Colonoscopy, Hematochezia, Cachexia, Anastomosis


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Colonoscopy, Hematochezia, Cachexia, Anastomosis

  1. 1. Colonoscopy Hematochezia Cachexia Anastomosis By Hana Jakubickova
  2. 2. Colonoscopy Introduction  Endoscopic examination of the whole colon with a camera on a flexible tube passed through the anus  Allows the doctor to look at the inner lining of large intestine (colon and rectum)  Could be used to look at the lower part of the small intestine
  3. 3. Colonoscopy Introduction (Cont.)  Helps find ulcers, colon polyps, tumors, and areas of inflammation  During a colonoscopy, tissues samples could be collected  Abnormal growths can be taken out Colonoscopy could be used as screening test to check for cancer or precancerous growths in the colon or rectum.
  4. 4. Anatomy of the Colon
  5. 5. Colonoscopy vs. Sigmoidoscopy
  6. 6. Indications for Colonoscopy  Blood in the stool or rectal bleeding  Dark or black stools  Unexplained changes in bowel habits, chronic diarrhea  Iron deficiency anemia  Sudden, unexplained weight loss  Abnormal results from a stool test or a barium enema test
  7. 7. Indications for Colonoscopy (Cont.)  Inflammatory bowel disease (IBD)  Crohn disease  Ulcerative colitis  Long-term, unexplained belly pain  Screening for colorectal cancer - people with no risk factors at age 50 - people with a family history of colon cancer at age 40, or 10 years before the age that the relative got cancer
  8. 8. Preparation for Colonoscopy  One to three days prior : - a low fiber or clear-fluid liquid only diet - don’t drink orange juice, prune juice, and milk (contain fiber) - don’t consume liquids and foods the are dyed red, orange, purple, or brown (no grape juice, fruit punch, cherry Jell-O, or grape popsicles) - cola and black coffee are usually allowed
  9. 9. Preparation for Colonoscopy (Cont.)  The day before the colonoscopy: - laxative tablet, laxative solution (Nulytely, Golytely) - if indicated stop taking aspirin, aspirin-like products, and blood thinners stop drinking clear liquids 6 to 8 hours prior  30 to 60 minutes before the test: - you may be given enema
  10. 10. Colonoscopy Procedure
  11. 11. Colonoscopy Procedure  Patient is undress and changed into an examination gown  Vital signs are check and monitored  Intravenous line is put in place (sedation and pain medication is given through IV line)  Patient is positioned on his/her left side with the knees up to the belly
  12. 12. Colonoscopy Procedure (Cont.)  The doctor - checks the anus for potential blockage (with a lubricated gloved finger) - gently puts lubricated colonoscope into the anus and moves it slowly through the rectum and colon - inflates the large intestine with carbon dioxide gas for a better view
  13. 13. Colonoscopy Procedure (Cont.)  The doctor - may ask the patient to move periodically so the scope can be adjusted for better viewing - slowly withdraws the scope once it reaches the opening to the small intestine - again examines the lining of the large intestine - removes polyps or performs biopsy if necessary
  14. 14. Polyp Removal Polyp is A sterile solution A portion of The polyp identified is injected under the polyp is is fully the polyp to lift it now removed removed away from deeper tissues
  15. 15. Colonoscopy Recovery The test usually takes 30 to 60 minutes.  After test: - patient is watched for 1 to 2 hours - could go home when fully awake - may not drive or operate machinery for 12 hours - should drink a lot of fluid - may have bloating or cramps
  16. 16. Hematochezia  Is the passage of bright red (or maroon) bloody stools from the rectum  Is also called bright red blood per rectum (BRBPR)  Is usually from the lower gastrointestinal tract (the colon or rectum) or from hemorrhoids It is distinguished from melena, which is stool with blood that has been altered by the gut flora and appears black, smelly, and tarry (sticky). Melena usually signifies bleeding from the upper gastrointestinal tract)
  17. 17. Hematochezia
  18. 18. Hematochezia Causes  Adults - hemorrhoids - enlarged, painful veins in the rectum - diverticulosis - condition where pockets (pouches) form in the colon - colorectal cancer - large polyp
  19. 19. Hematochezia Causes (Cont.)  Adolescents and young adults - ulcerative colitis – a type of inflammatory bowel disease that causes inflammation and sores (ulcers) in the lining of the large intestine; usually affects the lower section (sigmoid colon) and the rectum
  20. 20. Hematochezia Causes (Cont.)  Newborns - result of swallowed maternal blood at the time of delivery - initial symptom of necrotizing enterocolitis - acquired disease, primarily of preterm or sick neonates, characterized by mucosal or even deeper intestinal necrosis
  21. 21. Cachexia  Is physical wasting with loss of weight, fat, and muscle mass caused by disease  Occurs in people who are eating enough, but cannot absorb nutrients  Is not the same as anorexia (lack of appetite) or starvation (a healthy person’s body can adjust starvation by slowing down its use of nutrients, but in a cachectic patient, the body does not make this adjustment)
  22. 22. Cachexia Cachexia involves increased tissue metabolism. Protein synthesis is decreased and degradation is increased.
  23. 23. Cachexia Causes  Cancer (end-stage cancer – cancer cachexia)  AIDS (acquired immunodeficiency syndrome)  COPD (chronic obstructive pulmonary disease)  CHF (congestive heart failure)  Tuberculosis  Drug addiction  Some severe cases of schizophrenia (vesanic cachexia)
  24. 24. Cachexia Treatment  Additional caloric supplementation does not relieve cachexia.  Corticosteroids  Cannabinoids  Progestogens
  25. 25. Anastomosis  A surgical connection between two structures (usually tubular structures), such as blood vessels or loops of intestine
  26. 26. Anastomotic Techniques  Conventional methods - hand-sewn - stapled  Novel techniques - compression rings - tissue glues A compression ring
  27. 27. Anastomosis Anastomoses can be fashioned in these ways:  End-to-end  End-to-side  Side-to-side End-to-end anastomosis End-to-side anastomosis
  28. 28. Small Intestine Anastomosis
  29. 29. Anastomosis Phases of healing:  Lag phase (day 0-4) - Acute inflammatory responses occur - Anastomosis has no intrinsic strength  Fibroplasia phase (day 3-14) - Fibroblasts proliferate - Immature collagen is laid down
  30. 30. Anastomosis (Cont.) Phases of healing:  Maturation phase (beyond 10 days) - Collagen is remodeled - Strength of anastomosis is increased
  31. 31. Sources: Wikipedia, the free encyclopedia (Last modified June 25, 2009). Colonoscopy. Retrieved July 4, 2009, from WebMD. Monica Rhodes (August 11, 2008). Colorectal Cancer Health Center Colonoscopy. Retrieved July 4, 2009, from Wikipedia, the free encyclopedia (Last modified June 15, 2009). Hematochezia. Retrieved July 4, 2009, from Wikipedia, the free encyclopedia (Last modified July 3, 2009). Cachexia. Retrieved July 4, 2009, from
  32. 32. Sources (Cont.): (Last editorial review November 10, 2004). Definition of Cachexia. Retrieved July 4, 2009, from, a free on-line resource (Last updated April 21, 2009). Intestinal and Vascular Anastomoses. Retrieved July 4, 2009, from MedinePlus (Updated July 25, 2007). Medical Encyclopedia: Anastomosis. Retrieved July 4, 2009, from