Bowel Obstruction and Pancreatitis Quiz

Intestinal Obstruction (Bowel Obstruction)

• Types: Complete (no gas or stool passage) or Partial (gas or stool passage possible). Mechanical (physical blockage) or Non-mechanical (paralysis).
• Mechanical Causes: Adhesions, strangulated hernias, neoplasms (tumors), strictures (narrowing) from Crohn's disease, intussusception, sigmoid volvulus, mesenteric occlusion.
• Non-Mechanical Causes: Ileus (paralysis of the intestine), often due to surgery.
• Symptoms: Abdominal distention, pain, cramping, nausea, vomiting, early diarrhea, late constipation, fever, tachycardia (rapid heart rate).
• Complications: Electrolyte imbalance, dehydration, perforation (hole in bowel), infection, jaundice, obstruction of blood supply (tissue death/gangrene), sepsis, peritonitis.
• Risk Factors: Multiple abdominal surgeries, ventral hernias, ileocecal intussusception (children).
• Diagnosis: CT scan, focused history, physical examination.
• Management: NPO (nothing by mouth), NG tube (nasogastric tube), fluid and electrolyte replacement, antibiotics, bowel softeners, surgery if complete obstruction or necrosis.

Inflammatory Bowel Disease (IBD)

• Types: Crohn's disease, Ulcerative colitis. Chronic autoimmune conditions causing inflammation in the digestive tract.
• Crohn's Disease: Inflammation from mouth to anus, often affecting the small intestine.
• Ulcerative Colitis: Inflammation limited to the colon (large intestine).
• Symptoms (both): Diarrhea, abdominal pain, fever, fatigue, weight loss, potential blood in stool.
• Complications (both): Strictures, bowel obstruction, perforation, peritonitis, fistulas, abscesses, carcinoma (cancer).
• Crohn's specific complications: strictures and fistulas are frequent.
• Ulcerative colitis specific complications: toxic megacolon (very large, at risk of rupture)
• Diagnosis: Blood tests (elevated WBC, low hemoglobin), endoscopy, colonoscopy, biopsies, imaging (MRI, CT scan, small bowel series).
• Treatment: Medications (corticosteroids, immunosuppressants), surgical resection if needed, nutritional support (TPN, dietary modifications).
• Important nursing considerations for IBD: Monitoring for infections, fluid and electrolyte balance, patient teaching.

Pancreatitis

• Acute: Inflammation of the pancreas, ranging from mild edema to severe necrosis.
• Causes: Alcoholism, high cholesterol, gallbladder disease, biliary tract disease.
• Symptoms: Severe abdominal pain (LUQ, epigastric, radiating to back), sudden onset, aggravated by eating, not relieved by vomiting, potentially flushing, cyanosis, dyspnea (labored breathing), abdominal edema, nausea, vomiting, decreased or absent bowel sounds.
• Complications: Pseudocysts (fluid-filled sacs), abscesses, hemorrhage, pulmonary complications (pleural effusion, atelectasis, pneumonia), cardiovascular complications (hypotension), hypocalcemia (tetany), local or systemic.
• Diagnosis: Serum amylase/lipase levels, imaging (abdominal x-ray, CT scan), endoscopy.
• Treatment: NPO, NG tube, pain management, fluid and electrolyte replacement, infection control, surgical intervention in severe cases (i.e. abscess), endoscopic procedures (ERCP).
• Important nursing considerations for pancreatitis: Close monitoring of vital signs, I/O (input/output), pain management, electrolyte balance.

Cirrhosis

• Cause: Chronic liver damage leading to scarring. Common causes include alcohol abuse, NAFLD (non-alcoholic fatty liver disease).
• Symptoms (early): Anorexia, dyspepsia, flatulence, nausea, vomiting, abdominal pain, fever, lassitude, weight loss, enlarged liver/spleen.
• Symptoms (late): Jaundice, itching, skin lesions, spider angiomas, hormone changes, hematologic abnormalities, splenomegaly, bleeding tendencies, peripheral neuropathy, mental changes (hepatic encephalopathy), hematemesis (vomiting blood), melena (black, tarry stools).
• Complications: Portal hypertension (high pressure in portal vein), ascites (fluid build-up in abdomen), esophageal/gastric varices (enlarged veins), hepatic encephalopathy (brain dysfunction), hepatorenal syndrome (kidney failure), spontaneous bacterial peritonitis.
• Diagnosis: Blood Tests (liver function tests, albumin, bilirubin), imaging (ultrasound, CT scan), liver biopsy.
• Treatment: Rest, avoidance of alcohol and NSAIDs, management of ascites, prevention/treatment of bleeding (varices), treatment of complications.
• Important nursing considerations for cirrhosis: Monitoring for internal bleeding, fluid balance, mental status, nutrition and lifestyle changes, prevention of complications.