Small Intestine
- Lower GI
- Liver
- Bile
- Duodenum
- Pancreas
- Pancreatic Juices
- Iron
- Lipase Breaks Down Fat
- Jejunum
- Absorption
- Salt and Water Absorption
- Ileum
- B12
- Bile Absorption
- Colon
Irritable Bowel Syndrome (IBS) Assessment
- Abdominal Pain
- Relieved by Defecation
- Alternating Diarrhea and Constipation
- Fatigue
- Excessive Flatulence
- Sensation of Incomplete Evacuation
- Stressors
- Food Intolerances
- More Common in Women
- Rule Out Other Disorders
Irritable Bowel Syndrome (IBS) Interventions
- Identify Triggers
- Increase Fiber Intake
- Probiotics
- Anticholinergics
- Tricyclic Antidepressants (TCAs)
- Loperamide
- Linaclotide
- Tegaserod (Zelnorm)
- Lubiprostone (Amitiza)
- Alosetron (Lotronex)
Types of Intestinal Obstruction
- Adhesions
- Hernia
- Volvulus
- Intussusception
- Tumor
- Mesenteric Artery Occlusion
- Spinal Injury
- Paralytic Ileus
Meckel's Diverticulum
- True Diverticulum
- Vitelline Duct
- Yolk Stalk
- Contain Ectopic Tissue
- Pancreatic And Gastric Mucosa
- Hemorrhage
- Intussusceptions
- Volvulus
- 2 Feet From Ileocecal Valve
- 2 Inches Long
- 2% Population
- First 2 Years Of Life
- Pertechnetate T99
Volvulus Characteristics and Presentation
- Bowel Torsion
- Bowel Infarction
- Sigmoid Colon and Cecum
- Small Bowel Obstruction
- Abdominal Pain
- Unstable Vital Signs
- Peritonitis
Volvulus Diagnosis and Management
- Abdominal X-ray
- Coffee Bean Sign
- Kidney Bean Sign
- Abdominal CT Scan
- Whirl Sign
- Barium Enema
- Bird's Beak Sign
- Fluid Resuscitation
- Surgery
- Consider Antibiotics
Intestinal Obstruction
- Severe Abdominal Pain
- Vomiting
- High Pitched Bowel Sounds
- Abdominal Distention
- Increased Peristalsis
- Absent Bowel Sounds
- Paralytic Ileus
Intussusception
- Telescoping of Bowel Segments
- Lead Point
- Episodic Abdominal Pain
- Diarrhea
- Sausage-Shaped Mass
- Red Currant Jelly Stools
- Ultrasound/CT
- Target Sign
- More Common in Children
- Rotavirus Vaccine Contraindicated
- Air or Hydrostatic Enema
- Surgical Reduction
Hirschsprung Disease
- Failure of Neural Crest Cell Migration
- Involves Rectum
- Lack of Auerbach and Meissner Plexus
- Chronic Constipation
- Failure to Pass Meconium
- Congenital Megacolon
- Increased Risk with Down Syndrome
- RET Mutations
Appendicitis
- Fecalith leading to obstruction and infection
- Most commonly affects teenagers
- Initial peri-umbilical visceral pain
- Subsequent somatic right lower quadrant pain
- Rebound tenderness
- Positive psoas sign
- Pain at McBurney's point
- Leukocytosis
- Fever
- Appendectomy
Appendicitis Assessment
- Obstruction of Appendix
- Periumbilical Pain
- RLQ Pain
- Nausea/Vomiting/Anorexia
- Increased White Blood Cells
- Rebound Tenderness
- Fever
- Peritonitis
- Sepsis
Appendicitis Interventions
- Appendectomy
- Antibiotics
- IV Fluids
- No Enema or Laxative
- Semi-Fowler's Position
- Nasogastric Tube
- Diet as Tolerated
- Pain Management
- Early Ambulation
Acute Appendicitis Treatment
- CT Scan
- Immediate Appendectomy
- NPO
- IV Fluids
- Antibiotics
- Tertiary Intention
- Antibiotics Until Afebrile