Intestinal Obstruction and Colorectal Cancer

Intestinal Obstruction

• This is a blockage that stops the normal flow of intestinal contents.
• Cramping, abdominal pain, vomiting, abdominal distension, and constipation are clinical manifestations
• Treatment includes a Nasogastric (NG) tube, IV fluid replacement, and potentially surgery
• Nursing care involves monitoring electrolyte imbalances, managing pain, and educating the patient and family on recovery/prevention

Colorectal Cancer

• It mainly consists of adenocarcinomas and affects the colon and rectum
• Risk factors include being over 50, family history, smoking, obesity, heavy alcohol use, physical inactivity, and a high-fat diet
• Symptoms include rectal bleeding, changes in bowel habits, weight loss, fatigue, and abdominal discomfort
• Diagnosis is via a fecal occult blood test (FOBT), FIT, CEA levels, colonoscopy, and CT-guided virtual colonoscopy
• Nonsurgical management: radiation, chemotherapy
• Surgical management: colon resection, colectomy, colostomy
• Prevention includes regular screening, a healthy diet and exercise, and quitting smoking/alcohol

Irritable Bowel Syndrome (IBS)

• It is a functional GI disorder causing chronic abdominal pain and bowel changes
• IBS-D is diarrhea predominant
• IBS-C is constipation predominant
• IBS-M is mixed
• Symptoms: abdominal pain, bloating, fatigue, malaise, and altered bowel habits
• Management: stress reduction, diet modification, and drug therapy

Herniation

• Is the protrusion of an organ through a weak spot in the abdominal wall
• Assessment: lump or protrusion
• Absent bowel sounds indicate a medical emergency
• Nonsurgical management: use of a truss for support
• Surgical intervention: herniorrhaphy
• Types of hernias

Types Of hernias

• Epigastric: Upper abdomen, midline
• Incisional: At surgical incision site
• Umbilical: At the navel
• Inguinal (direct & indirect): Near the inguinal canal
• Femoral: In the femoral canal

Hemorrhoids

• These are swollen veins in the anorectal region
• Chronic constipation and straining during bowel movements are causes
• Bleeding, swelling, prolapse, pain, and discomfort are symptoms
• Management involves increased dietary fiber, pain management, and hemorrhoidectomy if severe

Peritonitis

• This is a life-threatening inflammation of the peritoneal cavity due to infection
• Causes include bacterial infection, ruptured appendix, perforated ulcer, and diverticulitis
• Severe abdominal pain, fever, tachycardia, guarding, and rigidity are symptoms
• Diagnosis involves WBC count, blood cultures, and abdominal imaging (X-ray, ultrasound)
• Management requires IV antibiotics, fluid replacement, and surgery if necessary

Appendicitis

• It is defined as inflammation of the appendix, which can lead to rupture
• Right Lower quadrant (RLQ) abdominal pain (McBurney's point), nausea, vomiting, fever, and rebound tenderness are symptoms
• Elevated WBC count and ultrasound/CT imaging are diagnostic
• Management: keep NPO and immediate appendectomy

Gastroenteritis

• It consists of inflammation of the stomach and intestines causing diarrhea and vomiting
• A viral or bacterial infection is the cause
• Nausea, vomiting, diarrhea, fever, and dehydration are symptoms
• Management includes fluid replacement and rest/supportive care

Ulcerative Colitis

• It is a chronic inflammatory disease of the colon and rectum
• Bloody diarrhea with mucus and abdominal cramps are symptoms
• Risk factors: genetic predisposition and environmental factors
• Diagnosis: colonoscopy, increased WBC, and ESR
• Management: anti-inflammatory medications and surgery (colectomy with ileostomy if severe)

Crohn's Disease

• It is a chronic inflammatory disease affecting any part of the GI tract
• Symptoms include abdominal pain, diarrhea, weight loss, malabsorption, and anemia
• Fistulas, strictures, and bowel obstruction are complications
• Diagnosis: endoscopy, CT/MRI scans
• Management: anti-inflammatory medications, nutritional support, and surgery if complications arise

Diverticular Disease

• It involves the formation of pouches (diverticula) in the intestinal wall
• Often asymptomatic
• Can cause abdominal pain, fever, and nausea
• Abscess formation and peritonitis are complications
• Management: high-fiber diet, antibiotics for infection, and surgery if complications arise

Celiac Disease

• It is an autoimmune disorder where gluten intake damages the small intestine
• Symptoms include diarrhea, bloating, malnutrition, skin rashes, and joint pain
• Diagnosis: antibody tests and small intestine biopsy
• Management: lifelong gluten-free diet

Parasitic Infection

• It is a GI infection caused by parasites such as giardia, hookworm, and tapeworm
• Diarrhea, nausea, and weight loss are symptoms
• Management: hand hygiene and antiparasitic medications

Mechanical Intestinal Obstruction

• This is caused by adhesions, tumors, hernia, volvulus, intussusception, and fecal impaction.

Nonmechanical Intestinal Obstruction

• This is caused by paralytic ileus (post-surgery, infection)
• Nonmechanical causes can be caused by post-surgical handling of intestines

Intestinal Obstruction Assessment

• Symptoms include pain, distention, obstipation, and vomiting
• Bowel sounds may be high-pitched (early) or absent (late)

Intestinal Obstruction Diagnosis

• Labs: high WBC, low Hgb & Hct (if bleeding), high BUN & creatinine (dehydration), electrolyte imbalances
• Imaging: CT scan (best), MRI, ultrasound

Intestinal Obstruction Management

• Nonsurgical: NG tube, IV fluids, NPO, pain control
• Surgical: Exploratory laparotomy (if severe)

Colorectal Cancer Risk Factors

• Age > 50
• Family history/genetic predisposition
• Obesity, smoking, high-fat diet
• History of IBD (Crohn’s, Ulcerative Colitis)

Colorectal Cancer Health Promotion

• Screening: Colonoscopy every 10 years, FOBT, FIT, CT colonography
• Prevention: Quit smoking, increase fiber, maintain healthy weight, exercise
• Sign and symptom: Bowel habit changes
• Sign and symptom: Rectal bleeding (maroon/black stool)

Irritable Bowel Syndrome

• IBS is characterized by abdominal pain, bloating, and altered bowel habits, with no identifiable structural cause

IBS Classifications

• IBS-D: Diarrhea predominant
• IBS-C: Constipation predominant
• IBS-A: Alternating diarrhea/constipation
• IBS-M: Mixed diarrhea & constipation

Hernias

• A hernia occurs when an organ or tissue pushes through a weak spot in muscle or connective tissue
• Management: Nonsurgical: Truss (supportive device)
• Surgical: Herniorrhaphy (hernia repair surgery)
• Absent bowel sounds equals a medical emergency

Hemorrhoid Management

• Increase dietary fiber, hydration
• Pain management
• Hemorrhoidectomy (surgical removal if severe)

Gastritis

• It is the inflammation of the gastric mucosa (stomach lining) due to irritants, infections, or autoimmune disorders
• Acute Gastritis is short-term, sudden inflammation caused by NSAIDs, alcohol, or infections
• Chronic Gastritis is long-term, progressive damage, often due to H. pylori infection or autoimmune causes

Gastritis Causes & Risk Factors

• H. pylori infection
• NSAID overuse (Aspirin, Ibuprofen)
• Alcohol & smoking
• Autoimmune disorders (pernicious anemia)
• Stress-related mucosal damage

Acute Gastritis Symptoms

• Epigastric pain, nausea, vomiting
• Gastric bleeding (hematemesis, melena)
• Chronic Gastritis: Mild symptoms until ulceration occurs
• Loss of appetite, bloating, nausea

Gastritis Diagnosis

• EGD (Endoscopy) is Gold standard
• H. pylori testing (breath, stool antigen, biopsy) can be used as well

Gastritis Treatment & Management

• Acute Gastritis:
• Supportive care (IV fluids, rest)
• Eliminate NSAIDs, alcohol
• PPIs (Omeprazole), H2 blockers
• Chronic Gastritis: H. pylori eradication (Triple or Quadruple therapy)
• Vitamin B12 supplements (for autoimmune cause)
• Dietary modifications

Gastric Cancer Risk Factors

• Atrophic gastritis, H. pylori infection
• Intestinal metaplasia (precancerous changes)
• Smoking, obesity, high-salt & nitrate-rich diet (pickled foods)
• Family history of gastric cancer

Gastric Cancer Diagnosis

• Diagnostic Test: EGD with biopsy (Gold standard)

Peptic Ulcer Disease (PUD)

• It consists of a break in the mucosal lining of the stomach or duodenum, leading to ulceration
• Gastric Ulcer causes Pain worsens with eating
• Duodenal Ulcer causes Pain relieved with eating but worsens later
• Stress Ulcers are Triggered by severe illness or trauma

PUD Risk Factors

• H. pylori infection
• NSAID use
• Smoking, alcohol
• Zollinger-Ellison Syndrome (excess acid production)

PUD Treatment

• Surgical Management:
• Vagotomy (severs vagus nerve to reduce acid)
• Pyloroplasty (widens pyloric sphincter)
• Partial gastrectomy (removes ulcerated portion)

Nutritional Standards

• Nutrition is the intake of food necessary for health
• Nutrition involves a balanced diet that provides essential nutrients to maintain body function and prevent diseases
• Dietary Reference Intakes (DRIs) are guidelines for nutrient intake based on age, sex, and health status,

Nutrition Standards

• Dietary Guidelines for Americans: General recommendations for healthy eating habits
• MyPlate: A visual guide for portion control and balanced meals, emphasizing fruits, vegetables, grains, protein, and dairy
• Common Diets: Keto, Paleo, Vegetarian, Vegan, Mediterranean, Raw, Low Carb, No Sugar

Nutritional Assessment

• Definition: The evaluation of a patient’s nutritional status through history, physical exam, and lab tests.
• Components: Review of Nutrition History: Diet, fluid intake, and access to food.
• Laboratory Data: Identifying deficiencies or imbalances
• Anthropometric Measurements: Height, weight, BMI, and skinfold thickness
• Psychosocial Assessment: Emotional and financial factors affecting nutrition
• Nutritional Screening: Done within 24 hours of hospital admission (as per The Joint Commission)
• Uses tools like BMI, Mini Nutritional Assessment (MNA-SF), and

Health Promotion & Prevention for Gastritis

• Balanced diet and avoid spicy or acidic foods
• Exercise & stress management
• Avoid alcohol, tobacco, and NASIDs

Gastric Cancer

• Advanced disease is when the tumor can spread to lymph nodes, liver or lungs

PUD Mnemonics and treatments

• PUD Causes: NSAIDs, Smoking, Alcohol, Infection (H. pylori), Duodenal ulcers
• PUD Complications: Perforation – Severe pain, rigid abdomen, Hemorrhage – Vomiting blood, melena, Pyloric obstruction – Bloating, vomiting
• H. Plyori treatment CAP Clarithromycin, Amoxicillin, PPI (Omeprazole)

Mnemonics

• Hemorrhoid prevention: H20 + Fiber = happy bowel
• For intestinal obstruction causes use HAV-FIT: Hernia, Adhesions, Volvus, fecal impaction, intussusception, tumor
• Gastric cancer risk factors H-PYLO H. Pylori, Obesity, & Smoking

Right vs. Left-Sided Colon Cancer

• Right: Black/tarry stools (melena)
• Left: Bright red blood in stool (hematochezia)

Gastric vs. Duodenal Ulcers

• Gastric Ulcer → Pain worsens with eating.
• Duodenal Ulcer → Pain improves with eating but worsens later

Undernutrition

• This is a deficiency of calories, protein, or other essential nutrients leading to poor health and physical function.
• Marasmus: Severe calorie and protein deficiency, leading to muscle wasting.
• Kwashiorkor: Severe protein deficiency, causing swelling (edema).
• Marasmic-Kwashiorkor: A combination of both conditions.
• Physical Risk Factors: Chronic illness, decreased appetite, difficulty swallowing, gastrointestinal disorders, and dementia.
• Psychosocial Risk Factors: Depression, loneliness, transportation access, and financial difficulties.

Eating Disorders

• Anorexia Nervosa: Extreme restriction of food intake, fear of weight gain, distorted body image.
• Bulimia Nervosa: Binge eating followed by purging (vomiting, laxatives, or excessive exercise).
• Binge Eating Disorder: Consuming large amounts of food without purging, leading to obesity.
• Body Dysmorphic Disorder: Distorted self-image, leading to unhealthy eating and exercise behaviors.

Assessment of Eating Disorders

• History: Eating patterns, food preferences, appetite changes, recent weight fluctuations.
• Physical Signs: BMI, skin/hair/nail changes, electrolyte imbalances, muscle weakness.
• Lab Tests: Cholesterol, Hemoglobin, Hematocrit, Serum Albumin, Thyroxine-Binding Prealbumin (PAB), Transferrin.
• Psychosocial Factors: Emotional stress, cultural influences, financial struggles, family history.

Implementation and Treatments for Eating Disorders

• Nutritional Therapy: Total Enteral Nutrition (TEN): Feeding via NG tube, NJ tube, PEG tube for severe cases.
• Parenteral Nutrition (PN): PPN (peripheral) or TPN (total) via IV when oral intake isn’t possible.
• Behavioral Therapy: Cognitive Behavioral Therapy (CBT), Meal Management, Medication (SSRIs)
• Prevention and Recovery Strategies: Address body image issues, establish balanced eating habits, and provide long-term support.

Overview of intestinal obstruction, its causes, symptoms and treatment. Also discusses colorectal cancer, risk factors, symptoms, diagnosis, and treatments. Nursing care involves monitoring, managing pain, and patient education.