1. Digestive Disorders: Lower Gastrointestinal Tract Presented by: APS Healthcare Southwestern PA Health Care Quality Unit (HCQU) November 2010 cjp

2. © 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.

3. © 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.

4. © 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

5. © 2009 APS Healthcare, Inc. 5 Gastro-intestinal Tract Components  Upper GI tract –Mouth –Esophagus –Stomach  Lower GI tract –Small intestine –Large intestine

6. © 2009 APS Healthcare, Inc. 6 Function Of The Lower GI Tract  Digestion  Elimination

7. © 2009 APS Healthcare, Inc. 7 Function And Structure Of Small Intestine  Digestion and absorption –Chyme – digested food from the stomach  Duodenum, jejunum, ileum

8. © 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

9. © 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

10. © 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

11. © 2009 APS Healthcare, Inc. 11 Diverticular Disease  Diverticulosis  Diverticulitis

12. © 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

13. © 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

14. © 2009 APS Healthcare, Inc. 14 Diagnosing Diverticulitis  Abdominal CT  Ultrasound

15. © 2009 APS Healthcare, Inc. 15 Treatment Of Diverticulitis  Depends on severity  Antibiotics  Pain relief  Surgery

16. © 2009 APS Healthcare, Inc. 16 Diverticulitis Prevention  Eat fiber  Drink fluids  Don’t delay bowel urges  Exercise regularly

17. © 2009 APS Healthcare, Inc. 17 Inflammatory Bowel Disease (IBD)  Ulcerative Colitis  Crohn’s Disease

18. © 2009 APS Healthcare, Inc. 18 Ulcerative Colitis Symptoms  Abdominal pain  Abdominal sounds  Diarrhea  Rectal pain  Weight loss  Fever

19. © 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

20. © 2009 APS Healthcare, Inc. 20 Ulcerative Colitis Treatment  Diet  Medications  Surgery

21. © 2009 APS Healthcare, Inc. 21 Crohn’s Disease Symptoms  Abdominal pain / cramping  Diarrhea  Fever  Anemia  Joint inflammation  Weight loss

22. © 2009 APS Healthcare, Inc. 22 Crohn’s Disease Diagnosis  Stool culture  Barium enema / x-ray  CT and ultrasound  Colonoscopy  Endoscopy  MRI  Laboratory Tests

23. © 2009 APS Healthcare, Inc. 23 Crohn’s Disease Treatment  Diet  Medication  Surgery

24. © 2009 APS Healthcare, Inc. 24 Irritable Bowel Syndrome  Unknown cause  Abdominal pain  Diarrhea  Constipation

25. © 2009 APS Healthcare, Inc. 25 Irritable Bowel Syndrome (IBS) Diagnosis  Symptom based

26. © 2009 APS Healthcare, Inc. 26 Irritable Bowel Syndrome Treatment  Diet  Reduce stress  Medications

27. © 2009 APS Healthcare, Inc. 27 Viral Gastroenteritis  Inflammation  Norovirus

28. © 2009 APS Healthcare, Inc. 28 Gastroenteritis Symptoms  Nausea  Vomiting  Diarrhea  Abdominal cramps

29. © 2009 APS Healthcare, Inc. 29 Gastroenteritis Transmission  Contaminated food or liquids  Undercooked shellfish  Close contact with infected persons  Seasonal

30. © 2009 APS Healthcare, Inc. 30 Gastroenteritis Treatment  Prevent dehydration

31. © 2009 APS Healthcare, Inc. 31 Gastroenteritis Prevention  Wash hands frequently  Cook food thoroughly  Bleach-based cleaner  Launder soiled linens

32. © 2009 APS Healthcare, Inc. 32 Antibiotic-Associated Diarrhea And Colitis  Clostridium difficile

33. © 2009 APS Healthcare, Inc. 33 C Diff Signs and Symptoms  Mild to moderate C. Diff  Severe C. Diff

34. © 2009 APS Healthcare, Inc. 34 C. Diff Transmission  Fecal-oral route  Spore forming bacteria

35. © 2009 APS Healthcare, Inc. 35 C. Diff treatment  Antibiotics –Flagyl –Vancomycin  Probiotics –Florastor  Drink fluids

36. © 2009 APS Healthcare, Inc. 36 C. Diff Prevention  Hand washing  Thorough cleaning  Prudent use of antibiotics

37. © 2009 APS Healthcare, Inc. 37 Celiac Disease  Immune system reaction to gluten  Small intestine damage  Autoimmune disease

38. © 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

39. © 2009 APS Healthcare, Inc. 39 Celiac Disease Causes And Diagnosis  Cause unknown  Blood tests  Biopsy

40. © 2009 APS Healthcare, Inc. 40 Celiac Disease Treatment And Prevention  Gluten-free diet  Vitamin and mineral supplements  Dietician referral

41. © 2009 APS Healthcare, Inc. 41 Hirschsprung’s Disease  Affects large intestine  Present at birth  Missing colonic nerve cells

42. © 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

43. © 2009 APS Healthcare, Inc. 43 Hirschsprung’s Disease Causes  Unknown cause  May be genetic

44. © 2009 APS Healthcare, Inc. 44 Hirschsprung’s Disease Diagnosis And Treatment  Abdominal x-ray  Anal manometry  Barium enema  Rectal biopsy  Pull-through procedure

45. © 2009 APS Healthcare, Inc. 45 Appendicitis  Finger-shaped protrusion  Unknown function

46. © 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

47. © 2009 APS Healthcare, Inc. 47 Appendicitis Causes  Obstruction  Infection

48. © 2009 APS Healthcare, Inc. 48 Appendicitis Diagnosis  Abdominal exam  Urine test  Blood test  Imaging tests

49. © 2009 APS Healthcare, Inc. 49 Appendicitis Treatment And Prevention  Appendectomy  Open surgery  Laparoscopic surgery  High fiber diet

50. © 2009 APS Healthcare, Inc. 50 Caregivers Make A Difference  Infection control  Dietary recommendations  Prompt reporting of behavioral changes

51. © 2009 APS Healthcare, Inc. 51 Suggested Trainings  Digestive Disorders: Upper GI  Bowel Management  Behavioral Manifestations Of Pain

52. © 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

53. © 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

54. © 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

55. © 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

56. © 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

57. © 2009 APS Healthcare, Inc. 57

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