Medical-Surgical 2nd Semester 2022-2023 PDF

Causes: incompetent lower esophageal sphincter, pyloric – stenosis, or motility disorders Incidence increases with aging Monitoring...

Causes: incompetent lower esophageal sphincter, pyloric – stenosis, or motility disorders Incidence increases with aging Monitoring Medical and surgical management are similar to that for GERD Inflammation of the gastric mucosa A common GI problem Can be chronic or acute Dietary indiscretion ✓ Pyrosis (heartburn) Overuse of certain medications ✓ Dyspepsia (indigestion) Excessive alcohol intake ✓ Regurgitation Bile reflux ✓ Dysphagia Radiation therapy ✓ Odynophagia Ingestion of strong acid or alkali ✓ Hypersalivation May be a sign of an acute systemic infection ✓ Esophagitis Can be caused by benign or malignant ulcers Endoscopy Helicobacter pylori Barium swallow Autoimmune diseases Ambulatory 12 to 36-hour esophageal pH monitoring Dietary factors Bilirubin monitoring Edema and hyperemia of the gastric mucosa Teach patient to avoid situations that decrease LES pressure or cause esophageal irritation. ↓ Diet ✓ Eating in relation to bedtime Decreased secretion of the hydrochloric acid ✓ Normal body weight, maintain ↓ Clothing HOB elevation (for non-ambulatory patients) Increased presence of the H. Pylori Medications ✓ Antacids ↓ ✓ Histamine receptor blockers (H2); ✓ PPI’s (proton pump inhibitors) Causes superficial erosion ✓ Prokinetic agents; , ↓ Hemorrhage is an increased amount of blood in the vessels of an organ - Wrapping of a portion of the gastric fundus around the or tissue in the body. sphincter area of the esophagus Barrett's esophagus is a condition in which the flat pink lining of the swallowing tube that connects the mouth to the Acute form: stomach (esophagus) becomes damaged by acid reflux, Abdominal discomfort which causes the lining to thicken and become red. Headache A condition in which the tissue lining of the esophagus is Lassitude (lack of energy/body weakness) replace by a tissue that is similar to the lining of the intestine – Nausea and vomiting A precancerous condition of the esophagus commonly Anorexia associated with long-standing GERD Hiccupping Chronic Form Symptoms of GERD Anorexia Heartburn Belching, nausea and vomiting, sour taste  Vitamin B12 deficiency Excessive secretion of HCL may also be the cause Achlorhydria/Hypochlorhydria to hyperchlorhydria Familial tendency Endoscopy, upper GI radiographic studies, histologic exam, use of NSAIDS diagnostic measures for H-pylori generates prostaglandins that are involved in the protection of gastrointestinal mucosa, while generates prostaglandins that mediate inflammation and pain in sites throughout the body. Refrain from alcohol or food until symptoms subsides Control of bleeding Diluting/neutralizing offending agent (ingestion of acid and Alcohol ingestion alkalis) excessive smoking Emetics and lavage Zollinger-Ellison syndrome NGT Gastric resection Erosion is caused either by increased activity of pepsin and Chronic Gastritis: Diet modification, promoting rest, reduce HCL or decreased resistance of the mucosa stress, pharmacologic therapy. ZES is suspected in unresponsive peptic ulcer can also be the cause: ✓ Ischemia : ✓ increased acid and pepsin production ✓ reflux Patient history Cushing's and Curling’s types Ask about the presenting signs and symptoms 72-hr dietary recall Any methods used to treat the symptoms May be asymptomatic Dull, gnawing pain/burning sensation in the midepigastinic area or in the back Anxiety related to treatment Eating usually relieves pain Imbalanced nutrition, less than body requirements related to Pyrosis inadequate intake Vomiting, constipation, diarrhea, bleeding [black( )– Risk for imbalanced fluid volume related to insufficient fluid upper; bright red ( )- lower] loss subsequent to vomiting Deficient knowledge Acute pain Physical findings Upper GI barium study Endoscopy Reduced anxiety Stool analysis Avoidance of irritating foods Biopsy, and histology (microscopic study of tissues) with Fluid balance culture. Relief of pain Urea breath test Dietary management Reduce anxiety ✓ Antibiotics (TAMCB) – if infection ang cause Optimal nutrition ✓ Proton-pump inhibitors (OLR) Promote fluid balance ✓ Bismuth salts Relieve pain ✓ H2 receptor antagonists (CRFN) ✓ Octreotide ✓ Cytoprotective agent ( & Exhibits less anxiety ) Avoids eating irritating foods or drinking carbonated beverages Maintains fluid balance Adheres to medical regimen Maintains appropriate weight (cutting of Vagus nerve) with or without Reports less pain pyloroplasty o Vagotomy ▪ Truncal A peptic ulcer is an excavation that forms in the mucosal ▪ Selective wall of the stomach, in the pylorus, and duodenum, or in the ▪ Proximal gastric vagotomy esophagus Depth of erosion is variable Occurs mostly in people between 40 and 60 y/o Results from infection with H. Pylori  o blood component therapy NG Tube Insertion o Monitoring o Lavage IFC and monitoring UO Proper positioning Transendoscopic coagulation Selective embolization PERFORATION AND PENETRATION signs and symptoms: Intractable pain radiating to the right shoulder Tender, rigid, board-like abdomen (hemorrhage) Vomiting, hypertension, tachycardia, fainting signs and symptoms: Back and epigastric pain Management: Chief complaint Surgery Ask about the nature of the pain Post Op: Monitoring 72-hour dietary recall Lifestyle habits PYLORIC OBSTRUCTION (GOO): Vital signs Signs and symptoms: Physical exam o Nausea and vomiting o Constipation : o epigastric fullness Acute pain related to the effect of gastric acid secretion on o weight loss damaged tissue Management: Insertion of NG Tube Imbalanced nutrition related to changes in diet Upper Gl endoscopy Balloon dilatation of the pylorus Surgery: Hemorrhage o Vagotomy Perforation o Antrectomy Penetration o gastrojejunostomy Pyloric Obstruction (Gastric Outlet Obstruction) Morbid obesity is the term applied to people who are more Relief of pain than two times their ideal body weight or whose body mass Reduced anxiety index (BMI) exceeds 30 kg/m2 Nutrition maintenance 100 pounds greater than the ideal body weight Absence of complications Patients with morbid obesity are at highest risk for health complications! Relieving pain Weight loss diet with behavioral modification and exercise o Avoid caffeine and aspirin Treatment of depression o Relaxation techniques : Reducing Anxiety o (Meridia) o (Xenical) SE: Sibutramine increases BP; Orlistat Increases BM, decreases absorption of some vitamins HEMORRHAGE Usually manifested by o BARIATRIC SURGERY: o Monitor the patient for signs of hypotension ▪ Jejunoileal bypass o Monitor High and Hct ▪ Gastric bypass is the iron-containing protein responsible for carrying ▪ Vertical banded gastroplasty oxygen in red blood cells whereas is the volume of red blood cells compared to the total blood volume. Treat the bleeding! (Blood transfusion) Replacing blood that was lost o IV line o CVP insertion  : Early stages: Asymptomatic Early symptoms seldom definitive: o Pain relieved with antacids Progressive: o Anorexia o Dyspepsia o Weight loss o Abdominal pain o Constipation o Anemia o Nausea and vomiting Removal of the tumor Gastrectomy (Total/Subtotal) Chemotherapy Radiation therapy Patient and family knowledge Assess for presence of bowel sounds Palpate the abdomen Assess for complication postop Anxiety related on surgical intervention Acute pain related to surgical incision Deficient knowledge about surgical procedures and postoperative course Imbalanced nutrition, less than body requirements, related to poor nutrition before surgery and altered GI system after surgery Relieve anxiety Relieve pain o Analgesics o No sedation o Maintain NG tube Resume enteral intake Recognize obstacles to adequate nutrition: General postop care similar to that for a patient recovering o Dysphagia and gastric retention from a gastric resection o Bile reflux Provide 6 small feedings o Dumping syndrome Encourage fluid intake o Vitamin and mineral deficiencies Teach patients signs of dehydration Discuss dietary instructions: Do not overeat Incidence: Men > Women Japan has higher incidence : Significant factor Other Factors: o Chronic inflammation of the stomach o Pernicious anemia o Achlorhydria o Gastric ulcers Is a term used to describe an abnormal infrequency or o H. Pylori infection irregularity of defecation, abnormal hardening of stools that o Genetics makes their passage difficult and sometimes painful, a  decrease in stool volume, or retention of stool for a prolonged Intestinal rumbling period. Anal spasms and tenesmus Signs and symptoms of dehydration : Medications: The characteristic of the stools can tell the location of the GI problem o Tranquilizers (muscle relaxants) o Anticholinergics (decreases peristalsis) o Antidepressants CBC o Opioids Urinalysis Rectal or anal disorders; Stool exam Endoscopy Obstruction Barium enema Metabolic, neurologic, and neuromuscular conditions (DM, Hirschsprung’s disease, Parkinson’s, Multiple Sclerosis) Endocrine disorders Potential for IBS, diverticular disease Immobility Dietary habits Monitoring through physical assessment Bed rest Increased OFI Abdominal distention No intake of foods that increase intestinal motility Borborygmus (a rumbling or gurgling noise) Administer antidiarrheal medications: Pain and pressure o o Decreased appetite Perianal hygiene Headache Fatigue Indigestion The involuntary passage of stool from the rectum Straining at stool (Valsalva maneuver) Small, hard, dry stools Trauma Neurologic disorders Hypertension Infection Fecal impaction Radiation treatment Fecal impaction Hemorrhoids and fissures Pelvic floor relaxation Megacolon Laxative abuse Advancing age Education Bowel habit training Rectal exams Increase fiber and OFI Endoscopic examinations Judicious use of laxatives: X-ray o Psyllium hydrophilic mucilloid (Metamucil) Barium enema o Magnesium OH Computed tomography scans o Mineral Oil Anorectal manometry o Bisacodyl (Dulcolax) Transit studies : Increased frequency of bowel movements, increased amount No specific cure of stool, and altered consistency of stool. Biofeedback therapy Frequent causes: Bowel training programs o Irritable bowel syndrome (IBS) Surgery o Inflammatory bowel disease (IBD) o Lactose intolerance : o Medications, endocrine factors, infection Take health history Can be acute or chronic Bowel training program Encourage meticulous skin hygiene : Facilitate the use of internal or external incontinence devices Secretory Osmotic Mixed is the inability of the digestive system to absorb : one or more of the major vitamins (especially vitamin B12 - Increased frequency and fluid content of stools Cobalamin), minerals (ie, iron and calcium), and nutrients (ie, Abdominal cramps carbohydrates, fats, and proteins). Distention  The conditions that cause malabsorption can be grouped into Several diagnostic tests may be prescribed, including stool the following categories: studies for quantitative and qualitative fat analysis, lactose causing generalized tolerance tests, D-xylose absorption tests, and Schilling tests. malabsorption (eg, celiac sprue, regional enteritis, radiation The hydrogen breath test that is used to evaluate enteritis) carbohydrate absorption. causing generalized malabsorption (eg, Endoscopy with biopsy of the mucosa is the best diagnostic small bowel bacterial overgrowth, tropical sprue, Whipple's tool. disease) Ultrasound studies, CT scans, and x-ray findings can reveal causing malabsorption (eg, bile acid pancreatic or intestinal tumors that may be the cause. deficiency, Zollinger-Ellison syndrome, pancreatic A complete blood cell count is used to detect anemia. insufficiency) Pancreatic function tests can assist in the diagnosis of (eg, after gastric or specific disorders. intestinal resection) (eg, disaccharidase deficiency leading to lactose Common supplements are water-soluble vitamins (eg, B12, intolerance) folic acid), fat-soluble vitamins (A, D, and K), and minerals (calcium, iron) Dietary therapy is aimed at reducing gluten intake in patients with celiac sprue. Folic acid supplements are prescribed for patients with tropical sprue. Antibiotics are sometimes needed Antidiarrheal agents to decrease intestinal education regarding diet and the use of nutritional supplements. It is important to monitor patients with diarrhea for fluid and electrolyte imbalances. The nurse conducts ongoing assessments to determine if the clinical manifestations related to the nutritional deficits have abated. Patient education includes information about the risk of osteoporosis related to malabsorption of calcium. The appendix is a small, finger-like appendage about 10 cm (4 in) long that is attached to the cecum just below the ileocecal valve. The appendix fills with food and empties regularly into the cecum. Because it empties inefficiently and its lumen is small, the appendix is prone to obstruction and is particularly vulnerable to infection (ie, appendicitis). the most common cause of acute abdomen in the United States, is the most common reason for emergency abdominal surgery. About 7% the population will have appendicitis at some time in their lives; males are affected more than females, and teenagers more than adults. The appendix becomes inflamed and edematous as a result of either becoming kinked or occluded by a fecalith (ie, hardened mass of stool), tumor, or foreign body. The The hallmarks of malabsorption syndrome from any cause are inflammatory process increases intraluminal pressure, diarrhea or frequent, loose, bulky, foul-smelling stools that initiating a progressively severe, generalized, or upper have increased fat content and are often grayish. Patients abdominal pain that becomes localized in the right lower often have associated abdominal distention, pain, increased quadrant of the abdomen within a few hours. flatus, weakness, weight loss, and a decreased sense of well- being. The chief result of malabsorption is malnutrition, manifested progresses to right by weight loss and other signs of vitamin and mineral lower quadrant pain and is usually accompanied by a low- deficiency  grade fever and nausea and sometimes by vomiting. preventing fluid is common. volume deficit is elicited at McBurney's point when reducing anxiety pressure is applied. (i.e., production or eliminating infection from the potential or actual disruption intensification of pain when pressure is released) may be of the GI tract present. maintaining skin integrity, and Pain on defecation suggests that the tip of the appendix is attaining optimal nutrition. resting against the rectum; pain on urination suggests that the tip is near the bladder or impinges on the ureter. Some rigidity of the lower portion of the right rectus muscle may is a saclike out pouching of the lining of the bowel that occur. extends through a defect in the muscle layer. Diverticula may may be elicited by palpating the left lower occur anywhere along the GI tract. quadrant; this paradoxically causes pain to be felt in the right exists when multiple diverticula are present lower quadrant. without inflammation or symptoms. Diverticular disease of If the appendix has ruptured, the pain becomes more diffuse; the colon is very common in developed countries, and its prevalence increases with age. results when food and bacteria retained in a diverticulum produce infection and inflammation that can impede drainage and lead to perforation or abscess formation. Diverticulitis is most common (95%) in the sigmoid colon. Approximately 20% of patients with diverticulosis have diverticulitis at some point. A diverticulum forms when the mucosa and submucosal layers of the colon herniate through the muscular wall because of high intraluminal pressure, low volume in the colon (ie, fiber- deficient contents), and decreased muscle I sucralfate strength in the colon wall (ie, muscular hypertrophy from hardened fecal masses). II pathognomonic Chronic constipation often precedes the development of Diagnosis is based on results of a complete physical diverticulosis by many years. examination and on laboratory and x- ray findings. Signs of acute diverticulosis are bowel irregularity and The complete blood cell count demonstrates an elevated intervals of diarrhea, abrupt onset of crampy pain in the left white blood cell count. The leukocyte count may exceed lower quadrant of the abdomen, and a low-grade fever. 10,000 cells/mm3, and the neutrophil count may exceed nausea and anorexia, and some bloating or abdominal 75%. distention may occur. With repeated local inflammation of Abdominal x-ray films, ultrasound studies, and CT scans may the diverticula, the large bowel may narrow with fibrotic reveal a right lower quadrant density or localized distention strictures, leading to cramps, narrow steals, and increased of the bowel. constipation. The major complication of appendicitis is of the A CT scan is the procedure of choice and can reveal appendix, which can lead to peritonitis or an abscess. abscesses. Perforation generally occurs 24 hours after the onset of pain. Abdominal x-ray findings may demonstrate free air under the Symptoms include a fever of 37.7°C or higher, a toxic diaphragm if a perforation has Occurred from the appearance, and continued abdominal pain or tenderness. diverticulitis. Diverticulosis may be diagnosed using barium enema, which shows narrowing of the colon and thickened muscle layers. when the diagnosis is diverticulitis, barium enema is contraindicated because of the potential for Surgery is indicated if appendicitis is diagnosed. To correct or perforation. prevent fluid and electrolyte imbalance and dehydration, antibiotics and intravenous fluids are administered until surgery is performed. A colonoscopy may be performed if there is no acute Analgesics can be administered after the diagnosis is made. diverticulitis or after resolution of an acute episode to Appendectomy (ie, surgical removal of the appendix) is visualize the colon, determine the extent of the disease, and performed as soon as possible to decrease the risk of rule out other conditions. perforation. Laboratory tests that assist in diagnosis include a CBC, revealing an elevated leukocyte count, and ESR. Goals include relieving pain ✓ Peritonitis  ✓ abscess formation, Fluid in the peritoneal cavity becomes turbid with increasing ✓ bleeding. amounts of protein, WBC, cellular debris. If an abscess develops, the associated findings are The immediate response of the intestinal tract is tenderness, a palpable mass, fever, and leukocytosis. hypermotility, soon followed paralytic ileus with an An inflamed diverticulum that perforates results in abdominal accumulation of air and fluid in the bowel. pain localized over the involved segment, usually the sigmoid; local abscesses lightly inflamed diverticula may erode areas adjacent to The early clinical manifestations of peritonitis frequently are arterial branches, causing massive rectal bleeding. the symptoms of the disorder causing the condition. At first, a diffuse type of pain is felt. The pain tends to become constant, localized, and more Intense near the site of the Diverticulitis can usually be treated on an outpatient basis inflammation. Movement usually aggravates it. The affected with diet and medicine therapy. When symptoms occur, rest, area of the abdomen becomes extremely tender and analgesics, and antispasmodics are recommended. distended, and the muscles become rigid. Rebound Initially, the diet is clear liquid until the inflammation tenderness and paralytic ileus may be present. Usually, subsides; then, a high-fiber, low- fat diet is recommended. nausea and vomiting occur and peristalsis is diminished. The This type of diet helps to increase stool volume, decrease temperature and pulse rate increase, and elevation of the colonic transit time, and reduce intraluminal pressure. leukocyte count. Antibiotics are prescribed for 7 to 10 days. Hospitalization is often indicated for those who are elderly, immunocompromised, or taking corticosteroids. The leukocyte is elevated. The HB and HCT levels may be low if blood loss occurred. An opioid is prescribed for pain relief; morphine is not used because it increases segmentation and intraluminal Serum electrolyte studies pressures. Oral intake is increased as symptoms subside. A An abdominal x-ray is obtained, and findings may show air low-fiber diet may be necessary until signs of infection and fluid levels as well as distended bowel loops. decrease. A CT scan of the abdomen may show abscess Peritoneal aspiration and culture and sensitivity studies when the acute episode of diverticulitis resolves, Surgery may be recommended to prevent repeated episodes.. Sepsis is the major cause of death from peritonitis. Two types of surgery are considered: may result from or. 1. One-stage resection in which the inflamed area is removed The inflammatory process may cause intestinal and a primary end-to-end anastomosis is completed obstruction. The two most common postoperative 2. Multiple-staged procedures for complications such as complications are and obstruction or perforation. is the is inflammation of the peritoneum, the serous membrane major focus of medical management. The lining the abdominal cavity and covering the viscera. administration of several liters of an isotonic solution is Usually, it is a result of bacterial Infection; the organisms prescribed. come from diseases of the GI tract or, in women, from the Analgesics, Antiemetics, Intestinal intubation and internal reproductive organs suction assist in relieving abdominal distention Peritonitis can also result from external sources such as peritonitis. Large doses of a broad-spectrum antibiotic injury or trauma (eg, gunshot wound, stab wound) or are administered intravenously. Surgical objectives inflammation that extends from an organ outside the include removing the infected material and correcting peritoneal area, such as the kidney the cause. The most common bacteria implicated are Surgical treatment is directed toward excision (ie, o Escherichia coli appendix), resection with or without anastomosis o Klebsiella o Proteus o Pseudomonas Ongoing assessment of pain, vital signs, GI function, Other common causes of peritonitis are , and fluid and electrolyte balance is important. , , and The nurse reports the nature of the pain, its location in. Peritonitis may also be associated with the abdomen, and any shifts in location. Administering abdominal surgical procedures and peritoneal dialysis. analgesic medication and positioning the patient for comfort are helpful in decreasing pain. Peritonitis is caused by leakage of contents from abdominal organs into the abdominal cavity, result of inflammation, infection, ischemia, trauma, or tumor perforation. Bacterial proliferation occurs. Edema of the tissues results, The term Inflammatory bowel disease refers to two chronic and exudation of fluid develops in a short time. Inflammatory GI disorders: (le, Crohn's disease or granulomatous colitis) and.  Both disorders have striking similarities but also several differences. cause of IBD is still unknown. Researchers think it is triggered by environmental agents such as pesticides, food additives, tobacco, and radiation commonly occurs in adolescents or young adults but can appear at any time of life. It is more common in women, and it occurs frequently in the older population (between the ages of 50 and 80). It can occur anywhere along the GI tract, but the most common areas are the distal ileum and colon. is seen two times more often in patients who smoke than in nonsmokers chronic inflammation that extends through all layers (ie, transmural lesion) of the bowel wall It is characterized by periods of remissions and exacerbations. The disease process begins with edema and thickening of the mucosa. Ulcers begin to appear on the inflamed mucosa. These lesions are not in continuous contact with one another and are separated by normal tissue. Fistulas, fissures, and abscesses form as the inflammation extends into the peritoneum. Granulomas occur in one half of patients. In advanced cases, the Intestinal mucosa has a cobblestone appearance. As the disease advances, the bowel wall thickens and becomes fibrotic, and the intestinal lumen narrows. onset of symptoms is usually insidious, with prominent lower right quadrant abdominal pain and diarrhea unrelieved by defecation. the patient tends to limit food intake, reducing the amounts and types of food to such a degree that normal nutritional requirements are not met. The result is weight loss, malnutrition, and secondary anemia. Chronic symptoms include diarrhea, abdominal pain, steatorrhea, anorexia, weight loss, and nutritional deficiencies. , , and are common. A examination is usually performed initially to determine whether the rectosigmoid area is inflamed. A of the upper GI tract that shows the classic "string sign" on an x-ray film of the terminal ileum, indicating the construction of a segment of intestine. Endoscopy and intestinal biopsy A is performed to assess hematocrit and hemoglobin levels (usually decreased) and the white blood cell count (may be elevated). The sedimentation rate is usually elevated.  Albumin and protein levels may be decreased, indicating of the colon with similar symptoms. A barium enema may malnutrition. show mucosal irregularities and focal strictures. CT scanning, MRU, and ultrasound can identify abscesses and perirectal involvement. Intestinal obstruction or stricture formation, perianal disease, stool examination fluid and electrolyte imbalances, malnutrition from malabsorption, and fistula and abscess formation. A fistula is an abnormal communication between two body In acute ulcerative colitis, cathartics are contraindicated structures, either internal or external. The most common when the patient is being prepared for barium enema or type of small bowel fistula that results from regional enteritis endoscopy because they may exacerbate the condition, is the (le, between the small which can lead to megacolon (ie, excessive dilation of the bowel and the skin). colon), perforation, and death. If the patient needs to have these diagnostic tests, a liquid diet for a few days before radiography and a gentle tap water enema on the day of the is a recurrent ulcerative and Inflammatory disease of the examination may be prescribed. Colonoscopy is mucosal and submucosal layers of the colon and rectum. contraindicated in severe disease because of the risk of The Incidence of ulcerative colitis is highest in Caucasians perforation. and people of Jewish heritage It is a serious disease, accompanied by systemic complications and a high mortality rate. Eventually, 10% to toxic megacolon, perforation, and bleeding as a result of 15% of the patients develop carcinoma of the colon. ulceration, vascular engorgement, and highly vascular granulation tissue. In toxic megacolon, the inflammatory process extends into the muscularis, inhibiting its ability to Ulcerative colitis affects the superficial mucosa of the colon contract and resulting in colonic distention. and is characterized by multiple ulcerations, diffuse Symptoms include fever, abdominal pain and distention, inflammations, and desquamation or shedding of the colonic vomiting, and fatigue. Colonic perforation from toxic epithelium. Bleeding occurs as a result of the ulcerations. megacolon is associated with a high mortality rate (15% to The mucosa becomes edematous and inflamed. 50%) The disease process usually begins in the rectum and Patients with IBD also have a significantly Increased risk of spreads proximally to involve the entire colon. Eventually, osteoporotic fractures due to decreased bone mineral the bowel narrows, shortens, and thickens because of density. Corticosteroid therapy may also contribute to the muscular hypertrophy and fat deposits. diminished bone mass. Diarrhea Medical treatment aimed at reducing inflammation, lower left quadrant abdominal pain suppressing inappropriate immune responses, providing Intermittent tenesmus rest for a diseased bowel so that healing may take place, rectal bleeding. improving quality of life, and preventing or minimizing The bleeding may be mild or severe, and pallor results. complications. The patient may have anorexia, weight loss, fever, vomiting, and dehydration, as well as cramping, the feeling of an urgent need to defecate, and the passage of 10 to 20 liquid Oral fluids and a low-residue, high-protein, high-calorie diet stools each day. with supplemental vitamin therapy and iron replacement are The disease is classified as , , or , prescribed to meet nutritional needs, reduce inflammation, depending on the severity of the symptoms. Hypocalcemia and control pain and diarrhea. Any foods that exacerbate and anemia frequently develop. diarrhea are avoided. Milk may contribute to diarrhea in Rebound tenderness may occur in the right lower quadrant. those with lactose intolerance. Extraintestinal symptoms include skin lesions (eg, erythema nodosum) eye lesions (eg, uveitis), joint abnormalities (eg, and and arthritis), and liver disease. medications are used to minimize peristalsis to rest the inflamed bowel. They are continued until the patient's stools assessed for tachycardia, hypotension, tachypnea, fever, approach normal frequency and consistency. and pallor. Aminosalicylate formulations such as Other assessments include the level of hydration and (Azulfidine) are often effective for mild or moderate nutritional status. The abdomen should be examined for inflammation characteristics of bowel sounds, distention, and tenderness. adverse sequelae such as hypertension, fluid retention, stool is positive for blood, and laboratory test results reveal cataracts, hirsutism (ie, abnormal hair growth), adrenal a low hematocrit and hemoglobin concentration, elevated suppression, and loss of bone density may develop. WBC, low albumin levels Immunomodulators (eg, [Imuran], electrolyte imbalance. Abdominal x-ray studies to ) have determining the cause of symptoms. been used to alter the immune response. The exact Sigmoidoscopy or colonoscopy and barium enema are mechanism of action of treating IBD is unknown. They are used for patients with severe disease who have failed other valuable in distinguishing this condition from other diseases  therapies useful in maintenance regimens to prevent relapses. most common indications for surgery are medically intractable disease, poor quality of life, or complications from the disease or medical therapy. More than one half of all patients with regional enteritis require surgery at some point. The procedure of choice is a. A newer surgical procedure developed for patients with severe regional enteritis is. 15% to 20% of patients with ulcerative colitis require surgical intervention. Indications for surgery include lack of improvement and continued deterioration, profuse bleeding, perforation, stricture formation, and cancer. (complete excision of colon, rectum, and anus) is recommended when the rectum is severely Involved.