Diarrhea: • Do not drink tap water or use it to brush your

Definition: teeth.
• Passage of several watery, unformed stools • Do not drink unpasteurized milk or dairy
products.
due to rapid mass movement.
• Do not use ice made from tap water.
• Comparison with the usual frequency and • Avoid all raw fruits and vegetables, including
consistency is a must. lettuce and fruit salads, unless they can be
Types: peeled and you peel them yourself.
• Can be acute or chronic (according to • Do not eat raw or rare meat and fish.
duration) • Do not eat meat or shellfish that is not hot
when served.
• Acute can due to toxic, dietary or infectious • Do not eat food from street vendors.
cause. (according to cause)
Causes: Constipation:
• Common cause of infectious diarrhea: Definition:
shigella, salmonella, staphylococci. Usually • Passage of dry, hard stools due to abnormal
comes from meat, milk, dried eggs. retention of feces in the large intestine or
• Neurogenic diarrhea: this is due to nervous delay/failure to defecate.
tension which stimulates PNS=Increased Location:
motility and mucus production. • It can be colonic or rectal
Effects: Causes:
• Prolonged diarrhea causes Fluid and The most common cause of constipation is a diet low
electrolyte imbalance =decreased body in fiber found in:
weight and fatigue • vegetables,
Character of stools and its probable indications: • fruits,
• and whole grains
• Bloody: desentery, ulcer • Not enough liquids
• Gaseous, rancid and pungent: • Lack of exercise
malabsorption • Medications
• Large, soft stools with food particles= • Irritable bowel syndrome
decreased HCL acid • Changes in life or routine such as
• Mucus: colitis, cancer of the colon pregnancy, older age, and travel
• Abuse of laxatives
Stool C/S: • Ignoring the urge to have a bowel movement
• Use sterile bottle to get specimen. • Specific diseases such as multiple sclerosis
• If possible, should be obtained before and lupus
antibiotic therapy. It should not contain poil, • Problems with the colon and rectum
barium, bismuth compounds • Problems with intestinal function.
Assess for: Important AnaPhysio Concepts:
• ACF of stools (amount, character and • Diaphragm is the strongest muscle that
frequency\) aides in the fecal-expulsion mechanism. It
• Weight can be weakened by pulmonary disorders.
• Bowel sounds • Large rectus muscle which creates
• Skin turgor increased intra-abdominal pressure that
• Fever aides in the fecal-expulsion mechanism can
• thirst be weakened by pregnancy, ascites and
• less frequent urination abdominal distention.
• dry skin • Levator ani muscles in the pelvic floor which
• fatigue also aids in the expulsion of feces can be
• light-headedness weakened by thepressureof the fetal head
• dark-colored urine during prenancy and child birth.
Nursing Management:
Asses for:
• Increase OFI. Use juices, broths or soups
• ACF of stools
that contain electrolytes.
• Pain in the sacrum, buttocks, thighs and
• Oral rehydration solutions such as pedialyte
hips.
maybe used especially for children,
• Use of cathartics and laxatives.
• Avoid foods that contain, caffeine, milk Client Education:
products, high fiber and oily foods.
• Increase OFI
Client Education:
• High fiber diet
 • Exercise b. Anti-diarrheal agents (Lomotil and
Immodium) : for diarrheal-predominant IBS
Fecal Incontinence:
c. Anticholinergics or Anti-spasmodic(Bentyl):
Irritable Bowel Syndrome:
for pain-predominant IBS
Definition:
• Is a CHRONIC GI disorder characterized by Intestinal Obstruction:
the presence of chronic or recurrent
• Partial or complete obstruction in the lower
diarrhea, constipation, abdominal pain and
GI tract (ileum is the most common site)
bloating.
• Types:
• Also called as spastic colon, nervous colon
or mucous colon. a. Mechanical: the bowel is physically
• Due to the impairment of motor or sensory obstructed by either intestinal contents,
function of GI. inflammation, tumor, hernias, strictures.
Etiology and risk factors: b. Non-mechanical: due to neuromuscular
• Exact cause is unknown. disturbances. also known as paralytic ileus.
• Risk Factors include:
a. diverticulitis Pathophysiology:
b. ingestion of foods with caffeine and
other gastric irritants Mechanical or non mechanical obstruction
c. lactose intolerance ↓
d. stress Intestinal contents( ingested foods, fluids gastic,
e. history of panic disorders, anxiety pancreatic and biliary secretions)
disorders and major depression accumulates at and above the area
S/Sx: ↓ ↓
• abdominal pain (LLQ) and cramps ↓ Intestinal absorption Increased peristalsis
RELIEVED by defecation or associated with as compensation
changes in stool’s ACF ↓
• abdominal distention Increased secretion
• sensation of incomplete evacuation of stool ↓
• Presence of mucus in stool Abdominal distention and
Assessment: pain
• Normal weight and bowel sounds ↓
• Diffused tenderness upon palpation. Bacterial Peritonitis
Dx: ↓
• Normal CBC Edema of the bowel and
• Normal Stool occult blood peritoneum
• Normal ESR ↓
• Barium enema, Sigmoidoscopy and Decreased fluid and
colonoscopy: colonic spasm is common electrolytes in the
during this procedure but is not definitive. Intravascular space
Interventions: ↓
• Health Teaching: Mild to Severe
a. Identify foods that upset one’s stomach and Hypovolemia
avoid them. ↓
b. Limit caffeine and alcohol intake Renal Insufficiency and
c. Milk and milk products should be avoided if even Death
lactose intolerance is detected. Etiology:
d. Regular intake of high fiber foods (30 to 40 g Mechanical Obstruction:
of fiber/day) • Adhesions (most common 45 to 65% of
e. Stress management cases)
f. Chew foods slowly • Tumors
• Hernias
• Drugs:
• Fecal impactions
a. Bulk forming laxatives (Metamucil): for
• Strictures
constipation-predominant IBS
• Intussusception
• Volvulus
 • Fibrosis • X-ray
• Vascular disorders • Barium enema, colonoscopy or
Non-mechanical: sigmoidocscopy except when perforation is
• Surgery already\ been determined
• MI • CT scan.
• Rib fractures • Explorative Laparotomy
• Pneumonia Interventions:
• Peritonitis • NGT (nasogasrtic tube for evacuation of
Hx: gastric contents)
• Past or recent abdominal surgery • NIT (nasointestinal tube for evacuation of
• History of IBD • NPO
• Hernias • Semi-fowler’s position with frequent position
• Trauma changes from side to side.
• Cancer • Fluids and Electrolyte replacement
• Peritonitis • Ice chips
Assessment: • Morphine for pain (SE: vomiting)
• Mid-abdominal pain or cramping, sporadic in
• IV antiobiotics
quality
• If strangulation is present, the pain is more
Inflammatory Bowel Disease:
steady and localized.
Ulcerative Colitis:
• Vomiting. Vomitus may contain bile and • Inflammation of the mucosal lining of the
mucus and maybe orange brown in color colon making it prone to ulcer.
and foul smelling. • It can result to loose stools with blood and
• Obstipation: no passage of stool may occur mucus, poor absorption of nutrients and
with complete obstruction thickening of the colon wall
Small Intestine Large-intestine Etiology and risk factor:
Obstruction obstruction • Unknown
Abdominal pain Intermittent abdominal
• Genetic predisposition
accompanied by cramping Hx:
peristaltic waves visible • Family history
in upper and middle • stress
abdomen. • Diet
• Elimination pattern
Upper or epigastric Lower abdominal • ACF of stools
abdominal distention distention • Weight
S/Sx:
Profuse Nausea and Minimal vomiting • Abdominal pain
vomiting • Bloody diarrhea
• Tenesmus (uncontrollable straining)
Obstipation Obstipation or ribbonlike
• Abdominal distention
stools
• Rebound tenderness if peritonitis is present
Sever fluid and No major F and E • Stool C/S
electrolyte imbalances imbalance Laboratory and diagnostic exam:
• H and H are low
Metabolic alkalosis Metabolic acidosis • WBC and ESR are high
• Na, K and Cl are low
• Barium enema with air contrast
Laboratory and diagnostic exams:
• WBC maybe normal except if strangulation is
Interventions:
present.
• Diarrheal management
• H and H, creatinine, BUN are often elevated • Salicylate compounds: Sulfasalazine inhibits
indicating dehydration.
prostaglandin synthesis
• Serum sodium, potassium and chloride are
• Corticosteroids
reduced.
• ABG
• Anti-diarrheal drugs such as motilium
• Chew foods thoroughly
 • NPO for severe cases • Ostomy care
• TPN • Be cautious of high fiber foods
• Ostomy care • Bedrest
• Be cautious of high fiber foods • Empty pouch when it is one half full
• Bedrest
• Empty pouch when it is one half full Client Education:
• Skin care in ostomy areas
Surgical Interventions: • B12 supplements
• Proctocolectomy with permanent ileostomy • Rest and stress management
• Low residue and high calorie diet
Crohn’s Disease:
Definition: Colorectal Cancer:
• Idiopathic inflammatory disease disease of Definition:
the small intestine, the colon or both. It is • Cancer of the colon and rectum (CRC)
chronic and nonspecific. • 95 percent are adenocarcinomas
• It involves all layers of the bowel but most • Abnormal proliferation of colonic mucosa
commonly the ileum starts as visible polyps in the colon that turns
• It is a slowly progressive and recurrent into malignant tumors
disease with predominant involvement of the • 70 % of the polyps in the colon occurs in the
regions of bowel with normal sections rectosigmoidal region.
between them. • Colorectalcancer may metastasize through
• Eventually, fissures, ulcerations and bowel direct extension (tisuue to tissue) and
thickening occurs resulting to diarrhea and through the circulatory and lymphatic
malabsorption of vital events. system.
Etiology: • Liver is the most common site of metastasis
• Genetics (15 to 30 % of cases).
• Mycobacterium paratubercolosis • It can also spread in the brain, lungs, bones
Assessment: and adrenal glands.
• Fever Etiology and risk factors:
• Abdominal pain • Genetics : first degree relative have a three-
• Loose stools fold chance in acquiring the disease
• Weight loss • Cause in unkown
• ACF of stools (steatorrhea) • 95 percent of cases are 50 years old and
• Abdominal tenderness above.
• Guarded movement • ↑ fat and ↓fiber diet
• Palpable mass in the RLQ • obesity
• High pitched, rushing bowel sounds • IBD and Crohn’s disease
Laboratory and diagnostic exam: • Eating foods such as:
• Decreased H and H if bleeding is present a. Red meat
• Decreased Serum levels of folic acid and b. Animal meat
B12 c. Fatty foods
• Decreased serum albumin levels d. Friend meats and fish
• ESR and WBC elevated e. Refined carbohydrates
• X-rays
• Barium enema Health Promotion and prevention:
• Diet modification
Interventions: • Regular exercise
• Diarrheal management • Daily vitamins, HRT, oral contraceptives
• Salicylate compounds: Sulfasalazine inhibits • Aspirin
prostaglandin synthesis Hx:
• Corticosteroids • Family history of CRC, IBD, Crohn’s, disease
• Anti-diarrheal drugs such as motilium • Diet
• Chew foods thoroughly • Stool
• NPO for severe cases Assessment:
• TPN • Ascending colon:
 ✔ Occult blood in stool • Double-contrast barium enema (air and
✔ Anemia barium)
✔ Anorexia and weight loss • Sigmoidoscopy and colonoscopy (definitive
✔ Pain above umbilicus test for CRC)
✔ Palpable mass in the RLQ • Liver scan may located distant sites for liver
• Descending colon: metastasis.
✔ Rectal bleeding • Psychosocial support
✔ Change in bowel habits
✔ Constipation or diarrhea
✔ Pencil or ribbon shaped stools
✔ Tenesmus
✔ Sensation of incomplete bowel emptying

• Duke’s Classification of CRC:

✔ Stage A: confined to bowel mucosa (80-90%
5 years survival rate)
✔ Stage B: Invading muscle wall
✔ Stage C: lymph node involvement
✔ Stage D; metastasis or locally unresectable
tumor (less than % 5 years survival rate)
Guidelines for early detection of CRC:
• Digital-rectal exam yearly after age 40
• FOBT yearly after age 50
• Proctosigmoidoscopy every 5 years after
age 50 following 2 negative result of yearly
examination

Collaborative Management/ Interventions:

• Surgery:
✔ Hemicolectomy: for ascending and
transverse colon caner
✔ Abdomino-perineal resection (APR): for
recto-sigmoid cancer
➢ There are two incisions:
1. Lower abdomen incision to remove
the sigmoid.
2. Perineal incision: to remove the
rectums
➢ T-binder is used to secure perineal
dressing
➢ Necessitates permanent colostomy

• Chemotherapy:
➢ Fluorouracil-5
• Radiotherapy
• Colonic surgery:

Laboratory and diagnostic exams:

• FOBT Fecal Occult Blood Test (Guiac stool
exam)
• CEA: Carcinoembryonic antigen: may be
elevated in 70 % of CRC patients but also
present in smokers and other malignancies.
• CT scan
• X-ray