Week 4.5: Obesity and GI Flashcards
What is the BMI of pre-obese, Class I Obesity, Class II Obesity, and Class III Obesity
Pre-obese - 25-29.9
Class I - 30-34.9
Class II - 35-39.9
Class III greater than equal to 40
We measure obesity though ___
BMI
BMI
body mass index
a measure of an adult’s weight in relation to his or her height, calculated by using the adult’s weight in kilograms divided by the square of his or her height in meters
What are some chronic conditions we are at risk for when obesity
Alzheimer Disease, Anxiety, Depression, Stroke
Asthma, Obstructive Sleep Apnea, resp infections
Non alcoholic fatty liver disease, liver cancer
thyroid cancer
CAD, MI, heart failure , HTN
Renal cancer
Type II Diabetes and Pancreatic cancer
colorectal cancer
hypercholesterolemia
prostate cancer
osteoarthritis
cholecystitis, cholelithiasis, gallbladder cancer
Treatment Options for Obesity
1 is Behavioral Modifications (diet and exercise)
- Pharmacological management
- Bariatric Surgery
What is the problem with pharmacology management for obesity
rarely do patients lose more than 10% of total body weight
Standard Treatment post Behavioral Modification for Obesity
Bariatric Surgery
How is bariatric surgery trending over time
it is trending upward (13000 in 98 to 278000 in 19)
What are the 2 mechanisms of Bariatric Surgery
- Restriction
2. Malabsorption depending on the type of surgery / Affect Absorption
Benefits of Bariatric Surgery
Total Body Weight Loss
Recovery of Chronic Illnesses
Criteria for Bariatric Surgery
- BMI greater than or equal to 40 kg/m^2
OR
- Patients with BMI greater than or equal to 35 and one or more severe obesity associated comorbid conditions
OR
- Patients with BMI greater than or equal to 30 with type 2 diabetes or metabolic syndrome
4 Major Types of Bariatric Surgery
- Biliopancreatic Diversion w/ Duodenal Switch
- Roux En Y Gastric Bypass
- Sleeve
- Gastric Banding
Biliopancreatic Diversion w/ Duodenal Switch
“Sleeve Gastrectomy w/ Duodenal Switch”
Half of stomach is removed, leaving a small area that holds about 60 mL
Jejunum is excluded from the GI tract and connected to the start of the duodenum and then the ileum on the other side
Pyloric Valve is still intact in this one
Is there risk for dumping syndrome with biliopancreatic diversion w/ duodenal switch
No there is no dumping syndrome since the pyloric valve is intact
Roux En Y Gastric Bypass
horizontal row of staples across fundus of stomach makes a pouch with a capacity of 20-30 mL - the jejunum is then divided and brought to the small pouch and then brought through roux limb
The pyloric valve is bypassed
Is there risk for dumping syndrome in Roux En Y Gastric Bypass
yes, the pyloric valve is bypassed entirely
Sleeve
Sleeve Gastrectomy
Stomach is incised vertically and up to 85% of the stomach is surgically removed, leaving a “sleeve” shaped tube that retains intact nervous innervation and dose not obstruct or decrease the size of the gastric outlet
The Gastric Sleeve can hold up to __ mL
20
Will a pt get dumping syndrome with a sleeve
no pyloric valve is left intact
Gastric Banding
a prosthetic device is used to restrict oral intake by creating a small pouch of 10-15 mL that empties through the narrow outlet into the remainder of the stomach
the band hangs outside the stomach for adjustment
many pts not successful with this procedure
What kind of bariatric surgery is being phased out
Gastric Binding
It is generally unsuccessful and also has lowest level of weight loss
What bariatric surgery leads to most excess weight loss
bilopancreatic diversion with DS
What is important to know about fluids and bariatric surgery
No fluids with meals, and avoid fluid intake 30 min before a meal and 30-60 min after a meal
Bariatric surgery postop care is similar to gastric resection but …
greater risk for complications due to obesity
What is a very important thing to do preop before bariatric surgery?
PSYCHOSOCIAL INTERVENTIONS to modify eating behaviors
What is contraindicated following a bariatric surgery
an NG tube - risk for perforation from disrupting surgical suture line
Nursing Diagnoses for Bariatric Surgery
Deficient knowledge about dietary limitations
Anxiety related to impending surgery
Acute pain related to surgical procedure
risk for deficient fluid volumes related to nausea, gastric irritation and pain
risk for infection related to anastomotic
imbalanced nutrition
disturbed body image
risk for constipation and/or diarrhea
Goals Pre and Post Op for Bariatric Surgery
preop and postop knowledge, manage anxiety
post op: manage pain, maintain homeostatic fluid balance, prevent infection, adhere to dietary instructions, vitamin supplements, lifelong follow up, positive body image, and normal bowel habits
T/F: After bariatric surgery, the average pt loses between 25-35% of presurgical body weight within the first 18-24 months post-procedure
True - pt will expect to see weight loss following bar surgery if following instructions
T/F: After bowel sounds have returned and oral intake is resumed follow bariatric surgery, 6 small feedings consisting of a total of 600 to 800 calories per day should be consumed
True
T/F: Traditionally, the term morbid obesity applies to adults whose body mass index (BMI) exceeds 40 kg/m^2
True
Risk Factors for GI Disorders
Family Hx
Lifestyle - stress, poor diet, alcohol, tobacco, smoking can all lead to these disorders - many of the disorders are associated with lifestyle behaviors
Domino Effect
Previous abdominal surgeries or trauma
Neurologic disorder
What can GERD lead to?
Barret’s esophagus –> predisposition for esophageal cancer
What can chronic gastritis lead to?
predisposition of gastric cancer
What can previous abdominal surgeries lead to
potential adhesions –> potential obstructions
What can neurological disorders like MS/Parkinsons can impair what
pt ability to move and have peristalsis which impairs movement of waste products
GERD
Backward movement of gastric or duodenal contents
makes pt feel like they are having heartburn and these episodes occur more than 2 times a week
What is the major cause of GERD
relaxation or weakness of LES (lower esophageal sphincter)
obesity can also cause GERD
Things that Trigger LES Relaxation
Fatty Food
Caffeinated Beverages
Carbonation
Chocolate
Milk
Chocolate Milk
Tobacco
Spearmint
Progesterone therapy and in surgery
NG tube also permanently impairs function
Medications: NSAIDS, Calcium Channel Blockers, Blood Pressure Meds, Nitroglycerine for chest pain
Pyloric Stenosis
Mucosal irritants - tomato’s and citrus
What to do prior to laying down for the night when you have GERD
do not eat 3 hours prior to laying down - no supine if you do
What is a classic symptom of GERD
“Waking up in the middle of the night feeling a pain in their throat or feeling heartburn”
Clinical Manifestations of GERD
Pyrosis Dyspepsia Sour Taste Hypersalivation Dysphagia Ordynophagia Eructation Fullness (even when eating a v small amount of food) - Early Satiety Nausea
Pyrosis
burning in the esophagus / heartburn
Dyspepsia
pain in the upper abdomen
Dysphagia
difficulty swallowing
Ordynophagia
Painful swallowing
Eructation
belching
When do symptoms worsen for GERD
worsens lying down, bending over, and occurs 30 min to 2 hours post meal
Non Surgical Interventions
Dont let the sphincters relax
Promote gastric emptying and avoid gastric distention
Watch those acidic foods
Medications
(eat small meals, lose some weight, stop smoking, keep HOB elevated after a meal, avoid tight clothing, avoid lying down after eating)
Surgical Intervention for GERD
Nissen Fundoplication
Nissen Fundoplication
takes the fundus and wraps it around the LES to reinforce the closing function of the sphincter
Risks of surgery of Nissen Fundoplication
Hemorrhage, Bleeding, Infection, Obstruction (If too tight)
Short bouts of temporary dysphagia
Bloating and gas buildup
Does Nissen Fundoplication cure GERD
no they still need to follow non surgical recommendations
Barretts Esophagus
w/ prolonged GERD acid erodes lining of the esophagus and turns cells of esophagus to look like the lining of the intestines
alterations can lead to esophageal cancer
Hiatal Hernia
when the opening through the diaphragm where the esophagus passes becomes enlarged and part of upper stomach moves into lower portion of the thorax
Risk Factors for Hiatal Hernias
Age
Obesity
Women more at risk
Concerns of Hiatal Hernias
Obstructions and Strangulations
What are the two types of Hiatal Hernias
- Sliding
2. Rolling
Sliding Hiatal Hernia
Gastroesophageal jxn is compromised
the stomach sits right in the esophagus
Rolling Hiatal Hernia
Gastroesophageal junction is intact or compromised
the stomach is pushed through the diaphragm and sits next to esophagus
How does a Sliding Hiatal Hernia present
can be asymptomatic
GERD symptoms
How does a Rolling HIatal Hernia Present
can be asymptomatic
GERD symptoms
breathlessness after eating
chest pain that mimics angina
feeling of suffocation
worse lying down (SOB)
since it is pushing on resp tract
Which type of hiatal hernia has a higher risk for strangulation?
Rolling Hiatal Hernia
Piece of stomach can be strangulated - leading to higher risk for strangulation
Interventions for Hiatal Hernias
limit or eliminate foods that relax LES
promote gastric emptying or avoid gastric distention (this also helps prevent movement of the hernia)
limit or eliminated foods that add fuel to the acid fire d/t acidic content (tomato and citrus)
medication reconcilliation
sleep in low fowlers position
Reglin to promote mobility and peristalsis
Gastritis
lining of the stomach is inflamed or swollen - disrupted stomach lining
over time the mucosa can erode due to this
Gastritis can be ___ or ___
acute or chronic
How long is acute gastritis compared to chronic gastritis
Acute = few hours to days
chronic = repeated exposure/recurrent episodes
What is the cause of non erosive acute gastritis
H pylori
What is the cause of erosive Gastritis
NSAIDS, motrin, ASA< Alcohol use
Why can H Pylori lead to pernicious anemia
Chronic Gastritis caused by H Pylori can destroy the parietal cells of the stomach leading to a lack of intrinsic factor production which is needed for VitB12 absorption –> therefore chronic gast. pts may need VitB12 injections lifelong
What makes gastritis worse
stress
caffeinated beverages
any triggers for GERD: smoking, spicy or highly se4asoned food, alcohol etc
What are some s/s of gastritis
acute: anorexia, epigastric pain, hemtaemesis, hiccups, melena or hematochezia, NV
Chronic: belching, early satiety, intolerance to fatty or spicy foods, NV, pyrosis, sour taste in mouth, vague epigastric discomfort relieved by eating
What are the goals for patients hospitalized for gastritis
relieving pain (abdominal)
promote fluid balance
reduce anxiety
promote optimal nutrition
Why is nutrition balance and fluid balance impaired with gastritis
they become essentially NPO and are not consuming enough calories so they arnt getting the food they need or are drinking and risk dehydration
Interventions to Treat Chronic Gastritis
If caused by H Pylori –> Combo of antibiotics
NSAIDS/Alcohol –> collaborate with health care team, educate patient, refer
smoking cessation
stress management
avoid trigger foods
focus on the mind-gut connection
Peptic Ulcer Disease (PUD)
sores in the lining of the GI system and these sores can erode at the mucosa
How does gastritis and PUD differ
Gastritis only effects the stomach lining while peptic ulcers are localized sores that can erode past the mucosal layer at least half a centimeter (deeper than gastritis)
A patient with H Pylori induced chronic gastritis is at high risk for developing
PUD
What are the 4 locations peptic ulcers can be found
Duodenum
Stomach
Pylorus
Esophagus
___ is the most common location for a peptic ulcer, and ___ is the second most common
Duodenum; Stomach
Risk Factors for PUD
age
genetics
stress
NSAID use
diet
Main Underlying Cause of PUD
H Pylori and Excessive secretion of hydrochloric acid
PUD Chief Complain
Dull gnawing burning pain in the mid epigastric area that can radiate into the back
due to radiation to the back rule out other potential causes
Nursing Management and Interventions for PUD
Dietary Modification
Smoking cessation
Pharmacologic therapy
surgical management
How is PUD diagnosed
via an upper endoscopy - provider will visualize the ulcer, lesion and inflammation
What is the drug regimen like for H Pylori infection
triple or quadruple therapy (with quadruple adding bismuth salts)
What is the timing of pain like for PUD depending on if it is duodenal or gastric
Duodenal (farther down so takes longer): 2-3 hours after a meal, occurs at night, relieved by food
Gastric - Immediately after a meal or 30-60 min after a meal, rarely at night, worse with food
What is the stomach acid secretion like for PUD depending on if it is duodenal or gastric
Duodenal - Hypersecretion
Gastric - Hypo or normal
What is weight change like with PUD depending on if it is duodenal or gastric and why?
Duodenal - Weight Gain - since food relieves the pain
Gastric - Weight Loss - since it becomes worse with food
4 Types of Surgical Interventions for PUD
Vagotomy
Pyloroplasty
Biliroth I
Biliroth II
When is surgical intervention for PUD done
if the obstruction or perforation or ulcer wont heal over 12-16 weeks
Vagotomy
Surgical Intervention for PUD
Involves severing the vagus nerve to decrease gastric acid making them less responsive to gastrin which can help prevent PUD
Pyloroplasty
Surgical Intervention for PUD
widens the opening of the lower part of the stomach so contents pass easier into the duodenum
Biliroth I (Gastroduodenostomy)
PUD Surgery
Lower portion of stomach (gastrin release area) and a small part of the duodenum and pylorus are removed and then what remains is resewn to the duodenum
Removes the pylorus so risk for dumping syndrome
Biliroth II (Gastrojejunostomy)
PUD Surgery
Removes lower portion of stomach and connects it to the jejunum
Can have dumping syndrome here
Nursing Dx for PUD
Pina
Fluid and Nutrition Balance
Anxiety
Home and Community Based Care
What are some common complications of PUD
Hemorrhage
Perforation and Penetration
Gastric Outlet Obstruction
___% of PUD pts hemorrhage and present with bloody stool or emesis
15%
What does perforation and penetration with PUD cause
erode the serousa –> gastric contents leak into peritoneum (peritonitis) –> EMERGENCY
When does gastric outlet obstruction from PUD occur
Area near pyloric sphincter is scarred and stenosed from healing ulcers over time meaning the sphincter cannot function right leading to scar tissue and obstruction
T/F: Most pepetic ulcers result from infection with the gram negative bacteria H pylori which may be acquired through ingestion of food and water
True
Currently the most commonly used therapy for peptic ulcers is a combination of ___, proton pump inhibitors, and bismuth salts that suppresses or eradicates H Pylori
Antibiotics
Chronic Constipation
Fewer than 3 BMs weekly or hard, dry, small, and difficult to pass based on normal BM schedule
Clinical manifestations of chronic constipation
straining
pain or pressure
sensation of incomplete evacuation
lumpy hard stools
fewer stools
Causes of Chronic Constipation
diet - low fiber
holding in poop
inadequate fluid intake (<8 glasses)
being a couch potato / lack of exercise
too active leading to being too busy and forgetting or not having time to BM
medications: pain meds, chronic laxative use
Hypothyroidism and Spinal Cord Injuries
Nursing Management for Chronic Constipation should focus on what
education and controlling any pain
Ways to prevent constipation
high residue high fiber diet
making sure pt is consuming enough fluids unless contraindicated
exercising
diet
Diarrhea
increased frequency of BM (more than 3 / day) and alternative consistency of the stool
When is diarrhea considered chronic
when changed consistency and 3/day stools persist 2-3 weeks or more
Clinical Manifestations of Diarrhea
Urgency
Perianal discomfort from frequency of BM and skin irritation around anus
abdominal cramping and distention
rumbling in the stomach or intestinal region
Causes of Diarrhea
stool softeners
antibiotics
tube feedings
C Diff
diabetic neuropathy or pancreatic insufficiency
inflammation
Complications of Diarrhea
dehydration!!
cardiac dysrhythmias
low potassium
skin irritation around anus
What is nursing management of diarrhea focused on
Dehydration!!!
But also:
Lyte Balance
Skin Integrity
Accurate Health Hx
Exploring Diet and IV Hydration / Lyte Replacement
Small bowel disorder leads to what stool characteristics
watery
Large bowel disorders leads to what stool characteristics
loose, semi solid
Malabsorption syndrome leads to what stool characteristics
voluminous, greasy
Inflammatory disorders leads to what stool characteristics
blood, mucus, pus
Pancreatic Insufficiency leads to what stool characteristics
oil droplets
Diabetic neuropathy leads to what stool characteristics
nocturnal frequency
C Diff leads to what stool characteristics
diarrhea, unexplained, and they are on antibiotics which can alter things
Diarrhea is defined as the increased frequency of more than 3 bowel movements per day
true
Inflammatory Bowel Disease (IBD)
A group of chronic disorders: Ulcerative colitis and Crohns disease
Ulcerative colitis
IBD
recurrent ulcerations that affect the mucosa and submucosa layers of the colon and rectum (particularly the transcending and descending colon
ulcers are often continuous/contiguous and are connected to one another
Crohn’s disease
IBD - AKA: Regional enteritis
Subacute and chronic inflammation of the GI tract that spreads deep into the tissue layers (deeper than UC) of the affected bowel tissue
Can happen anywhere mouth to anus but is typically found in the ileum and ascending colon
Has a cobblestone appearance because it does go deeper into the bowel layers
IBD is most common in what age group
15-30 year olds
Young people!: HS Students, College Students, Young Adults
Some links to smoking and active smoking for UC but needs more research
Location of UC v CD
UC - Colon
CD - Mouth to anus
What are the lesions like in UC v CD
UC - Contiguous
CD - Cobblestone / Not contiguous
What are the exacerbations like in UC v CD
UC - Exacerbations and remissions
CD - Prolonged bouts
What is the diarrhea like in UC v CD
UC: More severe (10-20 bouts QD)
CD: Less severe (5-6 bouts of QD)
Symptomology of UC v CD
UC: LLQ pain (where descending colon is), passage of mucus and pus, tenesmus (ineffective painful straining), rectal bleeding, anorexia
CD: RLQ crampy pain (ileum here), eating stimulates cramps, anorexia, steatorrhea, fever
Bleeding of UC v CD
UC: Common and severe
CD : not common and mild
Fistulas in UC v CD
UC: Rare
CD: Common
Other Complications in UC v CD
UC - Perforation, Toxic Megacolon –> Bowel perforation
CD: Bowel obstruction, abscesses, colon cancer
Surgery in UC v CD
UC: Curative (since removal can cure)
CD: Non curative (since it can be anywhere it cannot be cured)
What sort of pharmacologic treatments are done for IBD
corticosteroids and antibiotics
Big concern with IBD is ….
nutritional imbalance
the anorexia - IBD often underweight, malnutrition, malnourished - so its common (esp in CD) to see Parenteral nutrition - GI will need rest and anorexia
Biggest complication concerns of IBD
electrolyte imbalance
cardiac dysrhythmias related to electrolyte imbalances
GI bleeding with fluid volume loss
perforation of the bowel
Nursing Goals of IBD
bowel elimination
pain management
fluid volume
nutrition
fatigue
anxiety (v bad they are young)
coping
skin (frequent BM)
knowledge (deficit about IBD)
self health management
complications
Nursing Interventions for IBD
Diet, activity and stressors - nutritional therapy
ready access to restroom
pain management
fluid volume and low residue diet –> low gas diet easy to digest
rest
anxiety and coping
skin
understanding and self care
Irritable Bowel Syndrome (IBS)
chronic functional disorder associated with pain and disordered BMs
diagnosed s/s
What differentiates IBD and IBS
IBD - the doctor can do an endoscopy and visually see the ulcers
IBS - functional disorders means there is no diagnostic finding on colonoscopy (scope shows nothing) - diagnosed based on s/s
Clinical Manifestations of IBS
Disorder of frequency and consistency of stool - diarrhea to constipation back and abdominal pain/pain assoc with change in stool and stool appearance and frequency
Interventions for IBS
Education
Dietary Habits
Chew and Dont Drink with Meals - Fluid cause distention
Stress Management
T/F: The patient with IBS should select foods low in fiber in order to minimize intestinal irritation
False - want them to have high fiber foods
In Crohn’s disease, the clusters of ulcerations on the intestinal mucosae have a ___ appearance
Cobblestone
What are the 3 subclasses of Intestinal Obstructions be
Mechanical v functional
small bowel v large bowel
partial v complete
Mechanical Intestinal Obstruction
Caused from pressure on the intestinal wall and the pressure leads to adhesions, intussusception, inguinal hernia, hernia, or tumor
Functional Intestinal Obstruction
“Paralytic Obstruction”
When intestinal musculature cannot propel food, cannot do peristalsis, cannot propel weight
Common causes for Intestinal Obstructions
Endocrine Disorders and Neurological Disorders
What is the difference between partial and complete intestinal obstructions
Parial means only part of the movement is occluded; complete means nothing can move
A patient with intestinal obstruction is at significant risk for what
fluid imbalance - critically imbalanced
We want to maintain the fluid and lyte balance, insert and NG tube as orders, and be NPO
S/S of Intestinal Obstruction
Pain
May or may not have BM reported
potential mucus of blood in stool
abdomen distended!!!! (large and firm)
emesis
weakness
potential weight loss
Nursing Interventions for Bowel Obstructions
IV fluids
NG tube decompression
fluid and lyte replacement
surgery - if tissue is strangulated
fix root cause - ex: hernia
anti nausea meads- not PO, IV or suppository’s
T/F: Decompression of the bowel through a nasogastric tube is necessary for all patients with a small bowel obstruction
True - if the pt is obstructed they are getting an NG tube
General Nursing Considerations Post GI Surgery
- Resuming enteral intake (PO) - get them back up and moving
- Dysphagia
- Gastric Retention
- Bile Reflux (when pylorus removed/broken)
- Dumping Syndrome (when pylorus removed/broken)
- Vit and Min Deficiencies
Intestinal Diversion
Allows stool to leave the body when there is disease or injury
It is a pouch with a stoma that is from the wall of the colon or ileum v- brought to surface and fused with it
Ostomy location depends on…
disease and condition location - depends on where in the GI system is affected
What changes based on ostomy location
stool consistency
Colostomies
Sigmoidostomy
Descending Colon Ostomy
Transverse Colon Ostomy
Ascending Colon Ostomy
Ileostomy Stool
ostomy that bypasses the entire large intestine, so stools are liquid, frequently contain digestive enzymes, and must be pouched at all times
has lots of digestive enzymes so can be irritating to skin
How do the colostomy stools compare
Sigmoid - stool may be more solid - water absorbed
Descending - semisolid, less solid than sigmoid
Transverse - more mushy than descending
Ascending - liquid stool
Ileostomy byupasses what
colon, rectum, and anus
Which ostomy has fewest complications
Ileostomy
Colostomy
diverts colon to a stoma
Ileoanal Reservoir
essentially a “new rectum”
large intestine removed but anus remains intact and disease free
colon like pouch from last several inches of ileum
stool collects and exits during bowel movement
Continent Ileostomy (K Pouch)
For pts, with rectal or anal damage who do NOT want ostomy pouch
large intestine removed and a Kock pouch is made from the end of the ileum
effluent is then drained by inserting a catheter into a valve
Ostomy Care education should include
basic assessments
size
strict I&O
effluent monitoring
skin care and pouch care
diet and medications
monitor and report increase or decrease of effluent, stomal swelling, abdominal cramping and distention
When does effluent post ostomy surgery appear
not until 24-48 hours after surgery
Nursing Dx for Ostomy Care
Disturbed body image
Risk for impaired skin integrity r/t to irritation of the peristomal skin by the effluent
Imbalanced nutrition: less than body requirements r/t avoidance of foods
Anxiety r/t to the loss of bowel control
Risk for deficient fluid volume
Sexual dysfxn
Deficient Knowledgeo
Ostomy Irrigation
to stimulate emptying at scheduled times
note always in routine care but can help stop unplanned bowel movements or fecal drainage in social situations
gives pts control
T/F: The pt with an ileostomy with a Kock Pouch will not need to use an external collection bag
True
What is the main risk factor for esophageal cancer
barrets esophagus
what gender is more likely to get esophageal cancer
men
what race is more likely to get esophageal cancer
African American
Risk factors for esophageal cancer
smoking
ETOH use
gender
age
comorbidities
One of the number one complaints about esophageal cancer is what
dysphagia - trouble swallowing
sensation in throat or something is getting stuck
*also weight loss and weakness
by the time esophageal cancer symptoms appear
the cancer has advanced
Diagnostics for Esophageal Cancer
biopsy and endoscopy
Treatments for Esophageal cancer
chemo
radiation
re-sectioning esophagus with part of small intestine
What gender and races are more likely to get gastric cancer
men > women
native america, hispanic, african american > caucasian
Risk Factors for Gastric Cancer
poor diet
smoking
alcohol use
gastritis
How does gastric cancer present
clinical manifestations present like PUD
undiagnosed until CT scan
Diagnostic for Gastric Cancer
CT Scan
Treatments for Gastric Cancer
chemo and radiation - may be palliative not curative
total gastrectomy if it hasnt spread and is caught early
Duodenal Tumors
Usually benign and diagnosed incidentally
present asymptomatic
if severe, intermittent pain and occult bleeding occurs
can be removed with surgery
3rd most common cause of cancer death is via ____ cancer
colorectal
chief sign for colorectal cancer
change in bowel habits!!!’
*second most common manifestation is blood in stool
____ is the most prevalent cancer diagnosis in colorectal cancers
adenocarcinomas
How is colorectal cancer diagnosed
via colonoscopy and biopsy
Tenesmus
recurrent inclination to evacuate bowels - can be painful or spasming sensation
Risk Factors for colorectal cancer
increasing age - >50 yo
family hx of colon cancer or polyps
high consumption of ETOH
cig smoking
obesity
hx of gastrectomy
hx of inflammatory bowel disease
high fat, high protein (with high intake of beef), low fiber
genital cancer (endometrial CA< ovarian CA) or breast CA (in women)
S/S of Colorectal Cancer
Right Sided Lesions - Dull abdominal pain and melena
Left Sided Lesions - abdominal pain, cramping, narrowed stools, constipation, distention, bright red blood
Rectal lesion - tenesmus, rectal pain, feeling of incomplete evacuation after a BM. alternating constipation and diarrhea, bloody stool
The etiology of cancer of the colon and rectum is predominantly (90%) ____, a malignancy arising from the epithelial lining of the intestine
adenocarcinoma
