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Digestive Disorders: Lower Gastrointestinal Tract

Presented by: 

KEPRO SW PA Health Care Quality Unit(KEPRO HCQU)

November 2010 cjp

Disclaimer

Information or education provided by the APS SW PA HCQU is not intended to replace medical advice from the consumer's personal care physician, existing facility policy or federal, state and local regulations/codes within the agency jurisdiction. The information provided is not all inclusive of the topic presented.

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Objectives

• Recognize signs and symptoms of common lower GI disorders

• Identify non‐verbal indicators of pain

• Name supportive measures for individuals with lower GI disorders

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Gastro‐intestinal Tract Components

• Upper GI tract• Mouth• Esophagus• Stomach

• Lower GI tract• Small intestine• Large intestine

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Function Of The Lower GI Tract

• Digestion

• Elimination

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Function And  Structure Of Small Intestine

• Digestion and absorption• Chyme – digested food from the stomach

• Duodenum, jejunum, ileum

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Large Intestine

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Function And Structure Of The Large Intestine

• Movement of intestinal contents

• Absorption

• Cecum

• Ascending colon, transverse colon, descending colon

• Rectum

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Common Lower GI Tract Disorders

• Diverticular Disease

• Diverticulosis

• Diverticulitis

• Inflammatory Bowel Disease

• Ulcerative Colitis

• Crohn’s Disease

• Irritable Bowel Syndrome

• Viral Gastroenteritis• Norovirus

Inflamed Bowel – Morbus Crohn

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Disorders Of The Lower GI Tract 

• Antibiotic‐Associated Diarrhea and Colitis• Clostridium difficile (C. diff)

• Celiac Disease

• Hirschsprung’s Disease

• Appendicitis

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Diverticular  Disease

• Diverticulosis

• Diverticulitis

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Diverticulitis

• Common symptoms• Pain                                        • Change in Bowel Habits         • Fever• Nausea and vomiting• Constipation• Diarrhea

• Less common symptoms• Bloating• Rectal Bleeding

• Nonverbal signs of pain• Refusal to eat• Withdrawal• Crying

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Diverticular Disease Causes and Risk Factors

• Trapped fecal matter

• Reduced blood supply

• Age

• Inadequate fiber intake

• Lack of exercise

• Obesity 

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Diagnosing Diverticulitis

• Abdominal CT

• Ultrasound

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Treatment Of  Diverticulitis

• Depends on severity

• Antibiotics

• Pain relief

• Surgery

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Diverticulitis Prevention

• Eat fiber

• Drink fluids

• Don’t delay bowel urges

• Exercise regularly

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Inflammatory Bowel Disease (IBD)

• Ulcerative Colitis

• Crohn’s Disease

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Ulcerative Colitis Symptoms

• Abdominal pain

• Abdominal sounds

• Diarrhea

• Rectal pain

• Weight loss

• Fever

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Ulcerative Colitis Diagnosis And Screening

• Colonoscopy with biopsy

• American Cancer Society recommends screenings• 8 years after first diagnosis of severe disease or when a large part of 

intestine is involved

• 12‐15 years following a diagnosis where only the left side of the large intestine is involved

• Follow‐up examinations every 1‐2 years

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Ulcerative Colitis Treatment

• Diet

• Medications

• Surgery

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Crohn’s Disease Symptoms

• Abdominal pain / cramping

• Diarrhea

• Fever

• Anemia

• Joint inflammation

• Weight loss

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Crohn’s Disease Diagnosis

• Stool culture

• Barium enema / x‐ray

• CT and ultrasound

• Colonoscopy

• Endoscopy

• MRI

• Laboratory Tests

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Crohn’s Disease Treatment

• Diet

• Medication 

• Surgery

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Irritable Bowel Syndrome

• Unknown cause

• Abdominal pain

• Diarrhea

• Constipation

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Irritable Bowel Syndrome (IBS) Diagnosis

• Symptom based

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Irritable Bowel Syndrome Treatment

• Diet

• Reduce stress

• Medications

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Viral Gastroenteritis

• Inflammation

• Norovirus

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Gastroenteritis Symptoms

• Nausea

• Vomiting 

• Diarrhea

• Abdominal cramps

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Gastroenteritis Transmission

• Contaminated food or liquids

• Undercooked shellfish

• Close contact with infected persons

• Seasonal

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Gastroenteritis Treatment

• Prevent dehydration

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Gastroenteritis Prevention

• Wash hands frequently

• Cook food thoroughly

• Bleach‐based cleaner

• Launder soiled linens

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Antibiotic‐Associated Diarrhea And Colitis

• Clostridium difficile

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C Diff Signs and Symptoms

• Mild to moderate C. Diff

• Severe C. Diff

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C. Diff Transmission

• Fecal‐oral route

• Spore forming bacteria

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C. Diff treatment

• Antibiotics• Flagyl

• Vancomycin

• Probiotics• Florastor

• Drink fluids

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C. Diff Prevention

• Hand washing

• Thorough cleaning

• Prudent use of antibiotics

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Celiac Disease

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Celiac Disease

• Immune system reaction to gluten

• Small intestine damage

• Autoimmune disease

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Celiac Disease Signs And Symptoms

• Gastrointestinal symptoms• Intermittent diarrhea• Abdominal pain, bloating• Decreased appetite, weight loss• Constipation• Lactose intolerance• Stools that float

• Non‐gastrointestinal symptoms• Pale mouth sores• Painful skin rashes• Missed menstrual periods• Anemia• Joint pain, muscle cramps• Dental and bone disorders• Neuropathy

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Celiac Disease Causes And Diagnosis

• Cause unknown

• Blood tests

• Biopsy

Flattening of villi in Celiac Disease

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Celiac Disease Treatment And Prevention

• Gluten‐free diet

• Vitamin and mineral supplements

• Dietician referral

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Hirschsprung’s Disease

Normal colon depicting nerve cells Colon with Hirschsprung's disease

depicting missing nerve cells

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Hirschsprung’s Disease

• Affects large intestine

• Present at birth

• Missing colonic nerve cells

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Hirschsprung’s Disease Signs And Symptoms

• Newborn symptoms• Failure to pass stool• Infrequent, explosive stools• Jaundice• Poor feeding

• Adult symptoms• Chronic constipation• Anemia

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Hirschsprung’s Disease Causes

• Unknown cause

• May be genetic

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Hirschsprung’s Disease Diagnosis And Treatment

• Abdominal x‐ray

• Anal manometry

• Barium enema

• Rectal biopsy

• Pull‐through procedure

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Appendicitis

• Finger‐shaped protrusion

• Unknown function

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Appendicitis Signs And Symptoms

• Abdominal pain

• Rebound tenderness

• Nausea and vomiting

• Loss of appetite

• Low‐grade fever

• Constipation

• Inability to pass gas

• Diarrhea

• Abdominal swelling

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Appendicitis Causes

• Obstruction

• Infection

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Appendicitis Diagnosis

• Abdominal exam

• Urine test

• Blood test

• Imaging tests

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Appendicitis Treatment And Prevention

• Appendectomy

• Open surgery

• Laparoscopic surgery

• High fiber diet

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Caregivers Make A Difference

• Infection control

• Dietary recommendations

• Prompt reporting of behavioral changes

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Suggested Trainings 

• Digestive Disorders: Upper GI 

• Bowel Management

• Behavioral Manifestations Of Pain

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References

• Gastrointestinal Disorders, The Merck Manual of Geriatrics, The Merck Manuals Online Medical Library.  Retrieved on November 11, 2010 from http://www.merckmanuals.com/professional/sec02.html?WT.z_section =Gastrointestinal%20Disorders

• Viral Gastroenteritis, National Center for Immunization and Respiratory Disease, Division of Viral Diseases, Centers For Disease Control, (CDC)  Retrieved on November 23, 2010 from http://www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm

• Norovirus Q&A, National Center for Immunization and Respiratory Disease, Division of Viral Diseases, Centers For Disease Control, (CDC).  Retrieved on November 2, 2010 from http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus‐qa.htm

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References

• The Lower G.I. Tract, Introduction to Clinical Medicine Gastroenterology, North Carolina State University.  Retrieved on November 8, 2010 from      http://www.ece.ncsu.edu/imaging/MedImg/SIMS/GE.html

• Irritable Bowel Syndrome, Google Health.  Retrieved November 8, 2010 from https://health.google.com/health/ref/Irritable+bowel+syndrome

• Diverticulitis, by Mayo Clinic Staff, MayoClinic.com.  Retrieved on November 7, 2010 from http://www.mayoclinic.com/health/diverticulitis/DS00070/METHO=print

• Crohn’s Disease, Google Health.  Retrieved November 16, 2010 from https://health.google.com/health/ref/Crohn's+disease

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References

• Hirschsprung’s Disease, by Mayo Clinic Staff, Mayo Clinic.com.  Retrieved on November 16, 2010 from http://www.mayoclinic.com/health/hirschsprungs‐disease/DS00825

• Hirschsprung’s Disease, MedlinePlus.  Retrieved on November 16, 2010 from http://www.nlm.nih.gov/medlineplus/ency/article/001140.htm

• Ulcerative Colitis, Google Health.  Retrieved on November 16, 2010 from https://health.google.com/health/ref/Crohn's+disease

• Remicade, Drug Information Online, Drugs.com, retrieved on November 19, 2010 from http://www.drugs.com/remicade.html

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References

• Appendicitis, by the Mayo Clinic Staff, Mayo Clinic.com.  Retrieved on November 16, 2010 from http://www.mayoclinic.com/health/appendicitis/DS00274/METHOD=print

• Appendicitis, Digestive Disorders Health Center, WebMD.  Retrieved on November 26, 2010 from http://www.webmd.com/digestive‐disorders/digestive‐diseases‐appendicitis?page=2&print=true

• Celiac Disease, by Mayo Clinic Staff, Mayo Clinic.com, retrieved on November 4, 2010 from ttp://www.mayoclinic.com/health/celiac‐disease/DS00319/DSECTION=symptoms

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Test and Evaluation

The Top Twenty Fiber Foods

*By Warren Enker, M.D., F.A.C.S. Chief, Division of Colorectal Surgery

1. Dried beans, peas, and other legumesThis includes baked beans, kidney beans, split peas, dried limas, garbanzos, pinto beans and blackbeans.

2. Bran cerealsTopping this list are Bran Buds and All-Bran, but 100% Bran, Raisin Bran, Most and Cracklin' Bran arealso excellent sources.

3. Fresh or frozen lima beans, both Ford hook and baby limas

4. Fresh or frozen green peas

5. Dried fruit, topped by figs, apricots and dates

6. Raspberries, blackberries and strawberries

7. Sweet corn, whether on the cob or cut off in kernels

8. Whole-wheat and other whole-grain cereal products.Rye, oats, buckwheat and stone-ground cornmeal are all high in fiber. Bread, pastas, pizzas,pancakes and muffins made with whole-grain flours.

9. Broccoli-very high in fiber!

10. Baked potato with the skin(The skin when crisp is the best part for fiber.) Mashed and boiled potatoes are good, too-but notFrench fries, which contain a high percentage of fat.

11. Green snap beans, pole beans, and broad beans(These are packaged frozen as Italian beans, in Europe they are known as haricot or French beans.)

12. Plums, pears, and applesThe skin is edible, and are all high in pectin.

13. Raisins and prunesNot as high on the list as other dried fruits (see #5) but very valuable.

14. GreensIncluding spinach, beet greens, kale, collards, Swiss chard and turnip greens.

15. NutsEspecially almonds, Brazil nuts, peanuts, and walnuts (Consume these sparingly, because of theirhigh fat content.).

16. Cherries

17. Bananas

18. Carrots

19. Coconut(dried or fresh-but both are high in fat content).

20. Brussels sprouts