Diarrhea – 3 or more stools per day
● Acute – less than 14 days
● Chronic – more than 30 days
● C. diff – hospital acquired
○ Wash your hands
○ Spores can survive for up to 70 days
○ Contact precautions – gown, gloves
○ Lactobacillus probiotic used as preventative
○ Oral vancomycin for 10 days is drug of choice
● E.coli – bloody diarrhea
● Giardia lamblia – intestinal parasite
Irritable Bowel Syndrome
● Disorder of functional motility - digestion moving too fast or too slow
● S/S
○ Pain, bloating, distention of abdomen
● Diagnosis
○ Abdominal pain or discomfort 1 day per week for 3 months + two of these:
■ Related to defecation
■ Change in frequency of bowel mvts
■ Change in form
● Medications
○ IBS-D
■ Alosetran – women – watch for severe constipation, ischemic colitis
■ Loperamide
■ Dicyclomine – antispasmodic – will decrease motility
○ IBS-C
■ Lubiprostone - women
■ Linaclotide
● Pt teaching
○ Eat a well balanced diet, high fiber
○ Increase fluids, but NOT WITH MEALS
Appendicitis
● Inflammation of the appendix (right lower quadrant)
● McBurney’s point
○ Halfway between umbilicus and right iliac crest
● S/S
○ Early: dull, periumbilical pain, anorexia, N/V
○ Later: Persistent pain at MB’s point, fever, rebound tenderness, rigidity, guarding
● Nursing Care: prevent fluid volume deficit, relieve pain, prevent complications
○ IV fluids, antibiotics, analgesics
○ Surgery → appendectomy to avoid rupture
Diverticular Disease
● Diverticula - one pouch
● Diverticulosis - multiple pouches, typically asymptomatic
● Diverticulitis - inflamed pouches
● Mainly caused by low fiber diet, sedentary lifestyle, obesity, excess alcohol and NSAID use
● S/S
○ LLQ abdominal pain
○ Fever, N/V
○ Bowel freq/form change
● Diagnosis
○ CT scan with oral contrast
○ Sigmoidoscopy or colonoscopy
● Management
○ Pt will have decreased/absent abdominal sounds
○ Prevention: high-fiber, reduced red meat and fat
○ Acute diverticulitis – bowel rest to reduce inflammation, clear liquids, bed rest, analgesia
■ No barium enema – risk of perforation
○ Severe – hospitalization, NG tube, IV fluids and antibiotics, monitor for abscess and peritonitis
○ No morphine for pain – will increase intraluminal pressure
Peritonitis
● Inflammation of the peritoneum
● Primary peritonitis → blood-borne pathogen enters peritoneal cavity
○ Cirrhosis with ascites
○ Genital tract organisms
● Secondary peritonitis → perforation of abdominal organs
○ Ruptured appendix**
○ Peritoneal dialysis
○ Perforated gastric/duodenal ulcer
○ Gunshot or knife wounds
● S/S
○ Diffuse abdominal pain at first, but then becomes more local and intense pain
○ Tenderness over the area that is involved**
● Complication
○ Hypovolemic shock**
○ Sepsis
● Care
○ Antibiotics
○ IV fluids
○ NG suction – decompress gastric area, decrease distention
○ Analgesics
○ Monitor I/Os and electrolytes
○ Position pt with knees flexed for comfort
Colorectal Cancer
● Risk factor: red meat, smoking, alcohol
● Adenocarcinoma – most common type of carcinoma involved with colorectal cancer
● Insidious onset
● Right sided lesions – diarrhea, bleeding (unrecognized, early sign of anemia)
● Left sided lesions – present with bowel obstruction, hematochezia (fresh blood in stool)
● Complications: obstruction, bleeding, perforation, peritonitis, fistula formation
● Tenesmus – cramping rectal pain, feels like have not completely pooped
● Colonoscopy is gold standard
○ Starting at 45 until 75, every 10 years
○ High-risk, start at 40 and every 5 years
● Stages
○ 0 – NOT grown beyond mucosal layer
○ 1 – grown into submucosa
○ 2 – grown into muscle
○ 3 – lymph node involvement
○ 4 – spread to other organs
Inflammatory Bowel Disease – Chronic, inflammation of GI tract characterized by periods of remission are
interspersed with periods of exacerbation
● Two types:
○ Crohn’s Disease
■ Anywhere in the GI tract, mouth to anus
■ Skip lesions – reas of normal tissue, areas of inflamed tissue
■ All layers of bowel wall
● Cobblestone appearance from deep ulcerations
■ Rectal bleeding
■ Diarrhea, cramping
■ Fistulas are common
○ Ulcerative Colitis
■ Only in the colon – starts in rectum, spreads to cecum
■ Bloody diarrhea
■ Mucosal (inner) layer
● Electrolyte loss – can’t absorb through inflamed tissue
■ Pseudopolyps – tongue-like projections into bowel
● Complications
○ Perforations with possible peritonitis
● Management
○ High-calorie, high protein, high-vitamin diet
● Drugs
○ 5-ASA (sulfasalazine, mesalamine) and steroids (prednisone) – Decrease inflammation
○ Antimicrobials – Prevent or treat infection
○ Immunosuppressants – Suppress immune response