Transcript Ostomy Surgeries

RCS 6080
Medical and Psychosocial Aspects
of Rehabilitation Counseling
Gastrointestinal Conditions &
Ostomy Surgeries
Type of Gastrointestinal
conditions
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Irritable Bowel Syndrome (IBS)
Diverticulosis/Diverticulitis
Inflammatory Bowel Diseases
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Ulcerative Colitis
Crohn’s Disease
Irritable Bowel Syndrome (IBS)
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Irritable bowel syndrome is a disorder characterized
most commonly by cramping, abdominal pain, bloating,
constipation, and diarrhea.
IBS causes a great deal of discomfort and distress, but it
does not permanently harm the intestines and does not
lead to a serious disease, such as cancer. Most people
can control their symptoms with diet, stress
management, and prescribed medications. For some
people, however, IBS can be disabling. They may be
unable to work, attend social events, or even travel short
distances.
IBS
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As many as 20 percent of the adult
population, or one in five Americans, has
symptoms of IBS, making it one of the
most common disorders diagnosed by
doctors.
It occurs more often in women than in
men, and it begins before the age of 35 in
about 50 percent of people.
Causes of IBS
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Researchers have yet to discover any
specific cause for IBS.
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One theory is that people who suffer from IBS
have a colon (large bowel) that is particularly
sensitive and reactive to certain foods and
stress.
The immune system, which fights infection,
may also be involved
Some implication of Serotonin
What makes the symptoms of IBS
worse?
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large meals
bloating from gas in the colon
Medicines
wheat, rye, barley, chocolate, milk
products, or alcohol
drinks with caffeine, such as coffee, tea, or
colas
stress, conflict, or emotional upsets
Diagnosis of IBS
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There is no specific test for IBS, although
diagnostic tests may be performed to rule
out other diseases. These tests may
include stool sample testing, blood tests,
and x rays. Typically, a doctor will perform
a sigmoidoscopy, or colonoscopy.
Treatment for IBS
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No cure for IBS – MDs treat symptoms
For Constipations – use of laxatives
Antispasmotic to control colon spasms
Antidepressants
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(Antispasmotics & antidepressants can cause
constipation)
Muscle relaxants for bladder & intestines
Stress & IBS
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Stress can stimulate colon spasms in
people with IBS
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Colon is partially controlled by autonomic
nervous system
Stress management strategies may help
reduce colon spasms
Diet & IBS
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For many people careful eating reduces
IBS symptoms
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Keep a journal on what foods make
symptoms worse
Increasing dietary fiber may improve
symptoms
Drink 6-8 glasses of water per day
IBS Summary
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IBS is a disorder that interferes with the normal functions of the colon. The
symptoms are crampy abdominal pain, bloating, constipation, and diarrhea.
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IBS is a common disorder found more often in women than men.
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People with IBS have colons that are more sensitive and reactive to things
that might not bother other people, such as stress, large meals, gas,
medicines, certain foods, caffeine, or alcohol.
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IBS is diagnosed by its signs and symptoms and by the absence of other
diseases.
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Most people can control their symptoms by taking medicines (laxatives,
antidiarrhea medicines, antispasmodics, or antidepressants), reducing
stress, and changing their diet.
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IBS does not harm the intestines and does not lead to cancer. It is not
related to Crohn’s disease or ulcerative colitis.
Diverticulosis/Diverticulitis
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Many people have small pouches in their colons
that bulge outward through weak spots, like an
inner tube that pokes through weak places in a
tire. Each pouch is called a diverticulum (pl.
diverticula).
The condition of having diverticula is called
diverticulosis. About 10 percent of Americans
over the age of 40 have diverticulosis. The
condition becomes more common as people
age. About half of all people over the age of 60
have diverticulosis.
Diverticulitis
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When the pouches
become infected or
inflamed, the condition is
called diverticulitis. This
happens in 10 to 25
percent of people with
diverticulosis.
Diverticulosis and
diverticulitis are also
called diverticular
disease.
Complications
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Bleeding
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When diverticula bleed, blood may appear in the toilet
or in your stool. Bleeding can be severe, but it may
stop by itself and not require treatment
Abscess, Perforation & Peritonitis
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The infection causing diverticulitis often clears up
after a few days of treatment with antibiotics. If the
condition gets worse, an abscess may form in the
colon.
A large abscess can become a serious problem if the
infection leaks out and contaminates areas outside
the colon. Infection that spreads into the abdominal
cavity is called peritonitis.
Complications
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Fistula
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A fistula is an abnormal
connection of tissue between two
organs or between an organ and
the skin.
When diverticulitis-related
infection spreads outside the
colon, the colon's tissue may stick
to nearby tissues. The organs
usually involved are the bladder,
small intestine, and skin.
Intestinal obstruction
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The scarring caused by infection
may cause partial or total
blockage of the large intestine.
When this happens, the colon is
unable to move bowel contents
normally. When the obstruction
totally blocks the intestine,
emergency surgery is necessary.
Partial blockage is not an
emergency, so the surgery to
correct it can be planned.
Causes of Diverticular Disease
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The dominant theory is that a low-fiber diet is the main
cause of diverticular disease.
Diverticular disease is common in developed or
industrialized countries—particularly the United States,
England, and Australia—where low-fiber diets are
common. The disease is rare in countries of Asia and
Africa, where people eat high-fiber vegetable diets
Diverticulitis occurs when diverticula become infected or
inflamed. It is not certain what causes the infection. It
may begin when stool or bacteria are caught in the
diverticula. An attack of diverticulitis can develop
suddenly and without warning
Diagnosis of Diverticular Disease
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Medical History
Physical/digital exam of the rectum
X-rays
Treatment of Diverticular Disease
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Diverticulosis
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High Fiber Diet
Mild pain medications
Serious attack can
lead to hospitalization
and surgery
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Diverticulitis
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Tx is focused on
clearing up infection
Antibiotics (oral)
Hospitalization
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Liquid diet
IV antibiotics
Surgery
Points to Remember
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Diverticulosis occurs when small pouches, called diverticula, bulge
outward through weak spots in the colon (large intestine).
The pouches form when pressure inside the colon builds, usually
because of constipation.
Most people with diverticulosis never have any discomfort or
symptoms.
The most likely cause of diverticulosis is a low-fiber diet because it
increases constipation and pressure inside the colon.
For most people with diverticulosis, eating a high-fiber diet is the
only treatment needed.
You can increase your fiber intake by eating these foods: whole
grain breads and cereals; fruit like apples and peaches; vegetables
like broccoli, cabbage, spinach, carrots, asparagus, and squash;
and starchy vegetables like kidney beans and lima beans.
Diverticulitis occurs when the pouches become infected or inflamed
and cause pain and tenderness around the left side of the lower
abdomen
Ulcerative Colitis
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Ulcerative colitis is a disease that causes
inflammation and sores, called ulcers, in
the lining of the rectum and colon. Ulcers
form where inflammation has killed the
cells that usually line the colon, then bleed
and produce pus. Inflammation in the
colon also causes the colon to empty
frequently, causing diarrhea.
Ulcerative Colitis
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Ulcerative colitis can occur in people of any age,
but it usually starts between the ages of 15 and
30, and less frequently between 50 and 70
years of age. It affects men and women equally
and appears to run in families, with reports of up
to 20 percent of people with ulcerative colitis
having a family member or relative with
ulcerative colitis or Crohn’s disease. A higher
incidence of ulcerative colitis is seen in Whites
and people of Jewish descent
Symptoms of Ulcerative Colitis
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anemia
fatigue
weight loss
loss of appetite
rectal bleeding
loss of body fluids and nutrients
skin lesions
joint pain
growth failure (specifically in children)
Causes of Ulcerative Colitis
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People with ulcerative colitis have abnormalities of the
immune system, but doctors do not know whether these
abnormalities are a cause or a result of the disease. The
body’s immune system is believed to react abnormally to
the bacteria in the digestive tract.
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Ulcerative colitis is not caused by emotional distress or
sensitivity to certain foods or food products, but these
factors may trigger symptoms in some people. The
stress of living with ulcerative colitis may also contribute
to a worsening of symptoms.
Diagnosis of UC
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Physical Exam/Medical History
Blood tests for anemia or high white blood
cell count
Stool sample
Colonoscopy or sigmoidoscopy are most
accurate
X-rays with barium enema
Treatment of UC
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Antibiotics (Aminosalicylates) given orally, suppository or
by enema
Coritcosteriods – strong anti-inflammatory medication
Immunomodulators (for individuals who do not respond to
antibiotics or steroids). Increases immune system.
Hospitalization
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Attempts to stop diarrhea and replenish fluids/electolytes
Surgery (Ostomies)
About 5% of people with UC develop colon cancer
Crohn’s Disease
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Crohn’s disease is an ongoing disorder
that causes inflammation in any area of
the GI tract, from the mouth to the anus,
but it most commonly affects the lower
part of the small intestine, called the ileum.
Causes of Crohn’s Disease
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Several theories exist about what causes
Crohn’s disease, but none have been
proven
Research shows that the inflammation
seen in the GI tract of people with Crohn’s
disease involves several factors: the
genes the patient has inherited, the
immune system itself, and the
environment.
Symptoms of Crohn’s Disease
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The most common symptoms of Crohn’s
disease are abdominal pain, often in the lower
right area, and diarrhea. Rectal bleeding, weight
loss, arthritis, skin problems, and fever may also
occur. Bleeding may be serious and persistent,
leading to anemia. Children with Crohn’s
disease may suffer delayed development and
stunted growth. The range and severity of
symptoms varies.
Diagnosis of Crohn’s Disease
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Similar tests as Ulcerative Colitis
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Physical exam
Lab tests
Colonoscopy
X-rays
Biopsy
Complications of Crohn’s Disease
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Intestinal Blockage due to
scarring and thickening of
intestinal wall
Can also effect surrounding
tissues such as bladder,
vagina, or skin (fistulas)
Deficiencies in proteins,
calories, & vitamins
Other conditions: arthritis, gall
and or kidney stones, skin
disease, inflammation in mouth
or eyes
Drug treatment
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Anti-Inflammation Drugs
Cortisone/Steroids
Immune System Supressors
Medication to block body’s inflammation
response (Infliximab or Remicade)
Antibiotics
Anti-Diarrheal and Fluid Replacements
Other treatments
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Nutritional
supplementation
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Surgery
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Needed particularly for
children with Crohn’s
disease for proper
growth
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2/3 to 3./4 of all people
with Crohn’s disease
will require surgery at
some point in their
lives
Surgery can help, but
it is not a cure
(see ostomy part of
lecture)
Ostomy Surgeries
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Numerous medical conditions, including
congenital defects, trauma, inflammatory bowel
disease (IBD),and bowel and bladder cancer,
can be treated by ostomy surgeries
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These surgeries close the normal route of
elimination of bodily wastes and create a new
opening (stoma)
Ostomy Surgeries
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GI Stomas
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Jejunostomy
Ileostomy
Cecostomy
Colostomy
Colostomy
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Colostomy: A surgically
created opening in the
abdominal wall through
which digested food
passes.
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Temporary colostomy
Permanent colostomy
Reasons for surgery:
Cancer, diverticultis
trauma, imperforate anus
Vocational impact –
restrict heavy lifting
Ileostomy
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A surgically created opening in
the abdominal wall through
which digested food passes.
The Ileum (the lowest part of
the small intestine) is brought
through the abdominal wall to
form a stoma. A Ileostomy is
performed when a disease or
injured colon cannot be treated
successfully.
Vocational implication – restrict
heavy lifting.
Jejunostomy
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Can be used for either feeding or removal of
stool, depending on if the stoma is at the
beginning or end of the Jejunum.
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Feeding: A tube is placed into the jejunum versus
the stomach (gastrostomy). People with a
jejunostomy can eat and drink by mouth. The device
is an “insurance” mechanism for nutrition. It can be
temporary or permanent.
Stool removal: in certain instances a jejunostomy is
conducted similarly to the Ileostomy. Again, this
usually temporary.
Cecostomy
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A tube that goes through the skin into the
beginning of the large intestine to help remove
gas or feces by injecting a solution (antegrade
enema) that flushes the gas and stool out of the
rectum.
Can be temporary or permanent.
Urinary Stomas
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When a urinary stoma is created, the urine does not go to the
bladder. The urine is rerouted through an opening on the
abdomen (stoma) created by a surgeon.
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Vesicostomy:
An opening in the bladder created to connect the bladder to an
opening on the lower abdomen.
Ureterostomy:
The ureter (or ureters) is attached to the skin’s surface through a
small opening in the abdomen.
Ileal conduit:
A small section of the ileum (small intestine) is used to create a
passage for the urine to exit the body. This section of the small
intestine, called a conduit, is attached to the abdominal wall to
create a stoma. The urine flows from the kidneys, through the
ureters, and out the stoma
Psychosocial/Vocational
implications
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Vocational Implications
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Ostomy surgery itself does not present obstacles to
most vocational functioning – underlying disease
process may influence RTW
Changes in body image
Economic costs of living with an ostomy can be
considerable when complications from the stoma or
disease process develop
Provide information and education to the person in a
manner that relays a message of acceptance
Additional Resources and
Information from the Web
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United Ostomy Association (www.uoa.org)
International Ostomy Association
(www.ostomyinternational.org)
World Ostomy Resource
(www.powerup.com.au/~takkenb/OstomySites.htm
)
Crohn’s Colitis Foundation of America
(www.ccfa.org)
Oley Foundation (www.oley.org)