question

IBS

answer

irritable bowel syndrome not considered an inflammatory disease IBS is relapsing-remitting

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Labs and diagnostics for IBS

answer

CBC, WBC, RBC, hemoglobin, hematocrit electrolytes EST (erythrocyte sedimentation rate) CRP (C-reactive protein) Albumin and protein fecal occult blood abdominal X-ray Barium swallow and barium enema CT scan Upper or lower endoscopy MRI, US, WBC scan

question

Epidemiology of IBS

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prevalence estimated at 10-20% of population incidence approximately 1-2% per year 10-20% of people with IBS seek medical care per year

question

A diagnosis of IBS does not increase the risk for....

answer

death, cancer, inflammatory bowel disease

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Criteria for a person to be diagnosed IBS (Rome III Criteria)

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Must include BOTH of the following --> abdominal discomfort or pain associated with 2 or more of the following 25% of the time: 1. improvement with defecation 2. onset is associated with a change in the frequency of stool 3. onset is associated with a change in form (appearance) of stool AND... No evidence of an inflammatory, anatomic, metabolic or neoplastic process that explains the patient's symptoms

question

To be diagnosed IBS a person must have had symptoms for at least ____ days in the last ____ months

answer

at least 3 days in the last 3 months

question

How is IBS managed?

answer

patient education diet modification (fiber, metamucil, remove problem foods, high sugar foods, lactose) exercise medication (antispasmodics, anti-diarrheal meds, fibre supplements, tri-cyclic antidepressants) probiotics (manage symptoms, speeds transit through GI tract) non-pharmacological treatments (relaxation therapy, biofeedback, psychotherapy, hypnotherapy)

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Do people with IBS experience a benefit from modifying their diet?

answer

YES - 15-71%

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Symptoms may mimic IBS but actually could be...

answer

lactose intolerance

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Bowel irritants with IBS

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lactose cruciferous veggies (broccoli, beans) increase gas and bloating insoluble fibres (increase stool bulk) "friendly" microorganisms - breakdown cellulose

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UC and CD labs and diagnostics

answer

WBC, hematocrit, ESR and CRP ELEVATED, positive fecal occult blood RBC, Hgb, albumin and protein DECREASED

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Ulcerative colitis

answer

inflammation of the mucosa of the large intestine areas of inflammation are continuous

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Treatment for ulcerative colitis

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clear fluids IV fluids to maintain hydration and replace electrolytes activity as tolerated analgesic for pain control antiemetics for nausea stool charting strict monitoring of intake/output sometimes, patients are put on TPN (due to side effects of UC such as dehydration or anemia)

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Case study: Ulcerative colitis (Alison)

answer

after hydration, Alison is still experiencing abdominal pain and nausea no longer vomiting but the nausea makes her retch although she is not eating, she still has the need to defecate 5-10 times a day but only passes small amounts of mucus and blood

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Case study: Assessment of Alison

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pale skin fatigue lethargy SOB hyperactive bowel sounds VS - HR 126, BP 82/56, RR 32, T 37.9 Labwork - WBC High, RBC and Hgb Very Low, HCT Low

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Case study: Possible causes of Alison's UC

answer

- hypovolemia due to blood loss, because there is nothing about a change in patient's pain, and patient has been having rectal bleeding for a while - peritonitis could cause the change in vital signs so this is also possible

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Adrenal crisis

answer

low cortisol and low aldosterone low cortisol - liver issues --> decreased glucose output --> hypoglycaemia low cortisol - stomach --> decreased digestive enzymes --> vomiting, cramps, diarrhea low aldosterone - kidney --> losses of water and sodium (retention of potassium) --> hyperkalemia --> cardiac arrhythmias and decreased cardiac output --> hypotension

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Case study: Treatment for Alison's dehydration

answer

transfusion of 3U of PRBCs Post-transfusion bloodwork - Hgb is increased

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Case study: Alison's response to treatment

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nausea is worse, confusion, lethargy, difficult to rouse, abdomen severely distended and tender to palpation high temperature

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Case study: What does Alison have????

answer

TOXIC MEGACOLON

question

Toxic megacolon

answer

Emergency surgery (insert an NG tube, surgical prep, administer Abx and pre-op medications) Enterostomal therapist (ET Nurse) to mark the appropriate place for ostomy

question

WIll Alison have UC symptoms after her colectomy?

answer

NO

question

Complications of Ulcerative Colitis

answer

malnutrition bowel perforation toxic megacolon GI bleed complications outside of the GI tract (arthritis, inflammation of the eyes, pyelonephritis, kidney stones)

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Crohn's disease

answer

any portion of the GI tract terminal ileum is affected non-continuous in the GI tract (patchy) 'Cobblestone' appearance

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Types of crohn's

answer

stenosis inflammation fistula

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Areas of the GI tract affected by crohn's (%)

answer

small intestine 5% distal ileum 35% colon alone 20% other areas 40%`

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Assessment of crohn's disease patient's

answer

RLQ abdominal pain (colicky, moderate-severe pain) nausea malnourishment and ill frequent, watery diarrhea excoriation, painful anal region

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Acronym for Crohn's (CHRISTMAS)

answer

C - cobblestones (Radiology appearance) H - high temperature R - reduced lumen I - intestinal fistulae/Infliximab S - skip lesions T - transmural (all layers and may ulcerate) M - malabsorption A - abdominal pain S - submucosal fibrosis

question

Treatment/Nursing care for Crohn's Disease

answer

Clear fluids IV fluid to maintain hydration and replace electrolytes activity as tolerated analgesic for pain control antiemetic for nausea administer meds as ordered stool charting strict monitoring of intake/output

question

Medications for Crohn's

answer

5-ASA agent (Sulfasalazine or Asacol) --> sulpha only works with the large bowel, asocial will work in small intestine Antibiotics --> metronidazole Corticosteroids --> prednisone, budesonide, hydrocortisone Immune modulator --> methotrexate

question

What is the drawback to the use of metronidazole in Crohn's disease?

answer

increased risk of pseudomembraneous colitis when it is helpful in Crohn's: perianal disease, fistulae, perioperatively

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Complications of Crohn's (in the GI tract)

answer

malnutrition, bowel obstruction, fistula formation, anal fissures

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Complications of Crohn's (outside of the GI tract)

answer

arthritis inflammation of the eyes gall stones kidney stones, etc

question

Diet changes in Crohn's disease

answer

as inflammation resolves, pain and nausea settles down Progression of diet: clear fluids --> bland, low residue, low fat diet --> increased carbohydrates and protein --> increased Vitamin L and B12

question

If steatorrhea is present, the patient may need supplements of...

answer

fat soluble vitamins (ADEK)

question

If the terminal ileum is involved in Crohn's supplements of Vitamins __ and ___ may be needed

answer

K and B12

question

Low residue diet

answer

similar to a low-fibre diet grain products --> white bread, buns, bagels, cereals, arrowroot cookies, soda crackers, white rice, pasta fruits --> all juices except prune, applesauce, apricots, banana veggies --> juices, potatoes, well cooked and tender veggies, AVOID cruciferous veggies (broccoli, cauliflower, cabbage, kale) meat --> well cooked tender meat, fish and eggs, avoid beans and lentils nuts --> avoid all nuts and seeds, popcorn dairy --> as per HCP

question

GI issues treated with metronidazole:

answer

infection fistulas perianal ulcers

question

GI issues treated with morphine and hyoscine butylbromide

answer

pain

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GI issues treated with imodium, octreotide and cholestyramine

answer

severe diarrhea

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GI issues treated with pantaloon, ranitidine, and prochlorperazine (antiemetic)

answer

heartburn and nausea vomiting

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