Inflammatory bowel disease (IBD) is an umbrella term for disorders that cause chronic inflammation of the digestive tract. The two main types are ulcerative colitis, which affects the inner lining of the large intestine, and Crohn's disease, which penetrates deeper and can impact any part of the digestive tract. Symptoms include diarrhea, abdominal pain, fatigue, and weight loss. While the exact causes are unknown, it likely involves an immune system malfunction interacting with genetic and environmental factors. Treatment focuses on reducing inflammation through medications and potentially surgery if other options fail.

1. Inflammatory bowel disease (IBD)
JUSTIN V SEBASTIAN

2. Infl
ammatory bowel disease (IBD) is an umbrella term used to describe
disorders that involve chronic in
fl
ammation of digestive tract.
Types of IBD include
:
•
Ulcerative colitis. This condition causes long-lasting in
fl
ammation
and sores (ulcers) in the innermost lining of large intestine (colon)
and rectum
.
•
Crohn's disease. This type of IBD is characterised by in
fl
ammation
of the lining of digestive tract, which often spreads deep into affected
tissues
.
Both ulcerative colitis and Crohn's disease usually involve severe
diarrhoea, abdominal pain, fatigue and weight loss.

3. Cause
s
• The exact cause of in
fl
ammatory bowel disease remains
unknown
.
• One possible cause is an immune system malfunction. When
immune system tries to
fi
ght off an invading virus or
bacterium, an abnormal immune response causes the immune
system to attack the cells in the digestive tract, too.
• Heredity also seems to play a role in that IBD is more
common in people who have family members with the
disease. However, most people with IBD don't have this
family history.

4. Risk factor
s
•
Age. Most people who develop IBD are diagnosed before they're 30 years old
.
•
Race or ethnicity. Although whites have the highest risk of the disease, it can
occur in any race
.
•
Family history. Persons are at higher risk if there is a close relative — such
as a parent, sibling or child — with the disease
.
•
Cigarette smoking. Cigarette smoking is the most important controllable risk
factor for developing Crohn's disease
.
•
Non-steroidal anti-in
fl
ammatory medications. These include ibuprofen
(Advil, Motrin IB, others). These medications may increase the risk of
developing IBD or worsen disease in people who have IBD
.
•
Environment. Living in an industrialised country, more likely to develop
IBD. Therefore, it may be that environmental factors.

5. Pathophysiology
Ulcerative colitis affects the super
fi
cial mucosa of the colon and is characterised
by multiple ulcerations, diffuse in
fl
ammations, and desquamation or shedding of
the colonic epithelium
.
Bleeding occurs as a result of the ulcerations.
The mucosa becomes edematous and in
fl
amed.
The lesions are contiguous, occurring one after the other.
Abscesses form, and in
fi
ltrate is seen in the mucosa and submucosa with clumps
of neutrophils in the crypt lumens (ie, crypt abscesses).
The disease process usually begins in the rectum and spreads proximally to
involve the entire colon.
Eventually, the bowel narrows, shortens, and thickens because of muscular
hypertrophy and fat deposits.

6. Symptom
s
In
fl
ammatory bowel disease symptoms vary, depending on the severity of
in
fl
ammation and where it occurs. Symptoms may range from mild to severe.
Patient may likely to have periods of active illness followed by periods of
remission
.
Signs and symptoms that are common to both Crohn's disease and ulcerative
colitis include
:
•
Diarrhoe
a
•
Fever and fatigu
e
•
Abdominal pain and crampin
g
•
Blood in stoo
l
•
Reduced appetit
e
•
Unintended weight loss

7. Complication
s
Ulcerative colitis and Crohn's disease have some complications in
common and others that are speci
fi
c to each condition. Complications
found in both conditions may include
:
•
Colon cancer. Having IBD increases risk of colon cancer
.
•
Medication side effects. Certain medications for IBD are associated
with a small risk of developing certain cancers. Corticosteroids can
be associated with a risk of osteoporosis, high blood pressure and
other conditions
.
•
Primary sclerosing cholangitis. In this condition, in
fl
ammation
causes scars within the bile ducts, eventually making them narrow
and gradually causing liver damage.

8. Complications of ulcerative colitis may include
:
•
Toxic megacolon. Ulcerative colitis may cause the
colon to rapidly widen and swell, a serious condition
known as toxic megacolon
.
•
A hole in the colon (perforated colon). A perforated
colon most commonly is caused by toxic megacolon, but
it may also occur on its own
.
•
Severe dehydration. Excessive diarrhoea can result in
dehydration.

9. Diagnosis
Blood test
s
•
Tests for anaemia or infection. Doctor may suggest blood tests to check for anaemia
— a condition in which there aren't enough red blood cells to carry adequate oxygen
to tissues — or to check for signs of infection from bacteria or viruses
.
•
Fecal occult blood test. Patient may need to provide a stool sample so that doctor can
test for hidden blood in stool
.
Imaging procedure
s
•
X-ray. If there severe symptoms, doctor may use a standard X-ray of abdominal area
to rule out serious complications, such as a perforated colon
.
•
Computerized tomography (CT) scan. patient may have a CT scan — a special X-
ray technique that provides more detail than a standard X-ray does
.
•
Magnetic resonance imaging (MRI). An MRI is particularly useful for evaluating a
fi
stula around the anal area (pelvic MRI) or the small intestine (MR enterography).

10. Endoscopic procedures
•
Colonoscopy. This exam allows doctor to view
entire colon using a thin,
fl
exible, lighted tube
with an attached camera. During the procedure,
doctor can also take small samples of tissue
(biopsy) for laboratory analysis
.
•
Flexible sigmoidoscopy. Doctor uses a slender,
fl
exible, lighted tube to examine the rectum and
sigmoid, the last portion of colon
.
•
Upper endoscopy. In this procedure, doctor uses
a slender,
fl
exible, lighted tube to examine the
esophagus, stomach and
fi
rst part of the small
intestine (duodenum).

11. Treatmen
t
Anti-infl
ammatory drug
s
Anti-in
fl
ammatory drugs are often the
fi
rst step in the treatment of in
fl
ammatory
bowel disease. Anti-in
fl
ammatories include corticosteroids and aminosalicylates
.
Immune system suppressor
s
These drugs work in a variety of ways to suppress the immune response that
releases in
fl
ammation-inducing chemicals in the intestinal lining. For some people,
a combination of these drugs works better than one drug alone
.
Some examples of immunosuppressant drugs include azathioprine (Azasan,
Imuran), cyclosporine (Gengraf, Neoral, Sandimmune) and methotrexate (Trexall)
.
Antibiotic
s
Antibiotics may be used in addition to other medications or when infection is a
concern — in cases of perianal Crohn's disease, for example. Frequently prescribed
antibiotics include cipro
fl
oxacin (Cipro) and metronidazole (Flagyl).

12. Other medications and supplement
s
•
Antidiarrheal medications. A
fi
ber supplement — such as
psyllium powder (Metamucil) or methyl-cellulose (Citrucel) —
can help relieve mild to moderate diarrhea by adding bulk to stool
.
•
Pain relievers. For mild pain, doctor may recommend
acetaminophen (Tylenol, others)
.
•
Iron supplements. If there chronic intestinal bleeding, may
develop iron de
fi
ciency anaemia and need to take iron
supplements
.
•
Calcium and vitamin D supplements. Crohn's disease and
steroids used to treat it can increase risk of osteoporosis, so may
need to take a calcium supplement with added vitamin D.

13. Surger
y
If diet and lifestyle changes, drug therapy, or other treatments don't
relieve IBD signs and symptoms, doctor may recommend surgery
.
•
Surgery for ulcerative colitis. Surgery can often eliminate
ulcerative colitis. But that usually means removing entire colon
and rectum (proctocolectomy).
In most cases, this involves a procedure called an ileal pouch
anal anastomosis. This procedure eliminates the need to wear a
bag to collect stool. Surgeon constructs a pouch from the end of
small intestine. The pouch is then attached directly to anus,
allowing to expel waste relatively normally.

15. Nursing Diagnosis
1. Diarrhoea may be related to Inflammation, irritation, or
malabsorption of the bowel.
Nursing Interventions
•Ascertain onset and pattern of diarrhea
•Observe and record stool frequency, characteristics,
amount, and precipitating factors.
•Observe for presence of associated factors, such as fever,
chills, abdominal pain,cramping, bloody stools, emotional
upset, physical exertion and so forth.
•Promote bedrest.

16. 2. Risk for Deficient Fluid Volume may be related to excessive
losses through normal routes (severe frequent diarrhea,
vomiting)
Nursing Interventions
•Note possible conditions or processes that may lead to deficits
such as fluid loss, limited intake, fluid shifts, environmental factor.
•Monitor I&O. Note number, character, and amount of stools;
estimate insensible fluid losses (diaphoresis). Measure urine
specific gravity; observe for oliguria.
•Assess vital signs (BP, pulse, temperature).
•Observe for excessively dry skin and mucous membranes,
decreased skin turgor, slowed capillary refill.

17. 3. Acute Pain may be related to Hyper-peristalsis, prolonged
diarrhea, skin/tissue irritation, perirectal excoriation, fissures,
fistulas
Nursing Interventions
•Assess reports of abdominal cramping or pain, noting location,
duration, intensity (0–10 scale). Investigate and report changes
in pain characteristics.
•Review factors that aggravate or alleviate pain.
•Encourage patient to assume position of comfort (knees flexed).
•Provide comfort measures (back rub, reposition) and diversional
activities.

18. 4. Anxiety may be related to Physiological factors/
sympathetic stimulation (inflammatory process)
Nursing Interventions
•Review physiological factors, such as active medical
condition; recent or ongoing stressors.
•Observe and note behavioral clues (restlessness,
irritability, withdrawal, lack of eye contact, demanding
behavior).
•Encourage verbalization of feelings. Provide feedback.
•Provide a calm, restful environment.

19. ENTERITIS

20. ○ ENTERITIS IS THE INFLAMMATION OF
THE SMALL INTESTINE
ENTERO=Small intestine +ITIS=Inflammation

21. CAUSES
○ It is most commonly caused by contaminated
food and drinks by pathogenic microorganism
such as norovirus , rotavirus, campylobacter,
salmonella e.t.c (INFECTIOUS ENTERITIS)
○ Autoimmune diseases- crohn’s disease (regional
enteritis 40%) and Coeliac disease-autoimmune
reaction to gluten
○ Vascular disease( Ischemic enteritis) due to blood
flow.

22. ○ It may be medication induced such as NSAIDs
○ Alcohol or drug induced such as cocaine
○ Inflammation after radiation therapy (treatment of
cancer) it is radiation enteritis. In early stage it
causes destruction of crypt epithelium in chronic
form majority of intestine

23. SIGNS AND SYMPTOMS
Signs and symptoms of enteritis are highly variable and vary based on the
specific cause and other factors such as individual variance and stage of
disease.
• Abdominal pain
• Cramping
• Diarrhoea
• Nausea
• Vomiting
• Dehydration
• Fever
• Weight loss
• Pain, bleeding, Mucus discharge from rectum

24. ACUTE ENTERITIS
○ Acute inflammation of the small intestine
○ Etiology:-many infections(cholera, staphylococcal,
typhoid, sepsis) alimentary toxication (salmonellosis,
botulism) poisoning, allergic

25. CHRONIC ENTERITIS
○ It is the chronic inflammation of the small
intestine
It may be:-hemorrhagic ,necrotic and
granulomatous

26. COMPLICATIONS
○ Dehydration
○ Excessive thirst
○ Weakness
○ Fatigue
○ Lethargy
○ Poor urine output and urine is dark colour
○ dizziness

27. DIAGNOSIS
○ A medical history, physical examination and tests such as blood
counts, stool cultures, CT scans, MRIs, PCRs, colonoscopies
and upper endoscopies may be used in order to perform a
differential diagnosis. A biopsy may be required to obtain a
sample for histopathology.

30. TREATMENT
○ For mild cases treatment is not need, it
recovers within two to three days
○ In cases where symptoms persist or severe cases
treatment is needed
○ Oral rehydration solution(ORS) is used in cases
of diarrhoea
○ In infectious enteritis antibiotics are taken.

31. Malabsorption syndrome
• The main role of small intestine is to absorb nutrients
from the food you eat into your bloodstream.
• Malabsorption syndrome refers to a number of
disorders in which the small intestine can’t absorb
enough of certain nutrients and fluids.
• Nutrients that the small intestine often has trouble
absorbing can be macronutrients (proteins,
carbohydrates, and fats), micronutrients (vitamins
and minerals), or both.

32. Causes of malabsorption syndrome
Factors that may cause malabsorption syndrome include:
• damage to the intestine from infection, inflammation, trauma, or surgery
• prolonged use of antibiotics
• other conditions such as celiac disease, Crohn’s disease, chronic
pancreatitis, or cystic fibrosis
• lactase deficiency, or lactose intolerance
• certain defects that are congenital, or present at birth, such as biliary
atresia, when the bile ducts don’t develop normally and prevent the flow of
bile from the liver
• diseases of the gallbladder, liver, or pancreas
• parasitic diseases
• radiation therapy, which may injure the lining of the intestine
• certain drugs that may injure the lining of the intestine, such as
tetracycline, colchicine, or cholestyramine

34. Symptoms of malabsorption syndrome
Symptoms of malabsorption syndrome are caused when unabsorbed nutrients pass
through the digestive tract.
Many symptoms differ depending on the specific nutrient or nutrients that aren’t
being absorbed properly. Other symptoms are a result of a deficiency of that
nutrient, which is caused by its poor absorption.
You may have the following symptoms if you’re unable to absorb fats, protein, or
certain sugars or vitamins:
• Fats. You may have light-colored, foul-smelling stools that are soft and bulky.
Stools are difficult to flush and may float or stick to the sides of the toilet bowl.
• Protein. You may have dry hair, hair loss, or fluid retention. Fluid retention is
also known as edema and will manifest as swelling.
• Certain sugars. You may have bloating, gas, or explosive diarrhea.
• Certain vitamins. You may have anemia, malnutrition, low blood pressure,
weight loss, or muscle wasting.

35. Diagnosing malabsorption syndrome
Your doctor may suspect malabsorption syndrome if you have
chronic diarrhea or nutrient deficiencies, or have lost a significant
amount of weight despite eating a healthy diet. Certain tests are
used to confirm the diagnosis. These tests may include:
Stool tests
Stool tests can measure fat in samples of stool, or feces. These tests
are the most reliable because fat is usually present in the stool of
someone with malabsorption syndrome.
Blood tests
These tests measure the level of specific nutrients in your blood,
such as vitamin B-12, vitamin D, folate, iron, calcium, carotene,
phosphorus, albumin, and protein.

36. Breath tests
Breath tests can be used to test for lactose intolerance.
If lactose isn’t being absorbed, it enters the colon. Bacteria in the colon
break down the lactose and produce hydrogen gas. The excess hydrogen
is absorbed from your intestine, into your bloodstream, and then into
your lungs. You’ll then exhale the gas.
Imaging tests
Imaging tests, which take pictures of your digestive system, may be done
to look for structural problems. For instance, your doctor could request a
CT scan to look for thickening of the wall of your small intestine, which
could be a sign of Crohn’s disease.
Biopsy
You may have a biopsy if your doctor suspects you have abnormal cells
in the lining of your small intestine.

37. Treatment
• Doctor will likely start your treatment by addressing symptoms such as diarrhea.
Medications such as loperamide can help.
• Doctor will also want to replace the nutrients and fluids that body has been unable to
absorb. And they may monitor for signs of dehydration, which can include increased thirst,
low urine output, and dry mouth, skin, or tongue.
• Doctor will provide care based on the cause of the absorption problem. For instance, if
you’re found to have lactose intolerance, doctor will likely advise to avoid milk and other
dairy products or take a lactase enzyme tablet.
At this point, doctor may refer you to a dietitian. Dietitian may recommend:
• Enzyme supplements. These supplements can help your body absorb the nutrients it can’t
absorb on its own.
• Vitamin supplements. dietitian may recommend high doses of vitamins or other nutrients
to make up for those that are not being absorbed by intestine.
• Diet changes. dietitian may adjust diet to increase or decrease certain foods or nutrients.
For instance, patient may be advised to avoid foods high in fat to decrease diarrhea, and
increase foods high in potassium to help balance electrolytes.

38. Nursing Diagnosis
• Diarrhea related to indigestion secondary to
malabsorption
• Imbalanced nutrition less than body requirement
related to indigestion secondary to diarrhea.
• Fluid and electrolyte imbalance related to
indigestion secondary to malabsorption
• Knowledge deficit related to hospitalisation and
malabsorption disease
• Fear and anxiety related to hospitalisation

39. Nursing Intervention
•Improvement of nutritional status by appropriate diet planning and
supplementation of deficient nutrition.
•Restoration of fluid and electrolyte balance by oral and parenteral
therapy
•Continuous monitoring and recording of patient’s condition
•Relief of pain by medication and antidiarrheal agents for diarrhea as
prescribed by doctor
•Maintenance of skin integrity specially perineal area
•Health education to parents about general cleanliness, nutrition,
hydration, danger sign, home care and follow-up, for necessary medical
help.
•Relief of fear and anxiety about long term illness and hospitalisation by
appropriate explanation, reassurance and necessary support.

40. Intestinal Obstruction

41. Intestinal Obstruction
Intestinal obstruction exists when blockage prevents the normal
fl
ow of
intestinal contents through the intestinal tract.
Two types of processes can impede this
fl
ow.
Mechanical obstruction: An intraluminal obstruction or a mural obstruction
from pressure on the intestinal walls occurs. Examples are intussusception,
polypoid tumors and neoplasms, stenosis, strictures, adhesions, hernias, and
abscesses.
Functional obstruction: The intestinal musculature cannot propel the
contents along the bowel. Examples are amyloidosis, muscular dystrophy,
neurologic disorders such as Parkinson’s disease. The blockage also can be
temporary and the result of the manipulation of the bowel during surgery.

42. • The obstruction can be partial or complete. Its severity depends
on the region of bowel affected, and especially the degree to
which the vascular supply to the bowel wall is disturbed.
• Most bowel obstructions occur in the small intestine. Adhesions
are the most common cause of small bowel obstruction, followed
by hernias and neoplasms. Other causes include intussusception,
volvulus (ie, twisting of the bowel), and paralytic ileus.
• About 15% of intestinal obstructions occur in the large bowel;
most of these are found in the sigmoid colon. The most common
causes are carcinoma, diverticulitis, in
fl
ammatory bowel
disorders, and benign tumors.

43. SMALL BOWEL OBSTRUCTION
Pathophysiology
Intestinal contents accumulate above the intestinal obstruction.
Abdominal distention and retention of
fl
uid
Reduce the absorption of
fl
uids
Stimulate more gastric secretion.
Increasing distention and pressure within the intestinal lume
n
Decrease in venous and arteriolar capillary pressure.
Edema, congestion, necrosi
s
Rupture or perforation of the intestinal wal
l
Peritonitis.

44. Clinical Manifestations
• The initial symptom is usually crampy pain that is wavelike and colicky.
• The patient may pass blood and mucus, but no fecal matter and no
fl
atus.
• Vomiting occurs.
• If the obstruction is complete, the peristaltic waves initially become extremely
vigorous and eventually assume a reverse direction, with the intestinal contents
propelled toward the mouth instead of toward the rectum.
• If the obstruction is in the ileum, fecal vomiting takes place.
• First, the patient vomits the stomach contents, then the bile-stained contents of
the duodenum and the jejunum, and
fi
nally, with each paroxysm of pain, the
darker, fecal-like contents of the ileum.
• If the obstruction continues uncorrected, hypovolemic shock occurs from
dehydration and loss of plasma volume.

45. Assessment and Diagnostic Findings
• Abdominal x-ray studies show abnormal
quantities of gas,
fl
uid, or both in the bowel.
• Laboratory studies (ie, electrolyte studies and
a complete blood cell count) reveal a picture
of dehydration, loss of plasma volume, and
possible infection.

46. Medical Management
Decompression of the bowel through a nasogastric or small bowel tube is
successful in most cases. When the bowel is completely obstructed, the
possibility of strangulation warrants surgical intervention. Before surgery,
intravenous therapy is necessary to replace the depleted water, sodium,
chloride, and potassium.
The surgical treatment of intestinal obstruction depends largely on the
cause of the obstruction. In the most common causes of obstruction, such
as hernia and adhesions, the surgical procedure involves repairing the
hernia or dividing the adhesion to which the intestine is attached. In some
instances, the portion of affected bowel may be removed and an
anastomosis performed.

47. Nursing Management
• Nursing management of the nonsurgical patient with a small bowel obstruction
includes maintaining the function of the nasogastric tube, assessing and
measuring the nasogastric output, assessing for fluid and electrolyte imbalance,
monitoring nutritional status, and assessing improvement (eg, return of normal
bowel sounds, decreased abdominal distention, subjective improvement in
abdominal pain and tenderness, passage of flatus or stool).
• The nurse reports discrepancies in intake and output, worsening of pain or
abdominal distention, and increased nasogastric output.
• If the patient’s condition does not improve, the nurse prepares him or her for
surgery.
• Nursing care of the patient after surgical repair of a small bowel obstruction is
similar to that for other abdominal surgeries

48. LARGE BOWEL OBSTRUCTION
Pathophysiology
As in small bowel obstruction, large bowel obstruction results in an
accumulation of intestinal contents, fluid, and gas proximal to the obstruction.
Obstruction in the large bowel can lead to severe distention and perforation
unless some gas and fluid can flow back through the ileal valve.
Large bowel obstruction, even if complete, may be undramatic if the blood
supply to the colon is not disturbed.
If the blood supply is cut off, however, intestinal strangulation and necrosis
(ie, tissue death) occur; this condition is life threatening.
In the large intestine, dehydration occurs more slowly than in the small
intestine because the colon can absorb its fluid contents and can distend to a
size considerably beyond its normal full capacity.

49. Clinical Manifestations
• Large bowel obstruction differs clinically from small bowel
obstruction in that the symptoms develop and progress
relatively slowly.
• In patients with obstruction in the sigmoid colon or the
rectum, constipation may be the only symptom for days.
• Eventually, the abdomen becomes markedly distended, loops
of large bowel become visibly outlined through the abdominal
wall, and the patient has crampy lower abdominal pain.
• Finally, fecal vomiting develops. Symptoms of shock may
occur.

50. Assessment and Diagnostic Findings
Diagnosis is based on symptoms and on x-ray studies. Abdominal x-ray
studies (flat and upright) show a distended colon. Barium studies are
contraindicated.

51. Medical Management
• A colonoscopy may be performed to untwist and decompress the bowel.
• A cecostomy, in which a surgical opening is made into the cecum, may be
performed for patients who are poor surgical risks and urgently need relief
from the obstruction. The procedure provides an outlet for releasing gas
and a small amount of drainage.
• A rectal tube may be used to decompress an area that is lower in the
bowel.
• The usual treatment, however, is surgical resection to remove the
obstructing lesion.
• A temporary or permanent colostomy may be necessary. An ileoanal
anastomosis may be performed if it is necessary to remove the entire large
colon.

53. Nursing Management
• The nurse’s role is to monitor the patient for symptoms that indicate
that the intestinal obstruction is worsening and to provide emotional
support and comfort.
• The nurse administers intra- venous fluids and electrolytes as
prescribed.
• If the patient’s condition does not respond to nonsurgical treatment,
the nurse prepares the patient for surgery.
• This preparation includes pre- operative teaching as the patient’s
condition indicates.
• After surgery, general abdominal wound care and routine post
operative nursing care are provided.

54. Bowel Perforation

55. Bowel Perforation
• Bowel perforations occur when a hole is made in this lining,
often as a result of colon surgery or serious bowel disease.
• A hole in the colon then allows the contents of the colon to
leak into the usually sterile contents of abdominal cavity.
• Perforation of the bowel is considered a medical emergency
and requires immediate treatment.

56. Causes
Bowel perforations may occur spontaneously (unexpectedly) as a result of a medical
condition or instead be a complication of various diagnostic and surgical procedures that
accidentally create a hole in the colon. Trauma, especially blunt trauma to the abdomen, is
also an important cause of bowel perforations.
Procedure-Associated Causes
•
Enema: An improperly or forcefully inserted rectal tube for an enema can rip or push
through the colon lining.
•
Bowel preparation for colonoscopy: Rarely, the bowel preparation for a colonoscopy
can result in a perforation. This is more common in people with a history of constipation.
•
Sigmoidoscopy: Although the endoscope for a flexible sigmoidoscopy is flexible,
perforation remains a risk, but a rare one.
•
Colonoscopy: The tip of the endoscope has the potential to push through the inner lining
of the colon, although this is a rare complication.
•
Abdominal or pelvic surgery: Particularly, colon surgery as for colon cancer may be a
risk for perforation

57. Spontaneous Causes
Causes of spontaneous bowel perforation (those unrelated to surgery or
procedures) include:
•
Inflammatory bowel disease/colitis such as Crohn's disease and ulcerative
colitis.
•
Severe bowel obstruction, especially when the colon is "weakened" by
diverticular disease, or cancer
•
Trauma
•
Ischemic bowel disease (when the blood supply to the colon is
compromised)
•
Colon cancer
•
Foreign body ingestion, most commonly due to the ingestion of fish
bones, and bone fragments, as well as non-food items
•
Severe bowel impaction

58. Risk Factors
Scientists have found that a number of factors may increase risk of developing a bowel
perforation. These include both factors involved in surgery or a procedure (iatrogenic
causes) and bowel diseases characterised by inflammation.
Risk factors may include:
•
Recent or prior abdominal surgery
•
Recent or prior pelvic surgery
•
Age greater than 75
•
History of multiple medical problems
•
Trauma to the abdomen or pelvis (such as in an automobile accident)
•
A history of diverticular disease
•
A history of inflammatory bowel disease
•
Colon cancer
•
Female sex (women typically have a more flexible colon, which can lead to
accidental perforation during medical procedures, including a colonoscopy)
•
Diagnostic and surgical procedures involving the digestive tract, abdomen, or pelvis.

59. Bowel Perforation Symptoms
The symptoms of a bowel perforation can vary and may come on
slowly or rapidly depending on the underlying cause. Symptoms may
include:
•
Abdominal pain (often severe and diffuse)
•
Severe abdominal cramping
•
Bloating
•
Nausea and vomiting
•
A change in bowel movements or habits
•
Rectal bleeding
•
Fever (usually not immediately)
•
Chills
•
Fatigue

60. Complications
Left untreated, the contents of the bowel can leak out and
cause inflammation, infection, and even abscesses in
abdomen. The technical name for this is peritonitis.
Complications of untreated perforation may include:
•
Bleeding
•
Infection (peritonitis and sepsis)
•
Death
Complications depend on a person's general health, as well
as the amount of time it has taken to diagnose and treat the
perforation.

61. Diagnosis
If doctor suspects a bowel perforation, he can order tests to
confirm her suspicion.
• A simple abdominal X-ray may show gas outside the colon
but is not often diagnostic. A CT scan of abdomen with or
without contrast or a barium enema or swallow may be
needed.
• A complete blood count may show an elevation of white
blood cell count if the perforation has been present for a while,
or evidence of anaemia due to bleeding. Small perforations
may sometimes take several imaging studies and time to
accurately diagnose.

62. Treatment
• The majority of perforations are surgically repaired.
• Depending on the location and size of the tear, the
doctor might be able to fix it through an endoscope.

63. Colon cancer

64. • Colon cancer is cancer of
the large intestine (colon),
which is the final part of
digestive tract.

65. • Most cases of colon cancer begin
as small, noncancerous (benign)
c l u m p s o f c e l l s c a l l e d
adenomatous polyps. Over time
some of these polyps can become
colon cancers.

66. Causes
In most cases, it's not clear what causes colon
cancer.
Inherited gene mutations that increase the
risk of colon cancer
Inherited gene mutations that increase the risk of
colon cancer can be passed through families, but
these inherited genes are linked to only a small
percentage of colon cancers..

67. The most common forms of inherited colon
cancer syndromes are:
•
Hereditary nonpolyposis colorectal
cancer (HNPCC). HNPCC, also called
Lynch syndrome, increases the risk of
colon cancer and other cancers. People
with HNPCC tend to develop colon
cancer before age 50.

68. •
Familial adenomatous polyposis
(FAP). FAP is a rare disorder that
causes to develop thousands of polyps
in the lining of colon and rectum.
People with untreated FAP have a
greatly increased risk of developing
colon cancer before age 40.

69. Association between diet and
increased colon cancer risk
Studies of large groups of people have
shown an association between a typical
Western diet and an increased risk of
colon cancer. A typical Western diet is
high in fat and low in fiber.

70. Risk factors
Factors that may increase your risk of colon
cancer include:
•
Older age. The great majority of people
diagnosed with colon cancer are older than 50.
•
African-American race. African-Americans
have a greater risk of colon cancer than do
people of other races.

71. •
A personal history of colorectal cancer or
polyps. If already had colon cancer or
adenomatous polyps, have a greater risk of
colon cancer in the future.
•
Inflammatory intestinal conditions.
Chronic inflammatory diseases of the colon,
such as ulcerative colitis and Crohn's
disease, can increase risk of colon cancer.

72. •
Family history of colon cancer.
•
Low-fiber, high-fat diet. Colon cancer and
rectal cancer may be associated with a diet
low in fiber and high in fat and calories.
Some studies have found an increased risk
of colon cancer in people who eat diets
high in red meat and processed meat.

73. •
Smoking. People who smoke may have an
increased risk of colon cancer.
•
Alcohol. Heavy use of alcohol increases
risk of colon cancer.
•
Radiation therapy for cancer. Radiation
therapy directed at the abdomen to treat
previous cancers increases the risk of colon
and rectal cancer.

74. Pathophysiology of cancer
Carcinogens
Alteration in the genetic structure of the cellular
DNA
Defective cellular proliferation and defective
cellular differentiation
Cancer development

75. Symptoms
Signs and symptoms of colon cancer
include:
•
A change in bowel habits, including
diarrhea or constipation or a change in
the consistency of stool, that lasts longer
than four weeks
•
Rectal bleeding or blood in stool

76. •
Persistent abdominal discomfort, such
as cramps, gas or pain
•
A feeling that bowel doesn't empty
completely
•
Weakness or fatigue
•
Unexplained weight loss

77. Diagnosing colon cancer
•
Using a scope to
examine the inside of
colon. Colonoscopy
uses a long, flexible and
slender tube attached to
a video camera and
monitor to view entire
colon and rectum.

78. •
Blood tests. Doctor may test
blood for a chemical sometimes
produced by colon cancers
(carcinoembryonic antigen or
CEA).

79. Treatment
Surgery for early-stage colon cancer
If colon cancer is very small, doctor may recommend
a minimally invasive approach to surgery, such as:
•
Removing polyps during a colonoscopy. If
cancer is small, localized and completely contained
within a polyp and in a very early stage, doctor
may be able to remove it completely during a
colonoscopy.

80. •
Endoscopic mucosal resection.
Removing larger polyps may require
also taking a small amount of the
lining of the colon or rectum in a
procedure called an endoscopic
mucosal resection.

81. •
Minimally invasive surgery. Polyps that can't be
removed during a colonoscopy may be removed
using laparoscopic surgery. In this procedure,
surgeon performs the operation through several
small incisions in abdominal wall, inserting
instruments with attached cameras that display
colon on a video monitor. The surgeon may also
take samples from lymph nodes in the area where
the cancer is located.

82. Surgery for invasive colon cancer
If the cancer has grown into or through colon,
surgeon may recommend:
•
Partial colectomy. During this procedure, the
surgeon removes the part of colon that contains
the cancer, along with a margin of normal
tissue on either side of the cancer. Surgeon is
often able to reconnect the healthy portions of
colon or rectum.

83. •
Surgery to create a way for waste to leave
body. When it's not possible to reconnect
the healthy portions of colon or rectum,
may need an ostomy. This involves creating
an opening in the wall of abdomen from a
portion of the remaining bowel for the
elimination of stool into a bag that fits
securely over the opening.

84. •Chemotherapy
•Radiation therapy
•Immunotherapy
•Bone marrow transplantation
•Stem cell research
•Hospice

85. Nursing diagnosis
Based on the assessment data, nursing
diagnosis of the patient with cancer may include
the following
1. Impaired tissue integrity (oral mucus
membranes, alopecia, malignant skin lesions)
related to the effect of treatment and disease
2. Imbalanced nutrition less than the body
requirements related to anorexia or
malabsorption or increased demand.
3. Pain or chronic pain related to disease and
treatment effect.
4. Fatigue related to physical and psychological
stressors

86. 5. Disturbed body image related to changes in
appearance and role of function.
6. Anticipatory grieving related to expected loss and
altered role function
Nursing interventions
• Maintaining tissue integrity
• Addressing alopecia
• Managing malignant skin lesions
• Promoting nutrition
• Relieving pain
• Decreasing fatigue
• Improving body image and self esteem

87. • Assisting grieving
• Monitoring and managing potential
complications
• Managing bleeding.