Med Surg II Exam 1

Med Surg II Exam 1 Structures of the Lower GI tract Duodenum High alkaline, breakdown of cholesterol Pancreas releases breakdown enzymes Liver and biliary systems produce bile, metabolizes protein carbs and fats, vitamins and cholesterol are stored, detoxification of bacteria Jejunum and ileum absorbs dietary folic acid (jejunum) Ileum- increase of lymphoid cells Main areas of obstruction Cecum and appendix appendix exits from the cecum, there's no job for the appendix Colon 4.9 ft long, reabsorbs liquid, most bacteria Rectum and anus control of feces Small Intestine Folic acid produces RBCs, enhances appetite, Foods ▪ Beans, banana, dark green leafy, shellfish and liver Cobalamin Iron Fat-soluble vitamins Hormones and neurotransmitters Absorption of fat, carbohydrates, and proteins Diet for swallowing disorders Mechanical soft Include bread, hot cereal, ready-to-eat cereal soaked in milk, canned fruit, soft cooked vegetables, juice, scrambled eggs, ground meat, cooked beans, cooked peas, cottage cheese, yogurt without fruit, custards, puddings, cream soups and noodles. Acute Abdomen Epidemiology Very common with many causes Elderly Etiology Medical or surgical Pathophysiology Inflammation ▪ Infectious or chemical Obstruction ▪ Of the small or large bowel may be due to mechanical causes or paralysis of intestinal muscles and may be partial or complete. Vascular Assessment with clinical manifestations Pain assessment ▪ Origins ▪ Location ▪ Radiation ▪ Character of the abdominal pain Inspection ▪ Cullen’s sign: blush periumbilical discoloration, can occur with intra- abdominal bleeding ▪ Grey Turner or Fox signs: should be sought in the flank and inguinal area, respectively. ▪ Borborygmi: gurgling, slashing sound normally heard over large intestine. Vital signs Abdomen Diagnostic tests CT of abdomen and pelvis CBC, BMP Liver function test AST, ALT, albumin(low) and bilirubin will be evaluated to indicate any cirrhosis or hepatitis Appendicitis Pathophysiology The function of the appendix is not completely known, but it does regularly fill with and empty digested food. If untreated, necrosis, gangrene, and perforation follow. Obstruction of the appendix. Assessment with clinical manifestations Periumbilical pain Nauseous Low- grade fever Rovsing’s sign (Rebound tenderness- more pain after pressure is released) Pain in the RLQ McBurney’s point (pain elicited in the RLQ when firm pressure is applied) Diagnostic tests CBC (elevated WBC 10,000- 20,000) CT Ultrasound Planning and implementation Treatment: Appendectomy is the most common emergency abdominal surgery in the United States. Diverticulitis Diverticula disorders increase with age. Low fiber diets and those high in processed foods are associated with diverticular disease. Other correlates with the disorder are decreased activity levels and constipation. Pathophysiology The muscles where there are diverticular areas thicken, and the lumen is narrowed, which increases intraluminal pressure. With the deficient fiber intake seen in diverticular disease, the bowel develops a higher pressure, and the mucosa herniates through the muscle wall, which forms the diverticulum. As the diverticulum increases in size, it obstructs the bowel area and causes irritability of the colon. Assessment with clinical manifestations Change in bowel habits: Constipation or diarrhea Abdominal pain in the LLQ IBS development Abdominal cramping Generalized fatigue Low-grade fever Diagnostic tests CT scan of the abdomen and pelvis with or without contrast CBC (leukocytosis, elevated sedimentation rate, increased WBC) X-ray Planning and implementation Nurses can perform patient education in the community related to the necessary dietary changes, including an increased fiber intake and teaching the early symptoms of diverticular disease. Do not take NSAIDS and corticosteroids bc of increase of bleeding Take opioids with Colace, antispasmodics for abdominal cramping Obstruction Etiology Paralytic ileus reflects altered neuromuscular function that impairs gut motility and has multiple potential causes. Medication use (some anesthetic agents, opiates) may contribute to this state of localized paralysis. Intraperitoneal and retroperitoneal infection, arterial or venous injury, and metabolic derangements (hypokalemia) may also be associated with ileus. Pathophysiology Ingested fluids, food, swallowed air, digestive juices or secretions, and gas accumulate proximal to the blockage. The distal bowel collapses and the proximal loops dilate. Distension stimulates secretory activity, and the absorptive functions of mucous membranes fail. Can be either mechanical (physical or structural) or functional. Most obstructions occur in the small intestine. Assessment with clinical manifestations Colicky, mid-abdominal pain often over a period of days. Vomiting occurs early in the course, especially with proximal simple obstruction. A change in the character of the pain (continuous, increasing severity) suggests the development of more ominous ischemic complications. Pain lasting several days, with progressive distension, suggests a more distal obstruction. Patients may report reduced to absent flatus for days preceding presentation and distension. Auscultation typically reveals increased bowel sounds and high-pitched tinkling in early obstruction. Diagnostic tests CBC CT Ultrasonography MRI X-ray Nursing Interventions Careful abdominal examination is necessary in suspected obstruction. Palpation should follow percussion, and severe pain is unusual, unless strangulation, ischemia or infarction, or perforation have occurred. In that case, there may be signs suggestive of peritonitis and acute abdomen, including guarding and rebound tenderness. A careful search for inguinal hernias, a rectal exam for masses, and analysis of stool for occult blood conclude the abdominal assessment. Strict bowel rest and careful attention to fluid replacement for loss as well as maintenance, with appropriate laboratory guided electrolyte supplementation (especially potassium), are indicated. Colorectal Cancer Cancer of the rectum or colon.