LARGE BOWEL DISORDERS

PRESENTED BY- NEHA MAURYA

DIARRHEA • Increased in daily stool weight more than

200gm.

• Typically the patient may also describe an increase in stool liquidity and frequency of more than 3 times per day.

• Even one episode of liquid / semi formed stool it is considered as diarrhea.

Mechanism of diarrhea •Osmotic diarrhea : due to poorly absorbable osmotically

active solutes in the gut lumen.•Secretory diarrhea : secretion of cl and water with or

without inhibition of normal active sodium and water absorption. •Inflammation : exudation of mucus, blood and protein into

bowel lumen.•Abnormal intestinal motility : increased or decreased

contact between luminal contents and mucosal surface.

CAUSES: (many), foods, allergies, stress, milk products, tube feedings, medications, drugs&-• Infections- Bacteria: Campylobacter jejuni, E.coli, Shigella, Salmonella,

cholera vibrio, vibrio parahemolyticus etc.- Parasites: E.histolytica, G.lambia, Cryptosporidium, malaria etc.- Fungi: Candida albicans

SN. FEATURES Large Bowel diarrhea

1 Volume of stool Small

2 Color of stool Dark

3 Smell of stool Foul

4 Nature of stool Mucinous / jelly like

5 Type of stool Mucoid

6 Blood in stool Common

7 WBCs in stool Common

8 PresentTenesmus

Patient complains:

•If child:1. The child may have low grade fever, thirst, anorexia.2. Behavioral changes like irritability, restlessness, weakness,

lethargy, sleepiness, delirium, stupor 3. Physical changes like loss of weight, poor skin turgor, dry

mucus membranes, dry lips, pallor, sunken eyes, depressed fontanelles are also found.

Cont..

•Vital signs are changed as low blood pressure, tachycardia, rapid respiration, cold limbs and collapse.

•Decreased or absent urinary output.

•Convulsions and loss of consciousness may also present in some children with diarrheal diseases.

INVESTIGATION

1. Examination of the stool •Presence& absence of WBC•Occult or gross blood in the stool•Bacteria and parasitic organisms in the stool

2. Sigmoidoscopy or colonoscopy

3. Electrolytes abnormalities

Examination

• Assessment of the degree of dehydration by skin turgor , pulse , and BP measurement.

• Monitor urine output and ongoing stool losses.

COMPLICATION

Dehydration Hypovolemic shock Renal failure Paralytic ileus Toxic megacolon Malnutrition

TREATMENTElimination of the causeIV fluids and electrolytesMedications(antidiarrheal

agents-Lomotil, Imodium, Kaolin, Aluminum hydroxide)

Rehydration therapy

The management of diarrhea is a vast majority of children is best done with ORS solution and continued feeding.•ORT means drinking of solution of clean water, sugar and

mineral salt to replace the water and salt lost from the body during diarrhea, especially when accompanied by vomitting, i.e gastroenteritis.

Criteria for giving ORT•The appropriate amount of ORS solution to be given in the first

4 hours are as follows:Age less than 4 months or weight less than 5 kg- 200 to 400ml.Age 4 to 11months or weight 5 to 7.9 kg – 400 to 600 ml.Age 12 to 23 months or weight 8 to 10.9 kg – 600 to 800ml.Age 2 to 4 years or weight 11 to 15.9 kg – 800 to 1200ml.Age 5 to 14 years or weight 16 to 29.9 kg – 1200 to 2200 ml.Age 15years or older or weight 30kg or more to 2200 to

4000ml.

•During ORS therapy ,if child is having puffy eyelids, then ORS should be stopped and plain water and breastfeeding to be given

1. REHYDRATION: Sodium chloride 3.5g. Potassium chloride 1.5g. Tri sodium citrate 2.9g. glucose anhydrous 20.0g.

Home made

Nursing diagnosis• Fluid volume deficit related to diarrhea.

•Risk for cross-infection related to infective loose motion.

•Potential to altered skin integrity related to frequent passage of stools.

•Altered nutritional status, less than body requirement related to malabsorption and poor oral intake.

• Fear and anxiety related to illness and hospital procedures.

•Knowledge deficit related to causes of diarrhea and its prevention.

NURSING CONSIDERATIONS

Assess client’s fluid I&O and weight.Monitor for s/s of electrolyte disturbances and electrolyte

levels Record exact time, amount and character of each stool.Restrict client’s diet to clear liquids.Reintroduce food and fluids slowly to observe for improvement

or worsening.Client teaching that includes prevention of food contamination

with S. aureus and Salmonella.

Inability to completely evacuate the bowels or passing very hard stools is known as Constipation.

DEFINITION

CAUSES

DehydrationCancerChemical dependencyMechanical obstructionPsychosomatic disorder

Symptoms of

constipation

Headache

Abdominal bloating

Low back pain

Sense of rectal

fullness

PHARMACOLOGICAL MANAGEMENT OF CONSTIPATION

Laxatives: • promote a soft stool(eg: cellulose compound, saline products,

castor oil& dulcolax)

Cathartics• Results in a soft to watery stool with some cramping

Purgative: • is a harsh cathartic causing a watery stool with abdominal

cramping

Therapeutic Uses of enema

•Enemas can be used to provide a form of mechanical stimulation

•useful only for stool in the rectum, not in the intestinal tract.

• cleansing the colon in preparation with saline or soap water enema

•Eg: proctoclysis enema

PRECAUTION

•Constipation with N/V may indicate appendicitis and using laxatives could cause rupture•Constipation in pt after surgery•Rectal bleeding and sudden change in bowel habits may

indicate rectal cancer

NURSING CONSIDERATIONS

Warn client not to strain while defecating.Client should quit worrying Lots of fluids – drink prune juiceIncrease dietary bulk(whole grains& green leafy vegetables)ExerciseRegular schedule for defecation