Lower Gastrointestinal Disorders
KEY POINTS
ACUTE ABDOMINAL PAIN
Acute abdominal pain is a new pain that may signal a problem requiring immediate
surgery or other medical treatment.
Acute abdominal pain is a symptom of many different types of tissue injury and can arise
from damage to abdominal or pelvic organs and blood vessels.
Pain is the most common symptom of abdominal and pelvic problems. Nausea, vomiting,
diarrhea, fatigue, fever, and constipation may also be present.
Expected outcomes for the patient with acute abdominal pain include resolution of the
cause of the acute abdominal pain, relief of abdominal pain, freedom from complications
(especially hypovolemic shock and septicemia), and normal fluid, electrolyte, and
nutritional status.
It is important to monitor patients frequently to detect deteriorations in their condition
(e.g., fever, increased pulse and respirations, decreased BP, decreased oxygenation,
altered mental status, poor skin perfusion, decreased urine output).
CHRONIC ABDOMINAL PAIN
Common causes of chronic abdominal pain include irritable bowel syndrome (IBS),
diverticulitis, peptic ulcer disease, chronic pancreatitis, hepatitis, cholecystitis, pelvic
inflammatory disease, and vascular insufficiency.
Treatment for chronic abdominal pain is comprehensive and directed toward palliation of
symptoms using nonopioid analgesics and antiemetics, as well as nutritional,
psychologic, or behavioral therapies.
IRRITABLE BOWEL SYNDROME
Irritable bowel syndrome (IBS) is a chronic functional disorder characterized by
intermittent and recurrent abdominal pain or discomfort and stool pattern irregularities
(diarrhea, constipation, or both).
The cause is unknown and there are no specific findings. Treatment is directed at
psychologic and dietary factors as well as medications to regulate output and reduce
pain/discomfort.
ABDOMINAL TRAUMA
Blunt abdominal trauma commonly occurs with motor vehicle accidents and falls and
may not be obvious because it does not leave an open wound.
Penetrating trauma occurs with gunshot or knife wounds.
Common injuries of the abdomen include lacerated liver, ruptured spleen, pancreatic
trauma, mesenteric artery tears, diaphragm rupture, urinary bladder rupture, great vessel
tears, renal injury, and stomach or intestine rupture.
Emergency management of abdominal trauma focuses on establishing a patent airway
and adequate breathing, fluid replacement, and prevention of hypovolemic and septic
shock.
, INFLAMMATORY DISORDERS
Appendicitis
Appendicitis is inflammation of the appendix. Obstruction results in distention, venous
engorgement, and the accumulation of mucus and bacteria, which can lead to gangrene
and perforation.
Appendicitis typically begins with periumbilical pain, followed by anorexia, nausea, and
vomiting. The pain is persistent and continuous, eventually shifting to the right lower
quadrant and localizing at McBurney’s point.
The treatment is immediate surgical removal. Some patients need antibiotics and fluid
resuscitation before surgery.
Peritonitis
Peritonitis results from a localized or generalized inflammatory process of the
peritoneum that occurs when organisms or chemicals enter the sterile peritoneal cavity. It
can occur when sterility is inadequate during peritoneal dialysis and when an organ
perforates, releasing its contents into the peritoneal cavity.
Common symptoms of peritoneal irritation include the cause of abdominal pain, hard
abdomen, and tenderness over the involved area.
Major concerns are maintaining fluid and electrolyte balance and preventing septic shock.
Surgery is usually indicated to drain purulent fluid and repair damage. Other care
includes antibiotics, nasogastric suction, analgesics, and IV fluid administration.
Gastroenteritis
Gastroenteritis is an inflammation of the mucosa of the stomach and small intestine.
Clinical manifestations include nausea, vomiting, diarrhea, fever, and abdominal
cramping. Most cases are self-limiting and do not require hospitalization.
If the causative agent is identified, appropriate antibiotic and antimicrobial drugs are
given. Nursing care is focused on maintaining adequate hydration and relief of nausea,
vomiting, and diarrhea.
Inflammatory Bowel Disease
Crohn’s disease and ulcerative colitis are immunologically related disorders that are
referred to as inflammatory bowel disease (IBD).
IBD is characterized by an overactive, inappropriate, sustained immune response to
substances that are normally tolerated.
Patients suffer mild to severe acute exacerbations that occur at unpredictable intervals over
their lifetimes.
Ulcerative colitis affects the mucosal layer of the rectum and colon, but some patients do
have mild inflammation in the terminal ileum. The primary symptoms are bloody diarrhea
and abdominal pain. Medications are used to achieve and maintain remission.
Crohn’s disease can occur anywhere in the GI tract from the mouth to the anus but occurs
most commonly in the terminal ileum and colon. The inflammation involves all layers of
the bowel wall with segments of normal bowel occurring between diseased portions—the
so-called skip lesions.
KEY POINTS
ACUTE ABDOMINAL PAIN
Acute abdominal pain is a new pain that may signal a problem requiring immediate
surgery or other medical treatment.
Acute abdominal pain is a symptom of many different types of tissue injury and can arise
from damage to abdominal or pelvic organs and blood vessels.
Pain is the most common symptom of abdominal and pelvic problems. Nausea, vomiting,
diarrhea, fatigue, fever, and constipation may also be present.
Expected outcomes for the patient with acute abdominal pain include resolution of the
cause of the acute abdominal pain, relief of abdominal pain, freedom from complications
(especially hypovolemic shock and septicemia), and normal fluid, electrolyte, and
nutritional status.
It is important to monitor patients frequently to detect deteriorations in their condition
(e.g., fever, increased pulse and respirations, decreased BP, decreased oxygenation,
altered mental status, poor skin perfusion, decreased urine output).
CHRONIC ABDOMINAL PAIN
Common causes of chronic abdominal pain include irritable bowel syndrome (IBS),
diverticulitis, peptic ulcer disease, chronic pancreatitis, hepatitis, cholecystitis, pelvic
inflammatory disease, and vascular insufficiency.
Treatment for chronic abdominal pain is comprehensive and directed toward palliation of
symptoms using nonopioid analgesics and antiemetics, as well as nutritional,
psychologic, or behavioral therapies.
IRRITABLE BOWEL SYNDROME
Irritable bowel syndrome (IBS) is a chronic functional disorder characterized by
intermittent and recurrent abdominal pain or discomfort and stool pattern irregularities
(diarrhea, constipation, or both).
The cause is unknown and there are no specific findings. Treatment is directed at
psychologic and dietary factors as well as medications to regulate output and reduce
pain/discomfort.
ABDOMINAL TRAUMA
Blunt abdominal trauma commonly occurs with motor vehicle accidents and falls and
may not be obvious because it does not leave an open wound.
Penetrating trauma occurs with gunshot or knife wounds.
Common injuries of the abdomen include lacerated liver, ruptured spleen, pancreatic
trauma, mesenteric artery tears, diaphragm rupture, urinary bladder rupture, great vessel
tears, renal injury, and stomach or intestine rupture.
Emergency management of abdominal trauma focuses on establishing a patent airway
and adequate breathing, fluid replacement, and prevention of hypovolemic and septic
shock.
, INFLAMMATORY DISORDERS
Appendicitis
Appendicitis is inflammation of the appendix. Obstruction results in distention, venous
engorgement, and the accumulation of mucus and bacteria, which can lead to gangrene
and perforation.
Appendicitis typically begins with periumbilical pain, followed by anorexia, nausea, and
vomiting. The pain is persistent and continuous, eventually shifting to the right lower
quadrant and localizing at McBurney’s point.
The treatment is immediate surgical removal. Some patients need antibiotics and fluid
resuscitation before surgery.
Peritonitis
Peritonitis results from a localized or generalized inflammatory process of the
peritoneum that occurs when organisms or chemicals enter the sterile peritoneal cavity. It
can occur when sterility is inadequate during peritoneal dialysis and when an organ
perforates, releasing its contents into the peritoneal cavity.
Common symptoms of peritoneal irritation include the cause of abdominal pain, hard
abdomen, and tenderness over the involved area.
Major concerns are maintaining fluid and electrolyte balance and preventing septic shock.
Surgery is usually indicated to drain purulent fluid and repair damage. Other care
includes antibiotics, nasogastric suction, analgesics, and IV fluid administration.
Gastroenteritis
Gastroenteritis is an inflammation of the mucosa of the stomach and small intestine.
Clinical manifestations include nausea, vomiting, diarrhea, fever, and abdominal
cramping. Most cases are self-limiting and do not require hospitalization.
If the causative agent is identified, appropriate antibiotic and antimicrobial drugs are
given. Nursing care is focused on maintaining adequate hydration and relief of nausea,
vomiting, and diarrhea.
Inflammatory Bowel Disease
Crohn’s disease and ulcerative colitis are immunologically related disorders that are
referred to as inflammatory bowel disease (IBD).
IBD is characterized by an overactive, inappropriate, sustained immune response to
substances that are normally tolerated.
Patients suffer mild to severe acute exacerbations that occur at unpredictable intervals over
their lifetimes.
Ulcerative colitis affects the mucosal layer of the rectum and colon, but some patients do
have mild inflammation in the terminal ileum. The primary symptoms are bloody diarrhea
and abdominal pain. Medications are used to achieve and maintain remission.
Crohn’s disease can occur anywhere in the GI tract from the mouth to the anus but occurs
most commonly in the terminal ileum and colon. The inflammation involves all layers of
the bowel wall with segments of normal bowel occurring between diseased portions—the
so-called skip lesions.
