Gastrointestinal Disorders Quiz

Altered Elimination - GI Focus

• Altered stool elimination, including obstruction and peritonitis
• Appendicitis, a complication of things
• Diverticular disease
• Gallbladder disease
• Acute and chronic pancreatitis (from Chapter 3)
• Cancers:
  • Pancreatic cancer
  • Colon polyps and colon cancer
  • Kidney, bladder cancer (in a separate slide set)

Stool Elimination Process - Review

• Fecal matter enters the cecum via the ileocecal valve
• Fecal matter transport:
  • Peristalsis
  • Segmental movement
  • Mass movement
• Water and electrolyte removal
• Stool evacuation:
  • Rectal sphincter relaxation

General Manifestations of Altered Bowel Elimination

• Assess stool volume and characteristics (constipation/diarrhea) on patient history
• Assess for bleeding:
  • Melena (black, tarry stools) - potential GI bleed
  • Hematochezia (bright red blood) - often a lower GI bleed
  • Occult bleeding (hidden blood) - detected in lab tests
• Assess for pain, abdominal distention, anorexia, nausea, vomiting, and fever

Altered Bowel Elimination - 1. Altered Motility

• Diarrhea—food travels through the GI tract too quickly
• Constipation—food travels through the GI tract too slowly
• Altered water and vitamin absorption
• Decreased or increased storage time
• Risk for obstruction
• Consequences: diarrhea or constipation

Altered Bowel Elimination - 2. Altered Perfusion

• Global or focal
• Consequences: ischemia and infarction, pain

Altered Bowel Patency - 3. Intestinal Obstruction ("Bowel Obstruction")

• Inability to move contents through the intestine (small or large)
• Etiology:
  • Blockage (tumors, hernias, fecal impaction, adhesions, intussusception, volvulus)
  • Disease state (diverticulitis)
  • Paralytic ileus (inability of the intestine to contract normally)
  • Post-abdominal/pelvic surgery risk
• Clinical Manifestations and Etiology
• Mechanical causes (adhesions, radiation, surgery, fecal impaction, hernia, intussusception, trauma, tumor, narrowing/blockage of lumen, volvulus, extrinsic pressure)
• Functional causes (inflammation, diverticulitis, medication effects (anticholinergics, opioids), selected chemotherapies, neurologic disorders, paraneoplastic syndrome , spinal cord compression, etc)

Bowel Obstruction - Etiology and Clinical Manifestations

• Crampy abdominal pain, swelling, loss of appetite, vomiting (profuse in small bowel obstruction), no gas, decreased bowel sounds, constipation, or no stool output, fever.
• Diagnostic methods

Bowel Obstruction - Treatment

• NPO (Nothing by Mouth)
• Nasogastric tube (NG tube)
• Colon resection (if necessary)
  • Colostomy, stoma formed
• Manual extraction/Surgical removal
• Video on Bb (link provided)

Bowel Obstruction - Complications

• Small bowel: fluid and electrolyte imbalance, impaired mobility, ischemia, and tissue death, distention, perforation, infection (peritonitis)
• Large bowel: distention, cramping, and constipation

Peritonitis

• Inflammation of the peritoneum (abdominal lining) - emergency
• Etiology: bowel obstruction, ruptured organ, diverticulitis, trauma, peritoneal dialysis contamination
• Clinical Manifestations: fever, abdominal distention, rebound tenderness, abdominal pain, low/no bowel sounds (high concern)
• Treatment: IV fluids and electrolytes, NG tube for bowel rest, antibiotics (if bacterial), possible surgical intervention

Obstruction Can Lead to Sepsis and Shock

• No bowel sounds distal to the obstruction
• Increased abdominal pressure
• Compression of veins and arteries
• Edema of bowel wall
• Complications like peritonitis or perforation
• Sepsis can occur

Appendicitis

• Inflammation of the appendix
• Infections or obstruction leads to appendicitis (bacterial infection from fecal sources)
• Signs: elevated WBCs
• Symptoms: abdominal pain often shifting to the right lower quadrant (RLQ), nausea and vomiting, fever
• Treatment: surgical excision (preferably before rupture)

Diverticulum/Diverticulitis

• Diverticulum: small sacs/pouches in the colon
• Diverticulosis: presence of diverticula
• Diverticulitis: outpouching becomes packed with fecal material, causing irritation, inflammation, and infection
• Risks: chronic constipation, prolonged pressure on the large intestine walls, structural and functional changes

Diverticular Disease - Clinical Manifestations and Diagnosis

• Symptoms: abdominal pain (often in the left lower quadrant), fever, nausea, vomiting
• Consequences: decreased mobility, obstruction, impaired perfusion, perforation, hemorrhage
• Diagnosis: history of symptoms, physical exam (abdominal tenderness, distension), and other tests

Diverticular Disease - Diagnostics and Treatment

• Laboratory analyses: stool analysis (blood), blood samples (CBC), ultrasound, MRI, CT scan
• Colonoscopy or sigmoidoscopy for diagnosis and treatment of suspected cases
• Treatment: management of symptoms, bowel rest, control of infection (antibiotics), surgical correction for perforated diverticula

Gallbladder Diseases - Cholelithiasis and Cholecystitis

• Cholelithiasis: presence of gallstones in the gallbladder or bile ducts
• Risk factors (5 F's):
  • Female
  • Fair complexion
  • Fat (obese)
  • Fertile (or had children)
  • Forty (years of age and older)
• Cholecystitis: inflammation of the gallbladder (usually caused by gallstone obstruction)
• Symptoms: Pain N/V in the upper right quadrant (RUQ)
• Diagnosis: ultrasound, cholecystogram
• Complications: rupture of the gallbladder leading to peritonitis
• Treatment: extracorporeal shockwave lithotripsy, cholecystectomy (surgical removal)

Clinical Example (Ch. 3): Acute Pancreatitis - Pathophysiology

• Can be an acute episode or chronic disease
• Etiology: bile duct blockage by gallstones, excessive alcohol use
• Injury to acinar cells (producing amylase and lipase), pancreatic duct
• Protective digestive feedback mechanisms

Acute Pancreatitis - Clinical Manifestations

• Upper abdominal pain (often diffuse)
• Sudden onset
• Growing intensity
• Dull, steady ache
• Radiating to the back
• Nausea
• Vomiting
• Anorexia
• Diarrhea

Acute Pancreatitis - Diagnostic Criteria

• Laboratory analyses: elevated amylase and lipase levels
• Imaging studies : CT scan
• Other considerations: Liver function tests, possible alcohol use, and other evaluations to pinpoint the cause of the inflammation

Acute Pancreatitis - Treatment

• Intravenous hydration
• NPO (Nothing by Mouth)
• Analgesics
• Endoscopy (if caused by gallstones): Cholecystectomy
• Idiopathic: palliative and symptomatic treatment
• Alcohol-related: palliative, symptomatic treatment (including quitting alcohol)

Pancreatic Cancer

• Usually adenocarcinoma in the head of the pancreas
• Cause: idiopathic, smoking, chemical exposure, high-fat diet
• Symptoms: abdominal/back pain, nausea, vomiting, loss of appetite, weakness, fatigue, jaundice
• Diagnosis: biopsy
• Treatment: surgery (Whipple procedure), radiation, chemotherapy

Colon Polyps and Colon Cancer (Colorectal Cancer(

• Colon polyps (inward projections of the mucosal lining): benign or precancerous (dysplasia) or adenocarcinoma
• Caused by inflammatory reaction or neoplasm
• Diagnosis: colonoscopy or sigmoidoscopy
• Treatment: suspicious polyps biopsied; cancerous polyps removed

Colon Cancer (Colorectal Cancer)

• Etiology: DNA mutations in colon wall cells
• Risk factors: genetics, age, low fiber, smoking, ETOH, inflammatory disorders (Crohn's, UC)
• Clinical manifestations: constipation, abdominal fullness/discomfort, rectal bleeding, occult blood, back pain, weight loss, etc
• Diagnosis: colonoscopy with biopsy
• Treatment: surgery (colon resection), chemotherapy, radiation

Test your knowledge on various gastrointestinal disorders with this quiz. The questions cover symptoms, techniques for management, and complications related to conditions like constipation and appendicitis. See how well you understand the digestive system and its challenges!