Our Lady of Fatima UniversityCollege of Nursing

Valenzuela Campus

Intestinal Obstruction Partial Probably sec to Colonic Malignancy

A Case Study

Presented to:

Ms. Vanessa O. Umali, R.N. MAN

Presented by:

Maria Paula M. Bungay

July 2015

TABLE OF CONTENTS

I. Introduction

II. Objectives

III. Patient’s Profile

IV. Anatomy and Physiology

V. Pathophysiology

VI. Laboratory Examination Results

VII. Gordon’s Assessment

VIII. Nursing Care Plans

IX. Drug Study

X. Discharge Planning

I. Introduction

Intestinal obstruction

Intestinal obstruction is a partial or complete blockage of the bowel that results in the failure of the intestinal contents to pass through.

Causes

Obstruction of the bowel may due to:

A mechanical cause, which simply means something is in the way Ileus, a condition in which the bowel doesn't work correctly but there is no

structural problem

Paralytic ileus, also called pseudo-obstruction, is one of the major causes of intestinal obstruction in infants and children. Causes of paralytic ileus may include:

Chemical, electrolyte, or mineral disturbances (such as decreased potassium levels)

Complications of intra-abdominal surgery Decreased blood supply to the abdominal area (mesenteric artery ischemia) Injury to the abdominal blood supply Intra-abdominal infection Kidney or lung disease Use of certain medications, especially narcotics

In older children, paralytic ileus may be due to bacterial, viral, or food poisoning (gastroenteritis), which is sometimes associated with secondary peritonitis and appendicitis.

Mechanical causes of intestinal obstruction may include:

Abnormal tissue growth Adhesions or scar tissue that form after surgery Foreign bodies (ingested materials that obstruct the intestines) Gallstones Hernias Impacted feces (stool) Intussusceptions Tumors blocking the intestines Volvulus (twisted intestine)

Symptoms

Abdominal distention Abdominal fullness, gas Abdominal pain and cramping Breath odor Constipation Diarrhea Vomiting

Site of Obstruction Cause Relative Incidences (%)

Small intestine [85%]

Adhesions 60

Hernia 15

Tumors 15

miscellaneous 10

Large Intestine [15%]

CA colon 65

Diverticulitis 20

Volvolus 5

miscellaneous 10

Abstract

The management of patients with malignant bowel obstruction

(MBO) can be one of the most challenging aspects of advanced cancer

care, and as a result, their symptoms are often palliated poorly, especially

near the end of life. The term MBO encompasses a heterogeneous

clinical syndrome, defined as obstructive symptoms due to the presence

of intra-abdominal neoplastic disease. Radiological imaging, particularly

with computed tomography, is critical in determining the cause of obstruction

and possible therapeutic interventions. Options include laparotomy

with or without a stoma, decompression with a stent, or aggressive

medical therapy. Surgical decision-making involves the selection of

the intervention most likely to relieve symptoms and improve quality of

life for a particular patient at that particular point along his or her disease

course. Although MBO is a relatively common dilemma encountered in

clinical practice, there are no simple treatment guidelines or algorithms

to follow. Instead, each patient must be assessed individually to devise

a treatment plan that best balances the advantages and disadvantages

of the intervention, considering the patient’s prognosis, tumor biology,

and—most importantly—his or her goals of care, as determined through

an honest discourse between physician and patient. This review outlines

a surgical framework for clinicians managing patients with MBO.

II. Objectives

Nurse-Centered              

After the completion of this case study, the nurse will be able to: 

1. Understand the current statistics and latest trend regarding Intestinal Obstruction partial

probably sec to Colonic Malignancy.

2. Describe factually, the personal and pertinent family history of the patient and relate it to the

present condition. 

3. Perform comprehensive physical assessment. 

4. Trace the book-based and client-centered pathophysiology of Intestinal Obstruction partial

probably sec to Colonic Malignancy.

5. Determine the predisposing and precipitating factors and the signs and symptoms and

relate to the disease process. 

6. Enumerate and describe the diagnostic and laboratory procedures as well as the nursing

responsibilities in relation to the disease condition  

7. Enumerate the different treatment modalities and their indication specifically for the

patient’s condition. 

8. Identify the pharmacologic treatment provided to the patient, relate the actions of each drug

with the disease process and evaluate the patient’s response to the medications given. 

9. Identify nursing diagnoses, formulate short-term and long-term goals, carry out appropriate

interventions and evaluate the plan. 

10. Appraise the effectiveness of medical and surgical nursing management in treating the

patient. 

11. List the preventive measure for the occurrence of Intestinal Obstruction partial probably sec

to Colonic Malignancy for the benefit of the general public.

Patient –Centered

After the completion of this case study, the patient will be able to: 

1. Report understanding of the disease process. 

2. Understand the indications of the different diagnostic procedures and medical management

involved in her care. 

3. Cooperate with the necessary medical and nursing interventions. 

4. Adhere with the health teachings provided. 

5. Understand the different ways of health promotion and prevention in relation to the disease

condition.  

6. Demonstrate improved conditions as evidenced by absence of further complications.

III. Patient’s Profile

Name: Mr. Isaw

Age: 62 years old

Birthday: February 18, 1952

Nationality: Filipino

Religion: Roman Catholic

Civil Status: Married

Date Admission: July 2, 2015

Time of Admission: 12:15 PM

Chief Complaint's: Abdominal Pain

Initial Diagnosis: Intestinal Obstruction Partial Probably sec to Colonic Malignancy

Final Diagnosis: None

HISTORY OF PAST ILLNESS

During the previous years, Mr. Isaw was diagnosed Hypertensive in 2014 and a history

of vehicular accident 20 years ago, which affected his Left femur. He is a non-smoker and non-

alcoholic. As for childhood illness, he had chicken pox and measles. He also experienced

coughs and colds for common illness. To relieve symptoms, he would take different herbal

plants or purchase over-the-counter drugs. For the herbal plants, he prepares decoction with

one to two glasses of water for fifteen minutes or until one half of the liquid is left. Then, he will

drink it. He also experienced fever once in a while in which he takes over-the-counter drugs. Mr.

Isaw, has no family history of hypertension, Diabetes, Arthymias, Pulpomonary Tuberculosis,

and Cancer. For food allergies, crab and shrimp are contraindicated but no allergies to drugs.

HISTORY OF PRESENT ILLNESS

Prior to admission, Mr. Isaw complained of sudden onset abdominal pain described as

bloatedness more prominent in the epigastric and right periumbilical area. There was no

associated nausea, vomiting, change in bowel habits, hematochezia, melena, jaundice and

fever. Patient consulted at PGH, Abdominal X-ray revealed dilated small bowels. He was then

referred to the institution for further management.

PHYSICAL ASSESSMENT

Physician’s Physical Assessment done by the Resident on Duty (July 2, 2015, lifted from the

patient's chart)

Height: 5’6

Weight: 81 kg

Vital Signs as follows:

T: 36.9 °C PR: 116 bpm RR: 18cpm BP: 150/90 mmHg SAO2: 97%

GENERAL SURVEY

Mr. Isaw, Assessed/received patient lying on bed, awake, conscious, responsive,

and coherent. With the following vital signs:

Temperature: 36.7 °C

Heart rate: 70 bpm

Respiratory rate: 20 bpm

Blood Pressure: 140/90 mmHg

SAO2: 96%

NUTRITIONAL STATUS

Upon admission, Mr. Isaw was placed on NPO and IVF of D5LR 1 x Q8. CBC,

BT, PTPTT, FBS, BUN, CREA, Na, K, Cl, 12-LECG, Chest X-ray PA, abdominal

series, and Urinalysis were requested. NGT and Foley Catheter were inserted. Mr.

Isaw, was also given Omeprazole 40mg TIV O.D.

SKIN

> Pallor noted.

> Good skin turgor in both upper and lower extremities; the skin returns to its

previous state immediately after being tented.

> warm moist skin, no active dermatoses.

HAIR

> Hair is black and is evenly distributed.

> Silky and smooth hair.

> No areas of hair loss noted.

> Thick hair strands.

NAILS

> Trimmed clean nails.

> Concave shaped; with a nail plate angle of about 160 degrees.

> Smooth in texture.

> Intact epidermal lining around the nails.

> Capillary Refill Test less than 3 seconds.

SKULL AND FACE

> Rounded (normocephalic and symmetrical with frontal, parietal and occipital

prominences).

> Head has no cervical lymphadenophaties

> No nodules or masses upon palpation.

EYES AND VISION

> Eyebrows and eyelashes are evenly distributed.

> Eyelids are intact

> Pink palpebral conjuctiva

> Sclera appears white.

> Pale conjunctiva.

> No discharges and discoloration noted.

> Blink reflex intact.

EARS AND HEARING

> Ears are symmetrical in size and in line with the outer canthus of the eyes.

> Color of ears is the same with the facial skin.

> No discharges and foul odor noted upon inspection.

> Pinna and ear canal are clean.

> Auricles are firm and recoil to previous state when folded.

> No nodules or masses noted upon palpation

NOSE AND SINUSES

> No nasal discharge

> No tenderness masses and pain noted upon palpation

OROPHARYNX (Mouth and Throat)

> Dry and pale lips noted upon inspection

> Tongue is able to move freely

> Good oral hygiene.

> Thyroid gland moves with deglutition

NECK

> Jugular vein is not visible

> Muscles are equal in size with the head centered

> Slow muscle movement

> Lymph nodes are not palpable

CARDIOVASCULAR AND PERIPHERAL SYSTEM

> Skin color of palm of the hand and feet is pink.

> Pink nail beds upon inspection.

> Symmetric pulse volumes, full pulsations of peripheral pulses.

> Heart rate is 70 beats per minute.

> Blood Pressure is 140/90 mmHg

> (Vital signs taken during the time of assessment July 2, 2015 at 0715H)

RESPIRATORY SYSTEM

> Symmetric chest expansion

> Skin and chest wall are intact and has uniform temperature

> No tenderness and masses noted upon palpation

> Regular breathing pattern

> Presence wheezing and crackles sound upon auscultation

> Full and symmetric chest wall expansion

BREAST AND AXILLAE

> Breasts are symmetrical in size; color is the same as with the abdomen.

> Both nipples are symmetrical in size.

> No discharges noted.

> No tenderness, masses, and nodules noted upon palpation.

ABDOMEN

> Direct tenderness at epigastric area.

> Abdominal skin is intact.

> Distended abdomen noted.

> Audible bowel sound upon auscultation.

> Abdominal dullness upon percussion.

MUSCULOSKELETAL

> Posture is good, able to stand straight and can walk alone properly but slowly

> Scar at left thigh and right medial leg and foot

NEUROLOGIC

>with a GCS of 15

> Patient has times of looking in the distance and is slow in response when a

question asked.

> Patient was able to answer well when asked of her complete name, birth date and

age.

URINARY SYSTEM

> Patient has indwelling Foley Catheter

REPRODUCTIVE SYSTEM

> The patient refused to be assessed with her external reproductive organ but she

verbalized that she has minimal vaginal bleeding and complain of pain when

secretions are expelled.

REVIEW OF SYSTEM

Integumentary System

The patient has no history of bruises in both upper and lower extremities.

Head

The patient had no history of any form of head injuries.

Eyes

Patient had no history of any eye problems.

Ears and Hearing

Patient had no history of smelly discharges on both ears, and no complaints of

hearing impairment.

Breast and Axillae

The patient had no history of breast nodules, no enlargement, no tenderness, no

pain and unusual discharges.

Respiratory System

The patient has no history of asthma or other respiratory problems.

Cardiovascular System

The patient has a history of hypertension.

Genitourinary System

The patient had no history of any genital problems. Usually urinates 5 times a day.

Gastrointestinal System

The patient had experienced abdominal pain.

Musculoskeletal System

Patient has no history of joint pain.

Neurologic System

Patient had no history of any major mental problems.

Cranial Nerve Assessment:

CRANIAL NERVE ASSESSMENT TECHNIQUE

EXPECTED OUTCOME

ACTUAL FINDINGS

I: OlfactoryType: SensoryFunction: Smell

Ask the client to identify a scented object that you are holding.

Client is able toidentify differentsmell with eachnostril separatelyand with eyesclosed unless suchcondition like coldsis present.

The client was able to identify the aromas of cologne and alcohol that she had smelled.

II: OpticType: Sensory

Provide adequate lighting and ask client

The client should be able to read with

The client was able to read the words in the

Function: Vision to read words on a newspaper held at a distance of 36 cm (14 inches) with each eye first then both eyes.

each eye and both eyes.

newspaper at 14 inches.

III: Oculomotor, IV: Trochlear & VI: AbducensType: MotorFunction: Upward and Downward movement of Pupils.

-Hold a penlight 1 ft. in front of the client’s eyes. Ask the client to follow the movements of the penlight with the eyes only. Move the penlight upward, downward, sideward and diagonally.

-Ask the client to look straight ahead then approach the pupil with a penlight and observe for pupil constriction.

-Client’s eyes should be able to follow the penlight as it moves.

-The client’s eyes will have a normal reaction for PERRLA.

-Both eyes of the client were able to follow the Penlight’s movements.

-The client had a normal reaction to PERRLA as Pupils are equally round, reactive to light and accommodation.

V: TrigeminalType: SensoryFunction: Sensation of cornea

While client looks upward, lightly touch the lateral sclera of eye to elicit blink reflex.

Client should have a positive corneal reflex.

The client was able to elicit corneal reflex.

VII: Facial Type: MotorFunction: Facial movements

Ask client to: smile, frown and wrinkle forehead, show teeth, puff out cheeks, purse lips, raise eyebrows, close eyes tightly against resistance

Client should smile, frown and wrinkle forehead, show teeth, puff out cheeks, purse lips, raise eyebrows, close eyes tightly against resistance. Movements are symmetrical.

The client was able to do the facial movements symmetrically.

VIII: Vestibulocochlear/ acousticsType: SensoryFunction: Hearing

Have the Client occlude one ear. Out of the client’s sight, place a tickling watch 2 cm. Ask what the client can hear and repeat with the other

Client should be able to hear the ticking of the watch in both ears.

The client was able to hear the ticking of the watch in both ears.

ear.

IX. Glossopharyngeal & X: VagusType: Motor Function: Swallowing and Speaking

Ask the client to swallow and say its name.

The client should be able to swallow without difficulty and speak audibly.

The client was able to swallow without difficulty and speak audibly.

XI. Spinal AccessoryType: MotorFunction: strength and resistance

-Ask client to shrug the shoulders against your hands.

-Ask client to turn the head against resistance, first to the right then to the left, to assess the sternocleidomastoid muscle.

-There is symmetric, strong contraction of the trapezious muscles.

-There is strong contraction of the sternocleidomastoid muscle on the side opposite to the turned face.

The client was able to symmetrically contract the trapezious muscle.

-The client was able to contract strenocleidomastoid muscleon the side opposite to the turned face.

XII: HypoglossalType: MotorFunction: Movement and strength of tongue

Ask the client to protrude the tongue and move in different directions.

The client will be able to protrude her tongue and move in different directions.

The client was able to protrude his tongue and move it in different directions.

IV. Anatomy and Physiology

The digestive system, sometimes called the gastrointestinal tract, alimentary

tract, or gut, consists of a long hollow tube which extends through the trunk of the

body, and its accessory structures: the salivary glands, liver, gallbladder, and

pancreas (Fig. 20-1). The digestive tract is divided into two sections, the upper tract,

consisting of the mouth, esophagus, and stomach, and the lower tract, consisting of

the intestines.

FIGURE 20-1 Anatomy of the digestive system with associated events.

Inside this tube, ingested food and fluid, along with secretions from various

glands, are efficiently processed. First, they are broken down into their separate

constituents; then the desired nutrients, water, and electrolytes are absorbed into

the blood for use by the cells, and waste elements are eliminated from the body.

Within this system, the liver can reassemble the component nutrients into new

materials as they are needed by the body. For example, the proteins in milk are

digested by enzymes in the digestive tract, producing the component amino acids,

which are then absorbed into the blood. The individual amino acids are used by

the liver cells to produce new proteins, such as albumin or prothrombin, or they

may circulate as they are in the amino acid pool in the blood to be taken up by

individual cells as necessary.

The peritoneal cavity refers to the potential space between the parietal and

visceral peritoneum. A small amount of serous fluid is present in the cavity to

facilitate the necessary movement of structures such as the stomach. Numerous

lymphatic channels drain excessive fluid from the cavity.

Because serous membranes are normally thin, somewhat permeable, and

highly vascular, the peritoneal membranes are useful as an exchange site for

blood during peritoneal dialysis in patients with kidney failure (see Chapter 21).

However, such an extensive membrane may also facilitate the spread of infection

or malignant tumor cells throughout the abdominal cavity or into the general

circulation.

The mesentery is a double layer of peritoneum that supports the intestines

and conveys blood vessels and nerves to supply the wall of the intestine. The

mesentery attaches the jejunum and ileum to the posterior (dorsal) abdominal wall.

This arrangement provides a balance between the need for support of the

intestines and the need for considerable flexibility to accommodate peristalsis and

varying amounts of content.

The greater omentum is a layer of fatty peritoneum that hangs from the

stomach like an apron over the anterior surface of the transverse colon and the

small intestine. The lesser omen-tum is part of the peritoneum that suspends the

stomach and duodenum from the liver. When inflammation develops in the

intestinal wall, the greater omentum, with its many lymph nodes, tends to adhere to

the site, walling off the inflammation and temporarily localizing the source of the

problem. Inflammation of the omentum and peritoneum may lead to scar tissue

and the formation of adhesions between structures in the abdominal cavity, such

as loops of intestine, restricting motility and perhaps leading to obstruction.

Intestinal Obstruction

Intestinal obstruction refers to a lack of movement of the intestinal contents

through the intestine. Because of its smaller lumen, obstructions are more common

and occur more rapidly in the small intestine, but they can occur in the large

intestine as well. Depending on the cause and location, obstruction may manifest

as an acute problem or a gradually developing situation. For example, twisting of

the intestine could cause sudden total obstruction, whereas a tumor leads to

progressive obstruction. FIGURE 20-37 Colostomy. A, sigmoid colostomy-a

surgically created opening into the colon through the abdominal wall. B, The stoma

is the new opening on the abdomen. It is always red and moist, is not painful, but

may bleed easily. C, A plastic pouch to collect stools is attached to the stoma.

(Courtesy of Hollister Incorporated, Patient Education Series.)

Intestinal obstruction occurs in two forms. Mechanical obstructions are

those resulting from tumor, adhesions, hernias, or other tangible obstructions

(Fig. 20-38). Functional, or adynamic, obstructions result from neurologic

impairment, such as spinal cord injury or lack of propulsion in the intestine, and

are often referred to as paralytic ileus. While the end result can be the same,

these types manifest somewhat differently and require different treatment.

Colon

The colon is the last part of the digestive system in most vertebrates; it extracts

water and salt from solid wastes before they are eliminated from the body, and is the site

in which flora-aided (largely bacteria) fermentation of unabsorbed material occurs. Unlike

the small intestine, the colon does not play a major role in absorption of foods and

nutrients. However, the colon does absorb water, potassium and some fat soluble

vitamins.

In mammals, the colon consists of four sections: the ascending colon, the

transverse colon, the descending colon, and the sigmoid colon (the proximal colon

usually refers to the ascending colon and transverse colon). The colon, cecum, and

rectum make up the large intestine.

The location of the parts of the colon are either in the abdominal cavity or behind

it in the retroperitoneum. The colon in those areas is fixed in location.

Arterial supply to the colon comes from branches of the superior mesenteric artery

(SMA) and inferior mesenteric artery (IMA). Flow between these two systems

communicates via a "marginal artery" that runs parallel to the colon for its entire length.

Historically, it has been believed that the arc of Riolan, or the meandering mesenteric

artery (of Moskowitz), is a variable vessel connecting the proximal SMA to the proximal

IMA that can be extremely important if either vessel is occluded. However, recent

studies conducted with improved imaging technology have questioned the actual

existence of this vessel, with some experts calling for the abolition of the terms from

future medical literature.

Venous drainage usually mirrors colonic arterial supply, with the inferior

mesenteric vein draining into the splenic vein, and the superior mesenteric vein joining

the splenic vein to form the hepatic portal vein that then enters the liver.

Lymphatic drainage from the entire colon and proximal two-thirds of the rectum is to the

paraaortic lymph nodes that then drain into the cisterna chyli. The lymph from the

remaining rectum and anus can either follow the same route, or drain to the internal iliac

and superficial inguinal nodes. The pectinate line only roughly marks this transition.

Ascending colonThe ascending colon, on the right side of the abdomen, is about 25 cm long in

humans. It is the part of the colon from the cecum to the hepatic flexure (the turn of the

colon by the liver). It is secondarily retroperitoneal in most humans. In ruminant grazing

animals, the cecum empties into the spiral colon.

Anteriorly it is related to the coils of small intestine, the right edge of the greater

omentum, and the anterior abdominal wall. Posteriorly, it is related to the iliacus, the

iliolumbar ligament, the quadratus lumborum, the transverse abdominis, the diaphragm

at the tip of the last rib; the lateral cutaneous, ilioinguinal, and iliohypogastric nerves; the

iliac branches of the iliolumbar vessels, the fourth lumbar artery, and the right kidney.

The ascending colon is supplied by parasympathetic fibers of the vagus nerve (CN X).

Arterial supply of the ascending colon comes from the ileocolic artery and right colic

artery, both branches of the SMA. While the ileocolic artery is almost always present, the

right colic may be absent in 5–15% of individuals.

Transverse colonThe transverse colon is the part of the colon from the hepatic flexure to the

splenic flexure (the turn of the colon by the spleen). The transverse colon hangs off the

stomach, attached to it by a wide band of tissue called the greater omentum. On the

posterior side, the transverse colon is connected to the posterior abdominal wall by a

mesentery known as the transverse mesocolon.

The transverse colon is encased in peritoneum, and is therefore mobile (unlike

the parts of the colon immediately before and after it). Cancers form more frequently

further along the large intestine as the contents become more solid (water is removed) in

order to form feces.

The proximal two-thirds of the transverse colon is perfused by the middle colic

artery, a branch of SMA, while the latter third is supplied by branches of the IMA. The

"watershed" area between these two blood supplies, which represents the embryologic

division between the midgut and hindgut, is an area sensitive to ischemia.

Descending colonThe descending colon is the part of the colon from the splenic flexure to the

beginning of the sigmoid colon. The function of the descending colon in the digestive

system is to store food that will be emptied into the rectum. It is retroperitoneal in two-

thirds of humans. In the other third, it has a (usually short) mesentery. The arterial

supply comes via the left colic artery.

Sigmoid colonThe sigmoid colon is the part of the large intestine after the descending colon

and before the rectum. The name sigmoid means S-shaped (see sigmoid). The walls of

the sigmoid colon are muscular, and contract to increase the pressure inside the colon,

causing the stool to move into the rectum.

The sigmoid colon is supplied with blood from several branches (usually between 2 and

6) of the sigmoid arteries, a branch of the IMA. The IMA terminates as the superior rectal

artery. Sigmoidoscopy is a common diagnostic technique used to examine the sigmoid

colon.

Redundant colonOne variation on the normal anatomy of the colon occurs when extra loops form,

resulting in a longer than normal organ. This condition, referred to as redundant colon,

typically has no direct major health consequences, though rarely volvulus occurs

resulting in obstruction and requiring immediate medical attention.[4] A significant

indirect health consequence is that use of a standard adult colonoscope is difficult and in

some cases impossible when a redundant colon is present, though specialized variants

on the instrument (including the pediatric variant) are useful in overcoming this problem.

Standing gradient osmosisWater absorption at the colon typically proceeds against a transmucosal osmotic

pressure gradient. The standing gradient osmosis is a term used to describe the

reabsorption of water against the osmotic gradient in the intestines. This hypertonic fluid

creates an osmotic pressure that drives water into the lateral intercellular spaces by

osmosis via tight junctions and adjacent cells, which then in turn moves across the

basement membrane and into the capillaries.

Functions of the ColonThere are differences in the large intestine between different organisms, the

large intestine is mainly responsible for storing waste, reclaiming water, maintaining the

water balance, absorbing some vitamins, such as vitamin K, and providing a location for

flora-aided fermentation.Vitamin K is essential as a coagulation factor.

By the time the chyme has reached this tube, most nutrients and 90% of the

water have been absorbed by the body. At this point some electrolytes like sodium,

magnesium, and chloride are left as well as indigestible parts of ingested food (e.g., a

large part of ingested amylose, protein which has been shielded from digestion

heretofore, and dietary fiber, which is largely indigestible carbohydrate in either soluble

or insoluble form). As the chyme moves through the large intestine, most of the

remaining water is removed, while the chyme is mixed with mucus and bacteria (known

as gut flora), and becomes feces. The ascending colon receives fecal material as a

liquid. The muscles of the colon then move the watery waste material forward and slowly

absorb all the excess water. The stools get to become semi solid as they move along

into the descending colon. The bacteria break down some of the fiber for their own

nourishment and create acetate, propionate, and butyrate as waste products, which in

turn are used by the cell lining of the colon for nourishment. No protein is made

available. In humans, perhaps 10% of the undigested carbohydrate thus becomes

available; in other animals, including other apes and primates, who have proportionally

larger colons, more is made available, thus permitting a higher portion of plant material

in the diet. This is an example of a symbiotic relationship and provides about one

hundred calories a day to the body. The large intestine produces no digestive enzymes -

— chemical digestion is completed in the small intestine before the chyme reaches the

large intestine. The pH in the colon varies between 5.5 and 7 (slightly acidic to neutral).

I.II.III.

Colonic Carcinoma / Colon Carcinoma / Colon Cancer

Definition:

It is a disease in which malignant (cancer) cells form in the tissues of the

colon.

The colon is part of the body's digestive system. The digestive system

removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins,

and water) from foods and helps pass waste material out of the body. The digestive

system is made up of the esophagus, stomach, and the small and large intestines.

The first 6 feet of the large intestine are called the large bowel or colon. The last 6

inches are the rectum and the anal canal. The anal canal ends at the anus (the

opening of the large intestine to the outside of the body).

Risk Factors:

Age and health history can affect the risk of developing colon carcinoma .

Risk factors include the following:

Age 50 or older.

A family history of carcinoma of the colon or rectum.

A personal history of carcinoma of the colon, rectum, ovary,

endometrium, or breast.

A history of polyps in the colon.

Signs and Symptoms:

A change in bowel habits.

Blood (either bright red or very dark) in the stool.

Diarrhea, constipation, or feeling that the bowel does not empty

completely.

Stools that is narrower than usual.

Frequent gas pains, bloating, fullness, or cramps.

Weight loss for no known reason.

Feeling very tired.

Vomiting.

A specimen removed from a patient with colonic carcinoma

V. Pathophysiology

Pathophysiology of Colon Cancer

Predisposing factors: Age (56% >70yrs

old) Colorectal polyps Family history Previous colorectal

cancer Ulcerative colitis

/colonic crohn’s disease

Etiology:Unknown

Precipitating factors: Diet – high fat/low

fiber Smoking Alcohol drinking Lack of exercise

Precipitating factors:Patient broke her right leg due to falling on the stairs

Abnormal proliferation of cells

in the colon area

Diagnostic test: Fecal occult blood

test SigmoIdoscopy Digital Rectum

Exam Barium Enema

Arising from epithelial lining of the

intestine

Benign polyps occur

Surgical Treatment: Colonoscopy Virtual Colonoscopy Polypectomy

If treated

Increase in size ot the polyps

Continuous plorifetation of cells in the polyps

Exposure to carcinogens

Reduction likelihood of regrowth

Increase in size

Uncontrolled proliferation

of cells in the tumormarrow

COLON CANCER

Continues increase in size

Metatases of cancer cells in other organs

Formation of new tumorProliferation of cancer cells

in that areaComplications occur

Development of malignant tumor

If not treated

Signs and Symptoms: Rectal bleeding Bloody stools Abdominal pain Fatigue Constipation Diarrhea Nausea and

Vomiting

If treated If not treated

Surgical Treatment: Colonoscopy Chemotherapy Radiation Therapy

Diagnostic test: SigmoIdos

copy MRI

Reduction likelihood of regrowth

DEATH