T12: Lower GI & Colon Cancer Flashcards
appendicitis
inflammation of the appendix, located in the inferior part of the cecum
clinical manifestations of appendicitis
o Dull periumbilical pain, anorexia, nausea and vomiting
o Pain becomes persistent and localizes between the umbilicus and right iliac crest known as McBurney’s point
o Client usually prefers to lie still, often with the right leg flexed
McBurney’s point
Pain becomes persistent and localizes between the umbilicus and right iliac crest, when examiner pushes on this area pain is relieved, when area is release there is a lot of pain
diagnostics for appendicitis
o Complete history and physical exam
o CBC with differential
o Urinalysis (to rule out UTI)
o CT scan (preferred), MRI
intervention for appendicitis
o Treatment is aimed at preventing peritonitis and removing the appendix, GET IT OUT QUICK!
o Keep client NPO until HCP evaluates for surgery
If pain suddenly disappears it could mean …
it perforated
Post op appendectomy
o NPO
o NG to low intermittent suction
o Semi-fowlers position
o IV fluids with electrolyte replacement
o Blood transfusions as needed
o Antibiotics
peritonitis
results from a localized or generalized inflammatory process of the peritoneum
primary peritonitis
blood borne organisms enter peritoneal cavity
secondary peritonitis
abdominal organs perforate or rupture spilling into the peritoneal cavity
clinical manifestations fo peritonitis
o Abdominal pain
o Tenderness over the involved area
o Rebound tenderness
o Abdominal muscular rigidity and spasm
o Abdominal distention
o Fever, tachycardia, tachypnea, nausea and vomiting
complications of peritonitis
o Hypovolemic shock
o Sepsis
o Intra-abdominal abscess formation
o Paralytic ileus
o ARDS
o Peritonitis can be fatal if treatment is delayed
diagnostics for peritonitis
o CBC with differential
o Electrolytes
o Abdominal X-ray
o CT scan or ultrasound
management for peritonitis
o NPO status
o IV fluid replacement
o NG to low intermittent suction
o O2 PRN
o Drug therapy
o ANTIBIOTICS
o Analgesics
o Antiemetics
Colorectal caner risk factors
more common in men, highest mortality in African American men and women, risk increases with age
LYNCH SYNDROME
SPECIFIC GENETIC FORM OF CANCER
IF FAMILY MEMBER HAS IT, OTHERS MAY HAVE IT TOO
hereditary nonpolyposis colon cancer, DNA repair genes messed up p96
clinical manifestations of colorectal cancer
o Insidious onset
o Symptoms often do not appear until disease is in advanced stages
- Change in bowel habits
- Unexplained weight loss
- Vague abdominal pain
- Rectal bleeding is most common (bright red bleeding)
- Alternating constipation and diarrhea
-Change in stool caliber
· Narrow, ribbonlike, color
- Sensation of incomplete evacuation
screen ing for colorectal caner
Regular screening for polyps and cancer from ages 50 to 75 years of age
colonoscopy every
10 years
Flexible sigmoidoscopy, Double-contrast barium, CT colonography every
5 years
High-sensitivity fecal occult blood test (FOBT)
stool specimen for occult blood
Fecal immunochemical test (FIT)
· Test for blood in the stool
· Must be done frequently to catch intermittent bleeding common with tumors
gold standard diagnostic for colorectal cancer
colonoscopy
clear liquid diet
a diet that consists of foods that are liquid at room temperature and leave little residue in the intestine. Ex: Water, Sprite, Ginger Ale, all beverages without any residue, broth, Jello
CARECINOEMPRIONIC ANTIGEN (CEA)
MARKER FOR CANCER, WILL NOT TELL YOU WHAT KIND OF CANCER BUT TELLS YOU THAT CANCER IS PRESENT
stage 0 colorectal cancer
cancer has not grown beyond inner layer of colon wall
stage 1 colorectal cancer
grown to outer layer of wall
stage 2 colorectal cancer
tumor is through wall, not spread to lymph nodes
stage 3 colorectal cancer
cancer
spread to lymph nodes
stage 4 colorectal cancer
cancer spreads to distant sites in body such as liver or lung
surgical therapy for colorectal cancer
-polypectomy
-may need colostomy
- chemo and radiation
COLONIC J-POUCH OR COLOPLASTY
CREATE AN ALTERNATIVE RESERVOIR THAT REPLACES RECTUM AS A RESERVOIR FOR STOOL
o The anal sphincters remain
o Temporary colostomy allows for healing
Stoma appearance should normally look
pink or red and moist/red and beefy
ileostomy stool
stool with be more thin/liquid
Colostomy stool
stool will be more formed
