colonic carcinoma case study

Download Colonic Carcinoma Case Study

Post on 03-Apr-2015




0 download

Embed Size (px)


Benguet State University COLLEGE OF NURSING La Trinidad, Benguet

A Case Study on

Colonic CarcinomaPresented to the Faculty of the College of Nursing, Benguet State University In Partial Fulfillment of the Requirements in Related Learning Experience 105

Submitted by: Group 8 Audray Kyle Saydoven Noreen Paligpig Kathleen Mae Panagan Graile Pinas Aaron Rafael Perkins Shiki Charelle Reforba Warren Jae Sandoval Ma. Lorena Gabrielle Sanqui Corazon Sepulchre Marsha Sepulchre Jo-anne Bray Siadto Marinel Tabarejos Bherly Frank Tamid-ay Submitted to: Jon Erik Saluta, RN January 2011

P age |2



Patient s Information Name: Felipe Dacnas Alunday Sr. Address: Allaguia, Pinukpok, Kalinga Birthdate: June 11, 1947 Age: 63 years old Nationality: Filipino Religion: Roman Catholic Date of Admission: January 3, 2011 Time of Admission: 4.05 pm Admitting Physician: : Mathew B. Bawayan Attending Physician: Ponadon, Besarino, Douglas Admitting Diagnosis: Colonic Carcinoma S/P Anterior Resection (July 23, 2011) S/P Third Cycle Chemotherapy Principal Diagnosis: Colonic Carcinoma S/P Anterior Resection (July 23, 2011) S/P Fourth Cycle Chemotherapy Clinical History Chief Complaint: For fourth chemotherapy Review of systems: (+) Body Weakness, (-) Nausea and vomiting, (+) Anorexia, (-) Abdominal pain, (-) Constipation, (-) Diarrhea, (-)Diziness, (-) HA History of Present Illness: Present condition started when the patient was diagnosed with colon cancer last July 2010. Patient underwent colonic resection on July 2010 and was advised to undergo chemotherapy. Previous chemotherapies were done in BGHMC institution. There was associated nausea and vomiting. Patient was scheduled for his fourth chemotherapy hence admitted. Past medical History: (-) Other Hospitalization (+) HPN 2010 (-) Accidents or trauma in the past (-) Allergies Family History: (+) Hypertension, (-)DM, (-) BA, (-) CAD, (-) PTB Social and Environmental History Smoker, Non alcoholic beverage drinker

P age |3


Anatomy and Physiology 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 colon The 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.

P age |4

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 colon The 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 colon The 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 colon The 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).

P age |5

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 colon One 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 osmosis Water 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 Colon There 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

P age |6

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 un


View more >