GI

• What are two common manifestations of GI dysfunction related to defecation?

  Infrequent or difficult defecation
• What two characteristics are altered with constipation?

  Number and hardness
• What is essential to establish when a patient presents with constipation?

  Patient's normal bowel pattern
• Why is establishing a patient's normal bowel pattern important in assessing constipation?

  To determine the level of concern
• What is the normal range for bowel movement frequency?

  1-3 times/day to 3 times/week
• How many of the listed symptoms must be present to diagnose constipation?

  Two
• For how long must symptoms be present to diagnose constipation?

  At least 3 months
• What percentage of the time must straining occur to be considered a symptom of constipation?

  At least 25%
• What stool characteristic must be present at least 25% of the time to be considered a symptom of constipation?

  Lumpy or hard stools
• What sensation must be present at least 25% of the time to be considered a symptom of constipation?

  Sensation of incomplete emptying
• What interventions may be used at least 25% of the time to facilitate stool evacuation?

  Manual maneuvers
• How many bowel movements per week indicate constipation?

  Fewer than 3
• What is the definition of fecal impaction?

  Hard, dry stool retained in rectum
• What nursing interventions are appropriate for constipation?

  • Bowel retraining
  • Routine exercise
  • Increased fluid and fiber intake
  • Enemas
  • Drugs
• What type of drugs are used to treat constipation?

  Stool softeners and laxatives
• What neurological conditions may lead to constipation?

  Parkinson, MS, spinal cord injury
• What is the sensation of reflux described as?

  Heartburn
• What is the definition of GER?

  Backward movement into esophagus
• How is refluxed material returned to the stomach?

  Esophageal peristalsis
• How is refluxed acid neutralized?

  Saliva
• What causes esophageal mucosa injury in GERD?

  Acid content (pH<4.0)
• What can long-term esophageal mucosa injury lead to?

  Barrett esophagus
• What kind of conditions that increase abdominal pressure can contribute to GERD?

  Vomiting, coughing, lifting, bending, obesity
• What are some clinical manifestations of GERD?

  Heartburn, chronic cough, laryngitis
• How soon after eating does upper abdominal pain occur in GERD?

  Within 1 hour
• What diagnostic procedure can identify dysplastic changes in Barrett esophagus?

  Biopsy
• What non-pharmacological interventions can help with GERD?

  Elevate head of bed, reduce weight
• How do the locations of lesions differ between ulcerative colitis and Crohn disease?

  Ulcerative Colitis:

  • Colon and rectum
  • No "skip" lesions (continuous)

  Crohn Disease:

  • All of GI tract—mouth to anus
  • "Skip" lesions common
• What area is affected by ulcerative colitis versus Crohn's disease?

  Ulcerative Colitis:

  • Mucosal layer
  • Begins in sigmoid & rectum and extending upward

  Crohn Disease:

  • All layers of intestinal wall, transmural
  • Affects any part of the digestive tract, from mouth to anus (common in terminal ileum and ascending right colon)
• How does the inflammation differ between ulcerative colitis and Crohn's disease?

  Ulcerative Colitis:

  • Ulcerative and exudative (mucusy stools)

  Crohn Disease:

  • Ulcerations: Longitudinal and transverse inflammatory fissures extend into lymphoid tissue
  • Granulomatous produces a “cobblestone” appearance
• How does abdominal pain compare between ulcerative colitis and Crohn's disease?

  Ulcerative Colitis:

  • Occasional/milder

  Crohn Disease:

  • Common
• How do bloody stools differ between ulcerative colitis and Crohn's disease?

  Ulcerative Colitis:

  • Common
  • Diarrhea (10 to 20 bowel movements per day)
  • Bloody stools
  • Cramps

  Crohn Disease:

  • Less common
  • Diarrhea less than five stools per day
• What are the complications of ulcerative colitis versus Crohn's disease?

  Ulcerative Colitis:

  • Pseudo-polyps (mass or scare tissues)
  • Perirectal abscess
  • Cancer/colon (relatively common)

  Crohn Disease:

  • Steatorrhea
  • Anal fistulas
  • Anal fissures
  • Strictures
  • Malabsorption, anemia may develop as a result of malabsorption of vitamin B12 and folic acid
  • Cancer/colon (uncommon)
• What type of bacteria is Clostridium difficile?

  Gram-positive spore-forming bacillus
• What happens when C. difficile takes advantage in the gut?

  Disruption of microflora environment
• When is C. difficile infection common?

  After broad-spectrum antibiotics
• What is a life-threatening form of C. difficile disease?

  Pseudomembranous colitis
• What is pseudomembranous colitis?

  Severe inflammation r/t C diff
• What is a risk with severe C. difficile infection?

  Perforation
• What can be used prophylactically against C. difficile?

  Probiotics