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IRRITABLE BOWEL SYNDROME

Functional disorder of

motility in small and large

intestines- no organic dse

AKA: Spastic colon, irritable

colon, nervous indigestion,

pylorospasm and spastic

colitis, fxnal dyspepsia,

laxative or cathartic colitis-

no ulceration present

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Cause: stress,

emotional factors

Manifestation:

result in increase motility which leadsto spasm and Chronic abdominal pain

(diffused pain) LLQ (dissipates after

passage of gas), alternating diarrhea and constipation,

pasty pencil like stools,

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Hypersecretion of mucus

Dyspeptic symptoms ( flatulence,

nausea, anprexia, belching)

Spastic contractions (small, dry, hart,

pellet-like stools)

Foul breath, sour stomach, cramps

Behavioral disturbance ( anxiety,

depression, sleep disturbance,

weakness

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Diagnostic:

Noconfirmatory dx , r/oorganic

pathology

Hx of nervousness and emotional

disturbances

Barium enema,

stool exam,

Sigmoidoscopy/ colonoscopy-

reveal spasm

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Interventions (A-IBS)

Antidiarrheals, antispasmodics

(Probanthine,

avoid fatty, irritating and gas forming

foods,

Increase fluid intake

Increase fiber in the diet diet

Bulk former ( metamucil)

Stress management,

Rest, exercise, limit responsibilities

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Risk factors

Mechanical factors

Adhesion ( most common)

Formed after abd . Sx

Hernia ( incarcerated, strangulated)

Volvolus (twisting bowel)

Causes infarction Intussusception (telescoping bowel)

Tumors (chief cause)

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Neurogenic factors

Paralytic ileus Lack of peristaltic activity after abd. Sx

Tx- aspiration of the secretion by gastric

suction until the bowel begins to fxn

Vascular fctors

Complete occlusion (mesenteric infarction)

embolus

Partial occlusion (abdominal angina)

atherosclerosis

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PATHOPHYSIOLOGY

Bowel N secrete 7-8 electrolyte rich fluid

Obstruction partially retained fluid

Distention

Increase peristalsis- ends- flaccid

Increase P and reduce absorptive ability

Increase capillary permeability/backward peristalsis

Extravasate to peritoneal cavity

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Manifestations:

abdominal distention, cramping pain,diminished or absent bowel sounds, vomiting

fecal material, constipation

Diagnostics: Abdominal US and X-ray

Interventions:

GI decompression using NGT, (Miller Abbott

tube or Cantor tube )

Bowel resection with or without anastomosis

/ colostomy

NPO, F&E replacement

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INFLAMMORY BOWEL DISEASE

(IBD)

Ulcerative colitis

Crohns disease

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Definition

Crohns dse (regionalenteritis)

Chronic relapsing dse

that may develop

discontiuously in anysegment

Most- terminal ileum

Segmnetal &

Transmural -

submucosa

Less common than UC

Ulcerativecolitis

Entire length of the colon

and involves only the

mucosa & submucosa

inflammation andulcertation that starts in the

rectosigmoid area and

spreads upward;

mucosa is edematous,

thickened with eventual

scarring; consequently colon

loses elasticity and

absorption,

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Ulcerative colitis

13

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etiology

Crohns dse

Unclear

Genetic basis

Consideredautoimmune in

nature

Ulcerativecolitis

Bacterial

Altered immunity

Destructive enzymeand a lack of

protective substance

Emotional

disturbance-precipitate an

exacerbation

young adults (15 to

20 years old)

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pathophysiology

Crohns dse1. Thickening and

inflammation

happens2. Healing lesions

scar tissue

formation

obstruction ofGItract

3. Diarrhea, 3-5 / day

without blood.

Ulcerative colitis1. Diffuse inflammation

of intestinal mucosa

swelling of epithelial

cells necrosis cryptformation site of

abscess ulceration >

bleeding

2. Chronic narrowingof lumen

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manifestation Crohns dse

Abdominal pain RLQ

relieve after passing a

flatus/stool

Diarrhea less severe than

UC

Stool- Soft or semi-fluid ,

foul smelling & fatty(Steatorrhea),

Weight loss, anorexia,

anemia, fatigue

Ulcerative colitis Bloody diarrhea

15-20 times daily

with or without pus

Abdominalcramping/tenderness

Colicky pain in LLQ

N/V

Fever

Anorexia, Weight loss

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Diagnostic assessment

Hct and hgb

Barium enema with air contrast

Colonoscopy

biopsy

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Medical management

Primarily aims to control the symptoms Anti inflammatory therapy (sulfasalazine),

steroids

longer for crohns dse

Antidiarrheal (Imodium, lomotil)

Antispasmodic- dec postprandial pain and

diarrhea

Fluids, electrolytes replacement

Rest during acute attack

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Monitor bowel movement

consistency, frequency and volume. Correction of nutritional deficiencies

Institute dietary management:

Low-residue, lactose-free

Elemental diet- residue free, low in fat and

digested mainly in the upper jejunum

TPN if necessary- bowel rest, more

useful in crohns

Observe for fluid and nutritional

status

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Surgical management

Commonly used to tx ulcerative colitis

Indicative for both if complication arises

(obstruction, perforation, abscess, fisula)

Total proctocolectomy with permanent

ileostomy

Restorative procedure- ileorectal

anastomosis, ileoanal reservior, a Kock

pouch

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procedure

Total proctocolectomy with permanent

ileostomy

Colon & rectum removed and anus closed Terminal ileum is brought out through

abdominal wall

Permanent ileostomy formed

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Colostomy/Ileostomy

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ComparisonCategories Colostomy Ileostomy

Definition A portion of colon is brought

thru the abdominal wall

A portion of ileum is

brouht thru

abdominal wall

Indications Inflammation or obstruction of

large bowel; congenital orobstructive process of lower

intestinal tract, sigmoid/rectal

Ca

Ulcerative, Chrons

Purpose Provide outlet for intestinal

waste products

Serve as an exit for

waste products when

colon has been

removed

Discharge Liquid to formed stools Yellow green or brown

liquid

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ostomaCare

Apply appliance

Monitor for signs of leakage

Monitor stoma for size, color, and bleeding

Stoma care and irrigation Place petroleum gauze, or moist dressing over the

stoma

Skin Care Avoid gas forming food

Emptying pouch

Diet, fluid and electrolyte balance

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HEMORRHOIDS

Perianal varicose veins

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Two Types of Hemorrhoids

Internal - sup hemorrhoidal plexus External- inf hemorrhoidal plexus

Causes Many anastomoses between plexuses

lack of valve in portal vein

Contributory factors: ( inc intra-abdominalpresure

Chronic constipation, Pregnancy, Obesity Prolonged sitting or standing

Wearing constricting clothings

Disease conditions like liver cirrhosis, CHF

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Pathophysiology

Increase intra-abdominal pressure

(straining)

Distenstion of hemorrhoidal vein

Ampula is filled with formed stool

venous obstruction (repetition)

Permanent dilatation

push outside

bleeding

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diagnostic

Ext. Hemorrhage:

Visual examination

Internal hemorrhage:

History

Digital palpation

Proctoscopy

Asking client to strain during assessment

cause the vein to dilate

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MEDICAL MANAGEMENT

Used only for small, uncomplicated with mildsymptoms Reducing presure

Relieving pain Hot Sitz bath, warm compress

Pharmacologic Bulk laxatives

Stool softener

Local anesthetic application Nupercaine

Steriod- reduce pain and itching

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Dietary management

Increasing fluid and fiber

Surgical

Sclerotherapy

Rubber band ligation Int. hem

Cryosurgery- freezing

Laser removal

Hemorrhoidectomy- vein is excised ( open &

closed)

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POSTOP CARE

Patient Teaching Clean rectal area thoroughly after each

defecation

Sitz bath at home especially after defecation

Avoid constipation: High fiber diet

High fluid intake

Regular exercise

Regular time for defecation

Use stool softener until healing is complete Notify physician for the following:

Rectal bleeding

Continued pain on defecation

Continued constipation