LOWER GI DISORDERS: PART 2 1. 2. The patient may also experience N/V, diarrhea, constipation, gas, fatigue, fever, etc. Assessment: DETAILS about pain. When did it start? Where on the abdomen is it? What makes it better? Worse? What position are they in? Order of assessment: 1) visualize, 2) auscultate, 3) palpate. Abdomen shape. Bowel sounds present or absent? Tenderness with palpation? Where? ASK ABOUT PAIN BEFORE TOUCHING! What does their abdomen FEEL LIKE? 3. There is a whole table in your text (47.2) that details possible causes of acute abdominal pain and how each one will kill your patient from either septic shock or hypovolemic shock. 4. Goals: Pain management, hemodynamic stability, prevent complications. Ensure patent airway. O2 as needed. IV access and fluid replacement. CBC & electrolytes. Labs anticipating for surgery: pregnancy test, clotting studies, type & cross. Pain assessment. Amount & character of emesis. Closely manage intake and output as well as oxygen, fluid/electrolytes. Antiemetics. NPO/NG tube. Post-op: Early ambulation. 5. Mechanical obstruction is caused by an occlusion. Nonmechanical is when the gut is not MOVING (as in paralytic ileus - the most common cause of nonmechanical obstruction). Peristalsis may be greatly reduced or even STOPPED. The FOUR hallmark clinical manifestations of an obstruction are ABDOMINAL PAIN, N/V, DISTENTION, AND CONSTIPATION. The order and degree of these symptoms depend on the cause, location, and type of obstruction. SUDDEN pain. Projectile vomiting with BILE- containing vomitus. N/V, ABD distention, inability to pass gas. May have fever. If paralytic ileus, bowel sounds will be ABSENT. Bowel sounds will be hyperactive above the obstruction. 6. Bor-br-IG-my.
7. Most common cause of SBO is surgical adhesions. Others are hernia, cancer, stricture from Crohn's disease and intussusception after bariatric surgery. Most common cause of LBO is colorectal cancer, followed by diverticular disease. May also be adhesions, bowel ischemia, volvulus, & Crohn's disease. Location of obstruction also determines the extent of fluid, electrolyte, and acid-base imbalances. Higher up may result in metabolic alkalosis from vomiting, NG to suction. In small intestine, dehydration occurs rapidly. Dehydration and electrolyte imbalances occur later with large bowel obstructions. 8. Goals: Relieve obstruction and return to normal bowel function, mnimal to no discomfort, and normal fluid and electrolyte and acid-base status. Our major concerns are preventing fluid/electrolyte imbalances and recognizing signs of deterioration (e.g., hypovolemic shock, sepsis, bowel strangulation). HOW WILL YOU KNOW THE PATIENT IS GETTING BETTER? Relief from nausea, passing gas, decrease in abd distention. HOW WOULD YOU KNOW IF YOUR PATIENT IS GETTING WORSE? Increase pain, other organ involvement (respiratory symptoms, impaired renal function), acid- base imbalance. 9. A hernia is the protrusion of internal organs through an ABNORMAL opening or WEAK area in the wall of the cavity. They can be reducible or irreducible (also referred to as incarcerated. Reducible means IT MOVES. It can go back where it is supposed to be. Irreducible means it cannot be placed back into the cavity. It is trapped which can lead to STRANGULATION OR TISSUE DEATH.