Chapter 18 Altered EliminationPartII_bowel_cancer PDF

Ch. 18—Part II: Altered Elimination GI focus Altered stool elimination *obstruction; peritonitis * Appendicitis Diverticular disease Gallbladder disease Acute & Chronic Pancreatitis (from Ch. 3) Cancers: o Pancreatic Cancer o Colon polyps and colon cancer o In 1st slide set: Kidn...

Ch. 18—Part II: Altered Elimination GI focus Altered stool elimination *obstruction; peritonitis * Appendicitis Diverticular disease Gallbladder disease Acute & Chronic Pancreatitis (from Ch. 3) Cancers: o Pancreatic Cancer o Colon polyps and colon cancer o In 1st slide set: Kidney, Bladder Cancer Stool Elimination Process-Review Fecal matter entry o Enters cecum via ileocecal valve Fecal matter transport o Peristalsis  Segmental movement  Mass movement o Water and electrolyte removal Stool evacuation o Rectal sphincter relaxation General Manifestations of Altered Bowel Elimination Ask about these on history assessment! Altered stool volume Altered stool characteristics such as constipation/diarrhea Pain Bleeding Abdominal distention  Melena-passage of black, _____________ swollen, retention can be hard, fluid/ gas tarry stools (can mean GI _______) upper/older GI Anorexia,  Hematochezia – passage of Nausea, vomiting fresh, bright ________— bleed often lower GI bleed Fever  Occult --hidden Altered Bowel Elimination 1. Altered motility o Altered water and vitamin absorption o Decreased or increased storage time o Risk for obstruction too much water Consequences: d_______ iarehhea or c_______ onstipation 2. Altered perfusion o Global or Focal Consequences o Ischemia and infarction o Pain Altered Bowel Patency 3. Intestinal Obstruction “bowel obstruction” Inability to move contents through intestine. Can occur in small or large intestine Etiology: Blockage –tumors, hernias, stool impaction, adhesions, intussusception, or volvulus Disease state: like diverticulitis altered nueromuscular complication Paralytic Ileus: Inability of the intestine to contract normally (issue with the nerves/muscles). *Post abdominal pelvic surgery risk* twist twist collaspe in collapse in Bowel Obstruction Etiology and Clinical Manifestations Etiology List  Crampy abdominal pain; swelling of abdomen  Loss of appetite;  Vomiting (*profuse in small bowel obstruction)  no gas; decreased bowel sounds o How do we check for this? listen to all 4 quadrants for bowel sounds  Constipation or no stool output  Fever if infections Treatment of bowel obstruction NPO= ____________________ nothing by mouth per oral Nasogastric tube (NG) Often resolves Colon resection, if necessary o Colostomy o Stoma formed  Video on Bb: https://www.youtube.com/watch?v=3OXjFo-iuC8 manueal extraction to get stool out Bowel Obstruction: Complications Complications -In small bowel: fluid and constipation electrolyte imbalance -Impaired mobility; - Ischemia and tissue death -Distention and Perforation (tearing) --- Infection- peritonitis stool in peritional cavity can lead to urgent treatment needed! Large Bowel: distention, cramping, constipation A bowel obstruction complication: Peritonitis Peritonitis=. I_________ nflammation of the peritoneal m_________. emebrane Emergency situation! Etiology -Ascites apendix bursts -Ruptured organ or diverticula -Trauma -Peritoneal dialysis contamination - bowel obstruction Clinical Manifestations: F_____, ever abdominal distension and r______, ebound abdominal pain, low/no bowel sounds - rebound Treatment: Fluids and electrolytes NG tube (gives bowel rest) Antibiotics if bacterial Prevent complications in lungs Some may need surgical correction Obstruction can lead to sepsis and shock! No bowel sounds distal to obstruction Increased abdominal pressure Perforation Sepsis can occur Appendicitis  I____________ nflammation of appendix  Infections or obstruction leads to appendicitis (can be from bacterial laden fecal contents)  Signs: Elevated WBCs  Symptoms: Abdominal p_____ ain that shifts to r______ ight lower quadrant (RLQ) Nausea and vomiting F______ ever CT Scan/ cbc count Treatment: Surgical excision: Preferably before rupture!!! Diverticulum/Diverticulitis  Diverticulum: small s______; acs out pouches in the colon  Diverticulosis: presence of diverticulum  Diverticulitis: The outpouches become packed with fecal material and become irritated, inflamed and i__________ nfection  Risks: chronic c_________ onstipation Leads to prolonged p_______ ressure on large intestine walls alters structure and function Diverticular Disease Clinical Manifestations and Diagnosis Symptoms  Abdominal pain (l_____ eft lower quadrant)  F_____ ever  Nausea, Vomiting Consequences:  Decreased m______, obility Obstruction, Impaired perfusion.  Perforation or h_________ emmorage Diagnosis:  History of symptoms  Physical exam Abdominal tenderness D__________ istention Diverticular Disease Diagnostics and Treatment Laboratory analyses o Stool analysis: blood? o Blood samples: Complete blood count (CBC) Why? -Ultrasound, MRI or CT scan: look for inflamed and/or ruptured diverticula -_______oscopy colon or ______oscopy sigmoid Treatment: o Management of symptoms and bowel rest o Control i________ nfection with __________ antibiotics o S_______ urgery correction of perforated diverticula  Gallbladder Diseases Cholelithiasis  Presence of gallstones in gallbladder or bile ducts  Risk factors : 5 F’s F________ emale Fair complexion Fat (obese) Fertile or has children F_____ orty years of age +  Symptoms: N/V, RUQ (r_____ ight upper quadrant) pain  Treatment: Extracorporeal shockwave lithotripsy or cholecystectomy (remove gallbladder surgically Gallbladder Diseases Cholecystitis Inflammation of gallbladder. Usually caused by obstruction of bile due to gallstones duct Symptoms: pain in the upper right quadrant (RUQ), nausea/vomiting Diagnosis: ultrasound or cholecystogram Complication: rupture of the gallbladder leading to peritonitis Treatment: surgical removal (usually laparoscopically) called cholecystectomy Clinical Example (Ch. 3) Acute Pancreatitis Pathophysiology  Inflammation of pancreas  Can be an acute episode or a chronic disease Etiology  Bile Duct blockage by gallstones  Excessive alcohol use Injury to  Acinar cells (produce a____ mylase and l_______) ipase  pancreatic duct  protective digestive feedback mechanisms Acute Pancreatitis Clinical Manifestations Upper abdominal pain Nausea  Sudden onset Vomiting  Growing intensity  Anorexia Dull, steady ache  Radiating to back Diarrhea Decreased Pancreatic function  Acute Pancreatitis Diagnostic Criteria Amylase, Chk LFTS lipase levels Alk phos are ______ Assess Ab. Pain ETOH alchohol gallstones Ct scan Acute Pancreatitis Treatment Intravenous hydration NPO Analgesics May need endoscopy endoscope If caused by gallstones – >cholecystectomy If Idiopathic – palliative, symptomatic treatment If caused by Alcohol – palliative, symptomatic treatment ; Quit drinking alcohol – this will not cure pancreatitis Pancreatic Cancer Usually an adenocarcinoma occurring in head of pancreas  Cause: Idiopathic, smoking, chemical exposure, and consumption of high-fat diet high fat diets  Symptoms: Abdominal and back pain Nausea and vomiting Loss of appetite Weakness and fatigue Jaundice  Diagnosis: biopsy  Treatment: surgery (Whipple procedure), radiation, chemo REMINDER: Colon polyps and Colon Cancer (Colorectal cancer) Colon polyps: Inward projection of mucosal lining of colon—can be benign or precancerous (polyp dysplasia adenocarcinoma)  Caused by inflammatory reaction or neoplasm -Diagnosis: colonoscopy or sigmoidoscopy -Treatment: suspicious polyps biopsied; cancerous polyps removed  ulcerative colotis more at risk for cancer Colon Cancer (Colorectal cancer)  Etiology: DNA mutations in cells of colon wall Risk factors: genetics, age, low fiber, smoking, ETOH, inflammatory disorders like Crohn and Ulcerative Colitis Clinical Manifestations  Constipation, abdominal fullness/discomfort, rectal bleeding, occult blood, back pain, weight loss, etc. Diagnosis: colonoscopy with biopsy Treatment: Surgery (colon resection), chemo, radiation.