Bowel elimination disorders part 2 – Flashcards
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Polyp
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Mass of tissue that arises from the bowel wall and protrudes into the lumen. Any portion of bowel but mostly sigmoid & rectum
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Adenamatous polyps
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Disruption of normal cell proliferations to replace epithelial cells lining the intestine
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Tubular adenomas (pedunculated polyps)
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More common 65% of benign polyps in large intestine Globelike structure attached to intestinal wall by thin, stalk-like stem Malignancy r/t size
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Villous adenomas (sessile polyps)
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Broad base & elevated cauliflower-like surface Typically in rectosigmoid colon Lager than tubular Higher malignancy rate Not common
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Manifestation pf polyps
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Most are asymptomatic (most found during routine exams) Painless rectal bleeding (bright or dark red) often mistaken as hemorrhoids Larger polpys can cause pain/ cramping/ cause obstruction Diarrhea & mucous discharge d/t large villous
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Colorectal cacer
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Earlier dx the better Prevention/ early detection & intervention best cure People with family hx of adenomatous polyposis will develop cancer unless colon is removed
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Risk factors for colon cancer
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> 50 y/o Polyps of the colon/rectum Family hx of colorectal cancer IBD Radiation exposure Diet-high animal fat & cal intake (increases bacteria in gut)
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Complications of colorectal cancer
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Bowel obstruction d/t narrowing of bowel lumen by lesion Perforation of the bowel wall by tumor, allowing contamination of peritoneal cavity by bowel contents Direct extension of tumor into 2 adjacent organs
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Sigmoid colostomy
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Most common permanent (generally for cancer of rectum) Removal of sigmoid colon, rectum, & anus Stoma in LLQ of abd
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Double-barrel colostomy
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2 seperate stomas created Distal colon not removed by bypassed Functional proximal stome Distal stoma expells mucous
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Transverse loop colostomy
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Emergency procedure to relieve intestinal obstruction or perforation Typically temporary
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Harmtann procedure
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Common temporary colostomy Distal part of colon in place and oversewn for closure
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Hernia
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Defect in the abd that allows adb contents to protrude out of the abd cavity. Trauma, increased intra-abd pressure, surgery are a cause
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Reduciable hernia
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Abd contents protrude through abd wall to form a sac when intra-abd pressure increases then returns to abd cavity when pressure returns to normal
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Incarcerated hernia
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When the protruded abd contents cannot be returned into the abd cavity. Contents trapped, usually by narrow neck or opening Obstruction a risk-when lumen of bowel contained within hernia becomes occluded
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Strangulated hernia
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Blood supply to bowel & other tissues in the hernia sac is compromised, leading to necrosis Manifestations-Severe abd pain & distention, N/V, tachycardia & fever
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Intestinal obstruction
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A failure of intestinal contents to move through the bowel lumen. May affect the small or large bowel.
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Causes of Mechanical obstructions
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1. Problem outside the intestine (bands of scar tissue or hernia) 2. Problem within intestine (tumors or inflammatory bowel disease) 3. Obstruction of the intestinal lumen.
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Functional obstruction
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Occurs when peristalsis fails to propel intestinal contents allthough there is no mechanical obstruction
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Adynamic ilesus ( paralytic ileus or ileus)
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Most common obstruction after abd surgery. Accounts for most intestinal obstructions
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Manifestations of Small bowel obstruction
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Cramping or colicky pain (intermitten or increase in intestity) Vommiting (particularly in high or proximal obstructions) Visible perstaltic waves (noted in distended loops of bowel) Vommiting fecal contents (when bacteria fermentation occurs) Flatus & feces can be expelled early in the process Borborymi Later stages-bowel silent (paralytic ileus) Abd distention (minimal in proximal, pronounced with distal & paralytic ileus)
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Nursing observation manifestations of SBO
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Fluid & electrolyte imbalance Hypovolemia Dehydration tachycardia tachypneic BP drop Temp elevated Urine output drops Signs of hypovolemic shock
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Complications of bowel obstuction
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Hypovolemia Hypovolemic shock Stanulation (in incarcerated hernia or volvulous- impairs blood supply, gangrene may rapidly develope, causing bleedin into small lumen & peritoneal cavity, eventually causing preforation
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Complications of preforation
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Bacteria & toxins enter the paritoneum & potentially, the circulation, resultin in peritonitis & septic shock
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Large bowel obstruction
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Less frequent then SBO Cancer of the bowel common cause Volvulus, diverticulitits, inflammatory disorders, and fecal impaction are other causes
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Manifestation of large bowel obstruction
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Constipation Colicky abd pain (deep & cramping, severe continuous pain may signal bowel ischemia & possible preforation) Vommiting (late sign if at all) Distended abd High pitched tinking sounds w/ rushes & gurgles Localized tenderness or mass with palpation
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Dx of bowel obstructions
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WBC (mild leukocytosis d/t inflammatory responce) Serum osmolarity & electrolyte levels
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Gastrointestinal decompression
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Most partial small bowel treated with this NG tube or long intestinal tube Collected fluids & gases are removed using low suction until peristalsis returns or obstruction is relieved
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Surgery of bowel obstruction
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Required for complete mechanical obstructions For strangulated or incarcerated hernias NG tube placed prior to relieve V & abd distention & to prevent aspiration of intestinal contents
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Health promotion of bowel obstruction
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Increase fiber Generous fluid intake Excercise daily Comply with dietary restrictions (i.e. no popcorn)
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Diverticula
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Small outpouchings of the colon that occur in rows. Occur anywhere in intestinal tract excluding the rectum
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Pathophysiology of diverticula
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Most people asymptomatic Form when increased pressure within the bowel lumen cause mucosa to herniate through defects in the colon wall Deficient fiber & lack of fecal bulk contribute to muscle atropy & narrow bowel. Contraction of muscle in responce to stimuli (meals) occlude narrow lumen increasing intraluminal pressure. High pressure causes mucosa to herniate through muscle wall (causing diverticula)
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Diverticulosis
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Indicates presense of diverticula
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Manifestations of diverticulosis
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Most asymptomatic Episodic pain (usually left sided) Constipation Diarrhea
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Diverticulitis
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Inflammation in and around the diverticular sac Ususally only 1 diverticulum (usually sigmoid colon) Undigested food & bacteria collect in diverticula, forming hard mass that impairs the mucosal blood supply, allowin bacteria invasion
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Manifestations of diverticulitis
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Pain (left sided, mild-severe, steady or cramping) Constipation or increased freq of defication N/V low fever Abd distention Palpable mass in LLQ
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Complications of diverticulitis
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Bowel obstruction Fistula formation Hemorrhage
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Dx of diverticulitis
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Barium enema Xray Sigmoidoscopy/colonoscopy CT scan Hemoccult or guaiac stool testing (presence of occult blood) WBC count (leukocytosis w/left shift)
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Medications of diverticulitis
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Systemic broad spectrum antibiotics effected against normal bowel flora Oral antibitotics (Flagyl, Cipro, Septra, Bactrim) for mild Talwin for pain Stool softener (laxatives can further increase intraluminal pressure, they are avoided)
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Nutrition of diverticulitis
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High fiber Avoid foods with small seeds (popcorn, caraway seeds, figs, or berries)
