Lower GI (Intestinal Obstruction, Colon Cancer, Diverticulitis

Question 1

Non-mechanical

Intestinal Obstruction

Answer 1

• Paralytic ileus, most common

* Most commonly occurs post-op abdominal surgery

Question 2

Mechanical

Intestinal Obstruction

Answer 2

• Most often occur in small intestine:
• Surgical adhesions (most common cause) – days to years postop
• Hernias
• Strictures (from Crohn’s)
• 90% of all obstructions

Question 3

Intestinal Obstruction:

Collaborative Care

Answer 3

• Decompress intestine (NG to WS)
• Correction/ maintenance of fluid & electrolytes
• Pain control, if applicable
• Removal of obstruction if necessary…

Question 4

Colorectal Cancer: Risk Factors

Answer 4

• Diet high in red/processed meat
• Obesity
• Physical inactivity
• Alcohol
• Long-term smoking
• Low intake fruits & vegetables
• Genetic/familial and history of IBD

Question 5

Colorectal Cancer: Clinical Manifestations

Answer 5

• Insidious; don’t appear until disease is advanced
• Iron-deficiency anemia
• Rectal bleeding
• Abdominal pain
• Change in bowel habits
• Intestinal obstruction/perforation

Question 6

Colorectal Cancer S&S by Location of Primary Lesion—

Transverse colon 15%

RUQ/LUQ

Answer 6

Pain, obstruction, change in bowel habits, anemia

Question 7

Colorectal Cancer S&S by Location of Primary Lesion—

Descending Colon 5%

LLQ

Answer 7

Pain, change in bowel habits,
bright red
blood in stool,
obstruction

Question 8

Colorectal Cancer S&S by Location of Primary Lesion—

Rectum and
sigmoid colon 10%

Answer 8

Blood in stool, change in bowel habits,

rectal discomfort

Question 9

Colorectal Cancer S&S by Location of Primary Lesion—

Ascending Colon 25%

RLQ

Answer 9

Pain, mass,
change in
bowel habits, anemia

Question 10

Colorectal Cancer: Diagnostic Studies

Answer 10

• Regular screening & regular removal of pre-cancerous polyps
• Colonoscopy = gold standard for CRC screening
• If average risk – colonoscopy at 50 & then every 10 years
• If African American – start at 45
• If “at risk” – earlier, and more frequent
• Fecal occult blood test = less favorable, but acceptable; once yearly

Question 11

Surgery for rectal cancer?

Answer 11

• Local excision
• Abdominal-perineal resection (APR) w/ permanent colostomy
• Low anterior resection (LAR) to preserve sphincter function (maintains normal control over defecation)

Question 12

End-to-End Anastomosis

Answer 12

This technique connects (sew) the two open ends of the intestines together. After a bowel resection. (Ex. Tumor in sigmoid colon)

No stoma

Bowels just resumes it’s normal functions once peristalsis has picked back up.

Question 13

Where does most obstructions occur?

Answer 13

Small intestine

Question 14

Most common type of intestinal obstruction?

Answer 14

Mechanical

90% of all obstructions

Question 15

Most common cause of mechanical obstruction?

Answer 15

•Surgical adhesions —days to years postop

Question 16

How to avoid complications with a patient with a paralytic ileus (usually postop)?

Answer 16

Put NG to wall suction and wait it out for the patient to have peristalsis again. Otherwise they will keep throwing up again and again.

Question 17

Gold standard for CRC (colorectal cancer) screening?

Answer 17

Colonoscopy

If average risk - at 50 & then every 10 yrs

If African American 45

If “at risk” earlier, more frequent

Question 18

Which yearly test can be an alternative to a colonoscopy?

Answer 18

Fecal occult blood test—

Cologuard product that look at genetic DNA in the stool to see if the patient has any presence of colon cancer.

Question 19

AP Resection w/ Colostomy

Answer 19

Tumor in the rectum , the surgeon removes it. Anus resected; perianal skin closed. And takes the sigmoid colon and route it to the abdomen. And so forever and ever the pt will have a descending colostomy and that is the end of their GI tract.

Question 20

Lower Anterior Resection (Anus preserved)

Answer 20

2 step surgery
Remove the tumor bring the colon to the abdomen surface and allow for healing to take place.
Use a temporary colostomy with a rectal pouch (Hartmann’s)
Until healing has taken place.
Then they will go back and re-anastomose the 2 pieces of the colon where the ostomy was it will just be an incision now and the stool comes out the rectum like it would prior to surgery.

Question 21

Diverticulosis

Answer 21

out-pouching of intestinal mucosa

Question 22

Diverticulitis

Answer 22

Flare or exacerbation of Diverticulosis itis-inflammation

Question 23

Diverticulosis manifestations

Answer 23

Asymptomatic 
Abdominal pain
Bloating
Flatulence 
Change in bowel habits

Question 24

Diverticulitis manisfestations

Answer 24

Acute pain LLQ ( lower part of the colon)
Palpable abdominal mass
s/s infection (older adult may be afebrile, no change in WBC &/ or little pain ) often confused

Question 25

Diverticulosis/itis Prevention

Answer 25

High fiber (asparagus, beans, canned peas, broccoli, squash-acorn, potatoes, blackberries, strawberries, raspberries, bran cereal, popcorn)

Low fat/ red meat intake

High levels of physical activity

Question 26

Diverticulosis/itis

Management

Answer 26

High fiber; no evidence to support need for avoidance of nuts & seeds
Weight reduction if indicated
Avoid factors that increase abdominal pressure (ex. constipation)

Question 27

Goal for Acute diverticulitis ?

Answer 27

Rest bowel & decrease inflammation

Usually make them NPO to allow gut to rest and decrease inflammation

Question 28

How to treat severe acute diverticulitis?

Answer 28

hospitalization; IVF & antibiotics

• Monitor for abscess, bleeding & peritonitis
• Surgery if complications (may involve resection/temporary ostomy)

Question 29

What happens if a diverticulum ruptured?

Answer 29

Going to get stool in the peritoneum