- Temporary vs. permanent colostomy

• Intestinal infarction
- Embolectomy, Thrombectomy or Resection of gan-
grenous small or large bowel

- Colectomy with severe cases

Postoperative:
• NGT
• Clear liquid diet

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 Non-Inflammatory Bowel
Disorders
49. How often do - Assess Q4hr for proper placement, tube patency, and
you assess a output
NGT after getting
in- testinal - Monitor nasal skin around tube for irritation
obstruc- tion
surgery? - Secure to nose

Home Care Management:

50. Intestinal Ob- • Bowel Regime
struction Home • Colostomy Care
Care: • HH

Self Management Education:

• Report abdominal pain or distention, N/V, constipation
• Incisional care
• Drug Therapy
• Opioid analgesics
• Stool softener
• Laxative
- Polyethylene glycol

• Nutrition
• Activity Limitation

- Monitor vitals especially BP for fluid status

51. Nursing Care
of Patients - Assess abdomen at least 2x a day for bowel sounds,
who distention, and passage of flatus
have an
Intestinal - Monitor F&E including labs
Obstruction: Pg.
1159 Chart 56-6 Manage the patient who has NGT:
- Monitor drainage
- Ensure patency
- Check placement
- Irrigate tube
- Maintain NPO
- Provide mouth care
-Maintain semi-fowler's

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 Non-Inflammatory Bowel
Disorders

- Give analgesices as prescribed

- Gice alvimopan (Entereg) as prescribed- used for in-

creasing GI motility

- Maintain parenteral nutrition

52. Preventing - Eat high-fiber foods including raw fruits, vegetables, and
Fecal Impaction: whole-grain
Pg. 1161 Chart
56-7 - Drink adequate amounts of fluids

- Do not routinely use laxatives (Decreases abdominal

muscle tone and contributes to an atonic colon)

- Use natural foods to stimulate intestinal motility (Prunes,

apple slices, prune juice)

- Take bulk-forming laxatives (Metamucil) for fiber

- Check stool often for oozing or soft diarrheal stool- may

indicate fecal impaction

- have patient sit on toiler or bedside commode rather than on

bedpan

• Injury to structures located between diaphragm and

53. Abdominal pelvis
Trau- ma:
• Occurs with blunt or penetrating forces

• MVA •Liver-Most commonly injured organ in penetrating

trauma

• Spleen-Most commonly injured organ in blunt abdominal

trauma

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 Non-Inflammatory Bowel
Disorders
• Trauma is the leading cause of death in adults younger than
40 years of age in the US

54. Abdominal Trau- Assessment:

ma • First, assess ABC's
Assessment: • Abdominal distention, pain, N/V
• Opioids given after the physicians initial
assessment complete

• Ecchymosis (bruising) may indicate internal bleeding

• Lap seat belt distribution, alert HCP immediately!

• Tenderness, rebound tenderness, guarding, rigidity

• Absent or diminished bowel sounds may be caused by the

presence of blood, bacteria, or chemical irritant

• Dullness over hollow organs may indicate presence of

blood or fluid

• Mental status, VS, and skin perfusion are priority nursing

assessments

• Cullen's sign- superficial oedema and bruising in the

subcutaneous fatty tissue around the umbilicus.

Diagnostics:
• Abdominal US or FAST- Focused abdominal sonography for
Trauma

• Diagnostic peritoneal lavage- Large-bore catheter is in-

serted and if the drainage is pink or grossly blood, prepare for
surgery

• Abdominal CT

- Focus on risk for hemorrhage, shock, and peritonitis

55. Critical Rescue-
Once the pa-
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 Non-Inflammatory Bowel
Disorders
tient with - Mental status, vitals, and skin perfusion are priority
abdom- inal
trauma has been Mild Shock: Skin is pale, cool, and moist
assessed for
ABC's what do Moderate Shock: Diaphoresis is more marked and urine output
you do? ceases

Severe Shock: Change sin mental status are manifested as

agitation, disorientation, and recent memory loss

- Assess for abdominal trauma by asking presence, loca- tion,

and quality of pain

- Inspect abdomen, flank, back, genitalia, and rectum for

contusions

• Preserving or restoring hemodynamic stability

56. Abdominal
Trau- ma • Emergency Care
Interven- tions:
• Rapid Fluid volume infusion

• Type and Crossmatch

• ABG

• CBC

• Electrolyte, glucose, amylase, renal, LFT's

- Elevated WBC- indicates ruptured spleen

- Elevated transaminases indicate liver injury

- Elevated serum amylase- injury to pancreas or bowel

• Coagulation studies

• Continuous hemodynamic monitoring

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 Non-Inflammatory Bowel
Disorders
• Foley catheter
- UOP

• NGT, unless contraindicated

• Antibiotic Therapy

• Blunt Trauma can cause active, but not obvious damage.

• Intra-Abdominal Pressure Monitoring

- 0-5 mm HG, higher in obese individuals

• Report any increase in IAP immediately to HCP

• Surgical Management
- Exploratory laparotomy
57. Polyps: • Small growths covered with mucosa and attached to
surface of intestine

• Usually benign, may become malignant

• Usually asymptomatic

• Can cause gross rectal bleeding, intestinal obstruction or

intussusception

Diagnostic studies:
- BE
- Sigmoidoscopy

Colonoscopy:
- Biopsy specimens obtained
- Excision of polyp (polypectomy)- Monitor for abdominal
distention, pain, rectal bleeding, mucopurulent drainage from
rectum and fever.

• Follow-up endoscopic procedures R/T increased risk for

multiple polyps

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 Non-Inflammatory Bowel
Disorders

• FAP requires total colectomy

58. Colonoscopy: The direct visual examination of the inner surface of the entire
colon from the rectum to the cecum

59. Barium Enema: The exam used to visualize the lower portion of the gas-
trointestinal system after administration of a radiopaque
contrast medium is

60. Polyps in Colon:

61. Hemorrhoids: • Unnaturally swollen or distended veins in the anorectal region

• Internal vs. External

• Common and not significant unless causing pain or

bleeding

• Increased abdominal pressure

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 Non-Inflammatory Bowel
Disorders
• Worsens w/ pregnancy, constipation, obesity, HF, pro-
longed sitting or standing and strenuous exercise and weight
lifting

62. Hemorrhoids • Prevention of constipation by increasing fiber intake and

Health adequate hydration unless contraindicated
Promotion
and • Exercise regularly with a graduate buildup in intensity
Maintenance:
• Healthy weight

• Bleeding, swelling, and prolapse (bulging)

63. Hemorrhoids • Bright red blood
As- sessment: • Pain
• Itching
• Mucous discharge

Diagnostic:
• Visual inspection and digital examination

Nonsurgical:
64. Hemorrhoids In- • Local treatment and nutrition therapy
terventions: • Cold packs
• Sitz bath
• Topical anesthetics for severe pain
• OTC ointments for mild to moderate pain and itching
• Stool softener
- Docusate sodium
• Nutritional
- Diet high in fiber and fluids

Surgical:
• Hemorrhoidectomy
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 Non-Inflammatory Bowel
Disorders

• Complications: pain, thrombosis of other hemorrhoids,

infection, bleeding, and abscess formation

• Monitor for bleeding and pain postoperatively; teach

patients to report these problems and use moist heat to
promote comfort

• First postoperative BM will be painful. Be sure someone is

with or near when it occurs; some patients become light-
headed and diaphoretic w/ syncope

65. Malabsorption • Interferes with the ability to absorb nutrients

Syndrome:
• Related to a number of deficiencies, presence of bacte- rial,
disruption of mucosal lining of small intestine, altered
lymphatic and vascular circulation, or decrease in gastric or
intestinal surface area

• Chronic pancreatitis, pancreatic carcinoma, resection of the

pancreas, and cystic fibrosis

• Various disorders, physiological mechanisms limit ab-

sorption of nutrients because of one or more of these
abnormalities:
- Bile salt deficiencies
- Enzyme deficiencies
- Presence of bacteria
- Disruption of mucosal lining of SI
- Altered Lymphatic and vascular circulation
Decrease in gastric or intestinal surface

66. Malabsorption • Classic symptom: chronic diarrhea

Syndrome
Assessment: •Provide special skin protection measures

• Steatorrhea - Fat in stool

• Increased stool mass

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 Non-Inflammatory Bowel
Disorders

• Unintentional weight loss

• Bloating and flatus

• Decreased libido

• Easy bruising (purpura)

• Anemia

• Bone pain (Calcium & Vitamin D Deficiencies)

• Edema (Caused by hypoproteinemia)

67. Malabsorption • MCV, MCH, MCHC, Iron

Syndrome • Cholesterol
Diagnostics: • Calcium
• Albumin and total protein levels
• Fecal Fat Analysis
• Lactose tolerance test
• Schilling test
• Bile acid Breath Test
• Ultrasonography
• CT scan

68. Malabsorption • Avoidance of substances that aggravate malabsorption

Syndrome
Interventions: • Nutrition Management

• Low fat diet

• High protein, high calorie diet in small, frequent meals

• Lactose free

• Nutritional Supplements

Drug Therapy:

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Non-Inflammatory Bowel
Disorders
• Antibiotics
• Antidiarrheals
• Anticholinergics
• Dicyclomine hydrochloride

• IV therapy to replace fluid loss • Nonsurgical and surgical

management of primary disease

Common Supplements:
- Water-Soluble vitamins, folic acid & vitamin B complex

- Fat-soluble vitamins- Vitamin A, D, K

- Minerals- Calcium, iron, Magnesium

- Pancreatic Enzymes- Pancrelipase

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