L10 Flashcards
(22 cards)
Risk factors of colorectal cancer
High animal fat, high red meat and processed meat, low fibre
Other common risk factors
Pathophysiology of colorectal cancer
Start from polyps in the inner lining of colon or rectum (usually adenomas) —> develop 10-20 years —> penetrate through the wall of colon or rectum —> invade the lymphatic nodes and vascular system —> metastasise to distant organs, usually liver
S/s of colorectal cancer
- Weight loss as 1st sign
- Diarrhea/constipation, ribbon-like stool
Black tarry stool if tumour near the proximal part of the colon (near small intestine)
Red tarry stool if haemorrhage
Stool with mucus - Abdominal pain, with pressure in lower part/rectum
- Nausea and vomiting
Diagnostic test for colorectal cancer
- Fecal occult blood screening (suggest colonoscopy if +ve)
- Check for abdominal or rectal mass
- Blood test for CBC and carcinoembryonic antigen (CEA)
Staging of colorectal cancer
Stage I: limited to bowel submucosa and muscle
Stage II: pericolic or perirectal tissue
Stage III: invade one or more lymphatic nodes
Stage IV: metastasise to other organ
Surgery for cancer in ascending, transverse, descending, or sigmoid colon
Colectomy with bowel anastomosis
Tumours of rectum
- Anterior rectosigmoid resection: resection of sigmoid colon and part of rectum
—> prevent permanent colostomy - Abdominoperineal resection: resection of part of colon, entire rectum, anus and regional lymph nodes
—> require permanent colostomy
Ileostomy
- an opening at the ileum
- output: loose, acidic
- require adequate fluid to prevent dehydration and electrolyte imbalance
Colostomy
- an opening at the colon
- protect an end-to-end anastomosis (rest and promote healing)
- procedure following bowel obstruction, abdominal trauma, or perforated diverticulum
Double-barrelled colostomy
Two separate stomas
- proximal stoma: fecal materials pass out
- distal stoma: discharge only small amount of mucus
Pre-op nursing care for ostomy
Bowel preparation to reduce risk of peritoneal contamination e.g. lavage solution
Post-op nursing care for ostomy
- Monitor vital signs and bowel sounds
- Assess for surgical site, IV site, pain level, urine output, stoma, and colostomy
- Position the patient for lung expansion; encourage deep breathing and coughing exercise
Observation of the stoma
Shape: oval to round
Size: variable, protrude around 2cm
Colour: bright to deep red
Turgor: shinny and moist
Oedema: usually subside in 6-8 weeks
Peristomal: any skin abrasion or skin breakdown
Function: colostomy, around 3-4 days from flatus to stool
Potential complications for ostomy
- Haemorrhage
- Infection
- Anastomotic leakage (abdominal distention, fever, fecal drainage)
- Paralytic ileus (abdominal distention, absence of bowel sound, vomiting)
- Stoma necrosis (dark red), acute retraction, and lesion
Post-op care for ostomy
- Prevent haemorrhage and shock: monitor BP/P, amount and nature drainage and urine output, received accurate IVF, check CBC results
- Prevent DVT and pulmonary embolism: wear TED stockings
- Prevent wound infection: monitor temperature and wound condition
- Monitor stoma and drain site condition
- Prevent paralytic ileus: monitor bowel sound, with or without NG tube suppression
- Pneumonia: check SpO2
Pathophysiology of haemorrhoids
Increased anal pressure and weakening of connective tissues that support haemorrhoids vein —> downward displacement of the haemorrhoids vein —> dilated vein —> disrupted blood flow —> intravascular clot in the venue —> thrombosed external haemorrhoid
S/s of haemorrhoid
Local pain, itching, bleeding during defecation, external haemorrhoid seldom bleed but itchy, burning and edema
Causes of haemorrhoid
Constipation, obesity, prolonged standing or sitting, pregnancy, enlargement of prostate, uterine fibroids, and rectal tumours
Diagnostic test for haemorrhoid
Physical examination, anoscopy and or flexible sigmoidoscopy
Conservative treatment for haemorrhoid
- Correct constipation: encourage high-fibre diet and supplements, adequate fluid
- Local heart or cold applications
- Administer local anaesthetic and hydrocortisone
Other treatment for haemorrhoid
Rubber band ligation, haemorrhoidectomy
Post-op care
- Promote regular bowel movement
- Administer stool softener
- Suggest sit on pillow, avoid sit on ring-shaped device
- Warm bath
- Cold or compress for comfort
