1. INTESTINAL OBSTRUCTION AND COLORECTAL CANCER
By: Beverly Sorreta

2. INTESTINAL OBSTRUCTION
What is Intestinal Obstruction?
Intestinal obstruction is blockage of the inside of the intestines by an actual mechanical obstruction. Some causes include adhesions (scar tissue), foreign bodies, intussusception, ischemia (decreased blood supply), hernias, volvulus (twisting) or tumors. As blockage occurs gas and air distend the bowel proximal (closest) to the blockage. As the process continues, gastric (stomach), bilious (bile from the liver used in digestion) and pancreatic secretions (secretions from the pancreas used for digestion) begin to form a pool.
Water. Electrolytes, and protein accumulate in the area, this pooling and bowel distention decreases the circulating blood volume and the blood supply to the bowel tissue

3. In newborns and infants, intestinal obstruction is commonly caused by a birth defect, a hard mass of intestinal contents (meconium), or a twisting of a loop of intestine (volvulus).
In adults, an obstruction of the first segment of the small intestine (duodenum) may be caused by cancer of the pancreas; scarring from an ulcer, a previous operation, or Crohn's disease; or adhesions, in which a fibrous band of connective tissue traps the intestine. An obstruction also can occur when part of the intestine bulges through an abnormal opening (hernia), such as a weakness in the muscles of the abdomen, and becomes trapped. Rarely, a gallstone, a mass of undigested food, or a collection of parasitic worms may block the intestine

5. Intestinal adhesions are bands of fibrous tissue that can connect the loops of the intestines to each other, or the intestines to other abdominal organs, or the intestines to the abdominal wall. These bands can pull sections of the intestines out of place and may block passage of food
adhesions

6. Signs and symptoms
Crampy abdominal pain that comes and goes (intermittent)
Nausea
Vomiting
Inability to have a bowel movement or pass gas
Swelling of the abdomen (distention)
Abdominal tenderness

7. Risk factors
You're at an increased risk of developing intestinal obstruction if you've had abdominal surgery of any kind, surgery to remove part of your intestine (bowel resection) or other pelvic surgery, previous surgery for obstruction, or if you've had your appendix surgically removed (appendectomy). These surgeries can cause adhesions, which are one of the most common causes of intestinal obstruction.
Crohn's disease — an inflammatory condition that can cause the intestine's walls to thicken, narrowing its passageway
Cancer within your abdomen, especially if you had surgery to remove an abdominal tumor
A history of constipation
Malrotation, a condition present at birth (congenital) in which the intestine doesn't develop correctly

8. Treatment
Treatment for intestinal obstruction requires hospitalization. Giving fluids through an intravenous (IV) line, putting a nasogastric (NG) tube through the nose and stomach to allow the intestines to decompress, and placing a thin, flexible tube (catheter) into your bladder to drain urine.
Specific treatment depends on the cause of condition. Complete obstruction, in which nothing can pass through your intestine, is a medical emergency that requires immediate surgery to relieve the blockage

9. Interventions Careful monitoring of fluid and electrolytes
Place patient in Fowler’s position for greater diaphragm expansion
Encourage to breathe in the nose and not shallow air, which would increase distention and discomfort
Assess bowel sounds and abdominal girth to help to determine peristalsis

10. Diagnosis
X-rays may show dilated loops of intestine that indicate the location of the obstruction. The x-rays also may reveal air around the intestine or under the layer of muscle that separates the abdomen and the chest (diaphragm). Air normally is not found in those places and thus is a sign of rupture.

11. COLORECTAL CANCER
Cancer can start in any of the four sections or in the rectum. The wall of each of these sections (and rectum) has several layers of tissues. Cancer starts in the inner layer and can grow through some or all of the other layers.
Colorectal cancer, also called colon cancer or bowel cancer, includes cancerous growths in the colon, rectum and appendix. It is the third most common form of cancer and the second leading cause of death among cancers in the Western world. Many colorectal cancers are thought to arise from adenomatous polyps in the colon. These mushroom-like growths are usually benign, but some may develop into cancer over time. The majority of the time, the diagnosis of localized colon cancer is through colonoscopy. Therapy is usually through surgery, which in many cases is followed by chemotherapy

13. Symptoms
Frequently, the patient may be asymptomatic. This is one reason why many organizations recommend periodic screening for the disease with fecal occult blood testing and colonoscopy. When symptoms do occur, they depend on the site of the lesion. Generally speaking, the nearer the lesion is to the anus, the more bowel symptoms there will be, such as:
Change in bowel habits
change in frequency (constipation and/or (spurious) diarrhoea),
change in the quality of stools
change in consistency of stools
bloody stools or rectal bleeding
Stools with mucus
Tarry stools (melena)
Feeling of incomplete defecation (Tenesmus) (only associated with rectal cancer)
Reduction in calibre of faeces (only associated with rectal cancer)
Bowel obstruction (rare)

14. Risk Factors for Colorectal Cancer
Age:
Having had colorectal cancer before:
Having a history of polyps:
Having a history of bowel disease: Two diseases called ulcerative colitis and Crohn’s disease increase the risk of colon cancer. In these diseases, the colon is inflamed over a long period of time and there may be ulcers in its lining.
Family history of colorectal cancer:
Certain family syndromes:
Ethnic background: Jews of Eastern European descent (Ashkenazi Jews) have a higher rate of colon cancer.
Diet: A diet high in fat, especially fat from animal sources, can increase the risk of colorectal cancer.
Lack of exercise:
Overweight:
Smoking:
Alcohol:

15. Treatment
The 3 main types of treatment for colorectal cancer are surgery, radiation therapy, and chemotherapy. Newer, targeted therapies called monoclonal antibodies are now being used as well. Surgery is the main treatment for colon cancer.
Chemotherapy is used to reduce the likelihood of metastasis developing, shrink tumor size, or slow tumor growth. Chemotherapy is often applied after surgery. Radiation therapy is often used before surgery to decrease the chance of cancer cells implantation at the same time of resection.

16. Diagnosis, Screening, and Monitoring
Endoscopic image of colon cancer identified in sigmoid colon on screening colonoscopy in the setting of Crohn's disease.
Digital rectal exam (DRE): The doctor inserts a lubricated, gloved finger into the rectum to feel for abnormal areas. It only detects tumors large enough to be felt in the distal part of the rectum and is not really a screening test.
Fecal occult blood test (FOBT): a test for blood in the stool.
Endoscopy:
Sigmoidoscopy: A lighted probe (sigmoidoscope) is inserted into the rectum and lower colon to check for polyps and other abnormalities.
Colonoscopy: A lighted probe called a colonoscope is inserted into the rectum and the entire colon to look for polyps and other abnormalities that may be caused by cancer. A colonoscopy has the advantage that if polyps are found during the procedure they can be immediately removed. Tissue can also be taken for biopsy.

18. Interventions Pre-op (2 or 3 days of bowel prep of GoLYTELY or enemas)
* Turning, coughing, and deep breathing, wound splinting and leg exercises
Post-op (NG tube and Foley should be monitored, meticulous wound and stoma care, deep breathing, early ambulation, adequate nutrition, pain control).

19. THE END……