Download INTESTINAL OBSTRUCTION AND COLORECTAL CANCER

INTESTINAL
OBSTRUCTION
AND
COLORECTAL CANCER
By: Beverly Sorreta
INTESTINAL OBSTRUCTION
What is Intestinal Obstruction?
 Intestinal obstruction is blockage of the inside of the
intestines by an actual mechanical obstruction. Some
causes include adhesions (scar tissue), foreign bodies,
intussusception, ischemia (decreased blood supply),
hernias, volvulus (twisting) or tumors. As blockage
occurs gas and air distend the bowel proximal (closest)
to the blockage. As the process continues, gastric
(stomach), bilious (bile from the liver used in digestion)
and pancreatic secretions (secretions from the pancreas
used for digestion) begin to form a pool.
 Water. Electrolytes, and protein accumulate in the area, this
pooling and bowel distention decreases the circulating blood volume
and the blood supply to the bowel tissue
 In newborns and infants, intestinal obstruction is
commonly caused by a birth defect, a hard mass of
intestinal contents (meconium), or a twisting of a loop of
intestine (volvulus).
 In adults, an obstruction of the first segment of the small
intestine (duodenum) may be caused by cancer of the
pancreas; scarring from an ulcer, a previous operation, or
Crohn's disease; or adhesions, in which a fibrous band
of connective tissue traps the intestine. An obstruction
also can occur when part of the intestine bulges through
an abnormal opening (hernia), such as a weakness in the
muscles of the abdomen, and becomes trapped. Rarely,
a gallstone, a mass of undigested food, or a collection of
parasitic worms may block the intestine
adhesions
Intestinal adhesions are bands of fibrous tissue that can
connect the loops of the intestines to each other, or the
intestines to other abdominal organs, or the intestines to the
abdominal wall. These bands can pull sections of the
intestines out of place and may block passage of food
Signs and symptoms
 Crampy abdominal pain that comes and goes
(intermittent)
 Nausea
 Vomiting
 Inability to have a bowel movement or pass gas
 Swelling of the abdomen (distention)
 Abdominal tenderness
Risk factors
 You're at an increased risk of developing intestinal obstruction if
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you've had abdominal surgery of any kind, surgery to remove part of
your intestine (bowel resection) or other pelvic surgery, previous
surgery for obstruction, or if you've had your appendix surgically
removed (appendectomy). These surgeries can cause adhesions,
which are one of the most common causes of intestinal obstruction.
Crohn's disease — an inflammatory condition that can cause the
intestine's walls to thicken, narrowing its passageway
Cancer within your abdomen, especially if you had surgery to
remove an abdominal tumor
A history of constipation
Malrotation, a condition present at birth (congenital) in which the
intestine doesn't develop correctly
Treatment
 Treatment for intestinal obstruction requires
hospitalization. Giving fluids through an intravenous
(IV) line, putting a nasogastric (NG) tube through the
nose and stomach to allow the intestines to decompress,
and placing a thin, flexible tube (catheter) into your
bladder to drain urine.
 Specific treatment depends on the cause of condition.
Complete obstruction, in which nothing can pass
through your intestine, is a medical emergency that
requires immediate surgery to relieve the blockage
Interventions
 Careful monitoring of fluid and electrolytes
 Place patient in Fowler’s position for greater diaphragm expansion
 Encourage to breathe in the nose and not shallow air, which would
increase distention and discomfort
 Assess bowel sounds and abdominal girth to help to determine
peristalsis
Diagnosis
 X-rays may show dilated loops of intestine that
indicate the location of the obstruction. The xrays also may reveal air around the intestine or
under the layer of muscle that separates the
abdomen and the chest (diaphragm). Air
normally is not found in those places and thus is
a sign of rupture.
COLORECTAL CANCER
 Cancer can start in any of the four sections or in the rectum. The wall of
each of these sections (and rectum) has several layers of tissues. Cancer
starts in the inner layer and can grow through some or all of the other layers.
Colorectal cancer, also called colon cancer or bowel cancer, includes
cancerous growths in the colon, rectum and appendix. It is the third most
common form of cancer and the second leading cause of death among
cancers in the Western world. Many colorectal cancers are thought to
arise from adenomatous polyps in the colon. These mushroom-like growths
are usually benign, but some may develop into cancer over time. The
majority of the time, the diagnosis of localized colon cancer is through
colonoscopy. Therapy is usually through surgery, which in many cases is
followed by chemotherapy
Symptoms
 Frequently, the patient may be asymptomatic. This is one reason why many
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organizations recommend periodic screening for the disease with fecal
occult blood testing and colonoscopy. When symptoms do occur, they
depend on the site of the lesion. Generally speaking, the nearer the lesion
is to the anus, the more bowel symptoms there will be, such as:
Change in bowel habits
 change in frequency (constipation and/or (spurious) diarrhoea),
 change in the quality of stools
 change in consistency of stools
bloody stools or rectal bleeding
Stools with mucus
Tarry stools (melena)
Feeling of incomplete defecation (Tenesmus) (only associated with rectal
cancer)
Reduction in calibre of faeces (only associated with rectal cancer)
Bowel obstruction (rare)
Risk Factors for Colorectal Cancer
 Age:
 Having had colorectal cancer
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before:
Having a history of polyps:
Having a history of bowel
disease: Two diseases called
ulcerative colitis and Crohn’s
disease increase the risk of
colon cancer. In these
diseases, the colon is inflamed
over a long period of time and
there may be ulcers in its lining.
Family history of colorectal
cancer:
Certain family syndromes:
 Ethnic background: Jews of
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Eastern European descent
(Ashkenazi Jews) have a
higher rate of colon cancer.
Diet: A diet high in fat,
especially fat from animal
sources, can increase the risk
of colorectal cancer.
Lack of exercise:
Overweight:
Smoking:
Alcohol:
Treatment
 The 3 main types of treatment for colorectal cancer are surgery,
radiation therapy, and chemotherapy. Newer, targeted therapies
called monoclonal antibodies are now being used as well. Surgery is
the main treatment for colon cancer.
 Chemotherapy is used to reduce the likelihood of metastasis
developing, shrink tumor size, or slow tumor growth. Chemotherapy is
often applied after surgery. Radiation therapy is often used before
surgery to decrease the chance of cancer cells implantation at the same
time of resection.
Diagnosis, Screening, and Monitoring
 Endoscopic image of colon cancer identified in sigmoid colon on
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screening colonoscopy in the setting of Crohn's disease.
Digital rectal exam (DRE): The doctor inserts a lubricated, gloved
finger into the rectum to feel for abnormal areas. It only detects
tumors large enough to be felt in the distal part of the rectum and is
not really a screening test.
Fecal occult blood test (FOBT): a test for blood in the stool.
Endoscopy:
 Sigmoidoscopy: A lighted probe (sigmoidoscope) is inserted
into the rectum and lower colon to check for polyps and other
abnormalities.
Colonoscopy: A lighted probe called a colonoscope is inserted
into the rectum and the entire colon to look for polyps and other
abnormalities that may be caused by cancer. A colonoscopy has
the advantage that if polyps are found during the procedure they
can be immediately removed. Tissue can also be taken for biopsy.
Interventions
 Pre-op (2 or 3 days of bowel prep of
GoLYTELY or enemas)
* Turning, coughing, and deep breathing, wound
splinting and leg exercises
 Post-op (NG tube and Foley should be
monitored, meticulous wound and stoma care,
deep breathing, early ambulation, adequate
nutrition, pain control).
THE END……