Med-Surg - Gastrointestinal System, part 6: Irritable Bowel Syndrome, Abdominal Hernia

Hi, I'm Cathy with Level Up RN. In this video, I am going to talk about irritable bowel syndrome as well as an abdominal hernia. At the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key points I'll be covering in this video. So definitely stay tuned for that. And if you have our Level Up RN medical surgical nursing flashcards, definitely pull those out so you can follow along with me. First up, we have irritable bowel syndrome, or IBS, which is an intestinal disorder that causes abdominal pain and changes in bowel movements in the absence of other disorders. So the pathophysiology behind IBS is unknown, but risk factors can include stress, mental health disorders, intestinal bacterial overgrowth, as well as food sensitivities. Signs and symptoms can include abdominal pain, diarrhea, constipation, or a combination of both diarrhea and constipation. And then patients often report improvement in symptoms upon defecation. So in terms of diagnosis, we usually ask the patient to keep a food symptom journal in order to identify triggers of their symptoms. So foods that sometimes trigger these symptoms include milk, alcohol, caffeine, wheat, or eggs. In addition, we would need to do diagnostic testing to rule out other disorders, so this would include blood test and stool tests. In terms of treatment, two key medications that would be used in the treatment of IBS include Alosetron, which is used for IBS with diarrhea, and Lubiprostone, which is used for IBS with constipation. In terms of patient teaching, in addition to keeping that symptom food journal, we want the patient to increase their fiber intake, increase their physical activity, avoid gluten, and reduce stress if possible.
Next, we have an abdominal hernia, which is where a section of the intestine protrudes through weakness in the abdominal wall, so you can have a biblical hernia, which happens over the belly button, or an inguinal hernia, which happens around the groin area. So the pathophysiology behind this disorder is that we have muscle weakness and/or increased inter-abdominal pressure that allows for that herniation. So when I was pregnant with my second child, I ended up within a biblical hernia. So before getting pregnant, I had a laparoscopic surgery in my abdomen, and they closed my abdomen up. But by opening and closing my abdomen, it created a weakness in my abdominal wall. Then when I got pregnant, that obviously caused increased intra-abdominal pressure, and that's how I ended up with that umbilical hernia. So when that portion of the intestine protrudes through the abdominal wall, it can get caught and strangulated. And that, in turn, can cause obstruction of the bowel and bowel necrosis. So it can be very dangerous. In terms of risk factors associated with an abdominal hernia, those include obesity, pregnancy, which was my issue, as well as lifting of heavy objects. In terms of signs and symptoms, those include a lump or protrusion at the affected site. So when I was pregnant, I had this huge belly button that was sticking out, and I thought, "Oh, I guess I have an outie belly button while I'm pregnant." But no, it turned out it was a hernia.
In addition, if we end up with strangulation of that bowel, that can cause severe pain and decreased bowel sounds, when we have that strangulation or obstruction. In terms of treatment, the patient can be given what's called a truss, which is like a belt that holds the protruding tissue in place. We can also do a surgical repair of the hernia, which is what I had after I gave birth. And then if we end up with strangulation of the bowel, that may require a bowel resection, so removal of part of the bowel. In terms of patient teaching following a hernia repair, we want to advise the patient to avoid coughing. And if they need to cough or sneeze, they should splint the area. In addition, they should avoid heavy lifting and straining. All right. It's time for Quiz. I have three questions for you. First question does IBS cause diarrhea or constipation? The answer is it can cause either or both. So it's kind of a trick question. Don't hate me for that one. Question number two, obesity and pregnancy are risk factors for an abdominal hernia. True or false? The answer is true. Question number three, how can a patient identify triggers of their IBS? The answer is they can keep a food symptom journal. Okay. I hope this video has been helpful. Take care. Good luck studying. And in my next video, we are going to talk about intestinal obstructions as well as ostomies. So definitely stay tuned for that.