Page 196 - Critical Care Notes

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GI

Clinical Presentation
■ Lower right quadrant crampy abdominal pain that usually occurs after meals
■ Abdominal tenderness and spasm
■ Chronic diarrhea and steatorrhea (excessive fat in stool)
■ Weight loss, anorexia, malnutrition, anemia, and nutritional deficiencies
Diagnostic Tests
■ Sigmoidoscopy, colonoscopy, intestinal biopsies, and testing for
Clostridium difficile
■ Stool analysis for occult blood and steatorrhea and stool C&S
■ UGI series or endoscopy and barium enema/series
■ Abdominal x-rays and CT, MRI, or ultrasound of the abdomen
■ CBC, ESR, and C-reactive protein
■ Serum chemistries, including albumin, protein, and calcium, and liver
function tests
Management
■ Administer aminosalicylates:
■ Sulfasalazine (Azulfidine)
■ Mesalamine or mesalazine (5-ASA, Asacol, Pentasa)
■ Balsalazide (Colazal)
■ Olsalazine (Dipentum)
■ Administer corticosteroids:
■ Prednisone or hydrocortisone
■ Prednisolone or methylprednisolone
■ Beclomethasone or budesonide
■ Consider administration of antibiotics.
■ Consider: natalizumab (Tysabri), infliximab (Remicade), azathioprine
(Imuran), mercaptopurine (6-MP), methotrexate (MTX), cyclosporine
(Neoral).
■ Administer analgesics for pain.
■ Assess vital signs for ↑ HR and fever, and assess for pallor.
■ Assess bowel sounds, and examine abdomen for distention and
tenderness.
■ Assess number and frequency of stools, and test stool for occult blood and
parasites.
■ Administer IV fluids to correct fluid and electrolyte imbalance.
■ Maintain NPO with TPN, or provide diet high in protein and calories with
vitamins and iron.
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