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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 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 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
© 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 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 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 Hirschsprung’s Disease, MedlinePlus. Retrieved on November 16, 2010 from 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
© 2009 APS Healthcare, Inc. 55 References Appendicitis, by the Mayo Clinic Staff, Mayo Clinic.com. Retrieved on November 16, 2010 from =print Appendicitis, Digestive Disorders Health Center, WebMD. Retrieved on November 26, 2010 from 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
© 2009 APS Healthcare, Inc. 57
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