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Lower GI Module 3

Polyps of the Large Intestine. Arise from the mucosal surface of colon, project into lumenSessile-flat, attach directly to intestinal wallPendunculated-attach to intestine by a thin stalkRectosigmoid area- most commonClients asymptomatic, may have rectal bleeding or stool with occult blood. Type

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Lower GI Module 3

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    1. Lower GI Module 3

    2. Polyps of the Large Intestine Arise from the mucosal surface of colon, project into lumen Sessile-flat, attach directly to intestinal wall Pendunculated-attach to intestine by a thin stalk Rectosigmoid area- most common Clients asymptomatic, may have rectal bleeding or stool with occult blood

    3. Types of Polyps Benign Hyperplastic Inflammatory polyps Lipomas Juvenile Neoplastic Adenomas 3 types Tubular-most prevalent Villous adenomas-higher risk for becoming cancerous Familial adenomatous polyps (FAP)-genetic, autosomal dominant

    4. Polyps of the Large Intestine-Diagnosis Barium enema Sigmoidoscopy Colonoscopy Polypectomy

    5. Colorectal Cancer Adenocarcinoma most common Third most common cause of cancer deaths Most prevalent > 50 years of age Tumors spread through wall of intestine, spread to lymph nodes, liver Etiology-risk factors Age Familial history Polyps Inflammatory bowel disease Prior history High fat/low fiber diet

    6. Colorectal Cancer-Clinical Manifestations Nonspecific until disease progresses Left side Rectal bleeding Alternating constipation/diarrhea Ribbon like stools Sensation of incomplete evacuation Right side Crampy, colicky pain Weakness, fatigue, iron deficiency anemia

    7. Colorectal Cancer-Diagnostic Studies IMPORTANT Prevention for client age 50 or older Annual fecal blood test-avoid red meat, horseradish, iron preparations, NSAIDS, ASA Colonoscopy or Flexible sigmoidoscopy every 5 years Diagnosis: H&P-family history, previous history of Polyps Inflammatory bowel disease Digital rectal exam-important Flex sig and barium enema CEA, CBC CT scan Colonoscopy is gold standard

    8. Colorectal CancerTreatment Tumor staging Surgery Right hemicolectomy Left hemicolectomy Abdominal Perineal resection

    9. Colorectal CancerNursing Care Presurgery Pain management Monitor elimination patterns Psychosocial Post op Same as above If abdominal perineal resection Two wounds (abdominal and perineal) and a stoma Stoma care/ wound care as per health care provider

    10. Colorectal CancerNursing Post op (Cont) Perineal area May have JP/Hemovac drain May have packing-meticulous care is needed Sexual dysfunction may occur-psychosocial support Abdominal wound Monitor wound for excessive bleeding, odor

    11. Ostomy Surgery Surgical procedure, an opening allows passage of intestinal contents Ileostomy- Opening from ileum (Brookes ileostomy) Surgical treatment for Crohns, ulcerative colitis Cecostomy Opening between cecum and abdominal wall Colostomy Colon and abdominal wall

    12. Ostomy Surgery Colostomy Temporary Loop Double barrel Permanent Usually transverse

    13. Types of OstomiesEnd stoma End stoma Divide bowel and bring out proximal end as stoma Distal is either Removed (permanent colostomy) Oversown(temporary) left in abdominal cavity (Hartmans pouch)

    14. Types of OstomiesLoop stoma Bring a loop of bowel to surface and then open Stoma with proximal and distal opening Intact posterior wall Temporary ostomy

    15. Types of OstomiesDouble barrel Similar to loop but posterior wall is not intact Proximal end is functional Distal is mucous fistula Temporary ostomy

    16. Types of Ostomies Koch Pouch/Ileoanal Reservoir Koch pouch Continent ileostomy Ileoanal reservoir Total colectomy and ileoanal anastamosis with ileal reservoir

    17. Characteristics of Colostomies Ascending and transverse colostomy Semiliquid for ascending Semiliquid to semiformed for transverse Pouch and skin barriers needed Colostomy indicated for diverticulitis, tumors of the colon Sigmoid colon Formed stool Bowel regulation can be achieved Can irrigate Indicated for Cancer of the rectum

    18. Characteristics of Ileostomies Liquid to semiliquid stool Pouch and skin barriers needed Indicated for Crohns disease, ulcerative colitis

    19. Characteristics of a Normal Stoma Color Pink to rose colored Edema Mild to moderate Bleeding Small amount Review ostomy care as per textbook

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