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Inflammatory intestinal disorders
- 1. INFLAMMATORY INTESTINAL DISORDERS By Y.VVanaja Lecturer Vijay Marie College of Nursing
- 2. A part fromthe lower GI tract is susceptible to acute inflammation caused by bacterial, viral or fungal infection. Appendicitis Peritonitis Gastroenteritis Diverticulitis
- 3.
- 4. Introduction • The appendixis a small, finger-like appendage attached to the cecum just below the ileo-cecal valve. • Because it empties into the colon inefficiently and its lumen is small, it is prone to becoming obstructed and is vulnerable to infection. • The obstructed appendix becomes inflamed and edematous and eventually fills with pus, this is called appendicitis
- 5. Definition Appendicitis isan acute Inflammation of the vermiform appendix. Inflammation occurs when the lumen of the appendix is obstructed, leading to infection as bacteria invade the wall of the appendix “ “Ignatavivcious” • Appendicitis is an inflammation of the appendix, a narrow blind tube that extends from the interior part of the cecum. “Lewis” • the appendix becomes inflamed and edematous as a result of either kinked or occluded by a fecalith, tumor or foreign body “Brunner”
- 6. INCIDENCE • Males areaffected more than females. • Teenagers more frequently than adults. • The highest incidence is in those between the ages of 10 and 30years
- 7.
- 12. Lumen ofthe appendix is obstructed as a result of fecaliths Less common causes are – malignant tumors Trauma to the abdomen Intramural thickening caused by hyper growth of lymphoid tissue Venous engorgement Accumulation of mucus and bacteria
- 13. Pathophysiology Obstruction can resultfrom food matter, adhesion, or lymphoid hyperplasia Mucosa continues to secrete fluid. Increase in the intraluminal pressure and restricting the blood flow. End result is perforation and spillage of infected appendiceal contents into the peritoneum as inflammation continues, serosa and adjacent structures become inflammed
- 14. Resulting inthe generalized or upper abdominal pain that becomes localized in the RLQ eventually the inflamed appendix fills with pus If rapid process may result in peritonitis
- 15.
- 19. Painful urination Severe cramps Dunphy’ssign (increased pain with coughing). Obturator sign( pain on internal rotation of right thigh) Psoas sign (pain on extension of right thigh).
- 20.
- 26. Diagnostic evaluation • Completephysical examination. • Abdominal x-ray. • Ultrasound • Complete blood count • CT scan • Rectal exam • Urine test
- 29. • Antibiotics • NPO •Iv fluid • Analgesics • Antiemetics Medical managemen
- 30. Surgical management laparoscopicAppendectomy A new procedure is known as Natural orifice transluminal endoscopic surgery , does not require an external skin incision
- 32. Laparotomy isan open surgical approach with a larger abdominal incision for complicated or atypical appendicitis or peritonitis
- 33.
- 34. Introduction: The peritoneum isthe serous membrane forming the lining of the abdominal cavity Peritonitis is an inflammation of the peritoneum, the tissue that lines the inner wall of the abdomen and covers and supports most of abdominal organs. Peritonitis is usually caused by infection from bacteria or fungi.
- 35. Definition: Peritonitis is aninflammation of the peritoneum, the serous membrane lining the abdominal cavity and covering the viscera. “Brunner” Peritonitis is a life threatening, acute inflammation of the visceral/ parietal peritoneum and endothelial lining of the abdominal cavity. “ Ignatavicious”
- 36. Types of peritonitis Primaryperitonitis: • Infection develops in the peritoneum Secondary • Develops when an injury or infection in the abdominal cavity allows infectious organism into the peritoneum
- 37. Risk factors Riskfactors forprimary peritonitis: Liver disease (cirrhosis) Fluid in the abdomen Weakened immune system Pelvic inflammatory disease Risk factors for secondary peritonitis include: Appendicitis (inflammation of the appendix) Stomach ulcers, Twisted intestine, Pancreatitis Inflammatory bowel disease, Injury caused by an operation. Peritoneal dialysis, Trauma.
- 38. I- Infected peritonitis: 1) Generalized Infected peritonitis: Perforation of the part of the gastrointestinal tract is the most common cause of peritonitis 2) Systemic or localized infections (such as tuberculosis) may rarely have a peritoneal localisation. II –Non Infected Peritonitis Leakage of sterile body fluids into the peritoneum such as blood gastric juice
- 39. Pathophysiology Due to etiologicalfactors Leakage of contents from abdominal organs into the abdominal cavity Bacterial perforation Edema of the tissues results and exudation of the fluid develops in short time Fluid in the peritoneal cavity becomes turbid with increasing amounts of protein, white blood cells, cellular debris and blood Hyper motility of intestinal tract followed by paralytic ileus with an accumulation of air and fluid in the bowel
- 40. Clinical manifestations: Abdominalpain Tenderness over the involved area Rebound tenderness Muscular rigidity and spasm Abdominal distention Fever Tachycardia Tachypnea Nausea, vomiting Altered bowel disease
- 41. Muscular rigidity Peristalsis slows or stops in response to severe peritoneal inflammation and the lumen of bowel becomes distended with gas and fluid Respiratory problems can occur as a result of increased abdominal pressure against the diaphragm from intestinal distention and fluid shifts to the peritoneal cavity.
- 42. Diagnostic Evaluation: Historycollection Physical Examination CBC Serum electrolytes Abdominal X-ray Abdominal paracentesis & culture of fluid
- 43. Management Nonsurgical management IVfluids and broad spectrum antibiotics Monitor daily weight and I/O chart carefully NG tube decompresses the stomach and the intestine. Patient is NPO Monitor O2 saturation and Apply O2 as prescribed Administer analgesics Antiemetics Intestinal intubation and suction assist in relieving abdominal distention and in promoting intestinal function
- 44. Surgical Management ExploratoryLaparotomy – surgical opening into the abdomen Laparoscopy is used to remove or repair the inflamed or perforated organ Colon resection with or without colostomy for a perforated diverticulum Before the incision is closed the surgeon irrigates the peritoneum with antibiotic solutions Several catheters may be inserted to drain the cavity and provide a route for irrigation after surgery.
- 45.
- 46. Introduction Gastroenteritis isa medical condition characterized by inflammation of the gastrointestinal tract that involves both the stomach the small intestine resulting in some combination of diarrhea, vomiting, and abdominal pain and cramping. It usually happens because of infection by a virus or bacteria. It affects mainly the small bowel and can be caused by either viral or bacterial infections, which have similar manifestations.
- 47. Definitions: Gastroenteritis isan increase in the frequency and water content of stools and/or vomiting as a result of inflammation of the mucous membranes of the stomach and intestinal tract “ Ignatavicious” Gastroenteritis is an inflammation of the mucosa of the stomach and small intestine “ Lewis”
- 48. Types of Gastroenteritis: TYPECHARACTERISTICS Viral Gastroenteritis : Epidemic viral: Rotavirus & Norwalk virus • Caused by many parvovirus –type organisms transmitted by the fecal-oral route in food and water • Incubation period is 10-51hrs • Communicable during acute illness o Transmitted by the fecal-oral route or by contact with infected animals or infants o Incubation period 1-10 days o Rotavirus is most common in infants and young children o Norwalk virus affects young children and adults
- 49. TYPE CHARACTERISTICS Bacterial Gastroenteritis: Campylobacterenteritis: Escherichia coli diarrhea Shigellosis: • Transmitted by the fecal- oral route or contact with infected animals or infants • Incubation period – 1-10 days • Communicable for 2-7 weeks Transmitted by fecal contamination of food, water, or fomites • Transmitted by direct and indirect fecal- oral routes • Incubation period 1-7 days • Communicable during the acute illness to 4 after the illness • Humans possibly carries for months
- 50. Etiology Most causesare self limiting and do not require hospitalization Gastroenteritis is usually caused by viruses. However, bacteria, parasites, and fungus can also cause gastroenteritis. In children, rotavirus is the most common cause of severe disease. In adults, norovirus and Campylobacter are common causes. Eating improperly prepared food drinking contaminated water close contact with a person who is infected can spread the disease
- 52. Clinical Manifestations Nausea Vomiting Diarrhea Abdominal cramping and distention Fever Increased WBC Blood or mucus in the stool may be present In Patient with epidemic viral gastroenteritis – myalgia, headache, and malaise Weakness cardiac dysrhythmias due to hypokalemia
- 53. Infection withthe Norwalk virus has a rapid onset of nausea, abdominal cramps and diarrhea Campylobacter enteritis – foul smelling stools containing blood, 20 to 30 stools per day for up to 7 days. E-coli GE – may or may not have blood in the stool. Diarrhea can last for up to 10days Shigella - causes stools to have blood acidic mucus which can continue for up to 5 days
- 54. Diagnosis Stool culture serum glucose levels CBP Serum electrolytes
- 55. Management Monitoring ofintake and output Fluid replacement IV fluids such as half strength normal saline to replace sodiulm lost in vomitus Obtain weight and orthostatic B.P Until vomitings has ceased the patient should be on NPO status Skin care -
- 56. Drugs: Antiperistaltic agentsan initial dose of loperamide (Imodium) 4mg Antibiotics eg – ciprofloxacin, levofloxacin, azithromycin If GE due to shigellosis, antiinfective agents such as trimethoprim/sulfamethoxazole
- 57.
- 58. Introduction Diverticula are small,bulging pouches that can form in the lining of your digestive system. They are found most often in the lower part of the large intestine (colon). Diverticula are common, especially after age 40, and seldom cause problems. Sometimes, however, one or more of the pouches become inflamed or infected. That condition is known as diverticulitis .
- 59. Definitions: Diverticulitis is theinflammation of one or more diverticula “Ignatavicious” Diverticulitis results when food and bacteria retained in diverticulum produce infection and inflammation that can impede drainage and lead to perforation or abscess formation. “ Brunner”
- 60. Risk factors Congenitalpredisposition id suspected when the disorder occurs in those younger than 40 yrs of age. Aging: The incidence of diverticulitis increases with age. Obesity. Smoking. Lack of exercise. Diet high in animal fat and low in fiber. Certain medications Several drugs are associated with an increased risk of diverticulitis, including steroids, opioids and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).
- 61. Causes Diverticula usuallydevelop when naturally weak places in your colon give way under pressure. This causes marble-sized pouches to protrude through the colon wall. High intraluminal pressure. Diet low in fiber Retained undigested food in diverticula
- 62. Pathophysiology Due to HighIntraluminal pressure The muscle of the colon hypertrophies, thickens, and becomes rigid, and herniation of the mucosa and sub mucosa through the colon wall Decreased muscle strength in the colon wall If undigested food or bacteria become trapped in a diverticulum, however blood supply to that area is reduced Bacteria invade the diverticulum A diverticulum can become obstructed and then inflamed if the obstruction continues
- 63. Which canperforate and develop a local abscess A perforated diverticulum can progress to an intra abdominal perforation with peritonitis. Inflammation can also result in fistulas to other organs, such as the bladder and the vagina
- 64. Clinical Manifestations: Signsof acute diverticulosis are bowel irregularity intervals of diarrhea Abrupt crampy pain in the left lower quadrant of the abdomen . If diverticulitis is suspected Low-grade fever Nausea Abdominal pain Constipation Bleeding from the rectum Tenderness over the abdominal palpation Elevated temperature with chills Tachycardia
- 65. Diagnosis History collection Physical examination CBP Stool test for occult blood Urine analysis may show a few RBC X ray of the intestinal tract barium contrast Barium enema shows the diverticula of the large intestine Abdominal X ray too identify free air and fluid indicating perforation CT scan Abdominal Ultrasonography Colonoscopy 4 to 8 wks after acute phase– if rectal bleeding
- 66. Management Nonsurgical management Acombination of drug and no nutrition therapy with rest is used to decrease the inflammation. Broad- spectrum antimicrobial drugs, such as metronidazole plus trimethoprim/ sulfamethoxazole or ciprofloxacin Opioid analgesics – such as morphine sulfate. IV fluids to correct Dehydration & IV drug therapy antispasmodics such as propantheline bromide and oxyphencyclimine Assess the patient on ongoing basis for manifestations of fluid and electrolyte imbalance. Restriction of high fiber diet because it may cause irritation NPO NG tube - if nausea, vomiting or abdominal distention is severe. When inflammation is resolved and bowel function returns to normal, fiber containing diet is introduced gradually
- 67. Surgical management Emergencysurgery if peritonitis, bowel resection, or pelvic abscess is present. Colon resection with or without colostomy Some patients may have colostomy closure and anastomosis after the bowel has been allowed to rest for 3 to 6 months The patient may have one of two surgical approaches Conventional open approach or Minimally invasive surgery via a laparoscopy
- 69. Postoperative care Thepatient may have drain in place at the abdominal incision site for several days The stoma may be covered with a petroleum gauze dressing because the colostomy does not drain for about 2 days or colostomy bag may be placed over the stoma If the stoma is visible monitor for color and integrity The may be NPO with an NGT until peristalsis returns if open surgery is performed A tight seal around the stoma is essential to avoid contact feces with the skin Colostomy care