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Colorectal Cancer (CA colon) (Investigation (Lab result: (Na, K, Cl level…
Colorectal Cancer (CA colon)
Predisposing factor
Familial Adenomatous polyposis
High fat low fibre diet
inflammatory bowel disease
S/S
Altered bowel habits
Rectal bleeding
Abdominal pain/ discomfort
unexplained weight loss
Investigation
Fecal materials from NG tube aspiration
Digital Rectal Examination
Lab result:
Na, K, Cl level drop due to vomiting
WBC count increase & C-reactive protein -> determine inflammatory process
complete blood count
stool for occult blood
Abdominal & chest X-ray
presence and location of small/ large intestinal distention
Contrast Studies
Barium enema
identify the site of tumour more accurately than conventional colonoscopy
Diagnostic studies
Colonoscopy with endorectal ultrasound
Identify the source of obstruction
Confirm diagnosis with biopsy
endorectal ultrasound (EUS)
identify tumour site & staging
identify pelvic & perianal metastasis
CT Scan
More accurate to grade the level
MRI (magnetic resonance imaging)
more accurate for site
detect metastasis in pelvic
PET scan
detect distant metastases
Radioisotope Scans
locate rare tumour
Management
Primary prevention
Diet modification
Clinical scanning
Genetic testing to identify mutation
flexible sigmoidoscopy
以內視鏡技術來觀察大腸內壁黏膜的狀況, 從肛門放進大腸內, 整條大腸的一半,若在檢查過程中發現瘜肉，便會直接切除或抽取活組織進行病理化驗
colonoscopy: 整條大腸
Polypectomy
Stent insertion
decompression of obstruction
Chemotherapy
Adjuvant therapy
aim to shrink tumour prior to surgical excision
or eradicate tumour cells postoperatively
radiotherapy : for palliative purpose
Bowel surgeries
Hartmann's procedure
A 2-stages operation of rectosigmoid carcinoma
1) initial colonic resection (切) (in sigmoid colon) with proximal bowel mobilised to perform a colostomy & rectal pouch (Hartmann's pouch)
2) subsequent closure of (temporary) colostomy & re-anastomosis pf bowel
3) the Hartmann's pouch is then oversewn to the abdomen
temporary/ permanent end colostomy
Bowel resection
excision切除 of a segment of small/ large bowel
Right (ascending) / left (descending) hemicolectomy
End-to-end anastomosis (血管連接）
temporary diverting loop ostomy / double barrel -> may after the proximal & distal bowel anastomosis
Low-anterior resection
removal of the sigmoid colon and upper rectum
Abdominoperineal (AP) resection
cancer involving anorectum the entire anal canal and the distal 2 cm of the rectum (<5cm)
removal of the rectum & anus with permanent colostomy
end-colostomy also performed
Total colectomy: colon removed but preserve rectum = ileum directly connected to rectum
Partial exenterative
anterior exenteration: removal of bladder & radical hysterectomy
posterior exenteration: removal of radical hysterectomy, colon & rectum
Total exenteration
removal of uterus, vaginal, lymphatic nodes, bladder & rectum
pre-ot nursing siagoses
acute pain
pain management
severity increase with pt's anxiety
avoid overwhelming info.
reinforce & explain interventions
regular analgesics
may thru IMI
Opiates (e.g. morphine) may induce nausea & vomiting; antiemetics (e.g. stemetil) may needed
Hyoscine butylbromide (e.g. buscopan) -> useful for controlling colicky spasmodic pain
deficient fluid volumn
diarrhoea & constipation
Bowel decompression: decompress bowel & prevent painful distension by gas/ fluid
Bowel preparation
NPO for 6-8 hrs
aim to reduce risk of postoperative infection
low residue diet to decrease fecal content
fluid diet at the day before ot
medication (ducolax suppository, cathartics; prophylactic antibiotics)
NG tube insertion
connect to BSB & Q1H aspiration
ensure its patent
notice the amount, colour & characteristic of drainage
Post-ot
optimal nutrition: related to short bowel syndrome (shorten -> difficult in absorption)
enteral feeding
parenteral nutrition
fluid & electrolyte imbalance
For AP resection (Sitz bath to perineal wound)
immerse the pelvic/ perineal area in warm water (for wound cleaning)/ hot water for heat application
aim to promote wound healing by increase the circulation & decrease risk of wound infection
potassium permanganate (KMNO4)