week 10 day 2

Constipation Overview

• Definition: Fecal mass held in the rectum for prolonged time, resulting in fewer than 3 bowel movements per week.
• Symptoms include abdominal pain, indigestion, rectal pressure, hard dry stools, and incontinence of liquid stool.

Causes and Etiology of Constipation

• Medications such as narcotics and antacids.
• Delaying defecation can contribute to the condition.
• Low fiber and fluid intake in the diet.
• Immobility plays a significant role in the development of constipation.

Assessment of Constipation

• Assess for abdominal pain, indigestion, rectal pressure, hard dry stools, and liquid stool incontinence as common indicators.

Dietary Treatment for Constipation

• A high-fiber diet is essential for alleviating constipation.
• Foods high in fiber include raw fruits, vegetables, beans, peas, and legumes.

Additional Treatments for Constipation

• Increase fluid intake to 2-3 liters per day.
• Incorporate regular exercise into daily routines.
• Use stool softeners and laxatives as necessary.

Diarrhea Overview

• Definition: Rapid passage of fecal matter through the intestines, leading to frequent watery stools (more than 3 per day).

Etiology of Diarrhea

• Caused by infections (food or water), food allergies (milk, wheat), and antibiotics.
• Prevention includes proper food handling, hand hygiene, avoiding allergens, and taking probiotics.

Concerns Regarding Diarrhea in the Elderly

• Major risks include dehydration and hypokalemia, with vital signs exhibiting decreased blood pressure, increased pulse, and weakened pulse strength.

Treatment for Diarrhea

• Administer fluid and electrolyte replacement.
• Consider antidiarrheal medications and probiotics.
• The BRAT diet (bananas, rice, applesauce, toast) may be beneficial for recovery.

Appendicitis Overview

• Pathophysiology includes obstruction leading to increased pressure, decreased blood flow, ischemia, infarction, necrosis, and potential perforation.

Symptoms of Appendicitis

• Generalized abdominal pain that localizes to the right lower quadrant (RLQ).
• Pain worsens with movement and includes rebound tenderness.

Complications and Diagnosis of Appendicitis

• Complications may arise, including perforation and peritonitis.
• Diagnosis involves blood work (WBC count) and imaging (abdominal ultrasound, CT, or MRI).

Treatment of Appendicitis

• Patient management includes NPO status, avoiding laxatives or enemas, and preparing for an appendectomy if appendicitis is suspected.

Constipation Overview

• Definition: Fecal mass held in the rectum for prolonged time, resulting in fewer than 3 bowel movements per week.
• Symptoms include abdominal pain, indigestion, rectal pressure, hard dry stools, and incontinence of liquid stool.

Causes and Etiology of Constipation

• Medications such as narcotics and antacids.
• Delaying defecation can contribute to the condition.
• Low fiber and fluid intake in the diet.
• Immobility plays a significant role in the development of constipation.

Assessment of Constipation

• Assess for abdominal pain, indigestion, rectal pressure, hard dry stools, and liquid stool incontinence as common indicators.

Dietary Treatment for Constipation

• A high-fiber diet is essential for alleviating constipation.
• Foods high in fiber include raw fruits, vegetables, beans, peas, and legumes.

Additional Treatments for Constipation

• Increase fluid intake to 2-3 liters per day.
• Incorporate regular exercise into daily routines.
• Use stool softeners and laxatives as necessary.

Diarrhea Overview

• Definition: Rapid passage of fecal matter through the intestines, leading to frequent watery stools (more than 3 per day).

Etiology of Diarrhea

• Caused by infections (food or water), food allergies (milk, wheat), and antibiotics.
• Prevention includes proper food handling, hand hygiene, avoiding allergens, and taking probiotics.

Concerns Regarding Diarrhea in the Elderly

• Major risks include dehydration and hypokalemia, with vital signs exhibiting decreased blood pressure, increased pulse, and weakened pulse strength.

Treatment for Diarrhea

• Administer fluid and electrolyte replacement.
• Consider antidiarrheal medications and probiotics.
• The BRAT diet (bananas, rice, applesauce, toast) may be beneficial for recovery.

Appendicitis Overview

• Pathophysiology includes obstruction leading to increased pressure, decreased blood flow, ischemia, infarction, necrosis, and potential perforation.

Symptoms of Appendicitis

• Generalized abdominal pain that localizes to the right lower quadrant (RLQ).
• Pain worsens with movement and includes rebound tenderness.

Complications and Diagnosis of Appendicitis

• Complications may arise, including perforation and peritonitis.
• Diagnosis involves blood work (WBC count) and imaging (abdominal ultrasound, CT, or MRI).

Treatment of Appendicitis

• Patient management includes NPO status, avoiding laxatives or enemas, and preparing for an appendectomy if appendicitis is suspected.

Intestinal Hernia Pathophysiology

• Inguinal hernias occur when intestine protrudes through the inguinal canal in the groin.
• Conditions can lead to herniation due to pressure and weakness in the abdominal wall.

Signs and Symptoms of Inguinal Hernia

• Often asymptomatic at initial stages.
• Visible bulge that appears or increases with strain.
• May cause pain extending to the scrotum.

Umbilical Hernia Overview

• Occurs when intestine pushes through the abdominal wall or muscular layer near the umbilicus.
• Typically presents as a noticeable bulge in the abdomen.

Signs and Symptoms of Umbilical Hernia

• Prominent bulge in the umbilical region.

Risk Factors for Umbilical Hernia

• Congenital predisposition.
• Pregnancy increases abdominal pressure.
• Obesity contributes to muscle weakness.

Hernia Types

• Reducible Hernia: Bulge can be pushed back into the abdominal cavity upon applying pressure.
• Obstructed Hernia: Intestinal lumen becomes trapped, leading to bowel obstruction.
• Strangulated Hernia: Blood supply to the bowel is compromised, risking ischemia.

Treatment for Intestinal Hernia

• Initial assessment required to determine severity.
• Use of trusses to support the hernia.
• Avoid heavy lifting to reduce strain.
• Surgical intervention is often necessary for repair.

Ulcerative Colitis Pathophysiology

• Characterized by chronic inflammation limited to the superficial mucosa of the colon and rectum.

Etiology of Ulcerative Colitis

• Triggers include infections, allergic reactions, autoimmune responses, and idiopathic causes.

Signs and Symptoms of Ulcerative Colitis

• Frequent diarrhea accompanied by blood, pus, and mucus.
• Fecal urgency and abdominal pain, particularly in the left lower quadrant.
• Anemia and low serum protein levels.

Complications of Ulcerative Colitis

• Risk of bowel perforation, excessive hemorrhage, and severe dehydration.
• Increased likelihood of colon cancer.

Crohn's Disease Pathophysiology

• An autoimmune disorder characterized by chronic, relapsing inflammation affecting any part of the gastrointestinal tract.
• Features skip lesions that do not affect adjacent areas of the intestines.

Damage Caused by Crohn's Disease

• Formation of lesions leading to fistulas or fissures, scarring, intestinal narrowing, and obstruction.
• Nutritional malabsorption is a significant concern.

Signs and Symptoms of Crohn's Disease

• Daily diarrhea and persistent abdominal pain, especially in the right lower quadrant.
• Anemia and associated nutritional deficits.

Potential Complications of Crohn's Disease

• Similar risks as ulcerative colitis, including obstruction, fistula formation, malabsorption, and increased colon cancer risk.

Diagnosis of Inflammatory Bowel Disease (IBD)

• Diagnostic methods include stool cultures, complete blood count (CBC), and colonoscopy.

Medication for Treating IBD

• Common treatment options include anti-inflammatory agents and corticosteroids.

Dietary Management for IBD

• Nutritional supplements and increased fiber intake recommended.
• Limiting dairy and avoiding spicy foods.

Exacerbation Dietary Management for IBD

• During flare-ups, bowel rest and NPO (nothing per os) status may be necessary.

Colorectal Cancer Pathophysiology

• Begins as benign polyps that may progress to malignant tumors leading to metastasis.

Risk Factors for Colorectal Cancer

• Increased age (over 50 years), family history of colorectal issues, historical polyps, IBD diagnosis, and lifestyle factors like smoking, alcohol, obesity, high fat, and low fiber diet.

Early Signs and Symptoms of Colorectal Cancer

• Noticeable bleeding during bowel movements and changes in bowel habits.

Late Signs and Symptoms of Colorectal Cancer

• Advanced symptoms include severe pain and anorexia.

Diagnosis of Colorectal Cancer

• Recommended screenings start after age 50, including annual fecal occult blood tests and colonoscopies every five years.

Treatment for Colorectal Cancer

• Options include surgical resections, colostomy, radiation therapy, and chemotherapy.

Colectomy

• Surgical procedure to remove the colon.

Terminology Related to Ostomies

• Ostomy: Surgical opening created to divert waste.
• Stoma: The physical surface opening created on the body.
• Ileostomy: Ostomy formed from the small intestine, allowing waste to exit the body.

Intestinal Hernia Pathophysiology

• Inguinal hernias occur when intestine protrudes through the inguinal canal in the groin.
• Conditions can lead to herniation due to pressure and weakness in the abdominal wall.

Signs and Symptoms of Inguinal Hernia

• Often asymptomatic at initial stages.
• Visible bulge that appears or increases with strain.
• May cause pain extending to the scrotum.

Umbilical Hernia Overview

• Occurs when intestine pushes through the abdominal wall or muscular layer near the umbilicus.
• Typically presents as a noticeable bulge in the abdomen.

Signs and Symptoms of Umbilical Hernia

• Prominent bulge in the umbilical region.

Risk Factors for Umbilical Hernia

• Congenital predisposition.
• Pregnancy increases abdominal pressure.
• Obesity contributes to muscle weakness.

Hernia Types

• Reducible Hernia: Bulge can be pushed back into the abdominal cavity upon applying pressure.
• Obstructed Hernia: Intestinal lumen becomes trapped, leading to bowel obstruction.
• Strangulated Hernia: Blood supply to the bowel is compromised, risking ischemia.

Treatment for Intestinal Hernia

• Initial assessment required to determine severity.
• Use of trusses to support the hernia.
• Avoid heavy lifting to reduce strain.
• Surgical intervention is often necessary for repair.

Ulcerative Colitis Pathophysiology

• Characterized by chronic inflammation limited to the superficial mucosa of the colon and rectum.

Etiology of Ulcerative Colitis

• Triggers include infections, allergic reactions, autoimmune responses, and idiopathic causes.

Signs and Symptoms of Ulcerative Colitis

• Frequent diarrhea accompanied by blood, pus, and mucus.
• Fecal urgency and abdominal pain, particularly in the left lower quadrant.
• Anemia and low serum protein levels.

Complications of Ulcerative Colitis

• Risk of bowel perforation, excessive hemorrhage, and severe dehydration.
• Increased likelihood of colon cancer.

Crohn's Disease Pathophysiology

• An autoimmune disorder characterized by chronic, relapsing inflammation affecting any part of the gastrointestinal tract.
• Features skip lesions that do not affect adjacent areas of the intestines.

Damage Caused by Crohn's Disease

• Formation of lesions leading to fistulas or fissures, scarring, intestinal narrowing, and obstruction.
• Nutritional malabsorption is a significant concern.

Signs and Symptoms of Crohn's Disease

• Daily diarrhea and persistent abdominal pain, especially in the right lower quadrant.
• Anemia and associated nutritional deficits.

Potential Complications of Crohn's Disease

• Similar risks as ulcerative colitis, including obstruction, fistula formation, malabsorption, and increased colon cancer risk.

Diagnosis of Inflammatory Bowel Disease (IBD)

• Diagnostic methods include stool cultures, complete blood count (CBC), and colonoscopy.

Medication for Treating IBD

• Common treatment options include anti-inflammatory agents and corticosteroids.

Dietary Management for IBD

• Nutritional supplements and increased fiber intake recommended.
• Limiting dairy and avoiding spicy foods.

Exacerbation Dietary Management for IBD

• During flare-ups, bowel rest and NPO (nothing per os) status may be necessary.

Colorectal Cancer Pathophysiology

• Begins as benign polyps that may progress to malignant tumors leading to metastasis.

Risk Factors for Colorectal Cancer

• Increased age (over 50 years), family history of colorectal issues, historical polyps, IBD diagnosis, and lifestyle factors like smoking, alcohol, obesity, high fat, and low fiber diet.

Early Signs and Symptoms of Colorectal Cancer

• Noticeable bleeding during bowel movements and changes in bowel habits.

Late Signs and Symptoms of Colorectal Cancer

• Advanced symptoms include severe pain and anorexia.

Diagnosis of Colorectal Cancer

• Recommended screenings start after age 50, including annual fecal occult blood tests and colonoscopies every five years.

Treatment for Colorectal Cancer

• Options include surgical resections, colostomy, radiation therapy, and chemotherapy.

Colectomy

• Surgical procedure to remove the colon.

Terminology Related to Ostomies

• Ostomy: Surgical opening created to divert waste.
• Stoma: The physical surface opening created on the body.
• Ileostomy: Ostomy formed from the small intestine, allowing waste to exit the body.

Cholecystitis

• Cholecystitis is the inflammation of the gallbladder, often associated with obstruction caused by gallstones.
• Pathophysiology includes increased pressure leading to reduced blood flow and resultant ischemia, with bile retention acting as a chemical irritant.
• Risk factors include age over 60, family history, obesity, rapid weight loss, and biliary stasis.
• Symptoms include acute pain in the right upper quadrant, especially after fatty meals, nausea/vomiting, fever, and jaundice.
• Diagnosis commonly performed via abdominal ultrasound.
• Treatment includes oral bile acids, with a recommended low-fat diet to manage symptoms.
• Surgical treatment typically involves cholecystectomy (removal of the gallbladder).

Hepatitis

• Hepatitis is the inflammation of the liver, primarily caused by viral infections, alcohol consumption, and exposure to toxins.
• Known hepatotoxins include specific medications: amoxicillin-clavulanate, flucloxacillin, erythromycin, diclofenac, and acetaminophen among others.
• The pathophysiology involves inflammation which can impair bilirubin elimination.
• Bilirubin is derived from hemoglobin breakdown in the bone marrow, fat metabolism, and the Krebs cycle.

Hepatitis Types

• Hepatitis A:

  • Route: Fecal-oral transmission.
  • Onset: Abrupt symptoms.
  • Prevention: Vaccine available.

• Hepatitis B:

  • Route: Blood and body fluids.
  • Onset: Slow progression.
  • Complications: Potential for chronic infection and liver cancer.
  • Prevention: Vaccine and standard precautions.

• Hepatitis C:

  • Route: Blood and body fluids.
  • Onset: Slow onset.
  • Complications: Chronic infection and increased cancer risk.
  • Prevention: Standard precautions.

Symptoms of Hepatitis

• Preicteric Phase: Flu-like symptoms, gastrointestinal upset, joint pain, and right upper quadrant pain.
• Icteric Phase: Characterized by jaundice, pruritus (itching), clay-colored stools, and dark urine.
• Posticteric Phase: Increased energy levels and resolution of jaundice.

Treatment of Hepatitis

• Antiviral medications are prescribed for Hepatitis A, B, and C.
• Interventions include rest, proper nutrition, and avoidance of hepatotoxic medications.

Essential Concepts

• Cholecystitis is frequently linked to cholelithiasis (gallstones) and presents specific risk factors and symptoms.
• Hepatitis can be caused by various factors and exhibits three distinct phases, each with unique signs and symptoms.
• Understanding different hepatitis types helps frame their management and preventive measures.

Cholecystitis

• Cholecystitis is the inflammation of the gallbladder, often associated with obstruction caused by gallstones.
• Pathophysiology includes increased pressure leading to reduced blood flow and resultant ischemia, with bile retention acting as a chemical irritant.
• Risk factors include age over 60, family history, obesity, rapid weight loss, and biliary stasis.
• Symptoms include acute pain in the right upper quadrant, especially after fatty meals, nausea/vomiting, fever, and jaundice.
• Diagnosis commonly performed via abdominal ultrasound.
• Treatment includes oral bile acids, with a recommended low-fat diet to manage symptoms.
• Surgical treatment typically involves cholecystectomy (removal of the gallbladder).

Hepatitis

• Hepatitis is the inflammation of the liver, primarily caused by viral infections, alcohol consumption, and exposure to toxins.
• Known hepatotoxins include specific medications: amoxicillin-clavulanate, flucloxacillin, erythromycin, diclofenac, and acetaminophen among others.
• The pathophysiology involves inflammation which can impair bilirubin elimination.
• Bilirubin is derived from hemoglobin breakdown in the bone marrow, fat metabolism, and the Krebs cycle.

Hepatitis Types

• Hepatitis A:

  • Route: Fecal-oral transmission.
  • Onset: Abrupt symptoms.
  • Prevention: Vaccine available.

• Hepatitis B:

  • Route: Blood and body fluids.
  • Onset: Slow progression.
  • Complications: Potential for chronic infection and liver cancer.
  • Prevention: Vaccine and standard precautions.

• Hepatitis C:

  • Route: Blood and body fluids.
  • Onset: Slow onset.
  • Complications: Chronic infection and increased cancer risk.
  • Prevention: Standard precautions.

Symptoms of Hepatitis

• Preicteric Phase: Flu-like symptoms, gastrointestinal upset, joint pain, and right upper quadrant pain.
• Icteric Phase: Characterized by jaundice, pruritus (itching), clay-colored stools, and dark urine.
• Posticteric Phase: Increased energy levels and resolution of jaundice.

Treatment of Hepatitis

• Antiviral medications are prescribed for Hepatitis A, B, and C.
• Interventions include rest, proper nutrition, and avoidance of hepatotoxic medications.

Essential Concepts

• Cholecystitis is frequently linked to cholelithiasis (gallstones) and presents specific risk factors and symptoms.
• Hepatitis can be caused by various factors and exhibits three distinct phases, each with unique signs and symptoms.
• Understanding different hepatitis types helps frame their management and preventive measures.

Ulcerative Colitis Symptoms and Complications

• Diarrhea is a prominent symptom, often frequent and urgent.
• Blood, pus, and mucus may be present in stool.
• Patients experience fecal urgency leading to frequent, desperate urges to defecate.
• Abdominal pain is common, particularly in the lower left quadrant (LLQ) during defecation.
• Anemia and decreased serum protein levels may indicate malnutrition.

Ulcerative Colitis Complications

• Perforation of the colon can be a life-threatening complication.
• Hemorrhage can occur, leading to significant blood loss.
• Dehydration results from severe diarrhea and fluid loss.
• Increased risk of colon cancer is associated with long-standing ulcerative colitis.

Crohn’s Disease Pathophysiology

• Considered an autoimmune disorder with chronic and relapsing characteristics.
• Affects the entire gastrointestinal tract, not limited to specific areas.
• "Skip lesions" are characteristic, where segments of healthy tissue are interspersed with inflamed areas.

Effects of Crohn’s Disease

• Lesions can lead to the formation of fistulas or fissures, complicating the condition.
• Tissue damage results in scarring and narrowing of the intestines.
• Intestinal obstruction may occur due to strictures.
• Thickening of the intestinal wall can contribute to malabsorption issues.

Crohn’s Disease Symptoms

• Persistent diarrhea is a key symptom, often accompanied by urgency.
• Abdominal pain is prevalent, particularly in the right lower quadrant (RLQ).
• Patients are likely to experience anemia due to nutritional deficits.

Crohn’s Disease Complications

• Obstruction of the intestines can require surgical intervention.
• Fistulas or abscesses may form, creating further complications.
• Malabsorption and malnutrition are common due to damaged intestinal functioning.
• Increased risk of colon cancer is present with Crohn’s disease.

Diagnosis of Inflammatory Bowel Disease (IBD)

• Stool cultures are conducted to identify pathogens or causes of diarrhea.
• Complete blood count (CBC) is performed to assess for anemia and infection.
• Colonoscopy is essential for direct visualization and diagnosis of IBD.

Medications for IBD Treatment

• Anti-inflammatory agents are commonly prescribed to reduce inflammation.
• Corticosteroids may be used for their potent anti-inflammatory effects during flare-ups.

Dietary Management for IBD

• Nutritional supplements are often necessary to address deficiencies.
• Increased fiber intake may aid in digestion, but should be managed carefully.
• Limiting dairy products and avoiding spicy foods can help reduce irritation.

Dietary Management During Exacerbations

• Bowel rest is recommended to allow the gut to heal.
• NPO (nothing by mouth) status may be indicated during severe exacerbations to prevent further irritation.

Ulcerative Colitis Symptoms and Complications

• Diarrhea is a prominent symptom, often frequent and urgent.
• Blood, pus, and mucus may be present in stool.
• Patients experience fecal urgency leading to frequent, desperate urges to defecate.
• Abdominal pain is common, particularly in the lower left quadrant (LLQ) during defecation.
• Anemia and decreased serum protein levels may indicate malnutrition.

Ulcerative Colitis Complications

• Perforation of the colon can be a life-threatening complication.
• Hemorrhage can occur, leading to significant blood loss.
• Dehydration results from severe diarrhea and fluid loss.
• Increased risk of colon cancer is associated with long-standing ulcerative colitis.

Crohn’s Disease Pathophysiology

• Considered an autoimmune disorder with chronic and relapsing characteristics.
• Affects the entire gastrointestinal tract, not limited to specific areas.
• "Skip lesions" are characteristic, where segments of healthy tissue are interspersed with inflamed areas.

Effects of Crohn’s Disease

• Lesions can lead to the formation of fistulas or fissures, complicating the condition.
• Tissue damage results in scarring and narrowing of the intestines.
• Intestinal obstruction may occur due to strictures.
• Thickening of the intestinal wall can contribute to malabsorption issues.

Crohn’s Disease Symptoms

• Persistent diarrhea is a key symptom, often accompanied by urgency.
• Abdominal pain is prevalent, particularly in the right lower quadrant (RLQ).
• Patients are likely to experience anemia due to nutritional deficits.

Crohn’s Disease Complications

• Obstruction of the intestines can require surgical intervention.
• Fistulas or abscesses may form, creating further complications.
• Malabsorption and malnutrition are common due to damaged intestinal functioning.
• Increased risk of colon cancer is present with Crohn’s disease.

Diagnosis of Inflammatory Bowel Disease (IBD)

• Stool cultures are conducted to identify pathogens or causes of diarrhea.
• Complete blood count (CBC) is performed to assess for anemia and infection.
• Colonoscopy is essential for direct visualization and diagnosis of IBD.

Medications for IBD Treatment

• Anti-inflammatory agents are commonly prescribed to reduce inflammation.
• Corticosteroids may be used for their potent anti-inflammatory effects during flare-ups.

Dietary Management for IBD

• Nutritional supplements are often necessary to address deficiencies.
• Increased fiber intake may aid in digestion, but should be managed carefully.
• Limiting dairy products and avoiding spicy foods can help reduce irritation.

Dietary Management During Exacerbations

• Bowel rest is recommended to allow the gut to heal.
• NPO (nothing by mouth) status may be indicated during severe exacerbations to prevent further irritation.