colon patho
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colonTRANSCRIPT
Our Lady of Fatima UniversityCollege of Nursing
Valenzuela Campus
Intestinal Obstruction Partial Probably sec to Colonic Malignancy
A Case Study
Presented to:
Ms. Vanessa O. Umali, R.N. MAN
Presented by:
Maria Paula M. Bungay
July 2015
TABLE OF CONTENTS
I. Introduction
II. Objectives
III. Patient’s Profile
IV. Anatomy and Physiology
V. Pathophysiology
VI. Laboratory Examination Results
VII. Gordon’s Assessment
VIII. Nursing Care Plans
IX. Drug Study
X. Discharge Planning
I. Introduction
Intestinal obstruction
Intestinal obstruction is a partial or complete blockage of the bowel that results in the failure of the intestinal contents to pass through.
Causes
Obstruction of the bowel may due to:
A mechanical cause, which simply means something is in the way Ileus, a condition in which the bowel doesn't work correctly but there is no
structural problem
Paralytic ileus, also called pseudo-obstruction, is one of the major causes of intestinal obstruction in infants and children. Causes of paralytic ileus may include:
Chemical, electrolyte, or mineral disturbances (such as decreased potassium levels)
Complications of intra-abdominal surgery Decreased blood supply to the abdominal area (mesenteric artery ischemia) Injury to the abdominal blood supply Intra-abdominal infection Kidney or lung disease Use of certain medications, especially narcotics
In older children, paralytic ileus may be due to bacterial, viral, or food poisoning (gastroenteritis), which is sometimes associated with secondary peritonitis and appendicitis.
Mechanical causes of intestinal obstruction may include:
Abnormal tissue growth Adhesions or scar tissue that form after surgery Foreign bodies (ingested materials that obstruct the intestines) Gallstones Hernias Impacted feces (stool) Intussusceptions Tumors blocking the intestines Volvulus (twisted intestine)
Symptoms
Abdominal distention Abdominal fullness, gas Abdominal pain and cramping Breath odor Constipation Diarrhea Vomiting
Site of Obstruction Cause Relative Incidences (%)
Small intestine [85%]
Adhesions 60
Hernia 15
Tumors 15
miscellaneous 10
Large Intestine [15%]
CA colon 65
Diverticulitis 20
Volvolus 5
miscellaneous 10
Abstract
The management of patients with malignant bowel obstruction
(MBO) can be one of the most challenging aspects of advanced cancer
care, and as a result, their symptoms are often palliated poorly, especially
near the end of life. The term MBO encompasses a heterogeneous
clinical syndrome, defined as obstructive symptoms due to the presence
of intra-abdominal neoplastic disease. Radiological imaging, particularly
with computed tomography, is critical in determining the cause of obstruction
and possible therapeutic interventions. Options include laparotomy
with or without a stoma, decompression with a stent, or aggressive
medical therapy. Surgical decision-making involves the selection of
the intervention most likely to relieve symptoms and improve quality of
life for a particular patient at that particular point along his or her disease
course. Although MBO is a relatively common dilemma encountered in
clinical practice, there are no simple treatment guidelines or algorithms
to follow. Instead, each patient must be assessed individually to devise
a treatment plan that best balances the advantages and disadvantages
of the intervention, considering the patient’s prognosis, tumor biology,
and—most importantly—his or her goals of care, as determined through
an honest discourse between physician and patient. This review outlines
a surgical framework for clinicians managing patients with MBO.
II. Objectives
Nurse-Centered
After the completion of this case study, the nurse will be able to:
1. Understand the current statistics and latest trend regarding Intestinal Obstruction partial
probably sec to Colonic Malignancy.
2. Describe factually, the personal and pertinent family history of the patient and relate it to the
present condition.
3. Perform comprehensive physical assessment.
4. Trace the book-based and client-centered pathophysiology of Intestinal Obstruction partial
probably sec to Colonic Malignancy.
5. Determine the predisposing and precipitating factors and the signs and symptoms and
relate to the disease process.
6. Enumerate and describe the diagnostic and laboratory procedures as well as the nursing
responsibilities in relation to the disease condition
7. Enumerate the different treatment modalities and their indication specifically for the
patient’s condition.
8. Identify the pharmacologic treatment provided to the patient, relate the actions of each drug
with the disease process and evaluate the patient’s response to the medications given.
9. Identify nursing diagnoses, formulate short-term and long-term goals, carry out appropriate
interventions and evaluate the plan.
10. Appraise the effectiveness of medical and surgical nursing management in treating the
patient.
11. List the preventive measure for the occurrence of Intestinal Obstruction partial probably sec
to Colonic Malignancy for the benefit of the general public.
Patient –Centered
After the completion of this case study, the patient will be able to:
1. Report understanding of the disease process.
2. Understand the indications of the different diagnostic procedures and medical management
involved in her care.
3. Cooperate with the necessary medical and nursing interventions.
4. Adhere with the health teachings provided.
5. Understand the different ways of health promotion and prevention in relation to the disease
condition.
6. Demonstrate improved conditions as evidenced by absence of further complications.
III. Patient’s Profile
Name: Mr. Isaw
Age: 62 years old
Birthday: February 18, 1952
Nationality: Filipino
Religion: Roman Catholic
Civil Status: Married
Date Admission: July 2, 2015
Time of Admission: 12:15 PM
Chief Complaint's: Abdominal Pain
Initial Diagnosis: Intestinal Obstruction Partial Probably sec to Colonic Malignancy
Final Diagnosis: None
HISTORY OF PAST ILLNESS
During the previous years, Mr. Isaw was diagnosed Hypertensive in 2014 and a history
of vehicular accident 20 years ago, which affected his Left femur. He is a non-smoker and non-
alcoholic. As for childhood illness, he had chicken pox and measles. He also experienced
coughs and colds for common illness. To relieve symptoms, he would take different herbal
plants or purchase over-the-counter drugs. For the herbal plants, he prepares decoction with
one to two glasses of water for fifteen minutes or until one half of the liquid is left. Then, he will
drink it. He also experienced fever once in a while in which he takes over-the-counter drugs. Mr.
Isaw, has no family history of hypertension, Diabetes, Arthymias, Pulpomonary Tuberculosis,
and Cancer. For food allergies, crab and shrimp are contraindicated but no allergies to drugs.
HISTORY OF PRESENT ILLNESS
Prior to admission, Mr. Isaw complained of sudden onset abdominal pain described as
bloatedness more prominent in the epigastric and right periumbilical area. There was no
associated nausea, vomiting, change in bowel habits, hematochezia, melena, jaundice and
fever. Patient consulted at PGH, Abdominal X-ray revealed dilated small bowels. He was then
referred to the institution for further management.
PHYSICAL ASSESSMENT
Physician’s Physical Assessment done by the Resident on Duty (July 2, 2015, lifted from the
patient's chart)
Height: 5’6
Weight: 81 kg
Vital Signs as follows:
T: 36.9 °C PR: 116 bpm RR: 18cpm BP: 150/90 mmHg SAO2: 97%
GENERAL SURVEY
Mr. Isaw, Assessed/received patient lying on bed, awake, conscious, responsive,
and coherent. With the following vital signs:
Temperature: 36.7 °C
Heart rate: 70 bpm
Respiratory rate: 20 bpm
Blood Pressure: 140/90 mmHg
SAO2: 96%
NUTRITIONAL STATUS
Upon admission, Mr. Isaw was placed on NPO and IVF of D5LR 1 x Q8. CBC,
BT, PTPTT, FBS, BUN, CREA, Na, K, Cl, 12-LECG, Chest X-ray PA, abdominal
series, and Urinalysis were requested. NGT and Foley Catheter were inserted. Mr.
Isaw, was also given Omeprazole 40mg TIV O.D.
SKIN
> Pallor noted.
> Good skin turgor in both upper and lower extremities; the skin returns to its
previous state immediately after being tented.
> warm moist skin, no active dermatoses.
HAIR
> Hair is black and is evenly distributed.
> Silky and smooth hair.
> No areas of hair loss noted.
> Thick hair strands.
NAILS
> Trimmed clean nails.
> Concave shaped; with a nail plate angle of about 160 degrees.
> Smooth in texture.
> Intact epidermal lining around the nails.
> Capillary Refill Test less than 3 seconds.
SKULL AND FACE
> Rounded (normocephalic and symmetrical with frontal, parietal and occipital
prominences).
> Head has no cervical lymphadenophaties
> No nodules or masses upon palpation.
EYES AND VISION
> Eyebrows and eyelashes are evenly distributed.
> Eyelids are intact
> Pink palpebral conjuctiva
> Sclera appears white.
> Pale conjunctiva.
> No discharges and discoloration noted.
> Blink reflex intact.
EARS AND HEARING
> Ears are symmetrical in size and in line with the outer canthus of the eyes.
> Color of ears is the same with the facial skin.
> No discharges and foul odor noted upon inspection.
> Pinna and ear canal are clean.
> Auricles are firm and recoil to previous state when folded.
> No nodules or masses noted upon palpation
NOSE AND SINUSES
> No nasal discharge
> No tenderness masses and pain noted upon palpation
OROPHARYNX (Mouth and Throat)
> Dry and pale lips noted upon inspection
> Tongue is able to move freely
> Good oral hygiene.
> Thyroid gland moves with deglutition
NECK
> Jugular vein is not visible
> Muscles are equal in size with the head centered
> Slow muscle movement
> Lymph nodes are not palpable
CARDIOVASCULAR AND PERIPHERAL SYSTEM
> Skin color of palm of the hand and feet is pink.
> Pink nail beds upon inspection.
> Symmetric pulse volumes, full pulsations of peripheral pulses.
> Heart rate is 70 beats per minute.
> Blood Pressure is 140/90 mmHg
> (Vital signs taken during the time of assessment July 2, 2015 at 0715H)
RESPIRATORY SYSTEM
> Symmetric chest expansion
> Skin and chest wall are intact and has uniform temperature
> No tenderness and masses noted upon palpation
> Regular breathing pattern
> Presence wheezing and crackles sound upon auscultation
> Full and symmetric chest wall expansion
BREAST AND AXILLAE
> Breasts are symmetrical in size; color is the same as with the abdomen.
> Both nipples are symmetrical in size.
> No discharges noted.
> No tenderness, masses, and nodules noted upon palpation.
ABDOMEN
> Direct tenderness at epigastric area.
> Abdominal skin is intact.
> Distended abdomen noted.
> Audible bowel sound upon auscultation.
> Abdominal dullness upon percussion.
MUSCULOSKELETAL
> Posture is good, able to stand straight and can walk alone properly but slowly
> Scar at left thigh and right medial leg and foot
NEUROLOGIC
>with a GCS of 15
> Patient has times of looking in the distance and is slow in response when a
question asked.
> Patient was able to answer well when asked of her complete name, birth date and
age.
URINARY SYSTEM
> Patient has indwelling Foley Catheter
REPRODUCTIVE SYSTEM
> The patient refused to be assessed with her external reproductive organ but she
verbalized that she has minimal vaginal bleeding and complain of pain when
secretions are expelled.
REVIEW OF SYSTEM
Integumentary System
The patient has no history of bruises in both upper and lower extremities.
Head
The patient had no history of any form of head injuries.
Eyes
Patient had no history of any eye problems.
Ears and Hearing
Patient had no history of smelly discharges on both ears, and no complaints of
hearing impairment.
Breast and Axillae
The patient had no history of breast nodules, no enlargement, no tenderness, no
pain and unusual discharges.
Respiratory System
The patient has no history of asthma or other respiratory problems.
Cardiovascular System
The patient has a history of hypertension.
Genitourinary System
The patient had no history of any genital problems. Usually urinates 5 times a day.
Gastrointestinal System
The patient had experienced abdominal pain.
Musculoskeletal System
Patient has no history of joint pain.
Neurologic System
Patient had no history of any major mental problems.
Cranial Nerve Assessment:
CRANIAL NERVE ASSESSMENT TECHNIQUE
EXPECTED OUTCOME
ACTUAL FINDINGS
I: OlfactoryType: SensoryFunction: Smell
Ask the client to identify a scented object that you are holding.
Client is able toidentify differentsmell with eachnostril separatelyand with eyesclosed unless suchcondition like coldsis present.
The client was able to identify the aromas of cologne and alcohol that she had smelled.
II: OpticType: Sensory
Provide adequate lighting and ask client
The client should be able to read with
The client was able to read the words in the
Function: Vision to read words on a newspaper held at a distance of 36 cm (14 inches) with each eye first then both eyes.
each eye and both eyes.
newspaper at 14 inches.
III: Oculomotor, IV: Trochlear & VI: AbducensType: MotorFunction: Upward and Downward movement of Pupils.
-Hold a penlight 1 ft. in front of the client’s eyes. Ask the client to follow the movements of the penlight with the eyes only. Move the penlight upward, downward, sideward and diagonally.
-Ask the client to look straight ahead then approach the pupil with a penlight and observe for pupil constriction.
-Client’s eyes should be able to follow the penlight as it moves.
-The client’s eyes will have a normal reaction for PERRLA.
-Both eyes of the client were able to follow the Penlight’s movements.
-The client had a normal reaction to PERRLA as Pupils are equally round, reactive to light and accommodation.
V: TrigeminalType: SensoryFunction: Sensation of cornea
While client looks upward, lightly touch the lateral sclera of eye to elicit blink reflex.
Client should have a positive corneal reflex.
The client was able to elicit corneal reflex.
VII: Facial Type: MotorFunction: Facial movements
Ask client to: smile, frown and wrinkle forehead, show teeth, puff out cheeks, purse lips, raise eyebrows, close eyes tightly against resistance
Client should smile, frown and wrinkle forehead, show teeth, puff out cheeks, purse lips, raise eyebrows, close eyes tightly against resistance. Movements are symmetrical.
The client was able to do the facial movements symmetrically.
VIII: Vestibulocochlear/ acousticsType: SensoryFunction: Hearing
Have the Client occlude one ear. Out of the client’s sight, place a tickling watch 2 cm. Ask what the client can hear and repeat with the other
Client should be able to hear the ticking of the watch in both ears.
The client was able to hear the ticking of the watch in both ears.
ear.
IX. Glossopharyngeal & X: VagusType: Motor Function: Swallowing and Speaking
Ask the client to swallow and say its name.
The client should be able to swallow without difficulty and speak audibly.
The client was able to swallow without difficulty and speak audibly.
XI. Spinal AccessoryType: MotorFunction: strength and resistance
-Ask client to shrug the shoulders against your hands.
-Ask client to turn the head against resistance, first to the right then to the left, to assess the sternocleidomastoid muscle.
-There is symmetric, strong contraction of the trapezious muscles.
-There is strong contraction of the sternocleidomastoid muscle on the side opposite to the turned face.
The client was able to symmetrically contract the trapezious muscle.
-The client was able to contract strenocleidomastoid muscleon the side opposite to the turned face.
XII: HypoglossalType: MotorFunction: Movement and strength of tongue
Ask the client to protrude the tongue and move in different directions.
The client will be able to protrude her tongue and move in different directions.
The client was able to protrude his tongue and move it in different directions.
IV. Anatomy and Physiology
The digestive system, sometimes called the gastrointestinal tract, alimentary
tract, or gut, consists of a long hollow tube which extends through the trunk of the
body, and its accessory structures: the salivary glands, liver, gallbladder, and
pancreas (Fig. 20-1). The digestive tract is divided into two sections, the upper tract,
consisting of the mouth, esophagus, and stomach, and the lower tract, consisting of
the intestines.
FIGURE 20-1 Anatomy of the digestive system with associated events.
Inside this tube, ingested food and fluid, along with secretions from various
glands, are efficiently processed. First, they are broken down into their separate
constituents; then the desired nutrients, water, and electrolytes are absorbed into
the blood for use by the cells, and waste elements are eliminated from the body.
Within this system, the liver can reassemble the component nutrients into new
materials as they are needed by the body. For example, the proteins in milk are
digested by enzymes in the digestive tract, producing the component amino acids,
which are then absorbed into the blood. The individual amino acids are used by
the liver cells to produce new proteins, such as albumin or prothrombin, or they
may circulate as they are in the amino acid pool in the blood to be taken up by
individual cells as necessary.
The peritoneal cavity refers to the potential space between the parietal and
visceral peritoneum. A small amount of serous fluid is present in the cavity to
facilitate the necessary movement of structures such as the stomach. Numerous
lymphatic channels drain excessive fluid from the cavity.
Because serous membranes are normally thin, somewhat permeable, and
highly vascular, the peritoneal membranes are useful as an exchange site for
blood during peritoneal dialysis in patients with kidney failure (see Chapter 21).
However, such an extensive membrane may also facilitate the spread of infection
or malignant tumor cells throughout the abdominal cavity or into the general
circulation.
The mesentery is a double layer of peritoneum that supports the intestines
and conveys blood vessels and nerves to supply the wall of the intestine. The
mesentery attaches the jejunum and ileum to the posterior (dorsal) abdominal wall.
This arrangement provides a balance between the need for support of the
intestines and the need for considerable flexibility to accommodate peristalsis and
varying amounts of content.
The greater omentum is a layer of fatty peritoneum that hangs from the
stomach like an apron over the anterior surface of the transverse colon and the
small intestine. The lesser omen-tum is part of the peritoneum that suspends the
stomach and duodenum from the liver. When inflammation develops in the
intestinal wall, the greater omentum, with its many lymph nodes, tends to adhere to
the site, walling off the inflammation and temporarily localizing the source of the
problem. Inflammation of the omentum and peritoneum may lead to scar tissue
and the formation of adhesions between structures in the abdominal cavity, such
as loops of intestine, restricting motility and perhaps leading to obstruction.
Intestinal Obstruction
Intestinal obstruction refers to a lack of movement of the intestinal contents
through the intestine. Because of its smaller lumen, obstructions are more common
and occur more rapidly in the small intestine, but they can occur in the large
intestine as well. Depending on the cause and location, obstruction may manifest
as an acute problem or a gradually developing situation. For example, twisting of
the intestine could cause sudden total obstruction, whereas a tumor leads to
progressive obstruction. FIGURE 20-37 Colostomy. A, sigmoid colostomy-a
surgically created opening into the colon through the abdominal wall. B, The stoma
is the new opening on the abdomen. It is always red and moist, is not painful, but
may bleed easily. C, A plastic pouch to collect stools is attached to the stoma.
(Courtesy of Hollister Incorporated, Patient Education Series.)
Intestinal obstruction occurs in two forms. Mechanical obstructions are
those resulting from tumor, adhesions, hernias, or other tangible obstructions
(Fig. 20-38). Functional, or adynamic, obstructions result from neurologic
impairment, such as spinal cord injury or lack of propulsion in the intestine, and
are often referred to as paralytic ileus. While the end result can be the same,
these types manifest somewhat differently and require different treatment.
Colon
The colon is the last part of the digestive system in most vertebrates; it extracts
water and salt from solid wastes before they are eliminated from the body, and is the site
in which flora-aided (largely bacteria) fermentation of unabsorbed material occurs. Unlike
the small intestine, the colon does not play a major role in absorption of foods and
nutrients. However, the colon does absorb water, potassium and some fat soluble
vitamins.
In mammals, the colon consists of four sections: the ascending colon, the
transverse colon, the descending colon, and the sigmoid colon (the proximal colon
usually refers to the ascending colon and transverse colon). The colon, cecum, and
rectum make up the large intestine.
The location of the parts of the colon are either in the abdominal cavity or behind
it in the retroperitoneum. The colon in those areas is fixed in location.
Arterial supply to the colon comes from branches of the superior mesenteric artery
(SMA) and inferior mesenteric artery (IMA). Flow between these two systems
communicates via a "marginal artery" that runs parallel to the colon for its entire length.
Historically, it has been believed that the arc of Riolan, or the meandering mesenteric
artery (of Moskowitz), is a variable vessel connecting the proximal SMA to the proximal
IMA that can be extremely important if either vessel is occluded. However, recent
studies conducted with improved imaging technology have questioned the actual
existence of this vessel, with some experts calling for the abolition of the terms from
future medical literature.
Venous drainage usually mirrors colonic arterial supply, with the inferior
mesenteric vein draining into the splenic vein, and the superior mesenteric vein joining
the splenic vein to form the hepatic portal vein that then enters the liver.
Lymphatic drainage from the entire colon and proximal two-thirds of the rectum is to the
paraaortic lymph nodes that then drain into the cisterna chyli. The lymph from the
remaining rectum and anus can either follow the same route, or drain to the internal iliac
and superficial inguinal nodes. The pectinate line only roughly marks this transition.
Ascending colonThe ascending colon, on the right side of the abdomen, is about 25 cm long in
humans. It is the part of the colon from the cecum to the hepatic flexure (the turn of the
colon by the liver). It is secondarily retroperitoneal in most humans. In ruminant grazing
animals, the cecum empties into the spiral colon.
Anteriorly it is related to the coils of small intestine, the right edge of the greater
omentum, and the anterior abdominal wall. Posteriorly, it is related to the iliacus, the
iliolumbar ligament, the quadratus lumborum, the transverse abdominis, the diaphragm
at the tip of the last rib; the lateral cutaneous, ilioinguinal, and iliohypogastric nerves; the
iliac branches of the iliolumbar vessels, the fourth lumbar artery, and the right kidney.
The ascending colon is supplied by parasympathetic fibers of the vagus nerve (CN X).
Arterial supply of the ascending colon comes from the ileocolic artery and right colic
artery, both branches of the SMA. While the ileocolic artery is almost always present, the
right colic may be absent in 5–15% of individuals.
Transverse colonThe transverse colon is the part of the colon from the hepatic flexure to the
splenic flexure (the turn of the colon by the spleen). The transverse colon hangs off the
stomach, attached to it by a wide band of tissue called the greater omentum. On the
posterior side, the transverse colon is connected to the posterior abdominal wall by a
mesentery known as the transverse mesocolon.
The transverse colon is encased in peritoneum, and is therefore mobile (unlike
the parts of the colon immediately before and after it). Cancers form more frequently
further along the large intestine as the contents become more solid (water is removed) in
order to form feces.
The proximal two-thirds of the transverse colon is perfused by the middle colic
artery, a branch of SMA, while the latter third is supplied by branches of the IMA. The
"watershed" area between these two blood supplies, which represents the embryologic
division between the midgut and hindgut, is an area sensitive to ischemia.
Descending colonThe descending colon is the part of the colon from the splenic flexure to the
beginning of the sigmoid colon. The function of the descending colon in the digestive
system is to store food that will be emptied into the rectum. It is retroperitoneal in two-
thirds of humans. In the other third, it has a (usually short) mesentery. The arterial
supply comes via the left colic artery.
Sigmoid colonThe sigmoid colon is the part of the large intestine after the descending colon
and before the rectum. The name sigmoid means S-shaped (see sigmoid). The walls of
the sigmoid colon are muscular, and contract to increase the pressure inside the colon,
causing the stool to move into the rectum.
The sigmoid colon is supplied with blood from several branches (usually between 2 and
6) of the sigmoid arteries, a branch of the IMA. The IMA terminates as the superior rectal
artery. Sigmoidoscopy is a common diagnostic technique used to examine the sigmoid
colon.
Redundant colonOne variation on the normal anatomy of the colon occurs when extra loops form,
resulting in a longer than normal organ. This condition, referred to as redundant colon,
typically has no direct major health consequences, though rarely volvulus occurs
resulting in obstruction and requiring immediate medical attention.[4] A significant
indirect health consequence is that use of a standard adult colonoscope is difficult and in
some cases impossible when a redundant colon is present, though specialized variants
on the instrument (including the pediatric variant) are useful in overcoming this problem.
Standing gradient osmosisWater absorption at the colon typically proceeds against a transmucosal osmotic
pressure gradient. The standing gradient osmosis is a term used to describe the
reabsorption of water against the osmotic gradient in the intestines. This hypertonic fluid
creates an osmotic pressure that drives water into the lateral intercellular spaces by
osmosis via tight junctions and adjacent cells, which then in turn moves across the
basement membrane and into the capillaries.
Functions of the ColonThere are differences in the large intestine between different organisms, the
large intestine is mainly responsible for storing waste, reclaiming water, maintaining the
water balance, absorbing some vitamins, such as vitamin K, and providing a location for
flora-aided fermentation.Vitamin K is essential as a coagulation factor.
By the time the chyme has reached this tube, most nutrients and 90% of the
water have been absorbed by the body. At this point some electrolytes like sodium,
magnesium, and chloride are left as well as indigestible parts of ingested food (e.g., a
large part of ingested amylose, protein which has been shielded from digestion
heretofore, and dietary fiber, which is largely indigestible carbohydrate in either soluble
or insoluble form). As the chyme moves through the large intestine, most of the
remaining water is removed, while the chyme is mixed with mucus and bacteria (known
as gut flora), and becomes feces. The ascending colon receives fecal material as a
liquid. The muscles of the colon then move the watery waste material forward and slowly
absorb all the excess water. The stools get to become semi solid as they move along
into the descending colon. The bacteria break down some of the fiber for their own
nourishment and create acetate, propionate, and butyrate as waste products, which in
turn are used by the cell lining of the colon for nourishment. No protein is made
available. In humans, perhaps 10% of the undigested carbohydrate thus becomes
available; in other animals, including other apes and primates, who have proportionally
larger colons, more is made available, thus permitting a higher portion of plant material
in the diet. This is an example of a symbiotic relationship and provides about one
hundred calories a day to the body. The large intestine produces no digestive enzymes -
— chemical digestion is completed in the small intestine before the chyme reaches the
large intestine. The pH in the colon varies between 5.5 and 7 (slightly acidic to neutral).
I.II.III.
Colonic Carcinoma / Colon Carcinoma / Colon Cancer
Definition:
It is a disease in which malignant (cancer) cells form in the tissues of the
colon.
The colon is part of the body's digestive system. The digestive system
removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins,
and water) from foods and helps pass waste material out of the body. The digestive
system is made up of the esophagus, stomach, and the small and large intestines.
The first 6 feet of the large intestine are called the large bowel or colon. The last 6
inches are the rectum and the anal canal. The anal canal ends at the anus (the
opening of the large intestine to the outside of the body).
Risk Factors:
Age and health history can affect the risk of developing colon carcinoma .
Risk factors include the following:
Age 50 or older.
A family history of carcinoma of the colon or rectum.
A personal history of carcinoma of the colon, rectum, ovary,
endometrium, or breast.
A history of polyps in the colon.
Signs and Symptoms:
A change in bowel habits.
Blood (either bright red or very dark) in the stool.
Diarrhea, constipation, or feeling that the bowel does not empty
completely.
Stools that is narrower than usual.
Frequent gas pains, bloating, fullness, or cramps.
Weight loss for no known reason.
Feeling very tired.
Vomiting.
A specimen removed from a patient with colonic carcinoma
V. Pathophysiology
Pathophysiology of Colon Cancer
Predisposing factors: Age (56% >70yrs
old) Colorectal polyps Family history Previous colorectal
cancer Ulcerative colitis
/colonic crohn’s disease
Etiology:Unknown
Precipitating factors: Diet – high fat/low
fiber Smoking Alcohol drinking Lack of exercise
Precipitating factors:Patient broke her right leg due to falling on the stairs
Abnormal proliferation of cells
in the colon area
Diagnostic test: Fecal occult blood
test SigmoIdoscopy Digital Rectum
Exam Barium Enema
Arising from epithelial lining of the
intestine
Benign polyps occur
Surgical Treatment: Colonoscopy Virtual Colonoscopy Polypectomy
If treated
Increase in size ot the polyps
Continuous plorifetation of cells in the polyps
Exposure to carcinogens
Reduction likelihood of regrowth
Increase in size
Uncontrolled proliferation
of cells in the tumormarrow
COLON CANCER
Continues increase in size
Metatases of cancer cells in other organs
Formation of new tumorProliferation of cancer cells
in that areaComplications occur
Development of malignant tumor
If not treated
Signs and Symptoms: Rectal bleeding Bloody stools Abdominal pain Fatigue Constipation Diarrhea Nausea and
Vomiting
If treated If not treated
Surgical Treatment: Colonoscopy Chemotherapy Radiation Therapy
Diagnostic test: SigmoIdos
copy MRI
Reduction likelihood of regrowth
DEATH