Management of Patients With Intestinal and Rectal Disorders

Shu-Yi (Emily) Wang, PhD, RN, CNSgpwsy@hotmail.com

Denver School of Nursing

Pain on passive extension of the right thighPatient lies on left side Examiner extends patient's right thigh while applying counter resistance to the right hip

Inflamed appendix is in a retroperitoneal location in contact with the psoas muscle, which is stretched by this maneuver

Psoas sign

Inflamed appendix in the pelvis is in contact with the obturator internus muscle, which is stretched by this maneuver

Pain on passive internal rotation of the flexed thigh Examiner moves lower leg laterally while applying resistance to the lateral side of the knee resulting in internal rotation of the femur

Obturator sign

Etiology

fibre diet

stool density

intraluminal pressure

colonic wall tension

muscular hypertrophy,pulsion diverticula

tensile strength

elasticity

age

Pathophysiology

When the mucosa and submucosal layers of the colon herniate through the muscular walllow volume in the colon and decreased muscle strength in the colon wall

Anastomosis, Colostomy

Common GI causes of peritonitis

May also be associated with abdominal surgical procedure & peritoneal dialysis

Classifications

Crohn’s Disease

INDETERMINATE COLITIS

Ulcerative Colitis

Mucosal ulceration Transmural thickening, penetrating granulomas

See Table 38-4, pp. 1247, comparison of regional enteritis and ulcerative colitis

Intussusception invaginationOne part if the intestine slips into another part

Volvulus of the sigmoid colonbowel twists & turn on itself

Inguinal herniaContinuation of the peritoneum of the abdomen

Figure 38-6, pp. 1264

Abdominoperineal Resection

Diagnostic Studies

Rectal Examination

Visual

Digital

Knee-chest position

left lateral with hips & knees flexed position

standing with hips flexed and upper body supported by the examination table position

Tests

Sigmoidoscopy

Anaoscopy

Proctoscopy