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kol- Med Surg 320 Spring > Colorectal cancer > Flashcards

Colorectal cancer Flashcards

1
Q

most colorectal cancers are in what part of colon?

A

rectosigmoid

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2
Q

most common type colon cancer (think cellular level) and most common cause

A

> Most are adenocarcinomas

>Polyps form first and can transform into CRCs

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3
Q

How does colorectal cancer spread?

A
  • Directly into tissue
  • Through lymph
  • Through blood
  • Seeding: small piece of tumor breaks off and starts to grow somewhere else?
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4
Q

Complications from colorectal cancer

A
  • Bowel obstruction
  • Bowel perforation
  • Abscess formation
  • Fistula formation - especially if there is an obstruction
  • Bleeding
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5
Q

Risk factors for CRC

A
  • Age (>45)
  • Genetics
  • Crohn’s disease
  • Familial adenomatous polyposis
  • Ulcerative colitis
  • John Cunningham virus
  • HPV
  • Smoking
  • Obesity
  • Physical inactivity
  • Heavy alcohol consumption
  • High fat diet especially with lower fiber
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6
Q

when do we start screening- average vs high risk

A
  • 45 years of age screening = average risk

* Before 45 screening starts = high risk

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7
Q

types of screening tests for CRC

A
  • FOBT (fecal occult blood test)* = testing stool for blood you cannot see, indicates bleeding, need to follow up with colonscopy
  • if test negative does not mean you do NOT have cancer, just means no blood
  • Fecal Immunochemical Test (FIT)
  • FIT DNA Test
  • Colonoscopy* - looking for precancerous polyps
  • Double contrast barium enema

> > > > conversation with provider about right test

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8
Q

what does a negative FOBT mean?

A

= testing stool for blood you cannot see, indicates bleeding, need to follow up with colonscopy
*if test negative does not mean you do NOT have cancer, just means no blood

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9
Q

assessment for CRC (general vs 3 main)

A
  • History: risk
  • Changes in bowel habits
  • Changes in stool
  • Fatigue
  • Pain
  • Abdominal fullness
  • Weight loss
  • Distension
  • Masses

3 MAIN:

  • Rectal bleeding
  • Anemia
  • Changes in stool
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10
Q

Bleeding in CRC

A
  • May be trace amounts
  • Mahogany (bleeding further up) vs Bright red (bleeding lower down)
  • Gross blood most common with tumors on left side of colon/rectum
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11
Q

• Gross blood most common with tumors on _______ side of colon/rectum

A

left

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12
Q

CRC and blockage: feels like , most common in

A
  • Most common in transverse and descending colon

* Feels like: Gas pains, Cramping, Incomplete evacuation

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13
Q

partial vs complete bowel obstruction

A 
• Partial bowel obstruction
-->Visible peristaltic waves
--> Tinkling bowel sounds
• Complete bowel obstruction
--> Absence of bowel sounds
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14
Q

Rectosigmoid Cancers characterized by

A
  • Hematochezia
  • Straining
  • Narrowing of stools
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15
Q

Right Sided Tumors characterized by (3)

A
  • Mahogany colored stools
  • Anemia
  • Palpable mass
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16
Q

diagnostics for CRC

A
  • H&H
  • Liver enzymes
  • FOBT
  • Carcinoembryonic antigen
  • Double Contrast barium enema
  • CT
  • MRI
  • CT-Guided virtual colonoscopy
  • Sigmoidoscopy –> just take a look at lower portion of colon
  • Colonoscopy –> look @ entire colon
17
Q

colonoscopy vs sigmoidoscopy

A
  • Sigmoidoscopy –> just take a look at lower portion of colon
  • Colonoscopy –> look @ entire colon
18
Q

Grossest thing I have ever seen since I have started working in healthcare

A

a ton of corn stuck in this dudes colon during his colonoscopy. It was like a disgusting treasure hunt

“What are these little easter eggs?”
said @sepik - ruining corn and easter egg hunts for the rest of my life

19
Q

Interventions for CRC

A
  • Surgery: Colon resection
  • Radiation therapy
  • Chemotherapy
  • Comfort
20
Q

Goal of surgery and approach for CRC

A 
• Goal: Remove diseased tissue
• Surgery approach depends on 
	-Size of tumor
	-Condition of colon
	-Condition of patient
	-Location of tumor
	-Extent of disease
	-Color resection
21
Q

When piece of colon is diverted through opening in abd wall in order to bypass part of colon

A

colostomy

22
Q

entire colon is removed, ileum makes stoma

A

ileostomy

23
Q

◦ Colostomy w/ mucous fistula

A

= 2 different stomas
‣ mucous fistula= bottom = drains mucous
‣ top fistula= drains stool

24
Q

2 part surgery:

  • ->remove colon and have ileostomy, form j pouch that has time to heal
  • ->then reattach ileum to j pouch at anus , more control over BM
A

◦ Ileoanal pull through

25
Q

common w/ recto sigmoid cancer, entire rectum is removed , nothing below stoma

A

• Abdoperineal Resection=

26
Q

temporary, loop of bowel is brought over through 2 openings

A

loop ostomy

27
Q

Preoperative Interventions for ostomy

A
  • WOCN meeting before surgery! (if time)
  • Bowel prep (if time)
  • Antibiotic
  • Education
28
Q

Post op interventions for CRC/ ostomy

A
  • NG tube
  • IV patient controlled analgesic
  • NPO
  • Colostomy care
  • Wound management- WOCN will only be by periodically, primary RN must follow orders and provide care as needed/assess stoma
29
Q

stoma size and color should be

A
  • Assess color (reddish-pink) frequently, ever 1 hour post-op
  • “Bud” protrudes ¾” from skin
30
Q

drainage post op from ostomy- when stool be there?

A 
• Should be working in 2-3 days
	◦ at first sanginous
	◦ serosanginous
	◦ serous 
	◦ stool
31
Q

what size wafer for ostomy?

A

-Cut wafer ⅛ - 1/16” larger than stoma

32
Q

need to put this on before putting on appliance

A

skin prep

33
Q

measure the stoma 1x weekly _____ weeks

A

6-8

34
Q

MATCH THE STOOL TYPE

ILEOSTOMY
ASCENDING
TRANSVERSE
DESCENDING

solid, pasty, liquid

A

Ileostomy= liquid

Ascending colon= liquid

Transverse colon= pasty

Descending colon= solid stool

35
Q

to all my mission peeps out there- what is your favorite stool qualifier?

A

Semi-formed Seedy Large is always a special combo to see and chart

36
Q

regardless of what kind of ostomy stool will always be what at first?

A

liquidy

37
Q

Abdominoperineal Resection Wound Management

A
  • Monitor drainage
  • JP Drains
  • Discomfort
  • Rectal pain and itching
  • Risk of infection
38
Q

Post-Acute Care interventions for CRC

A
  • Hospice
  • Home health
  • Radiation and/or chemo

kol- Med Surg 320 Spring (43 decks)

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