Intestinal Obstruction

Symptoms in the small bowel

Occur fast

hematochezia

passage of stools containing blood (as from diverticulosis or colon cancer or peptic ulcer).

Anorectal Disorder

Abscess - infectous area around rectum - sitz bath Fistula - opening between vagina and rectum fissure tear in annal lining stool softener and sitz surgery Hemorrhoids - rectal bleeding internal and external - treat the symptoms and S Band Polyps - massive tissue, growth maybe a precursor to cancer

clinical manifestations of mechanical obstructions

Adhesions (band of scar tissue develops after surgery, Hernias, Volvulus (twisting), intussusception (telescoping) Tumor. midabdominal pain or cramping, vomiting, obstipation, diarrhea (this is with a partial blockage) alteration in bowel pattern and stool, abdominal distention, Borborygmi - hyper loud active bowel sounds, (as this progress bowel sounds and stool decrease. Abdominal tenderness.

Screenings

Digital rectal exam annually after 40 but if risk factors sooner. Fecal occult blood test annually after 50 Colorectal screening --flexible sigmoidoscopy and colon x-ray every 5 years after 50 --colonoscopy every 10 years --barium enema - not routine - scopes are routine

Sympotoms in the large bowel

Occur slow

Postoperative care for minimally invasive inguinal hernia

Elevate scrotum to prevent and control swelling Address difficulties in voiding that may occur I & Os If they cough they need to splent. Ambulate early observe for s/s of complications they need scrotal support - hernia corset, tight underware this helps with swelling - edema

Diagnosis

FOBT Fecal Occult Blood Test Barium enema sigmoidoscopy colonoscopy for colonrectal cancer - carcinoembryonic antigen CEA (carcinoma antigen) this is a blood test that reveals this antigen it is not diagnostic by good for prognosis. Hemoglobin and hematocrit values usually decreased due to blood loss

Fistula

Fistula - opening between vagina and rectum

Other complications

If hypovolemia is severe renal insufficiency or death can result Bacterial peritonitis with or without perforation can result Bacteria in the intestinal contents lie stagnant can compromise blood flow to intestines bacteria without blood supply can form and release an endotoxin into the peritoneal or systemic circulation and cause septic shock.

Types of Hernias

Indirect inguinal more common in men can desend into scrotum Ddirect inguinal more common in men desends but not as far femoral this is more common in women who have had multipul births umbilical in children at birth incisional or ventral from surgery can be sooner or later

Obstipation

Intestinal obstruction; severe constipation

Obstruction of teh intestine

Most common reason for surgery of the small intestine. most obstructions are in the small intestine it is smaller and easier to block. In all age groups but older more at risk.

Hemoglobin

Normal Adult Female Range: 12.0 - 16.0 g/dL Normal Adult Male Range: 13.5 - 17.5 g/dL Normal Newborn Range: 14 - 20 g/dL

Hematocrit

Normal Adult Female Range: 36 - 46 percent Normal Adult Male Range 41 - 53 percent Normal Newborn Range: 49 - 61 percent

Herniation

Weakness in the abdominal muscle wall through which a segment of teh bowel or other abdominal structure protrudes.

Does the location of the blockage matter.

Yes. if high in the small intestin you have a loss of gastric hydrochloride and get metabolic alkalosis. Below the duodenum but above the large bowel loss of acids and bases so acid base is usually not compromised. At the end of teh small intestine you loss of alkaline fluids = metaboic acidosis.

Risk factors for colorectal cancer

age - 90% above 50 family history - genetic component chronic inflammatory bowel disease - increases risk diet - western diet increases risk not enough fiber weight and lifestyle - diet and inactivity = constipation

Functional (non mechanical)

aka paralytic ileus or adynamic ileus doesn't involve a physical obstruction in or outside the intestine. instead peristalisis is decreased or absent as a result of neuromuscular disturbances. parilitic ilius paralized bowel not moving nothing flows through. this results in a slowing or a backup of intestinal contents.

colorectal cancer manifestations

any changes in bowel pattern incomplete evacuation sensation cramping or pain weakness, fatigue and bleeding if more advanced rectal bleeding, hematochezia, passage of red blood via the rectum anemia change in stool texture mass in abdomen

Postoperative care for Herniorrhaphy

avoid coughing deep breath and ambulate avoid lifting to prevent recurrence assess bowel sounds routine post-op incisional care, ice, scrotal elevation scrotal support or tight fitting underwear may shower in 2 - 3 days.

Tretment for metastiasis interventions

based on staging and grading classification, radiation therapy and drug therapy

Closed loop obstruction

blockage in two diffentnt areas

Colorectal Cancer

cancer in the colon or rectum which makes up the large intestine. 95% are adenocarcinomas.

clinical manifestations of functional/paralytic ileus/non mechanical

constant diffuse discomfort Abdominal distention decreased or absent bowel sounds vomiting obstipation

Herniorrhaphy

conventional surgery with incision to repair hernia

Intestinal Obstruction definition

exists when blockage prevents the normal flow of intestinal contents through the intestinal tract. It can be partial or complete. and is classified as mechanical or non mechanical (functional)

Nursing Diagnosis

fluid vol. deficit r/t n/v, anorexia and fluid shifts Altered nutrition less than body requirements r/t dietary restrictions, n/v and malabsorption Constipation high risk for infection r/t potential perforation or intestinal contents into peritoneal cavity Abdominal pain r/t distension, obstruction, increased peristalsis

non reducable hernia aka incarcerated hernia

it becomes larger on the outside the area straggualtes - cuts off blood flow and necrosis / death of tissue results. This is an emergency they are at risk for peritonitis and sepsis.

functional/paralytic ileus/non mechanical

most common cause handling of the intestines during abdominal surgery, intestinal function is lost for a few hours or several days. This can also be caused by inflammation due to peritonitis, vascular insufficiency to bowel called intestinal ischemia. It results when arterial or venous thrombosis or an embolus decreases blood flow. Sever loss of blood flow can result in infarction of surrounding organs ie bowel.

If mass and cancer is suspected

must do a biopsy to determine malignacy

Strangulated obstruction

obstruction with compromised blood flow, risk for peritonitis is greatly increased. major blood loss into the intestin and the peritoneum can result.

Nursing diagnoses

pre op anxiety, knowledge deficit grieving post op fluid volume deficit, infection, pain body image disturbances anticipatory grieving grief of their own death prior to surgery. pt and family current methods of coping dffective sources of support in past crises client and family present methods of coping signs of anticipatory grieving like crying support groups good resource

Surgical management nursing care

preoperative NPO day of surgery The procedure is minimally invasive inguinal hernia repair (MIIHR) Scope used or Conventional herniorrhaphy this requires an incision These are elective surgeries except in emergency situations and are outpatient procedures.

Cause of most

scarr tissue

Treatment

surgery segmental resection abdominoperineal resection - A&P resection there is an incision & perineal incision Permanent or temporary colostomy - maybe stoma Resection rectum may have surgery

Fissure

tear in annal lining stool softener and

intussusception

telescoping this is more common in children they are well one day and sick the next

mechanical (obstruction) and functional/paralytic ileus/non mechanical

the intestinal contents accujmulate above the area of obstruction. distention results due to inability to absorb and move them down the tract. The lag causes an increas in effort and stimulates more secretions which leads to more distention. Then the bowel becomes edematous and increased capillary permeability results. Plasma leaks into the peritoneal cavity and fluid trapped in the intestinal lumne decreases the absorption of fluid and electrolytes into the vacular space. Reduced circulatory blood volume (hypovolemia) this is from mild to hypovolemic shock and electrolyte imbalances occur.

Mechanical

the powel is physically blocked py problems outside the intestine (adhesions), in the bowel wall (crohns), or in the intestinal lumen (tumors). can be caused also by complications of appendicitis, hernias, fecal impactions, strictures due to crohns or previous radiation telescoping (intussusception) Volvulus (twisting of the intestine) Fibrosis disorders like endometriosis vascular disorders like emboli and arteriosclerotic

Teach

to be screened, educate on risk factors, teach high fiber diet

over 65 most common cause

tumors and fecal impaction.

Volvulus

twisting this could be from trauma it is life threatening can perforate = peritoits and sepsis

Reducable hernia

you can return the bulge back to its original place by pushing on it. Some use truss. These generally cause no problems.