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Digestive Disorders: Lower Gastrointestinal Tract Presented by: APS Healthcare Southwestern PA Health Care Quality Unit (HCQU) November 2010 cjp
© 2009 APS Healthcare, Inc. 2 Disclaimer Information or education provided by the 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. Certificates for training hours will only be awarded to those who attend a training in its entirety. Attendees are responsible for submitting paperwork to their respective agencies.
© 2009 APS Healthcare, Inc. 3 Note of Clarification While mental retardation (MR) is still recognized as a clinical diagnosis, in an effort to support the work of self-advocates, the APS SW PA HCQU will be using the terms intellectual and/or developmental disability (ID/DD) to replace mental retardation (MR) when feasible.
© 2009 APS Healthcare, Inc. 4 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
© 2009 APS Healthcare, Inc. 5 Gastro-intestinal Tract Components Upper GI tract –Mouth –Esophagus –Stomach Lower GI tract –Small intestine –Large intestine
© 2009 APS Healthcare, Inc. 6 Function Of The Lower GI Tract Digestion Elimination
© 2009 APS Healthcare, Inc. 7 Function And Structure Of Small Intestine Digestion and absorption –Chyme – digested food from the stomach Duodenum, jejunum, ileum
© 2009 APS Healthcare, Inc. 8 Function And Structure Of The Large Intestine Movement of intestinal contents Absorption Cecum Ascending colon, transverse colon, descending colon Rectum
© 2009 APS Healthcare, Inc. 9 Common Lower GI Tract Disorders Diverticular Disease –Diverticulosis –Diverticulitis Inflammatory Bowel Disease –Ulcerative Colitis –Crohn’s Disease Irritable Bowel Syndrome Viral Gastroenteritis –Norovirus
© 2009 APS Healthcare, Inc. 10 Disorders Of The Lower GI Tract Antibiotic-Associated Diarrhea and Colitis –Clostridium difficile (C. diff) Celiac Disease Hirschsprung’s Disease Appendicitis
© 2009 APS Healthcare, Inc. 11 Diverticular Disease Diverticulosis Diverticulitis
© 2009 APS Healthcare, Inc. 12 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
© 2009 APS Healthcare, Inc. 13 Diverticular Disease Causes and Risk Factors Trapped fecal matter Reduced blood supply Age Inadequate fiber intake Lack of exercise Obesity
© 2009 APS Healthcare, Inc. 14 Diagnosing Diverticulitis Abdominal CT Ultrasound
© 2009 APS Healthcare, Inc. 15 Treatment Of Diverticulitis Depends on severity Antibiotics Pain relief Surgery
© 2009 APS Healthcare, Inc. 16 Diverticulitis Prevention Eat fiber Drink fluids Don’t delay bowel urges Exercise regularly
© 2009 APS Healthcare, Inc. 17 Inflammatory Bowel Disease (IBD) Ulcerative Colitis Crohn’s Disease
© 2009 APS Healthcare, Inc. 18 Ulcerative Colitis Symptoms Abdominal pain Abdominal sounds Diarrhea Rectal pain Weight loss Fever
© 2009 APS Healthcare, Inc. 19 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
© 2009 APS Healthcare, Inc. 20 Ulcerative Colitis Treatment Diet Medications Surgery
© 2009 APS Healthcare, Inc. 21 Crohn’s Disease Symptoms Abdominal pain / cramping Diarrhea Fever Anemia Joint inflammation Weight loss
© 2009 APS Healthcare, Inc. 22 Crohn’s Disease Diagnosis Stool culture Barium enema / x-ray CT and ultrasound Colonoscopy Endoscopy MRI Laboratory Tests
© 2009 APS Healthcare, Inc. 23 Crohn’s Disease Treatment Diet Medication Surgery
© 2009 APS Healthcare, Inc. 24 Irritable Bowel Syndrome Unknown cause Abdominal pain Diarrhea Constipation
© 2009 APS Healthcare, Inc. 25 Irritable Bowel Syndrome (IBS) Diagnosis Symptom based
© 2009 APS Healthcare, Inc. 26 Irritable Bowel Syndrome Treatment Diet Reduce stress Medications
© 2009 APS Healthcare, Inc. 27 Viral Gastroenteritis Inflammation Norovirus
© 2009 APS Healthcare, Inc. 28 Gastroenteritis Symptoms Nausea Vomiting Diarrhea Abdominal cramps
© 2009 APS Healthcare, Inc. 29 Gastroenteritis Transmission Contaminated food or liquids Undercooked shellfish Close contact with infected persons Seasonal
© 2009 APS Healthcare, Inc. 30 Gastroenteritis Treatment Prevent dehydration
© 2009 APS Healthcare, Inc. 31 Gastroenteritis Prevention Wash hands frequently Cook food thoroughly Bleach-based cleaner Launder soiled linens
© 2009 APS Healthcare, Inc. 32 Antibiotic-Associated Diarrhea And Colitis Clostridium difficile
© 2009 APS Healthcare, Inc. 33 C Diff Signs and Symptoms Mild to moderate C. Diff Severe C. Diff
© 2009 APS Healthcare, Inc. 34 C. Diff Transmission Fecal-oral route Spore forming bacteria
© 2009 APS Healthcare, Inc. 35 C. Diff treatment Antibiotics –Flagyl –Vancomycin Probiotics –Florastor Drink fluids
© 2009 APS Healthcare, Inc. 36 C. Diff Prevention Hand washing Thorough cleaning Prudent use of antibiotics
© 2009 APS Healthcare, Inc. 37 Celiac Disease Immune system reaction to gluten Small intestine damage Autoimmune disease
© 2009 APS Healthcare, Inc. 38 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
© 2009 APS Healthcare, Inc. 39 Celiac Disease Causes And Diagnosis Cause unknown Blood tests Biopsy
© 2009 APS Healthcare, Inc. 40 Celiac Disease Treatment And Prevention Gluten-free diet Vitamin and mineral supplements Dietician referral
© 2009 APS Healthcare, Inc. 41 Hirschsprung’s Disease Affects large intestine Present at birth Missing colonic nerve cells
© 2009 APS Healthcare, Inc. 42 Hirschsprung’s Disease Signs And Symptoms Newborn symptoms –Failure to pass stool –Infrequent, explosive stools –Jaundice –Poor feeding Adult symptoms –Chronic constipation –Anemia
© 2009 APS Healthcare, Inc. 43 Hirschsprung’s Disease Causes Unknown cause May be genetic
© 2009 APS Healthcare, Inc. 44 Hirschsprung’s Disease Diagnosis And Treatment Abdominal x-ray Anal manometry Barium enema Rectal biopsy Pull-through procedure
© 2009 APS Healthcare, Inc. 45 Appendicitis Finger-shaped protrusion Unknown function
© 2009 APS Healthcare, Inc. 46 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
© 2009 APS Healthcare, Inc. 47 Appendicitis Causes Obstruction Infection
© 2009 APS Healthcare, Inc. 48 Appendicitis Diagnosis Abdominal exam Urine test Blood test Imaging tests
© 2009 APS Healthcare, Inc. 49 Appendicitis Treatment And Prevention Appendectomy Open surgery Laparoscopic surgery High fiber diet
© 2009 APS Healthcare, Inc. 50 Caregivers Make A Difference Infection control Dietary recommendations Prompt reporting of behavioral changes
© 2009 APS Healthcare, Inc. 51 Suggested Trainings Digestive Disorders: Upper GI Bowel Management Behavioral Manifestations Of Pain
© 2009 APS Healthcare, Inc. 52 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_secti on =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
© 2009 APS Healthcare, Inc. 53 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=p rint Crohn’s Disease, Google Health. Retrieved November 16, 2010 from https://health.google.com/health/ref/Crohn's+disease
© 2009 APS Healthcare, Inc. 54 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
© 2009 APS Healthcare, Inc. 55 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
© 2009 APS Healthcare, Inc. 56 To register for future trainings, or for more information on this or any other physical or behavioral health topic, please visit our website at www.hcqu.apshealthcare.com
© 2009 APS Healthcare, Inc. 57
Evaluation Please take a few moments to complete the evaluation form found in the back of your packets. Thank You!
Test Review There will be a test review after all tests have been completed and turned in to the Instructor.
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