LOWER GI

Question 1

How do you treat C Diff

Answer 1

Treated w/ IV or oral metronidazole (flagyl) and/or
oral vancomycin

Probiotics and fecal transplantation

Question 2

C. Diff Clinical Manifestations

Answer 2

• Loose or liquid stool, blood or mucus
• Fever, headache, malaise
• N/V, abdominal cramping

Question 3

C Diff Diagnostic Tests

Answer 3

– Stool studies
* Blood, mucus, WBCs,
parasites
* Culture to identify
organism
* C. difficile identified
by measurement of
its toxins (toxin A &
B)

Question 4

What is the Etiology and Pathophysiology of Fecal Incontinence

Answer 4

– Motor function
* Obstetric trauma
* Childbirth, aging, menopause
* Fecal impaction
* Damage from anorectal surgery
– Sensory function
* Neurologic conditions
* Diabetic neuropathy
* Decreased LOC

Question 5

What are Assessment and Diagnostic
Studies done for Fecal Incontinence

Answer 5

• Requires sensitivity
• H & P
• Rectal exam
• Abdominal x-ray

Question 6

How might your treat Fecal Incontinence

Answer 6

• Remove impaction
• Regular defecation, high-
  fiber diet, increased
  fluids
• Kegel exercises
• Surgical repair

Question 7

Etiology and Pathophysiology of Constipation

Answer 7

• Insufficient dietary fiber
• Inadequate fluid intake
• Decreased physical activity
• Ignoring urge to defecate
• Medications (opioids)
• Diseases (DM, neurologic diseases)

Question 8

Clinical Manifestations of Constipation

Answer 8

Decreased frequency of stools, difficult to pass
stools, a decrease in stool volume, and/or
retention of feces in the rectum

Question 9

Best way to fix constipation

Answer 9

• Nutritional therapy
• Medications

Question 10

Which medications for constipation can be taken daily

Answer 10

• Bulk-forming laxatives
• Methylcellulose (Citrucel),
  Psyllium (Metamucil)
• Stool softeners
• Docusate (Colace)
• Saline and osmotic solutions
• Polyethylene glycol (Miralax)
• Stimulants
• Senna (Senokot)

Question 11

Which medications for constipation should only be taken as needed d/t dependance

Answer 11

• Stool lubricants
• Mineral Oil Enema (Fleet’s)
• Saline and osmotic solutions
• Magnesium citrate, milk of
  magnesia
• Lactulose (Chronulac)
• Stimulants
• Bisacodyl (Dulcolax)

Question 12

Define Diverticulosis

Answer 12

Diverticulosis is the condition of having multiple pouches (diverticula) in the colon that are not inflamed. These are outpockets of the colonic mucosa and submucosa through weaknesses of muscle layers in the colon wall.

• Common to have no
  symptoms
• Discovered during routine
  colonoscopy
• Other symptoms
• Abdominal pain
• Bloating
• Flatulence
• Change in bowel habits
• Blood in stool

Question 13

Define Diverticulitis

Answer 13

The presence of diverticula is known as diverticulosis (die-vur-tik-yoo-LOE-sis). When one or more of the pouches become inflamed, and in some cases infected, that condition is known as diverticulitis (die-vur-tik-yoo-LIE-tis).

• Left lower quadrant
  abdominal pain (sigmoid
  colon)
• Elevated temperature
• Leukocytosis
• Palpable abdominal
  mass

Question 14

Describe complications of diverticular disease

Answer 14

Diverticulum may bleed into the intestine.

Diverticulum may rupture, causing bacteria and blood to spill into abdominal cavity, causing infection. An abnormal channel (fistula) may form between the large intestine and another organ

Question 15

What diagnostic tests are used for diverticulosis and diverticulitis

Answer 15

• Preferred test is abdominal CT w/ oral contrast
• Abdominal and chest x-rays to rule out other
  causes

Home Care:
* Oral antibiotics
* Clear liquid diet
* Rest

Hospitalized
* NPO
* Bed rest
* IV antibiotics
* IV fluids
* Monitor for
complications
* May require
surgical
intervention

• Surgical Implementation
• Usually involves resection of involved colon with
  primary anastomosis or temporary colostomy
• If colostomy, it is reanastomosed after the colon
  heals

Question 16

What would you instruct your pt to do after diverticulitis attack subsides?

Answer 16

• High-fiber diet
• Decreased fat and red meat intake
• Physical activity
• Lose weight if needed
• Avoid activities than increase intraabdominal pressure

Begin ambulating