Mdc 2 Final Exam Study Guide

 Nonmechanical (paralytic ileus or adynamic ileus) obstruction vs. Mechanical obstruction (intussusception, volvulus) o Both mechanical and non-mechanical obstructions: intestinal contents accumulate at and above obstruction. Distention results from and testing inability to move or absorb contents. Peristalsis increases to compensate for lag. Abdominal distention due to increased secretions. Edematous bowel increased capillary permeability. Fluid trapped in intestinal lumen decreases fluid an electrolyte absorption in vascular space , plasma leaking into peritoneal cavity. Hypovolemia (decrease circulatory blood volume) electrolyte imbalance. o Most common cause obstruction in 65 or older :diverticulitis, tumors, and fecal impaction o SMALL-BOWEL OBSTRUCTIONS: Abdominal discomfort or pain by visible peristaltic waves in upper and middle abdomen. Upper or epigastric abdominal distention. N/V (may be fecal). Obstipation (severe constipation). Severe fluid and electrolyte imbalances. Metabolic alkalosis. o LARGE-BOWEL OBSTRUCTIONS: Intermittent lower abdominal cramping & distention. Minimal or no vomiting. Obstipation or ribbonlike stools. No major fluid & electrolyte imbalances. Metabolic acidosis (not always present) o Non mechanical:  ↓or absent peristalsis result of neuromuscular disturbance, resulting in a slowing of the movement or a backup of intestinal contents. Not physical obstruction in or out of intestine.  Postoperative ileus (POI) (paralytic ileus): most common: intestines handled in surgery. Intestinal function lost few hrs to days →electrolyte imbalances, hypokalemia.  Arterial or venous thrombosis or embolus: vascular insufficiency to bowel ( intestinal ischemia ) ↓ blood flow intestinal blood vessels → bowel infarction. (s/s: severe constant pain)  Caused by: a neurogenic, physiologic, or chemical imbalance as a result of shock, Peritonitis.  Assessment : constant pain, Abdominal distention, decreased bowel sounds in early obstruction, absent bowel sounds in later stages, vomiting gastric contents and bile with no odor, obstipation. o Mechanical obstruction (intussusception, volvulus, etc.)  Adhesions, Benign or malignant tumor, Complications of appendicitis, Hernias, Fecal impactions, Crohn's disease , radiation therapy, Intussusception, Volvulus, Fibrosis, Vascular disorders (e.g., emboli and arteriosclerotic narrowing of mesenteric vessels)  Small intestine mechanical obstruction: Sporadic, localized mid abdominal pain or cramping. vomiting. Vomiting bile or mucus or Brown orange foul smelling =fact area. Diarrhea in partial obstruction.  Mechanical colonic obstruction: milder abdominal pain & tenderness. Lower abdominal distention. Obstipation. Ribbonlike stools if partial. borborygmi (high pitch bowel sounds.. early stage → body tries to push obstruction, over working),  Assessment: tachycardia, obstipation, N/V/D, Abdominal distention, cramping, pain and rigidity, hiccups, w/ w/o guarding, hypotension. o Interventions: monitor vital signs, assess bowel sounds, monitor F & E, Ng tube q 4 hrs, NPO, Is & Os  Colorectal cancer labs (CEA), diagnostics o Colon and Rectum (Large intestine). Bleeding & change in stool (most common signs), anemia, change in stool shape & consistency. o Most are adenocarcinomas (malignant from glandular structures in epithelial tissue), highly curable o Laboratory Assessment  H&H: ↓w/tumor bleeding (14-18 hgb, 42-52 hct) 1st indication tumor.  Liver enzymes: ↑ if metastasis to liver.  Fecal occult blood test (FOBT): Q 5 yrs, + indicates GI bleeding. false + w/ certain drugs or vitamins. No Vit C, aspirin, iron, red meat 48 hrs prior test. 2-3 samples 3 consecutive days. – tests do not rule out CRC→ more testing