Appendicitis/Peritonitis/Intestinal obstruction ect

Your role in the

**early detection of stomach cancer focuses on 1. identifying the patient at risk because of specific disorders such as -H. pylori infection, -pernicious anemia, and -achlorhydria. 2. Be aware of symptoms associated with -stomach cancer and -the significant findings on physical examination. 3. Symptoms often -occur late and -mimic other conditions, such as Peptic Ulcer Disease. 4. Poor appetite, -weight loss, -fatigue, and -persistent stomach distress are symptoms of stomach cancer. 5. Encourage patients with a positive family history of stomach cancer to undergo diagnostic evaluation if -anemia, -Peptic Ulcer Disease, or -vague epigastric distress are present. 6. It is important that you recognize the possibility of stomach cancer in a patient who is treated for -Peptic Ulcer Disease and -does not get relief with prescribed therapy.

the people that will develop appendicitis is most likely in those

1. 10 to 30 years of age. 2. A common cause of appendicitis is obstruction of the lumen by a fecalith (accumulated feces). 3. Obstruction results in -distention; -venous engorgement; and the -accumulation of mucus and -bacteria, which can lead to -gangrene, -perforation, and -peritonitis.

Diagnostic Studies: Peritonitis

1. A CBC is done to determine elevations in WBC count and -hemoconcentration from fluid shifts. 2. Peritoneal aspiration may be done with the fluid analyzed for -blood, -bile, -pus, -bacteria, -fungus, and -amylase content. 3. An abdominal x-ray may show dilated loops of bowel consistent with -paralytic ileus, -free air if perforation has occurred,or -air and fluid levels if an obstruction is present. 4. Ultrasound and -CT scans may be useful in identifying -ascites and -abscesses. 5. Peritoneoscopy may be helpful in the patient without ascites. -It allows for direct examination of the peritoneum and -the ability to obtain biopsy specimens for diagnosis. 6. Patients with milder cases of peritonitis or those who are poor surgical risks receive conservative care. 7. Treatment consists of -antibiotics, -NG suction, -analgesics, and -IV fluid administration. 8. Surgery is indicated to locate the cause of the inflammation, -drain purulent fluid, and -repair any damage ( perforated organs).

the most common symptom of peritonitis

1. Abdominal pain 2. A universal sign is tenderness over the involved area. 3. Rebound tenderness, -muscular rigidity, and -spasm are other signs of peritoneal irritation. 4. Patients may lie still and -take only shallow breaths because movement worsens the pain. 5. Abdominal distention, -fever, -tachycardia, -tachypnea, -nausea, -vomiting, and -altered bowel habits may be present. 6. These manifestations vary, depending on the severity and acuteness of the underlying condition. 7. Complications include -hypovolemic shock, -sepsis, -intraabdominal abscess formation, -paralytic ileus, and -acute respiratory distress syndrome. 8. Peritonitis can be fatal if treatment is delayed.

Interprofessional Care: Peritonitis

1. Diagnostic Assessment -History and physical examination -CBC, including WBC differential -Serum electrolytes -Abdominal x-ray - Abdominal paracentesis and culture of fluid - CT scan or ultrasound -Peritoneoscopy 2. Management Preoperative or Nonoperative -NPO status -IV fluid replacement -NG to low-intermittent suction -O2 PRN -Parenteral nutrition as needed 3. Drug Therapy -Antibiotic therapy -Analgesics (morphine) -Antiemetics as needed 4. Postoperative -NPO status -NG to low-intermittent suction -Semi-Fowler's position -IV fluids with electrolyte replacement -PN as needed -Blood transfusions as needed 5. Drug Therapy -Antibiotic therapy -Sedatives and opioids -Antiemetics as needed

The patient with peritonitis is extremely ill and needs skilled supportive care:

1. Establish IV access so that you can give replacement fluids lost to the peritoneal cavity and -have access for antibiotic therapy. 2. Monitor the patient for pain and -response to analgesics. 3. You may position the patient with knees flexed to increase comfort. 4. Sedatives may relieve anxiety and promote rest. 5. Accurate monitoring of intake and output and electrolyte status is essential to determine replacement therapy. 6. Frequently monitor vital signs. 7. Give antiemetics to decrease nausea and vomiting and -prevent further fluid and electrolyte losses. 8. Place the patient on NPO status. 9. The patient may need an NG tube to decrease gastric distention and -further leakage of bowel contents into the peritoneum. 10. Give low-flow oxygen therapy as needed. 11. If the patient had an open surgical procedure, -drains are inserted to remove purulent drainage and -excess fluid. 12. Postoperative care is similar to that for the patient who had a laparotomy

Diagnostic Studies: Intestinal Obstructions

1. Perform a thorough history and physical examination. 2. Imaging can identify an obstruction and -guide decisions about surgery. 3. Abdominal x-rays, -CT scan, or -contrast enema may be done. 4. Sigmoidoscopy or -colonoscopy provides direct visualization of an LBO. 5. Blood tests include a CBC and blood chemistries. 6. A high WBC count may mean -strangulation or -perforation. 7. Increased hematocrit values may reflect hemoconcentration. 8. Decreased hemoglobin and hematocrit values may mean -bleeding from cancer or -strangulation with necrosis. 9. Serum electrolytes, -BUN, and -creatinine are monitored to -assess the degree of dehydration. 10. Metabolic alkalosis can develop from vomiting

Causes of Peritonitis

1. Primary -Blood-borne organisms -Cirrhosis with ascites -Genital tract organisms 2. Secondary -Appendicitis with rupture -Blunt or penetrating trauma to abdominal organs -Diverticulitis with rupture -Ischemic bowel disorders -Pancreatitis -Perforated intestine -Perforated peptic ulcer -Peritoneal dialysis -Postoperative (breakage of anastomosis)

Appendicitis typically begins with

1. RLQ-dull periumbilical pain, followed by -anorexia, -nausea, and -vomiting. 2. The pain is persistent and continuous, -eventually shifting to the right lower quadrant and -localizing at McBurney's point (halfway between the umbilicus and right iliac crest). 3. A low-grade fever may develop. 4. Further assessment reveals -localized tenderness, -rigidity, -rebound tenderness, and -muscle guarding. 5. Coughing, -sneezing, and -deep inhalation worsen pain. 6. The patient usually prefers to lie still, often with the right leg flexed. 7. The older adult may report -less severe pain, -slight fever, and -discomfort in the right iliac fossa. 8. Rupture -Paralytic ileus, -diffuse pain, -abdominal distention

Manifestations of Small and Large Intestinal Obstructions

1. Small Intestine: Proximal Onset: Rapid Vomiting: Frequent and copious Pain: Colicky, cramping, occurs at frequent intervals Bowel movement: Feces for a short time Abdominal distention: Minimal 2. Small Intestine: Distal Onset: Rapid Vomiting: Less frequent Pain: Colicky, occurs more intermittently Bowel movement: Gradual constipation Abdominal distention: Increased 3. Large Intestine Onset: Gradual Vomiting: Late or absent Pain: Persistent, cramping Bowel movement: Obstipation Abdominal distention: Increased

The diagnostic studies for stomach cancer are

1. Upper GI endoscopy is the best diagnostic tool. 2. The stomach can be distended with air during the procedure, -stretching the mucosal folds. . 3. Tissue biopsy and -histologic examination - are important in diagnosing stomach cancer. 4. Endoscopic ultrasound, -CT, -MRI, and -PET scanning can be used to stage the disease. 5. Laparoscopy is done to determine peritoneal spread. 6. Blood studies detect anemia -and determine its severity. 7. Increased liver enzymes and serum amylase levels may mean liver and pancreatic involvement. 8. Stool examination provides evidence of occult or -gross bleeding. 9. The presence of tumor markers can help diagnose cancer. -Carcinoembryonic antigen (CEA) -Serum level above 2.5 mg/ml = possible CA

Pseudo-obstruction is a

1. a mechanical obstruction without any cause found on radiologic imaging. 2. It is a GI motility disorder. There are several conditions associated with pseudo-obstruction. 3. These include major surgery, -electrolyte imbalance, -neurologic conditions, -medications, -sepsis, -cancer, -trauma, and -burns

Stomach cancer probably begins with

1. a nonspecific mucosal injury because of infection (H. pylori), -autoimmune-related inflammation, -repeated exposure to irritants such as bile or -NSAIDs, and -tobacco use. 2. Stomach cancer has been associated with -diets high in smoked foods, -salted fish and -meat, and -pickled vegetables. 3. Whole grains and -fresh fruits and -vegetables are associated with reduced rates of stomach cancer. 4. Infection with H. pylori, especially at an early age, -is a risk factor for stomach cancer. -It is possible that H. pylori and -resulting cell changes can induce a sequence of transitions from -dysplasia to cancer. 5. People with lymphoma of the stomach (mucosa-associated lymphoid tissue [MALT]) are at higher risk of stomach cancer.

The 4 hallmark clinical manifestations of an obstruction are

1. abdominal pain, -nausea and -vomiting, -distention, and -constipation. 2. The order and degree these appear vary by the -cause, -location, and -type of obstruction 3. Colicky abdominal pain is usually the first symptom. 4. In SBO, the pain is often of sudden onset. 5. It occurs at 4- to 5-minute intervals for proximal obstructions and - less often for distal obstructions. 6. The nature of the vomiting gives a clue to the level of obstruction. 7. In a proximal obstruction, patients rapidly develop -nausea and -vomiting. -It may be projectile and contain bile. -Vomiting usually gives temporary relief from abdominal pain in higher obstructions. 8. Vomiting from a more distal small bowel obstruction is -more gradual in onset and -more fecal and foul smelling. 9. Bowel sounds may be high-pitched above the area of obstruction. 10. Bowel sounds are usually absent with paralytic ileus. 11. Signs of LBO include abdominal distention, -either obstipation or -a marked change in bowel function, and -lack of flatus. 12. The patient has persistent, cramping abdominal pain. -Bowel sounds are usually present and become progressively hypoactive. -Vomiting is rare. 13. Strangulation causes severe, constant pain that is rapid in onset. 14. With both types, abdominal tenderness and -rigidity occur. 15. The patient appears acutely ill, with signs of dehydration and sepsis. 16. These include -tachycardia, -dry mucous membranes, and -hypotension. 17. The patient's temperature may rise above 100°F (37.8°C)

Stomach (gastric) cancer is an

1. adenocarcinoma of the stomach wall. 2. stomach cancer has been steadily declining in the United States. 3. Asian Americans, -Pacific Islanders, -Hispanics, and -blacks have higher rates of stomach cancer than non-Hispanic whites. 4. incidence is higher in men than in women 5. Stomach cancer mostly affects older people 40-70. 6. more than 50% have advanced metastatic disease.

Stomach cancers often spread to

1. adjacent organs before any distressing symptoms occur. 2. Manifestations include -unexplained weight loss, indigestion, -abdominal discomfort or pain, -signs and symptoms of anemia. 3. The patient may report early satiety, or -a sense of being full sooner than usual. 4. Anemia is common. -It is caused by chronic blood loss as the lesion erodes through the mucosa or -from pernicious anemia -caused by loss of intrinsic factor 5. The person appears pale and weak. 6. They may report -fatigue, -weakness, -dizziness, and, in -extreme cases, -shortness of breath. 7. The stool may be positive for occult blood. 8. Supraclavicular lymph nodes that are hard and -enlarged suggest metastasis via the thoracic duct. 9. The presence of ascites is a poor prognostic sign.

When diagnostic tests confirm cancer, Because of changes in

1. appetite and -early satiety, -the patient may be malnourished. 2. Surgery may be delayed until the patient is more physically able to withstand it. 3. A positive nutritional state enhances wound healing and -the ability to deal with infection -and other possible postoperative complications. 4. The patient may better tolerate several small meals a day than 3 regular meals. 5. It may be challenging to persuade the patient to eat when he or she has no appetite and is depressed. 6. Getting the patient's caregiver to help with meals -and encourage intake may be beneficial. 7. Diet may be supplemented by commercial liquid supplements and vitamins. 8. If the patient is unable to ingest oral feedings, -the HCP may prescribe EN or PN 9. If needed, packed RBCs and fluid volume restoration may be given during the preoperative period. 10. Radiation therapy or chemotherapy is used as an adjuvant to surgery -or for palliation. 11. Your role is to provide detailed instructions, -reassure the patient, and -ensure completion of the designated number of treatments. 12. Teach the patient about skin care, -need for nutrition and -fluid intake, and -the use of antiemetic drugs

Stomach cancer: Other predisposing factors include

1. atrophic gastritis, -pernicious anemia, -adenomatous polyps, -hyperplastic polyps, and -achlorhydria (absent or low production of gastric HCl). 2. Smoking and obesity -both increase the risk for stomach cancer. 3. Although first-degree relatives of patients with stomach cancer are at increased risk, only about 10% of stomach cancers have an inherited component. 4. Stomach cancer spreads by direct extension and -typically infiltrates rapidly to the surrounding tissue and liver. 5. Seeding of tumor cells into the peritoneal cavity occurs late in the course of the disease.

short bowel syndrome: Patients often take multiple medications to help

1. control fecal output. 2. PPIs, -H2 blockers, -α-adrenergic receptor agonists (e.g., clonidine), or -octreotide reduce excess fluid secretion. 3. Opioid antidiarrheal drugs decrease intestinal motility 4. For patients who have limited ileal resections, -cholestyramine reduces diarrhea resulting from -unabsorbed bile acids by increasing their excretion in feces. 5. Bile acids stimulate intestinal fluid secretion and -reduce colonic fluid absorption. 6. Antibiotic therapy is used if bacterial overgrowth is contributing to diarrhea.

Intestinal Obstruction: Monitor the patient closely for signs of

1. dehydration and electrolyte imbalances. -Give IV fluids as ordered. -Assess for signs and symptoms of fluid imbalance. 2. Some patients, especially older adults, may not tolerate rapid fluid replacement. 3. Monitor serum electrolyte levels closely. 4. A patient with a high intestinal obstruction is more likely to have metabolic alkalosis. 5. A patient with a low obstruction is at greater risk for metabolic acidosis. 6. The patient is often restless and constantly changes position to relieve the pain. 7. Provide comfort measures and -promote a restful environment. 8. With an NG tube in place, -oral care is extremely important. -Vomiting leaves an unpleasant taste in the patient's mouth, and -fecal odor may be present. 9. The patient breathes through the mouth, -drying the mouth and -lips. 10. Provide frequent oral care and -water-soluble lubricant for the lips. 11. Check the nose for signs of irritation from the NG tube. 12. Clean and dry this area daily, -apply water-soluble lubricant, and -retape the tube. 13. Check the NG tube every 4 hours for patency.

short bowel syndrome: Refer the patient to a

1. dietitian. 2. The ideal diet is high in protein and -complex carbohydrates and -low in fat and -concentrated sweets. 3. Oral supplements of -calcium, -zinc, and -multivitamins may be needed. 4. Soluble fiber is encouraged if the colon is present. 5. The patient should eat at least -6 small meals per day -to increase the time of contact between food and the intestine. 6. Oral intake may be supplemented with elemental nutrient formulas and -tube feeding during the night. 7. Patients with severe malabsorption may need PN

short bowel syndrome: Intestinal transplantation is

1. done at a few specialized transplant centers in the United States. 2. It is considered the only long-term treatment option for patients with intestinal failure who have significant complications from PN or nutrition failure. 3. The leading cause of intestinal failure is SBS. 4. Transplantation may include -the intestine alone, -liver and -intestine, or -multivisceral combinations -stomach, -duodenum, -jejunum, -ileum, -colon, and/or -pancreas

short bowel syndrome: The treatment goals are that the patient will have

1. fluid and electrolyte balance, -normal nutritional status, and -control of diarrhea. 2. The main treatment is -nutritional support involving PN, -EN, -medications, and -a tailored diet. 3. In the immediate period after massive bowel resection, patients receive -PN to replace fluid, -electrolyte, and -nutrient losses and to rest the bowel. 4. Those with severe resections will need PN indefinitely. 5. EN and -a normal diet are gradually resumed to stimulate the remaining intestine to function better. 6. Some can eventually stop PN.

Patient examination includes a complete

1. history, 2. physical examination, and a 3. differential WBC count. 4. Most patients have a mildly to moderately high WBC count. 5. A urinalysis is done to rule out genitourinary conditions that mimic appendicitis. -Pregnancy test (rule out ectopic pregnancy 6. CT scan is the preferred diagnostic procedure. -However, ultrasound and MRI are options. 7. If there is a delay in diagnosis and treatment, -the appendix can rupture and the resulting peritonitis can be fatal. 8. The standard treatment of appendicitis is an immediate appendectomy (surgical removal of appendix). 9. If the inflammation is localized, surgery should be done as soon as the diagnosis is made. 10. Antibiotics and fluid resuscitation are started before surgery. 11. If the appendix has ruptured and there is evidence of -peritonitis or -an abscess, -giving parenteral fluids and antibiotic therapy for 6 to 8 hours before the appendectomy helps prevent dehydration and sepsis.

Appendicitis is

1. inflammation of the appendix, a narrow blind tube that extends from the inferior part of the cecum. 2. It is the most common reason for emergency abdominal surgery 3. Fills with food and empties into the cecum 4. Prone to infection or obstruction due to small size 5. 4 in long.

Intestinal obstruction occurs when

1. intestinal contents cannot pass through the GI tract. 2. The obstruction may occur in the -small (SBO) or -large (LBO) intestine. 3. It can be partial or -complete, -simple or -strangulated. 4. Partial obstructions do not completely occlude the intestinal lumen, -allowing for some fluid and gas to pass through. -They usually resolve with conservative treatment. 5. A complete obstruction totally occludes the lumen and -usually requires surgery. 6. A simple obstruction has an intact blood supply; -a strangulated one does not

A number of chemotherapy drugs can be used to treat stomach cancer.

1. intraperitoneal administration of chemotherapy agents may also be used to treat metastatic disease. 2. Radiation therapy may be used together with chemotherapy to -reduce the recurrence or -as a palliative measure to decrease tumor mass and -provide temporary relief of obstruction.

Intestinal Obstruction: If blood flow is inadequate, bowel tissue becomes

1. ischemic, then -necrotic, and -the bowel may perforate. 2. In the most dangerous situation the bowel becomes so distended that the blood flow stops, - causing edema, -cyanosis, and -gangrene of a bowel segment. 3. This is called intestinal strangulation or -intestinal infarction. 4. If not quickly corrected, -the bowel will become -necrotic and -rupture, -leading to infection, -septic shock, and -death. 5. The location of the obstruction determines the extent of fluid, -electrolyte, and -acid-base imbalances. 6. If the obstruction is high ( upper duodenum), -metabolic alkalosis may result from the loss of gastric hydrochloric (HCl) acid through vomiting or -NG intubation and suction. 7. When the obstruction is in the small intestine, -dehydration occurs rapidly. 8. Dehydration and electrolyte imbalances do not occur early in large bowel obstruction. 9. If the obstruction is below the proximal colon, -solid fecal material accumulates until symptoms of discomfort appear

Peritonitis results from a

1. localized or generalized inflammatory process of the peritoneum 2. occurs when blood-borne organisms enter the peritoneal cavity. -For example, the ascites that occurs with cirrhosis of the liver provides an excellent liquid environment for bacteria to flourish. -Organisms can enter the peritoneum during peritoneal dialysis. 3. Secondary peritonitis is much more common. 4. It occurs when abdominal organs perforate or rupture and release their contents -bile, -enzymes, and -bacteria into the peritoneal cavity. 5. Common causes include a -ruptured appendix, -perforated gastric or -duodenal ulcer, -severely inflamed gallbladder, and -trauma from gunshot or -knife wounds. 6. Intestinal contents and bacteria irritate the normally sterile peritoneum and produce an initial chemical peritonitis. -Bacterial peritonitis develops a few hours later. 7. The resulting inflammatory response leads to massive fluid shifts (peritoneal edema) and -adhesions as the body tries to wall off the infection. 8. Peritoneum is normally sterile

Short bowel syndrome results in reduced

1. nutrient, -fluid, and -electrolyte absorption. 2. This leads to -dehydration, -weight loss, -diarrhea, -malnutrition, -vitamin deficiencies, and -electrolyte imbalances. 3. Other manifestations include -abdominal pain, -flatulence, and -steatorrhea. 4. The patient may develop lactase deficiency and -bacterial overgrowth. 5. Those who do not receive appropriate nutrition may have manifestations associated with specific deficiencies. -For example, patients may have peripheral neuropathy from -vitamin B12, -vitamin E, -copper, or -thiamine deficiencies or -fatigue due to anemia from decreased folate or iron

The assessment of a person with stomach cancer

1. obtains information about appetite and -changes in eating patterns over the previous 6 months. 2. Determine the patient's normal weight and -any recent weight changes. 3. Unexplained weight loss and anorexia are common. 4. Evaluate the patient's nutritional status. 5. Cachexia may be present if oral intake has been reduced for an extended period. 6. A malnourished patient does not respond well to chemotherapy or radiation therapy and - is a poor surgical risk. 7. The patient may report a history of vague abdominal symptoms, including -dyspepsia and -intestinal gas discomfort or -pain. 8. If the patient reports pain, explore where and when it occurs and -how it is relieved. 9. Determine the patient's personal perception of the health problem and -method of coping with hospitalization, -diagnostic tests, and -procedures. 10. A possible diagnosis of cancer and -a treatment plan that may include -surgery, -chemotherapy, or -radiation treatment is stressful. 11. If surgery is planned, -assess the patient's expectations about surgery (cure or palliation) and -how the patient has responded to previous surgical procedures.

A nonmechanical obstruction occurs with

1. occurs with reduced or -absent peristalsis due to altered neuromuscular transmission of the parasympathetic innervation to the bowel. 2. It may result from a neuromuscular** or -vascular disorder. **** 3. Paralytic ileus -lack of intestinal peristalsis and -bowel sounds is the most common form of nonmechanical obstruction.* 4. It occurs to some degree after any abdominal surgery. 5. It can be hard to know if a postoperative obstruction is due to -paralytic ileus or -adhesions. 6. One clue is that bowel sounds usually return before postoperative adhesions develop. 7. Other causes of paralytic ileus include peritonitis, inflammatory responses -acute pancreatitis, -acute appendicitis 8. electrolyte abnormalities -especially hypokalemia, and -thoracic or -lumbar spinal fractures. Vascular obstructions are rare. They are the result of an interference with the blood supply to a part of the intestines. The most common causes are emboli and atherosclerosis of the mesenteric arteries. Emboli may originate from thrombi in patients who have chronic atrial fibrillation, diseased heart valves, and prosthetic valves. Venous thrombosis may occur in conditions of low blood flow, such as heart failure and shock.

Intestinal obstruction is a potentially life-threatening condition. Major concerns are

1. preventing fluid and -electrolyte deficiencies and -early recognition of deterioration in the patient's condition - hypovolemic shock, -sepsis, -bowel strangulation. 2. Nursing assessment begins with a detailed patient history and -physical examination. 3. Determine the location, -duration, -intensity, and -frequency of abdominal pain. 4. Record the onset, -frequency, -color, . -odor, and -amount of vomitus. 5. Assess bowel function, including the -passage of flatus. 6. Auscultate for bowel sounds and -document their character and location. 7. Inspect the abdomen for scars, -visible masses, and -distention. 8. Assess whether abdominal tenderness or -rigidity is present. 9. Measure the abdominal girth. 10. Check for signs of peritoneal irritation -muscle guarding, -rebound pain 11. If the HCP decides to wait to see if the obstruction resolves on its own, -assess the patient regularly. 12. Notify the HCP of changes in -vital signs, -changes in bowel sounds, -decreased urine output, -increased abdominal distention, and -pain. 13. Maintain a strict intake and output record, -including emesis and tube drainage. 14. A urinary catheter allows for hourly monitoring of urine output. - Report if the urine output is less than 0.5 mL/kg of body weight per hour. -This indicates inadequate vascular volume and -the potential for acute kidney injury. 15. Rising serum creatinine and BUN levels are other indicators of acute kidney injury.

Managing the patient who has manifestations of appendicitis focuses on

1. preventing fluid volume deficit, -relieving pain, and -preventing complications. 2. To ensure the stomach is empty in case surgery is needed, -keep the patient NPO until the HCP evaluates the patient. 3. Monitor vital signs and perform ongoing assessment to detect any deterioration in condition. 4. Give IV fluids, -analgesics, and -antiemetics as ordered. 5. Provide comfort measures. -Avoid laxatives and enemas 6. Patients are usually discharged within 24 hours after an uncomplicated laparoscopic appendectomy. 7. Ambulation begins a few hours after surgery, and -the diet is advanced as tolerated. 8. Those who had a perforation usually have a longer length of stay and need IV antibiotic therapy. 9. Most patients resume normal activities 2 to 3 weeks after surgery.

Short bowel syndrome (SBS) is a condition in which the

1. small intestine does not have enough surface area to absorb enough nutrients. 2. This leaves the person unable to meet -energy, -fluid, -electrolyte, and -nutritional needs to stay healthy on a normal diet. 3. Causes of SBS include -diseases that damage the intestinal mucosa, -surgical removal of too much small intestine -with Crohn's disease, -cancer, and -congenital defects.

short bowel syndrome: Three drugs have FDA approval for the treatment of SBS:

1. somatropin, 2. glutamine, and 3. teduglutide (Gattex). -Somatropin enhances intestinal adaption and -increases the flow of water, -electrolytes, and -nutrients into the bowel. 4. Glutamine improves intestinal absorption. 5. Teduglutide increases the surface area of the intestine and -improves intestinal absorption of fluids and nutrients.

If a strangulated obstruction or perforation is present

1. the patient will need emergency surgery to relieve the obstruction and survive. 2. In some, especially those due to surgical adhesions, -an obstruction may resolve without surgery.** 3. Surgery may involve simply resecting the obstructed segment of bowel and -anastomosing the remaining healthy bowel back together. 4. Partial or -total colectomy, -colostomy, or -ileostomy may be done when extensive obstruction or necrosis is present. 5. Sometimes, an obstruction can be removed nonsurgically. 6. Colonoscopy offers a means to -remove polyps, -dilate strictures, and -remove and destroy tumors with a laser. 7. The initial treatment includes placing the patient on -NPO status, -providing IV fluid therapy with either -normal saline or - lactated Ringer's solution, and -giving IV antiemetics. 8. If needed, insert an NG tube for decompression and -give ordered electrolyte replacement. 9. Obtain blood cultures and -start IV antibiotic therapy. 10. Some patients need PN to allow bowel rest and -improve nutritional status before surgery. 11. The treatment goal for a patient with a malignant obstruction is to regain patency and -resolve the obstruction. 12. Malignant tumor: -Stents can be placed via endoscopic or fluoroscopic procedures. -They are used for palliative purposes or as "a bridge to surgery," -allowing a patient to avoid emergency surgery. -This gives the interprofessional team time to correct fluid volume problems and -treat other problems, thus improving surgical outcomes. 13. Corticosteroids with antiemetic properties that decrease edema and inflammation may be used with stent placement.

The surgical aim is to remove as much of the stomach as required to remove

1. the tumor and -a margin of normal tissue. 2. The location and extent of the lesion, -the patient's physical condition, and -the HCP's preference determine the specific surgery used 3. Lesions in the antrum or pyloric region are generally treated by either a Billroth I or II procedure 4. When the lesion is in the fundus, a total gastrectomy with esophagojejunostomy is done 5. When metastasis has occurred to -adjacent organs, such as the -spleen, -ovaries, or -bowel, -the surgical procedure is extended as needed. 6. If the tumor extends into the transverse colon, -partial colon resection is done. 7. Surgical removal of the tumor if possible, and -palliative care if the tumor is un-resectable or metastasized 8. Surgical Removal -Colostomy (temp. or perm.) -Ileostomy (temp. or perm.) -Total gastrectomy

In mechanical obstruction

1. there is a physical obstruction of the intestinal lumen. 2. Most intestinal obstructions occur in the small intestine***. -Surgical adhesions are the most common cause of SBO. -They can occur within days of surgery or years later. -Other causes of SBO are -hernia, -cancer, -strictures from Crohn's disease, and -intussusception after bariatric surgery. 3. The most common cause of LBO is -colorectal cancer (malignant obstruction) followed by diverticular disease. 4. Other causes include -adhesions, -ischemia, -volvulus, and -Crohn's disease.

Vascular obstruction

are rare. 2. They are the result of an interference with the blood supply to a part of the intestines. 3. The most common causes are emboli and -atherosclerosis of the mesenteric arteries. 4. Emboli may originate from thrombi in patients who have -chronic atrial fibrillation, -diseased heart valves, and . -prosthetic valves. 5. Venous thrombosis may occur in conditions of low blood flow, such as -heart failure and -shock

Intestinal Obstruction: About 6 to 8 L of fluid enter the

small intestine daily 1. Most of the fluid is absorbed before it reaches the colon. 2. Around 75% of intestinal gas is swallowed air. 3. When an obstruction occurs, -fluid, -gas, and -intestinal contents accumulate proximal to the obstruction. 4. Distention reduces fluid absorption and -initially stimulates intestinal secretions. 5. Distal to the obstruction, -the bowel empties, and -then collapses. 6. As distention increases in the proximal bowel, -intraluminal bowel pressure rises. 7. The increased pressure leads to an increase in capillary permeability and -extravasation of fluids and electrolytes into the peritoneal cavity. 8. Eventually the intestinal muscle becomes fatigued, and -peristalsis stops. 9. Retention of fluids in the intestine and - peritoneal cavity leads to a severe reduction in circulating blood volume. 10. This leads to hypotension and hypovolemic shock

The treatment of choice for stomach cancer is

surgical removal of the tumor. 1. Preoperative management focuses on -correcting nutritional deficits and -treating anemia. 2. Transfusions of packed RBCs correct the anemia. 3. If gastric outlet obstruction occurs, -gastric decompression may be needed before surgery.

The causes of intestinal obstruction are either

1. mechanical 2. Nonmechanical.