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Medical Surgical (Gastro-Intestinal Presentation)

Clinical Instructor: Sir Jiddo
by

Mary Knoll Espejo

on 12 June 2014

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Transcript of Medical Surgical (Gastro-Intestinal Presentation)

Fecal Incontinence
Nursing Update
Peritonitis
Management of Chronic Inflammatory Bowel Disease
Pathophysiology
Constipation
Nursing Update
GROUP 3
Management of Patients with Intestinal and Rectal Disorders
Types of Inflammatory Bowel Disease
Nursing Update
Pathophysiology
Diarrhea
Nursing Update
Priority Nursing Care Plan
Diverticular Disease
Nursing Update
Conditions of Malabsorption
Nursing Update
Priority Nursing Care Plan
Colorectal Cancer
Nursing Update
Pathophysiology
Appendicitis
Nursing Update
Small and Large Bowel Obstruction
Polyps of the Colon and Rectum Diseases
Nursing Update
Irritable Bowel Syndrome
Priority Nursing Care Plan
Priority Nursing Care Plan
Priority Nursing Care Plan
Researchers have developed an oral capsule that vibrates as it moves through the digestive tract has shown notable promise as a non-pharmacological treatment for constipation. In the pilot study, the vibrating capsule was found to nearly double the weekly bowel movements of patients suffering from chronic idiopathic constipation (CIC) and constipation predominant irritable bowel syndrome (C-IBS).

Yishai Ron, MD, lead researcher for the study and director of Neurogastroenterology and Motility at Tel-Aviv Sourasky Medical Center’s Department of Gastroenterology and Hepatology, said despite the widespread use of medication to treat constipation, nearly 50 percent of patients are unsatisfied with the treatment either because of side effects, safety concerns about long-term use, or the fact that it simply doesn’t work.
Twenty-six patients took the vibrating capsule twice per week and responded to a daily bowel movement and laxative use questionnaire. All patients initially underwent a two-week preliminary period without the use of laxatives. Patients reported an increase in spontaneous bowel movements from two to four times per week, as well as a decrease in constipation symptoms, including reduced difficulty in passing stools and incomplete evacuation.
The study also found minimal side effects from the capsule use. (The capsule, which houses a small engine inside, is programmed to begin vibrating six to eight hours after swallowing. The vibrations (mechanical stimulations) cause contractions in the intestine, which help move stool through the digestive tract.
Antibiotics often viable alternative to surgery.
Priority Nursing Care Plan
Recent research has identified CT scanning as the best choice for diagnosing diverticulitis. The use of antibiotic therapy is beneficial in complicated diverticulitis but not in uncomplicated diverticulitis. Inflammation that is present on histologic and endoscopic evaluation is related to complicated and recurring diverticulitis. Surgical interventions and other treatments should be determined on an individualized basis, and further studies are needed to identify best practices in the care of patients with diverticulitis.
Diverticulitis is a chronic condition whose presentation may be complicated or uncomplicated. Most uncomplicated cases can be treated on an outpatient basis, while complicated cases require inpatient care and possible surgical intervention. Some uncertainty exists with regard to the treatment of diverticulitis, and further research is warranted. Meanwhile, all patients should be educated about disease prevention and when to seek medical care.
Priority Nursing Care Plan
Chronic illness can have a major impact on patients and their families, especially when treatment regimens must be continued indefinitely. Individual coping mechanisms, belief systems, feelings of powerlessness and family support all affect quality of life and rehabilitation potential.7 Psychosocial and family assessment are, therefore, very important in the assessment process for home dialysis training. If the patient is struggling with role changes in the family, depression, changes in body image or sexual dysfunction, it is important to provide an atmosphere that is safe and conducive to discussion and which involves the patient in setting his own goals. In this way, patients can maximize their own potentials and be successful in managing their care at home.
Pathophysiology
Lower risk for bowel obstruction with less invasive surgery: Study
Priority Nursing Care Plan
The lifetime probability of a colorectal cancer diagnosis is 4.7% in women and 5.0% in men. Incidence and mortality rates are 30% to 40% higher in men than in women overall, though this disparity varies by age.
Nursing Management of Patients with Anorectal Conditions
Pathophysiology
Diarrhea is the reversal of the normal net absorptive status of water and electrolyte absorption to secretion. Such a derangement can be the result of either an osmotic force that acts in the lumen to drive water into the gut or the result of an active secre¬tory state induced in the enterocytes. In the former case, diarrhea is osmolar in nature, as is observed after the ingestion of nonabsorbable sugars such as lactulose or lactose in lactose malabsorbers. Instead, in the typical active secretory state, enhanced anion secretion (mostly by the crypt cell compartment) is best exemplified by enterotoxin-¬induced diarrhea.
In osmotic diarrhea, stool output is proportional to the intake of the unabsorbable substrate and is usually not massive; diarrheal stools promptly regress with discontinuation of the offending nutrient, and the stool ion gap is high, exceeding 100 mOsm/kg. In fact, the fecal osmolality in this circumstance is accounted for not only by the electrolytes but also by the unabsorbed nutrient(s) and their degradation products. The ion gap is obtained by subtracting the concentration of the elec¬trolytes from total osmolality (assumed to be 290 mOsm/kg), according to the formula: ion gap = 290 – [(Na + K) × 2].
In secretory diarrhea, the epithelial cells’ ion transport processes are turned into a state of active secretion. The most common cause of acute-onset secretory diarrhea is a bacterial infection of the gut. Several mechanisms may be at work. After colonization, enteric pathogens may adhere to or invade the epithelium; they may produce enterotoxins (exotoxins that elicit secretion by increasing an intracellular second messenger) or cytotoxins. They may also trigger release of cytokines attracting inflammatory cells, which, in turn, contribute to the acti¬vated secretion by inducing the release of agents such as prostaglandins or platelet-activating factor. Features of secretory diarrhea include a high purg¬ing rate, a lack of response to fasting, and a normal stool ion gap (ie, 100 mOsm/kg or less), indicating that nutrient absorption is intact.
Nursing Update
Nursing Update
Fecal incontinence is one of the most emotionally devastating of all nonfatal conditions. Many patients do not respond satisfactorily to conservative measures, and there is a need for new and effective strategies when medical therapy fails. The development of sacral nerve stimulation and other forms of neuromodulation and the injection of biologically compatible substances into the anal sphincter complex have brought renewed enthusiasm for using these novel treatments in this underserved population. Because injectable bulking agents such as dextranomer in stabilized hyaluronic acid can be administered in an outpatient setting, this procedure is being marketed to both gastroenterologists and surgeons. This article reviews both sacral nerve stimulation and dextranomer bulking agents and compares their strengths and potential limitations in patients with fecal incontinence.
Priority Nursing Care Plan
Nitazoxanide (Alinia) for Oral Suspension (100 mg/5 mL) is now available for the treatment of diarrhea caused by Cryptosporidium parvum and Giardia lamblia in children 1 to 11 years of age. Nitazoxanide for oral suspension is a product of Romark Pharmaceuticals. Nitazoxanide is also available in a tablet formation for patients over the age of 11. Nitazoxanide for oral suspension is dosed twice daily for 3 days and should be taken with food.
The safety and effectiveness of nitazoxanide has not been established in HIV-positive patients, patients with immunodeficiency, or in patients younger than 1 year of age. The safety and effectiveness of nitazoxanide oral suspension or tablets has not been established for the treatment of diarrhea caused by C. parvum in patients 12 years and older. A single tablet of nitazoxanide contains a greater amount of nitazoxanide than is recommended for pediatric dosing and therefore should not be used in pediatric patients 11 years of age or younger.
Priority Nursing Care Plan
Priority Nursing Care Plan
Nursing Update: Umbilical Stem Cells may offer treatment for Inflammatory Bowel Diseases
and
Nursing Update: RedHill Biopharma’s RHB-104 MAP Treatment for Crohn’s Disease
Priority Nursing Care Plan for IBD (Crohn's Disease)
Priority Nursing Care Plan for Ulcerative Colitis
New Drug Might Help Treat Irritable Bowel Syndrome
By Amanda Gardner
HealthDay Reporter
TUESDAY, Sept. 18 (HealthDay News) — A new drug significantly reduces the abdominal pain and constipation characteristic of certain types of irritable bowel syndrome, according to two new studies.
Both phase 3 trials, published online Sept. 18 in the American Journal of Gastroenterology, formed much of the basis for approval of the drug, Linzess (linaclotide), by the U.S. Food and Drug Administration in August, said Dr. William Chey, lead author of one of the studies and co-editor-in-chief of the journal.
“These are as good a set of results as we’ve seen on a drug for patients with constipation-predominant irritable bowel syndrome,” said Chey, who is a professor of medicine at the University of Michigan Health System, in Ann Arbor.

Both trials were funded by Forest Research Institute and Ironwood Pharmaceuticals, Inc., which make the drug. An Ironwood employee provided editorial assistance for both studies.

Irritable bowel syndrome is a difficult-to-diagnose and difficult-to-treat condition that can have paradoxically opposite symptoms.

Although patients with irritable bowel syndrome universally complain of abdominal pain and discomfort, this can be due either to diarrhea or constipation or a combination, Chey said.

No one knows exactly what causes the condition (and it may be more than one condition) so a diagnosis is made based on symptoms.

Until the approval of Linzess, only two drugs were approved for the condition, one for constipation-predominant irritable bowel syndrome and one for diarrhea-predominant irritable bowel syndrome, Chey said.

And roughly half of patients don’t have adequate symptom relief with prescription drugs, over-the-counter medications or dietary changes, he added.

The trial led by Chey involved 804 adults, mostly women, who were randomly assigned to receive 290 micrograms of Linzess or an inactive placebo once a day for six months.

Several outcomes were measured but the most rigorous was one stipulated by the FDA: that the patient reported an improvement of at least 30 percent in abdominal pain and an increase of at least one bowel movement each week for six to 12 weeks, among other gauges.

About one-third of participants taking Linzess experienced the FDA-specified improvements, including less pain and increased bowel movements, versus 14 percent of those in the placebo group, the investigators found.

On average, participants reported about 43 percent improvement in abdominal pain by the end of the treatment period, along with easing of other symptoms such as cramping and bloating. The improvements started almost right away.

The second trial looked at 800 patients randomly assigned to the same dose of Linzess or a placebo, this time for 12 weeks. Again, about one-third of patients taking Linzess reported improvements in pain and constipation versus 21 percent in the placebo group.

When patients were later switched from linaclotide to a placebo, their symptoms returned, the researchers found.

The main side effect was diarrhea, the study authors, led by Dr. Satish Rao, of Georgia Health Sciences University in Augusta, noted in the report.

Linzess is believed to work by stimulating the secretion of chloride and water in the intestine. This helps soften the stool and stimulate contractions that can lead to bowel movements, Chey explained.
Commenting on the research, Dr. Timothy Pfanner, a gastroenterologist and assistant professor of internal medicine at Texas A&M Health Science Center College of Medicine, said: “This is a really interesting drug in that it works differently than anything else we have. It basically acts on some nerve receptors and stimulates them to inhibit the pain response and reduces bloating and increases motility,” he added.

“There are lots of drugs out there for constipation,” Pfanner noted. “What makes this different is it may actually help with the irritable bowel-type symptoms, particularly bloating and pain. That’s a real advantage.”

Unlike inflammatory bowel disease — which includes Crohn’s disease and ulcerative colitis — biopsies reveal no abnormalities in the colons of people with irritable bowel syndrome. In inflammatory bowel disease, biopsies show “all kinds of inflammation,” Pfanner said. “The colon looks angry and red and swollen.”

Although a price hasn’t been set for Linzess, a similar existing drug costs patients roughly $200 to $300 per month.
End of presentation.
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