Transcript Gall Bladder Disease

Colorectal Cancer—statistics
Second leading cause of death from cancer
Most are adenocarcinoma
Half occur in rectosigmoid area
Over ¾ of cancers come from polyps that spread
into mucosal lining and into lymph system and
then to liver or lungs
More common in men than women
Mortality rates highest among blacks
Colorectal Cancer—Risk Factors
Age—most are over 50
PMH or FH
Hx polyps or inflammatory bowel disease
Obesity
Smoking
ETOH
High red meat ingestion
Manifestations
Hematochezia or melena
Weakness, anemia, wt loss
Change in bowel habits
Change in stool caliber
Fullness in lower abdomen or rectum
Abdominal pain/cramping
Diagnostics
Colonoscopy is gold standard—polyps or tumors
may be seen, but bx is confirmation
Hemoccult or guaiac
H&H
Coag studies
Liver functions
CEA
CT
Medical Management
Treatment depends on TNM classification
Polypectomy during colonoscopy
Colon resection with end-to-end anastomosis—
lymphs are usually removed
If metastasized, surgery may be palliative
Chemo for + lymph nodes with 5-FU and one
other drug
Radiation as adjuvant or for metastasis to
reduce tumor size & provide symptomatic relief
Nursing Management
Preop teaching—may need ostomy teaching
If reanastamosis is done, then postop care is
routine abdominal surgery. Incision may be
large, but closed with staples. Pt may have NGT
or TPN.
If abdominal-perineal surgery is done for
extensive metastasis, care of open perineal
wound and drain management is necessary
Patient Education
For prevention:
– Hemoccult q yr
– Patients > 50 to have routine colonoscopy—repeat q
10y unless + hx
– Teaching regarding colonoscopy prep
For postop:
– Home instruction on sitz baths, wound & ostomy
care
– Don’t forget psychosocial issues & grief mgmt
Ostomies (1069)
Ileostomy—small bowel; Colostomy—colon
Continent pouch—total colectomy with
reanastamosis at ileoanal area with
formation of an ileoanal pouch.
Indications: cancer, inflammatory bowel
disease, perforated diverticula, intestinal
obstruction
Preop Nursing Management
Fluid replacement
IV antibiotics
Bowel cleansing
NG tube
Antiemetics
I&O
Education
Postop Nursing Management
Assessment of stoma and effluent
I&O
Labs
NPO, IVF and TPN, NGT
Incisional care and peristomal skin care
Diet progression
Ambulation
Meds
Emotional support
Team approach to care
Patient Education
Self-care of ostomy including assessment, skin
care, and changing the appliance
Management of diet
Management of odors
If continent pouch is made, patient must gain
bowel control
Gall Bladder Disease
Chapter 44, p. 1126
Definitions
Cholecystitis—acute infection
Cholelithiasis—calculi (stones), usually
from concentrated cholesterol
May have either one alone or both
Pathophysiology
Impaired drainage leads to bacterial
growth, irritation, and inflammation
Empyema (pus) develops followed by
areas of necrosis and gangene
Wall becomes thick and edematous
Abscess can develop
Assessment
S&S:
– Epigastric distress
– NV
– RUQ colicky pain
– Referred to shoulder
– +Murphy’s sign
– Fever
– Fat intolerance
Dx tests:
– WBC
– Liver enzymes
– Bilirubin
– Abd xray
– US
– Cholecystograph
– ERCP
– Transhepatic
choleangiography
Complications
If duct becomes blocked:
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Abd distention
Jaundice
Pruritis
Clay-colored stools
Dark urine (like Coke)
Perforation
Fistula development
Sepsis
Treatment—Nonsurgical
Analgesics
IVF
NPO—possible NGT
Low fat diet progression if improved
Ursodiol
Lithotripsy
Treatment—Surgical
Laparoscopic:
– 24h stay with 2 wk recovery
– CO2 complications
Open:
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3-5 day stay with 6-8 wk recovery
IVF
NGT
Foley
JP, T-tube
Postop Nursing Care
Prevent respiratory complications (both)
Splint incision (both)
IVF, IV pain meds and antibiotics (open)
I&O (includes what?) (both)
Dressing & incision (open)
Antiembolism interventions (both)
Patient Education
Dietary
Dressing and drain management
S&S infection
Meds and pain management
S&S to report (think outside the box)
Medications for GI Unit
Antacid: Mylanta
Antiflatulent: Mylicon
Antiemetic: Phenergan
Antidiarrheal: Lomotil
Laxative: MOM
Cytoprotective agent: Carafate
H2 Receptor Antagonist: Pepcid
Anticholingergic: Probanthine
Meds cont’d
Proton pump inibitor: Prilosec
Prostaglandin analog: Cytotec
Appetite suppressant: Fastin
GI stimulant: Reglan
Antibiotics: Biaxin, Flagyl
Antiviral: interferon
Herbal: ginger