Intestinal and Rectal Disorders: Constipation

Intestinal and Rectal Disorders

• GI tract anatomy includes the small intestine (nutrient absorption), large intestine (water absorption, stool formation), and rectum/anus (waste storage and elimination).
• Defecation is stimulated by peristalsis and rectal distension, influenced by diet, hydration, activity, and the nervous system.

Constipation

• Primary (functional) constipation results from lifestyle factors like low fiber or dehydration.
• Secondary constipation stems from medications, neurological or endocrine disorders.
• Symptoms include infrequent bowel movements (less than 3 per week), straining, hard stools, and a feeling of incomplete evacuation.
• Dietary management involves increasing fiber to 25-30g daily and drinking 2-3 liters of water.
• Regular physical activity is a key management strategy along with medications.
• Medications include bulk-forming laxatives (Psyllium), stool softeners (Docusate sodium), osmotic agents (Lactulose, Polyethylene glycol), and stimulant laxatives (Senna, Bisacodyl).

Diarrhea

• Diarrhea can be caused by infections (bacterial, viral, parasitic), food intolerance (lactose, celiac), or medications (antibiotics, laxatives).
• Potential complications include dehydration (especially in children and elderly), electrolyte imbalances, and malabsorption.
• Oral Rehydration Therapy (ORT) treats mild dehydration.
• IV fluids are used for severe dehydration.
• Antidiarrheal medications (Loperamide, Bismuth subsalicylate) are considered only if the cause isn't infectious.
• Restoring gut flora can be achieved by using probiotics.
• BRAT diet modifications (bananas, rice, applesauce, toast) are also helpful.

Hemorrhoids

• Internal hemorrhoids are located inside the rectum and may protrude.
• External hemorrhoids are found under the skin around the anus and are more painful.
• Risk factors include chronic constipation, pregnancy, obesity, and prolonged sitting/standing.
• Symptoms are rectal bleeding (bright red), pain/itching, and swelling/lump near the anus.
• Lifestyle changes include increased fiber/hydration and avoiding straining.
• Topical treatments involve hydrocortisone creams, witch hazel, and sitz baths.
• Surgical interventions (hemorrhoidectomy, rubber band ligation) are considered for severe cases.

Irritable Bowel Syndrome (IBS)

• IBS types include IBS-C (constipation dominant), IBS-D (diarrhea dominant), and IBS-M (mixed).
• Common triggers include stress, high-fat foods, caffeine, dairy, and artificial sweeteners.
• Symptoms involve abdominal pain/cramping, altered bowel habits (diarrhea, constipation, or both), bloating, and excessive gas.
• The Low FODMAP diet helps avoid fermentable carbs.
• Medications include antispasmodics (Dicyclomine), fiber supplements (for IBS-C), Loperamide (for IBS-D), and probiotics.

Inflammatory Bowel Disease (IBD)

• Ulcerative Colitis (UC) affects the colon and rectum with continuous inflammation.
• Crohn's Disease can affect any part of the GI tract and has patchy inflammation.
• Symptoms include chronic diarrhea (possibly with blood/mucus), abdominal pain, weight loss, and malnutrition.
• Management involves anti-inflammatory drugs (Mesalamine, Sulfasalazine), corticosteroids, immunomodulators (Azathioprine, Infliximab). Surgery is considered for UC (colectomy) and Crohn's (bowel resection).

Diverticulosis and Diverticulitis

• Diverticulosis is the formation of small pouches (diverticula) in the colon.
• Diverticulitis is inflammation/infection of these diverticula.
• Symptoms include LLQ pain, fever, and nausea/vomiting.
• Treatment includes a high-fiber diet for prevention, antibiotics for infection, and bowel rest (NPO, IV fluids). Surgery is done if complications like abscess or perforation occur.

Bowel Obstruction

• Small Bowel Obstruction (SBO) is typically due to adhesions, hernias, or tumors.
• Large Bowel Obstruction is often caused by colorectal cancer, volvulus, or diverticular disease.
• Symptoms are cramping pain, distension, vomiting (possibly with fecal odor), and absence of bowel movements/gas.
• Management involves NPO status, a nasogastric (NG) tube for decompression, and IV fluids for hydration. Surgery is done if the obstruction doesn't resolve.

Colorectal Cancer

• Risk factors include family history, high-fat/low-fiber diet, smoking/alcohol use, and history of IBD.
• Symptoms are changes in bowel habits, blood in stool, unintentional weight loss, and abdominal pain.
• Colonoscopy is the recommended screening method starting at age 50 (or earlier with high risk).
• Other prevention methods include a high-fiber/low-fat diet and regular physical activity.
• Treatments are surgery (colectomy), chemotherapy, and radiation therapy.

Ostomy Care (Ileostomy and Colostomy)

• A healthy stoma is pink/red and moist.
• An unhealthy stoma is pale, dusky, or black, suggesting ischemia.
• Nursing interventions include emptying the pouch when 1/3 to 1/2 full, changing the appliance every 3-5 days (or if leaking).
• The skin is cleaned with warm water (avoiding alcohol-based cleansers), and skin irritation is prevented with barrier creams.

Malabsorption Syndromes

• Common types include Celiac Disease, Lactose Intolerance, and Short Bowel Syndrome.
• Symptoms involve chronic diarrhea, steatorrhea (fatty stools), weight loss, and nutrient deficiencies (iron, B12, Vitamin D).
• Management for Celiac requires a gluten-free diet.
• Management for Lactose Intolerance requires lactose avoidance or lactase supplements, and nutritional supplements are used to address deficiencies.

Appendicitis

• Symptoms include RLQ pain (McBurney's point), rebound tenderness, nausea/vomiting, low-grade fever, and increased WBC count.
• Management involves surgical removal (appendectomy), being NPO before surgery, and pain management.
• You should monitor for signs of rupture such as sudden pain relief followed by peritonitis.

Short Bowel Syndrome (SBS)

• SBS is a malabsorption disorder caused by extensive small intestine resection.
• It leads to poor nutrient absorption and is often caused by surgical removal of parts of the small intestine, Crohn's complications, or congenital defects.
• Symptoms include chronic diarrhea, steatorrhea, malnutrition, weight loss, and vitamin/mineral deficiencies.
• Treatment involves a high-protein/low-fat diet with small, frequent meals.
• You should use Parenteral nutrition (TPN) if severe.
• Medication includes antidiarrheal agents and bile acid sequestrants.
• A small bowel transplant is an option if needed.

Celiac Disease

• Celiac's is an autoimmune disorder triggered by gluten ingestion, causing damage to intestinal villi and malabsorption.
• Symptoms include chronic diarrhea, fatigue, weight loss, bloating, abdominal pain, and anemia.
• Diagnosis involves blood tests (anti-tissue transglutaminase) and endoscopic biopsy.
• Management involves adhering to a strict, lifelong gluten-free diet.
• Supplementation includes iron, calcium, vitamin D, and B12.
• You should monitor for complications (osteoporosis, anemia, lactose intolerance).

Lactose Intolerance

• Definition: Deficiency of lactase enzyme, leading to inability to digest lactose.
• Symptoms include bloating and gas.
• Diagnosis: Hydrogen breath test.
• Management: Avoid dairy or use lactose-free alternatives, lactase enzyme supplements, and calcium plus vitamin D supplements.

Fecal Incontinence

• Fecal Incontinence: Loss of bowel control, leading to unintentional stool passage.
• Causes: Nerve damage (stroke, multiple sclerosis, diabetes), weak pelvic muscles (childbirth, aging), and chronic constipation.
• Management: bowel training techniques, high-fiber diet, pelvic floor exercises (Kegels), and surgical options for severe cases.

Gastroenteritis

• Gastroenteritis: Inflammation of the stomach and intestines, usually caused by infection.
• Causes: Viral (rotavirus, norovirus), bacterial (Salmonella, E. coli), and parasitic (Giardia).
• Symptoms: Nausea, vomiting, diarrhea, and dehydration.
• Management: Oral rehydration therapy (ORT) for mild cases, IV fluids for severe dehydration.
• It's important to avoid anti-diarrheal medications if a bacterial infection is suspected and maintain proper hand hygiene.

Peritonitis

• Peritonitis: Inflammation of the peritoneum, often due to infection.
• Causes: Perforated ulcer, appendicitis rupture, bowel perforation, and peritoneal dialysis infection.
• Symptoms: Severe abdominal pain, guarding, board-like rigidity of the abdomen, high fever, and tachycardia.
• Emergency Management: Immediate IV antibiotics, surgical intervention and IV fluids/electrolyte replacement.

Clostridium difficile (C. diff) Infection

• Clostridium difficile: Bacterial infection leading to severe diarrhea and colitis.
• Risk Factors: Recent antibiotic use, hospitalization, and immunosuppression.
• Symptoms: Watery (foul-smelling) diarrhea, fever, and abdominal pain and may lead to pseudomembranous colitis.
• Management: Discontinue the causative antibiotic, administer metronidazole or vancomycin, and use strict infection control. Probiotics may help prevent recurrence.

Intestinal Perforation

• Intestinal Perforation: A hole or tear in the intestinal wall.
• Causes: Trauma, untreated ulcers, appendicitis rupture, and complications of Crohn's/diverticulitis.
• Symptoms: Severe abdominal pain, board-like rigidity, absent bowel sounds and signs of shock.
• Emergency Management: NPO status, IV fluids, broad-spectrum antibiotic and immediate surgery. You should monitor for sepsis and peritonitis.

Additional Key Concepts in GI Nursing Care

• Bowel Elimination Assessment: Frequency, color, consistency, shape, and presence of blood/mucus.
• Dietary Considerations: High-fiber for constipation, low-residue for inflammatory conditions, gluten-free for celiac, and lactose-free for lactose intolerance.
• Bowel Training & Pelvic Floor Therapy: Regular toileting schedule, Kegel exercises, and biofeedback.
• Common Diagnostic Tests: Colonoscopy to screen for colorectal cancer, endoscopy for upper GI issues, CT scan for obstructions/perforations, and stool tests for infections.

Hepatic Disorders (Liver Diseases)

Liver Anatomy and Function

• The liver metabolizes carbohydrates, fats, and proteins.
• The liver detoxifies harmful substances.
• The liver produces bile for digestion.
• The liver stores vitamins A, D, B12 and minerals (iron, copper) and regulates blood clotting via clotting factors.
• The liver breaks down red blood cells and converts hemoglobin to bilirubin.

Hepatitis (Liver Inflammation)

• Hepatitis can be caused by viral infections (A, B, C, D, E), alcohol consumption, autoimmune conditions, drug use (acetaminophen overdose), or fatty liver disease.
• Symptoms: fatigue, malaise, jaundice, abdominal pain (RUQ), dark urine, pale stools, nausea, and vomiting.
• Hepatitis A (HAV) is transmitted via the oral route.
• Hepatitis B (HBV) is transmitted blood and sexual activity.
• Hepatitis C (HCV) is transmitted blood and carries a high risk of chronic disease/liver cancer.
• Hepatitis D (HDV) only impacts individuals with HBV.
• Hepatitis E (HEV) is transmitted via the oral route and is dangerous in pregnant individuals.
• Management is based on supportive care such as hydration/rest, antiviral medications (HBV, HCV), and vaccination (HAV, HBV).

Cirrhosis (Chronic Liver Scarring)

• Causes: chronic hepatitis (HBV, HCV), alcoholic liver disease, non-alcoholic fatty liver disease (NAFLD), autoimmune hepatitis, and biliary obstruction.
• Symptoms: jaundice, ascites, hepatomegaly, peripheral edema, spider angiomas, and esophageal varices.
• Complications: portal hypertension, hepatic encephalopathy, bleeding tendencies, and liver cancer.
• Management: low-sodium diet/diuretics for ascites, lactulose for encephalopathy, beta-blockers for varices, and liver transplant if needed.

Fatty Liver Disease (Steatosis)

• Causes: alcoholic fatty liver disease (AFLD) or non-alcoholic fatty liver disease (NAFLD) due to obesity/diabetes.
• Symptoms: are often asymptomatic, but fatigue and RUQ discomfort may occur.
• Diagnosis: is made via liver function tests, ultrasound (showing fatty deposits), and biopsy (for severity).
• Management: includes weight loss/exercise, control of diabetes/cholesterol, avoidance of alcohol/hepatotoxic drugs, and high-protein diets.

Hepatic Encephalopathy (Brain Dysfunction Due to Liver Failure)

• Causes: liver failure leading to buildup of ammonia, GI bleeding, infections, or constipation.
• Symptoms: confusion, memory loss, asterixis, personality changes, agitation, and coma if severe.
• Diagnosis: includes elevated ammonia levels, EEG changes, and clinical assessment.
• Lactulose and Rifaximin are used for management.

Portal Hypertension (High Blood Pressure in the Liver's Portal System)

• Causes: cirrhosis, liver tumors, and hepatic vein thrombosis.
• Symptoms: splenomegaly, ascites, esophageal varices, and caput medusae.
• Complications: life-threatening variceal bleeding and hepatorenal syndrome.
• Management: beta-blockers, endoscopic variceal ligation, and TIPS.

Liver Cancer (Hepatocellular Carcinoma)

• Causes: chronic HBV/HCV infection, cirrhosis, and aflatoxin exposure.
• Symptoms: unexplained weight loss, RUQ pain, jaundice, and abdominal mass.
• Diagnosis: Alpha-fetoprotein (AFP) blood test, imaging (CT scan, MRI), and liver biopsy (definitive).
• Management: surgical resection, liver transplant, targeted and palliative therapy.

Wilson's Disease (Genetic Copper Overload)

• Is an autosomal recessive disorder leading to copper buildup.
• Symptoms: neurological symptoms, Kayser-Fleischer rings, and liver dysfunction.
• Diagnosis: ceruloplasmin levels, 24-hour urine copper test, and liver biopsy.
• Management: copper chelation therapy, lifelong low-copper diet, and liver transplant.

Hemochromatosis (Iron Overload)

• Is a genetic disorder or from frequent blood transfusions.
• Symptoms: fatigue, joint pain, bronze skin pigmentation, diabetes, and liver cirrhosis.
• Diagnosis: serum ferritin, liver biopsy, and genetic testing.
• Management: phlebotomy and iron chelators.

Liver Transplatation

• Indications: End-stage liver disease, liver cancer, and genetic liver diseases
• Post transplant care: immunosuppressants (tacrolimus, cyclosporine).

Autoimmune Hepatitis

• Liver inflimation caused by an overreactive immune response
• Can be associated with other autoimmune diseases Symptoms: Jaundice, fatigue, liver enlargement etc
• Diagnostics: Liver blood test, elevated enzymes and liver biopsy
• Management is liver transplants and prescription drugs

Hepatorenal Syndrome (Liver-Induced Kidney Failure)

• Results from severe cirrhosis leading to decrease kidney blood flow
• Symptoms: Jaundice, increased blood urea nitrogen etc
• Diagnostics: Exclusion of other kidney diseases
• Management : Albumin infusion to improve kidney circulation and prevent peritonitis

Syндromes (Hepatic vein thrombosis)

• Is caused Blood clotting disorder leading to liver tumor
• Symptoms: RUQ pain, Hepatomegaly, light stool , etc
• Can be diagnosed through : Doppler (Detect blood flow obstruction) , biopsy of liver
• Management: Anticoagulation therapy.

Gallbladder and pacreatic Diseas

Anatony function of the Biiliary System

• Components: Liver, Galbladder, Bile ducts, Pancreas
• Functions: Aid in fat digestion, Waste elimination (Helps excrete bilrubin and cholesterol)

Choilethiasis (Gallstones)

• Can be caused by exess cholesterol in Bile,bile stasis,bilirubin levels
• Risk factors can be obesity, rapid weight loss, overweigh, pregnancy etc
• Symphtoms nausea, light stool, jaudice,and pain
• Management the goal is too keep patient npo to maintain gallbaldder health,pain killers,IV fuids etc.

Choclecyctitis ( inflimation of the galbladder)

• Can be caused by galstone blockage and infectin
• symptoms vomitng ,nausea,refered pain to the right side
• can be diagnosed with Ultrasound and Hida scan
• Managment involvwe IV Antibiotics ,low fat diet and post surgery care

primary Biliary Cholangitis (PBC)

• Can be caused from a chronic atuoimmine destruction of ducts
• Mainly affecting middle aged woman
• Management Antibiotics
• Sympotms: Fatigue, joint pain & rash, Jaundice