Lower Gastrointestinal Disorders Overview

Lower Gastrointestinal Objectives

• Constipation and diarrhea, preventative measures, complications, and standard treatment should be described
• Nursing diagnoses associated with constipation and diarrhea, enemas, and rectal tubes should be discussed
• Inflammatory & Infectious disorders, appendicitis, peritonitis, diverticulosis & diverticulitis should have an overview including; medications, diet modifications, and surgical procedures
• Inflammatory Bowel Disease (IBD): Crohn's disease & ulcerative colitis should be described
• Etiology, clinical manifestations, complications, and treatment of Crohn's disease & ulcerative colitis should be compared and contrasted
• Common nursing diagnoses that may be used for inflammatory bowel disease should be listed
• Irritable Bowel Syndrome (IBS) cause and treatment should be described
• Different types of hernias, possible complications, prevention of and treatment including surgery should be compared & contrasted
• Malabsorption, types of absorption disorders, lactose intolerance, and celiac disease should be defined
• Typical signs & symptoms, complications, and treatment including nutritional/dietary needs for malabsorption, types of absorption disorders, lactose intolerance, and celiac disease should be defined
• Factors associated with small bowel obstruction (SBO) and a large bowel obstruction (LBO) should be discussed
• Signs & symptoms, diagnostic tests and the use of gastrointestinal tubes in relation to small bowel obstruction (SBO) and a large bowel obstruction (LBO) should be discussed
• Nursing care for anorectal problems such as hemorrhoids, anal fissures, and rectal abscess should be described
• Nursing care for a client with lower GI bleeding should be discussed
• Risk factors for colon/rectal cancer, signs & symptoms, and treatments available including surgery should be stated
• Ostomy and stoma should be defined

Problems of Elimination - Constipation

• Constipation can be caused by rectal and metabolic conditions, medications, or decreased fiber/fluids, and mobility
• Constipation can be treated with fiber, exercise, water, suppositories, and enemas (not to use regularly)
• Obstipation is chronic constipation where the intestines are never fully emptied, eventually leading to obstruction

Enema and Rectal Tube

• Enema is the washing out of colon with large quantities of solution, to clear colon of feces
• Rectal Tube purpose not mentioned in the text

Problems of Elimination - Diarrhea

• Diarrhea can be caused by bacterial or viral infections, food, inflammatory disease, malabsorption, radiation, or enteral tube feedings
• Diarrhea Treatment is to replace fluids/electrolytes (Pedialyte), eliminate cause, and administer antidiarrheal agents like Lomotil or Imodium, and alcohol-free barrier for skin protection
• Fluids/electrolytes when treating diarrhea should be administered by oral or IV route

Anorectal Problems

• Hemorrhoids, anal fissures, anorectal abscess, and rectal prolapse are examples of anorectal problems
• Nursing care for anorectal problems includes pain control, sitz bath, stool softeners to reduce straining, and a high-fiber diet

Irritable Bowel Syndrome (IBS) - Cause & Symptoms

• Irritable bowel syndrome (IBS) includes recurrent abdominal pain and abnormal bowel movements
• Possible causes of irritable bowel syndrome (IBS) could be related to changes in gut microbiota, autonomic dysfunction, altered motility of GI tract, and/or psychological factors
• Symptoms of irritable bowel syndrome (IBS) can include abdominal pain or cramps, excess gas and bloating, diarrhea, constipation, mucus in poop, and/or feeling like you're unable to empty your bowels after pooping

Irritable Bowel Syndrome (IBS) - Treatment and Management

• Diet for IBS should include increased fiber and fluid intake while avoiding gluten, cheese, milk, gas forming foods, caffeinated beverages, and lactose/fructose/sorbitol.
• Treatments for IBS also include increased physical activity, stress management, reassurance, psychosocial support, anticholinergic meds, and antidepressants

Abdominal Inflammatory Disease: Appendicitis

• Appendicitis is the inflammation of the appendix located in the RLQ (Right Lower Quadrant) of the abdomen
• Appendicitis is caused typically by a hard mass of feces, obstruction caused by a stone, inflammation, tumor, or parasites
• Clinical manifestations of appendicitis include RLQ (Right Lower Quadrant) pain, fever, anorexia, N/V (nausea/vomiting), rebound tenderness, and/or diarrhea or constipation
• Complications of appendicitis include peritonitis, signs and symptoms are T>100, abdominal pain, tenderness and rigidness
• Sudden relief of pain as a complication of appendicitis could be a sign of a ruptured appendix
• Appendicitis is treated with IV fluids, antibiotics, and an appendectomy
• Nursing interventions for appendicitis are VS (vital signs), IV fluid therapy, pain control, and proper post-surgery care

Abdominal Hernia

• Cause of Abdominal Hernia can be coughing, straining, lifting, obesity, pregnancy, and/or poor wound healing
• Nursing intervention of Abdominal Hernia is observation, support device implemented and potential surgery (herniorrhaphy/hernioplasty), and manual replacement (if reducible) are all forms of nursing interventions
• Patient Education for Abdominal Hernia are small meals, avoid lifting, eat high fiber foods and support binder implementation
• Potential complications of Abdominal Hernia include strangulation of the hernia and incarceration

Absorption Disorders

• Lactose intolerance includes deficiency in lactase
• Symptoms of Lactose intolerance includes abdominal cramping, excessive gas, and/or loose stools
• Celiac disease is an autoimmune disorder where ingestion of gluten leads to damage to small intestine
• With Celiac Disease it is important to Avoid BROW (barley, rye, oat, and wheat)

Diverticular Disease

• Diverticula is a small bulging pouch that can occur anywhere in the small intestine or colon
• Diverticulosis is multiple diverticula in the colon
• Diverticulitis is when diverticula become inflamed
• Risk factors for diverticular disease include age >40, low fiber diet, high fatty foods, red meat, obesity, sedentary lifestyle, smoking, alcohol, and certain medications (ie NSAIDs)
• Complications of diverticular disease include GI bleeding, undigested food getting stuck in protrusions causing an infection and/or bowel obstruction, abscess, fistulae, and rupture causing peritonitis
• Symptoms of Diverticular Disease are pressure inside the colon causes the mucosa and submucosa to bulge out through weak spots in the intestines

Diverticular Disease Nursing Interventions

• Clients should be placed on bed rest
• Follow NPO (nothing by mouth) order per MD (medical doctor)
• Administer ordered IV fluids
• Insert NG (nasogastric) tube to suction if needed for severe cases
• Diverticular Disease Medications are Analgesics, antispasmodics for Diarrhea, bulk forming laxatives (Metamucil) and antibiotics
• Diverticular Disease can be treated with CT guided percutaneous drainage of abscesses, bowel resection and/or colostomy

Intestinal Obstruction

• Intestinal obstruction is a serious intestinal condition in which the intestines are completely or partially blocked, preventing the contents of the intestines from passing through Signs include:
• Mechanical: tumor, adhesions, strangulated hernia, intussusception
• Non-mechanical: paralytic ileus, absence of peristalsis
• Symptoms:
• Nausea/vomiting (depends on location)
• Abdominal distention
• Abdominal cramps
• No BS (if functional obstruction)
• High pitched Bowel Sounds above obstructed area (if mechanical)
• Diagostics include:
• Abd X-ray
• CT scan
• Barium enema
• CBC, electrolytes (hypokalemia)
• Arterial Blood Gas (metabolic acidosis vs metabolic alkalosis)
• Medical and surgical management
• NPO (nothing by mouth)
• IV fluid
• Intestinal decompression
• Most mechanical obstructions require surgery

Intestinal Obstruction Nursing Interventions

• Elevate the head of the bed.
• Replace K+ per order.
• Place NG tube to suction per order.
• Monitor vital signs
• Lemon swab to moisten mouth
• Oral care

Ostomy

• Ascending colostomy means stool is soft/semi-liquid
• Descending (Left) Colostomy stool is soft
• Right lower side of abdomen
• (NO pills with enteric coating)
• Liquid/semiliquid is consistent stool
• Avoid hard to digest foods
• Avoid high fiber/gassy foods
• Fluid intake should be monitored
• Empty when pouch is ⅓ full
• Transverse colostomy means stool is soft/semi-liquid

Inflammatory Bowel Disease (Crohn's VS Ulcerative colitis)

• Crohn's Disease is an immune-mediated disease that can affect any part of the digestive tract from mouth to anus
• Mucosa only, usually involves rectum & colon
• Crohn's is red, edematous mucosa that bleeds easily, pseudopolyps Typical signs and symptoms of Crohn's include:
• Diarrhea
• RLQ pain
• Ulcers in mouth
• Weight loss, fatigue, Typical signs and Symptoms of Ulcerative Colitis include:
• Dehydration
• Anemia
• Hemorrhage
• Hypovolemia
• A client during EXTREME/LONG exacerbations can eat diet is High in PROTEIN & calories to maintain WT & recovery or elemental diet

Inflammatory Bowel Disease Medications

Medications include:

• 5-ASA (ie. Mesalamine, sulfasalazine)- 1st line tx; decrease inflammatory response
• Corticosteroids- for acute exacerbations of IBD
• Antidiarrheal- to reduce peristalsis and rest bowel
• Immunomodulators- for pts who do not respond well to tx
• Antibiotics (metronidazole, ciprofloxacin)- tx crohn's related fistula Inflammatory Bowel Disease goal is to maintain remission

Colon Cancer

• Potential cause of Colon Cancer include lack of dietary fiber Symptoms include change in bowel habits, blood or mucus in stools, abdominal or rectal pain and weight loss
• Barium enema, abdominal and rectal exam are examples of diagnostics for Colon Cancer including fecal occult blood and CEA
• Colon cancer is treated by therapeutic intervention and potential surgery like Colostomy or Resection

Explore lower gastrointestinal disorders, including constipation, diarrhea, IBD (Crohn's, ulcerative colitis), IBS, and hernias. Understand preventative measures, complications, treatments, and nursing diagnoses. Review medications, diet modifications, and surgical procedures for managing these conditions.