Our Lady of Fatima University

College of Nursing
Valenzuela Campus

Intestinal Obstruction Partial Probably sec to Colonic

Malignancy

A Case Study
Presented to:
Ms. Vanessa O. Umali, R.N. MAN

Presented by:
Maria Paula M. Bungay
July 2015

TABLE OF CONTENTS

I. Introduction
II. Objectives
III. Patients Profile
IV. Anatomy and Physiology
V. Pathophysiology
VI. Laboratory Examination Results
VII. Gordons Assessment
VIII. Nursing Care Plans
IX. Drug Study
X. Discharge Planning

I. Introduction

Intestinal obstruction
Intestinal obstruction is a partial or complete blockage of the bowel that results in the
failure of the intestinal contents to pass through.
Causes
Obstruction of the bowel may due to:

A mechanical cause, which simply means something is in the way

Ileus, a condition in which the bowel doesn't work correctly but there is no
structural problem

Paralytic ileus, also called pseudo-obstruction, is one of the major causes of intestinal
obstruction in infants and children. Causes of paralytic ileus may include:

Chemical, electrolyte, or mineral disturbances (such as decreased potassium

levels)
Complications of intra-abdominal surgery
Decreased blood supply to the abdominal area (mesenteric artery ischemia)
Injury to the abdominal blood supply
Intra-abdominal infection
Kidney or lung disease
Use of certain medications, especially narcotics

In older children, paralytic ileus may be due to bacterial, viral, or food poisoning
(gastroenteritis), which is sometimes associated with secondary peritonitis and
appendicitis.
Mechanical causes of intestinal obstruction may include:

Abnormal tissue growth

Adhesions or scar tissue that form after surgery
Foreign bodies (ingested materials that obstruct the intestines)
Gallstones
Hernias
Impacted feces (stool)
Intussusceptions
Tumors blocking the intestines
Volvulus (twisted intestine)

Symptoms

Abdominal distention
Abdominal fullness, gas
Abdominal pain and cramping
Breath odor
Constipation
Diarrhea
Vomiting

Site of Obstruction
Small intestine
[85%]

Large Intestine
[15%]

Cause

Relative Incidences (%)

Adhesions

60

Hernia

15

Tumors

15

miscellaneous

10

CA colon

65

Diverticulitis

20

Volvolus

miscellaneous

10

Abstract
The management of patients with malignant bowel obstruction
(MBO) can be one of the most challenging aspects of advanced cancer
care, and as a result, their symptoms are often palliated poorly, especially
near the end of life. The term MBO encompasses a heterogeneous

clinical syndrome, defined as obstructive symptoms due to the presence

of intra-abdominal neoplastic disease. Radiological imaging, particularly
with computed tomography, is critical in determining the cause of obstruction
and possible therapeutic interventions. Options include laparotomy
with or without a stoma, decompression with a stent, or aggressive
medical therapy. Surgical decision-making involves the selection of
the intervention most likely to relieve symptoms and improve quality of
life for a particular patient at that particular point along his or her disease
course. Although MBO is a relatively common dilemma encountered in
clinical practice, there are no simple treatment guidelines or algorithms
to follow. Instead, each patient must be assessed individually to devise
a treatment plan that best balances the advantages and disadvantages
of the intervention, considering the patients prognosis, tumor biology,
andmost importantlyhis or her goals of care, as determined through
an honest discourse between physician and patient. This review outlines
a surgical framework for clinicians managing patients with MBO.
II. Objectives
Nurse-Centered
After the completion of this case study, the nurse will be able to:

1.

Understand the current statistics and latest trend regarding Intestinal Obstruction partial
probably sec to Colonic Malignancy.

2.

Describe factually, the personal and pertinent family history of the patient and relate it to the
present condition.

3.

Perform comprehensive physical assessment.

4.

Trace the book-based and client-centered pathophysiology of Intestinal Obstruction partial

probably sec to Colonic Malignancy.

5.

Determine the predisposing and precipitating factors and the signs and symptoms and
relate to the disease process.

6.

Enumerate and describe the diagnostic and laboratory procedures as well as the nursing
responsibilities in relation to the disease condition

7.

Enumerate the different treatment modalities and their indication specifically for the patients
condition.

8.

Identify the pharmacologic treatment provided to the patient, relate the actions of each drug
with the disease process and evaluate the patients response to the medications given.

9.

Identify nursing diagnoses, formulate short-term and long-term goals, carry out appropriate
interventions and evaluate the plan.

10. Appraise the effectiveness of medical and surgical nursing management in treating the
patient.
11. List the preventive measure for the occurrence of Intestinal Obstruction partial probably sec
to Colonic Malignancy for the benefit of the general public.
Patient Centered
After the completion of this case study, the patient will be able to:
1. Report understanding of the disease process.

2. Understand the indications of the different diagnostic procedures and medical management
involved in her care.
3. Cooperate with the necessary medical and nursing interventions.
4. Adhere with the health teachings provided.
5. Understand the different ways of health promotion and prevention in relation to the disease
condition.
6. Demonstrate improved conditions as evidenced by absence of further complications.

III. Patients Profile

Name: Mr. Isaw
Age: 62 years old
Birthday: February 18, 1952
Nationality: Filipino
Religion: Roman Catholic
Civil Status: Married
Date Admission: July 2, 2015
Time of Admission: 12:15 PM
Chief Complaint's: Abdominal Pain
Initial Diagnosis: Intestinal Obstruction Partial Probably sec to Colonic Malignancy
Final Diagnosis: None

HISTORY OF PAST ILLNESS

During the previous years, Mr. Isaw was diagnosed Hypertensive in 2014 and a history
of vehicular accident 20 years ago, which affected his Left femur. He is a non-smoker and nonalcoholic. As for childhood illness, he had chicken pox and measles. He also experienced
coughs and colds for common illness. To relieve symptoms, he would take different herbal
plants or purchase over-the-counter drugs. For the herbal plants, he prepares decoction with
one to two glasses of water for fifteen minutes or until one half of the liquid is left. Then, he will
drink it. He also experienced fever once in a while in which he takes over-the-counter drugs. Mr.
Isaw, has no family history of hypertension, Diabetes, Arthymias, Pulpomonary Tuberculosis,
and Cancer. For food allergies, crab and shrimp are contraindicated but no allergies to drugs.
HISTORY OF PRESENT ILLNESS
Prior to admission, Mr. Isaw complained of sudden onset abdominal pain described as
bloatedness more prominent in the epigastric and right periumbilical area. There was no
associated nausea, vomiting, change in bowel habits, hematochezia, melena, jaundice and
fever. Patient consulted at PGH, Abdominal X-ray revealed dilated small bowels. He was then
referred to the institution for further management.

PHYSICAL ASSESSMENT
Physicians Physical Assessment done by the Resident on Duty (July 2, 2015, lifted from the
patient's chart)
Height: 56
Weight: 81 kg
Vital Signs as follows:
T: 36.9 C

PR: 116 bpm

GENERAL SURVEY

RR: 18cpm

BP: 150/90 mmHg

SAO2: 97%

Mr. Isaw, Assessed/received patient lying on bed, awake, conscious, responsive,

and coherent. With the following vital signs:
Temperature: 36.7 C
Heart rate: 70 bpm
Respiratory rate: 20 bpm
Blood Pressure: 140/90 mmHg
SAO2: 96%
NUTRITIONAL STATUS
Upon admission, Mr. Isaw was placed on NPO and IVF of D5LR 1 x Q8. CBC,
BT, PTPTT, FBS, BUN, CREA, Na, K, Cl, 12-LECG, Chest X-ray PA, abdominal
series, and Urinalysis were requested. NGT and Foley Catheter were inserted. Mr.
Isaw, was also given Omeprazole 40mg TIV O.D.
SKIN
> Pallor noted.
> Good skin turgor in both upper and lower extremities; the skin returns to its
previous state immediately after being tented.
> warm moist skin, no active dermatoses.
HAIR
> Hair is black and is evenly distributed.
> Silky and smooth hair.
> No areas of hair loss noted.

> Thick hair strands.

NAILS
> Trimmed clean nails.
> Concave shaped; with a nail plate angle of about 160 degrees.
> Smooth in texture.
> Intact epidermal lining around the nails.
> Capillary Refill Test less than 3 seconds.
SKULL AND FACE
> Rounded (normocephalic and symmetrical with frontal, parietal and occipital
prominences).
> Head has no cervical lymphadenophaties
> No nodules or masses upon palpation.
EYES AND VISION
> Eyebrows and eyelashes are evenly distributed.
> Eyelids are intact
> Pink palpebral conjuctiva
> Sclera appears white.
> Pale conjunctiva.
> No discharges and discoloration noted.

> Blink reflex intact.

EARS AND HEARING
> Ears are symmetrical in size and in line with the outer canthus of the eyes.
> Color of ears is the same with the facial skin.
> No discharges and foul odor noted upon inspection.
> Pinna and ear canal are clean.
> Auricles are firm and recoil to previous state when folded.
> No nodules or masses noted upon palpation
NOSE AND SINUSES
> No nasal discharge
> No tenderness masses and pain noted upon palpation
OROPHARYNX (Mouth and Throat)
> Dry and pale lips noted upon inspection
> Tongue is able to move freely
> Good oral hygiene.
> Thyroid gland moves with deglutition
NECK
> Jugular vein is not visible
> Muscles are equal in size with the head centered

> Slow muscle movement

> Lymph nodes are not palpable
CARDIOVASCULAR AND PERIPHERAL SYSTEM
> Skin color of palm of the hand and feet is pink.
> Pink nail beds upon inspection.
> Symmetric pulse volumes, full pulsations of peripheral pulses.
> Heart rate is 70 beats per minute.
> Blood Pressure is 140/90 mmHg
> (Vital signs taken during the time of assessment July 2, 2015 at 0715H)
RESPIRATORY SYSTEM
> Symmetric chest expansion
> Skin and chest wall are intact and has uniform temperature
> No tenderness and masses noted upon palpation
> Regular breathing pattern
> Presence wheezing and crackles sound upon auscultation
> Full and symmetric chest wall expansion
BREAST AND AXILLAE
> Breasts are symmetrical in size; color is the same as with the abdomen.
> Both nipples are symmetrical in size.

> No discharges noted.

> No tenderness, masses, and nodules noted upon palpation.
ABDOMEN
> Direct tenderness at epigastric area.
> Abdominal skin is intact.
> Distended abdomen noted.
> Audible bowel sound upon auscultation.
> Abdominal dullness upon percussion.
MUSCULOSKELETAL
> Posture is good, able to stand straight and can walk alone properly but slowly
> Scar at left thigh and right medial leg and foot
NEUROLOGIC
>with a GCS of 15
> Patient has times of looking in the distance and is slow in response when a
question asked.
> Patient was able to answer well when asked of her complete name, birth date and
age.
URINARY SYSTEM
> Patient has indwelling Foley Catheter
REPRODUCTIVE SYSTEM

> The patient refused to be assessed with her external reproductive organ but she
verbalized that she has minimal vaginal bleeding and complain of pain when
secretions are expelled.

REVIEW OF SYSTEM
Integumentary System
The patient has no history of bruises in both upper and lower extremities.
Head
The patient had no history of any form of head injuries.

Eyes
Patient had no history of any eye problems.
Ears and Hearing
Patient had no history of smelly discharges on both ears, and no complaints of
hearing impairment.
Breast and Axillae
The patient had no history of breast nodules, no enlargement, no tenderness, no
pain and unusual discharges.
Respiratory System
The patient has no history of asthma or other respiratory problems.

Cardiovascular System
The patient has a history of hypertension.
Genitourinary System
The patient had no history of any genital problems. Usually urinates 5 times a day.
Gastrointestinal System
The patient had experienced abdominal pain.
Musculoskeletal System
Patient has no history of joint pain.
Neurologic System
Patient had no history of any major mental problems.

Cranial Nerve Assessment:

CRANIAL NERVE

ASSESSMENT
TECHNIQUE

EXPECTED
OUTCOME

I: Olfactory
Type: Sensory
Function: Smell

Ask the client to identify Client is able to

a scented object that identify different
you are holding.
smell with each
nostril separately
and with eyes
closed unless such
condition like colds
is present.

II: Optic
Type: Sensory

Provide adequate
lighting and ask client

ACTUAL FINDINGS
The client was able to
identify the aromas of
cologne and alcohol
that she had smelled.

The client should be

The client was able to
able to read with each read the words in the

Function: Vision

to read words on a
newspaper held at a
distance of 36 cm (14
inches) with each eye
first then both eyes.

eye and both eyes.

III: Oculomotor, IV:

Trochlear & VI:
Abducens
Type: Motor
Function: Upward
and Downward
movement of Pupils.

-Hold a penlight 1 ft. in -Clients eyes should

front of the clients
be able to follow the
eyes. Ask the client to penlight as it moves.
follow the movements
of the penlight with the
eyes only. Move the
penlight upward,
downward, sideward
and diagonally.

newspaper at 14
inches.

-Both eyes of the client

were able to follow the
Penlights movements.

-Ask the client to look

straight ahead then
approach the pupil with -The clients eyes will -The client had a
a penlight and observe have a normal reaction normal reaction to
for pupil constriction. for PERRLA.
PERRLA as Pupils are
equally round, reactive
to light and
accommodation.
V: Trigeminal
Type: Sensory
Function: Sensation
of cornea

While client looks

Client should have a
The client was able to
upward, lightly touch
positive corneal reflex. elicit corneal reflex.
the lateral sclera of eye
to elicit blink reflex.

VII: Facial
Type: Motor
Function: Facial
movements

Ask client to: smile,

frown and wrinkle
forehead, show teeth,
puff out cheeks, purse
lips, raise eyebrows,
close eyes tightly
against resistance

VIII:
Vestibulocochlear/
acoustics
Type: Sensory
Function: Hearing

Have the Client

Client should be able to The client was able to
occlude one ear. Out of hear the ticking of the hear the ticking of the
the clients sight, place watch in both ears.
watch in both ears.
a tickling watch 2 cm.
Ask what the client can
hear and repeat with
the other ear.

IX. Glossopharyngeal Ask the client to

& X: Vagus
swallow and say its

Client should smile,

frown and wrinkle
forehead, show teeth,
puff out cheeks, purse
lips, raise eyebrows,
close eyes tightly
against resistance.
Movements are
symmetrical.

The client was able to

do the facial
movements
symmetrically.

The client should be

The client was able to
able to swallow without swallow without

Type: Motor
Function:
Swallowing and
Speaking

name.

XI. Spinal Accessory

Type: Motor
Function: strength
and resistance

-Ask client to shrug the -There is symmetric,

The client was able to
shoulders against your strong contraction of
symmetrically contract
hands.
the trapezious muscles. the trapezious muscle.

-Ask client to turn the

head against
resistance, first to the
right then to the left, to
assess the
sternocleidomastoid
muscle.
XII: Hypoglossal
Type: Motor
Function: Movement
and strength of
tongue

Ask the client to

protrude the tongue
and move in different
directions.

difficulty and speak

audibly.

difficulty and speak

audibly.

-There is strong
contraction of the
sternocleidomastoid
muscle on the side
opposite to the turned
face.

-The client was able to

contract
strenocleidomastoid
muscleon the side
opposite to the turned
face.

The client will be able

to protrude her tongue
and move in different
directions.

The client was able to

protrude his tongue and
move it in different
directions.

IV. Anatomy and Physiology

The digestive system, sometimes called the gastrointestinal tract, alimentary

tract, or gut, consists of a long hollow tube which extends through the trunk of the
body, and its accessory structures: the salivary glands, liver, gallbladder, and
pancreas (Fig. 20-1). The digestive tract is divided into two sections, the upper tract,
consisting of the mouth, esophagus, and stomach, and the lower tract, consisting of
the intestines.
FIGURE 20-1

Anatomy of the digestive system with associated events.

Inside this tube, ingested food and fluid, along with secretions from various
glands, are efficiently processed. First, they are broken down into their separate
constituents; then the desired nutrients, water, and electrolytes are absorbed into
the blood for use by the cells, and waste elements are eliminated from the body.
Within this system, the liver can reassemble the component nutrients into new
materials as they are needed by the body. For example, the proteins in milk are
digested by enzymes in the digestive tract, producing the component amino acids,
which are then absorbed into the blood. The individual amino acids are used by the
liver cells to produce new proteins, such as albumin or prothrombin, or they may

circulate as they are in the amino acid pool in the blood to be taken up by
individual cells as necessary.
The peritoneal cavity refers to the potential space between the parietal and
visceral peritoneum. A small amount of serous fluid is present in the cavity to
facilitate the necessary movement of structures such as the stomach. Numerous
lymphatic channels drain excessive fluid from the cavity.
Because serous membranes are normally thin, somewhat permeable, and
highly vascular, the peritoneal membranes are useful as an exchange site for
blood during peritoneal dialysis in patients with kidney failure (see Chapter 21).
However, such an extensive membrane may also facilitate the spread of infection
or malignant tumor cells throughout the abdominal cavity or into the general
circulation.
The mesentery is a double layer of peritoneum that supports the intestines
and conveys blood vessels and nerves to supply the wall of the intestine. The
mesentery attaches the jejunum and ileum to the posterior (dorsal) abdominal wall.
This arrangement provides a balance between the need for support of the
intestines and the need for considerable flexibility to accommodate peristalsis and
varying amounts of content.
The greater omentum is a layer of fatty peritoneum that hangs from the
stomach like an apron over the anterior surface of the transverse colon and the
small intestine. The lesser omen-tum is part of the peritoneum that suspends the
stomach and duodenum from the liver. When inflammation develops in the
intestinal wall, the greater omentum, with its many lymph nodes, tends to adhere to
the site, walling off the inflammation and temporarily localizing the source of the
problem. Inflammation of the omentum and peritoneum may lead to scar tissue
and the formation of adhesions between structures in the abdominal cavity, such
as loops of intestine, restricting motility and perhaps leading to obstruction.
Intestinal Obstruction

Intestinal obstruction refers to a lack of movement of the intestinal contents

through the intestine. Because of its smaller lumen, obstructions are more common
and occur more rapidly in the small intestine, but they can occur in the large
intestine as well. Depending on the cause and location, obstruction may manifest
as an acute problem or a gradually developing situation. For example, twisting of
the intestine could cause sudden total obstruction, whereas a tumor leads to
progressive obstruction. FIGURE 20-37 Colostomy. A, sigmoid colostomy-a
surgically created opening into the colon through the abdominal wall. B, The stoma
is the new opening on the abdomen. It is always red and moist, is not painful, but

may bleed easily. C, A plastic pouch to collect stools is attached to the stoma.
(Courtesy of Hollister Incorporated, Patient Education Series.)

Intestinal obstruction occurs in two forms. Mechanical obstructions are

those resulting from tumor, adhesions, hernias, or other tangible obstructions
(Fig. 20-38). Functional, or adynamic, obstructions result from neurologic
impairment, such as spinal cord injury or lack of propulsion in the intestine, and
are often referred to as paralytic ileus. While the end result can be the same,
these types manifest somewhat differently and require different treatment.

Colon
The colon is the last part of the digestive system in most vertebrates; it extracts
water and salt from solid wastes before they are eliminated from the body, and is the site
in which flora-aided (largely bacteria) fermentation of unabsorbed material occurs. Unlike
the small intestine, the colon does not play a major role in absorption of foods and
nutrients. However, the colon does absorb water, potassium and some fat soluble
vitamins.
In mammals, the colon consists of four sections: the ascending colon, the
transverse colon, the descending colon, and the sigmoid colon (the proximal colon
usually refers to the ascending colon and transverse colon). The colon, cecum, and
rectum make up the large intestine.
The location of the parts of the colon are either in the abdominal cavity or behind
it in the retroperitoneum. The colon in those areas is fixed in location.
Arterial supply to the colon comes from branches of the superior mesenteric artery
(SMA) and inferior mesenteric artery (IMA). Flow between these two systems
communicates via a "marginal artery" that runs parallel to the colon for its entire length.
Historically, it has been believed that the arc of Riolan, or the meandering mesenteric
artery (of Moskowitz), is a variable vessel connecting the proximal SMA to the proximal
IMA that can be extremely important if either vessel is occluded. However, recent studies
conducted with improved imaging technology have questioned the actual existence of
this vessel, with some experts calling for the abolition of the terms from future medical
literature.
Venous drainage usually mirrors colonic arterial supply, with the inferior
mesenteric vein draining into the splenic vein, and the superior mesenteric vein joining
the splenic vein to form the hepatic portal vein that then enters the liver.
Lymphatic drainage from the entire colon and proximal two-thirds of the rectum is to the
paraaortic lymph nodes that then drain into the cisterna chyli. The lymph from the
remaining rectum and anus can either follow the same route, or drain to the internal iliac
and superficial inguinal nodes. The pectinate line only roughly marks this transition.
Ascending colon
The ascending colon, on the right side of the abdomen, is about 25 cm long in
humans. It is the part of the colon from the cecum to the hepatic flexure (the turn of the
colon by the liver). It is secondarily retroperitoneal in most humans. In ruminant grazing
animals, the cecum empties into the spiral colon.
Anteriorly it is related to the coils of small intestine, the right edge of the greater
omentum, and the anterior abdominal wall. Posteriorly, it is related to the iliacus, the
iliolumbar ligament, the quadratus lumborum, the transverse abdominis, the diaphragm
at the tip of the last rib; the lateral cutaneous, ilioinguinal, and iliohypogastric nerves; the
iliac branches of the iliolumbar vessels, the fourth lumbar artery, and the right kidney.
The ascending colon is supplied by parasympathetic fibers of the vagus nerve (CN X).
Arterial supply of the ascending colon comes from the ileocolic artery and right colic
artery, both branches of the SMA. While the ileocolic artery is almost always present, the
right colic may be absent in 515% of individuals.
Transverse colon
The transverse colon is the part of the colon from the hepatic flexure to the
splenic flexure (the turn of the colon by the spleen). The transverse colon hangs off the

stomach, attached to it by a wide band of tissue called the greater omentum. On the
posterior side, the transverse colon is connected to the posterior abdominal wall by a
mesentery known as the transverse mesocolon.
The transverse colon is encased in peritoneum, and is therefore mobile (unlike
the parts of the colon immediately before and after it). Cancers form more frequently
further along the large intestine as the contents become more solid (water is removed) in
order to form feces.
The proximal two-thirds of the transverse colon is perfused by the middle colic
artery, a branch of SMA, while the latter third is supplied by branches of the IMA. The
"watershed" area between these two blood supplies, which represents the embryologic
division between the midgut and hindgut, is an area sensitive to ischemia.
Descending colon
The descending colon is the part of the colon from the splenic flexure to the
beginning of the sigmoid colon. The function of the descending colon in the digestive
system is to store food that will be emptied into the rectum. It is retroperitoneal in twothirds of humans. In the other third, it has a (usually short) mesentery. The arterial supply
comes via the left colic artery.
Sigmoid colon
The sigmoid colon is the part of the large intestine after the descending colon
and before the rectum. The name sigmoid means S-shaped (see sigmoid). The walls of
the sigmoid colon are muscular, and contract to increase the pressure inside the colon,
causing the stool to move into the rectum.
The sigmoid colon is supplied with blood from several branches (usually between 2 and
6) of the sigmoid arteries, a branch of the IMA. The IMA terminates as the superior rectal
artery. Sigmoidoscopy is a common diagnostic technique used to examine the sigmoid
colon.

Redundant colon
One variation on the normal anatomy of the colon occurs when extra loops form,
resulting in a longer than normal organ. This condition, referred to as redundant colon,
typically has no direct major health consequences, though rarely volvulus occurs
resulting in obstruction and requiring immediate medical attention.[4] A significant
indirect health consequence is that use of a standard adult colonoscope is difficult and in
some cases impossible when a redundant colon is present, though specialized variants
on the instrument (including the pediatric variant) are useful in overcoming this problem.
Standing gradient osmosis
Water absorption at the colon typically proceeds against a transmucosal osmotic
pressure gradient. The standing gradient osmosis is a term used to describe the
reabsorption of water against the osmotic gradient in the intestines. This hypertonic fluid
creates an osmotic pressure that drives water into the lateral intercellular spaces by
osmosis via tight junctions and adjacent cells, which then in turn moves across the
basement membrane and into the capillaries.
Functions of the Colon
There are differences in the large intestine between different organisms, the large
intestine is mainly responsible for storing waste, reclaiming water, maintaining the water
balance, absorbing some vitamins, such as vitamin K, and providing a location for floraaided fermentation.Vitamin K is essential as a coagulation factor.

By the time the chyme has reached this tube, most nutrients and 90% of the
water have been absorbed by the body. At this point some electrolytes like sodium,
magnesium, and chloride are left as well as indigestible parts of ingested food (e.g., a
large part of ingested amylose, protein which has been shielded from digestion
heretofore, and dietary fiber, which is largely indigestible carbohydrate in either soluble
or insoluble form). As the chyme moves through the large intestine, most of the
remaining water is removed, while the chyme is mixed with mucus and bacteria (known
as gut flora), and becomes feces. The ascending colon receives fecal material as a
liquid. The muscles of the colon then move the watery waste material forward and slowly
absorb all the excess water. The stools get to become semi solid as they move along
into the descending colon. The bacteria break down some of the fiber for their own
nourishment and create acetate, propionate, and butyrate as waste products, which in
turn are used by the cell lining of the colon for nourishment. No protein is made
available. In humans, perhaps 10% of the undigested carbohydrate thus becomes
available; in other animals, including other apes and primates, who have proportionally
larger colons, more is made available, thus permitting a higher portion of plant material
in the diet. This is an example of a symbiotic relationship and provides about one
hundred calories a day to the body. The large intestine produces no digestive enzymes chemical digestion is completed in the small intestine before the chyme reaches the
large intestine. The pH in the colon varies between 5.5 and 7 (slightly acidic to neutral).

I.
II.
III.

Colonic Carcinoma / Colon Carcinoma / Colon Cancer

Definition:
It is a disease in which malignant (cancer) cells form in the tissues of the
colon.
The colon is part of the body's digestive system. The digestive system
removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins,
and water) from foods and helps pass waste material out of the body. The digestive
system is made up of the esophagus, stomach, and the small and large intestines.
The first 6 feet of the large intestine are called the large bowel or colon. The last 6
inches are the rectum and the anal canal. The anal canal ends at the anus (the
opening of the large intestine to the outside of the body).
Risk Factors:
Age and health history can affect the risk of developing colon carcinoma .
Risk factors include the following:

Age 50 or older.

A family history of carcinoma of the colon or rectum.

A personal history of carcinoma of the colon, rectum, ovary,

endometrium, or breast.

A history of polyps in the colon.

Signs and Symptoms:

completely.

A change in bowel habits.

Blood (either bright red or very dark) in the stool.
Diarrhea, constipation, or feeling that the bowel does not empty
Stools that is narrower than usual.
Frequent gas pains, bloating, fullness, or cramps.
Weight loss for no known reason.
Feeling very tired.
Vomiting.

A specimen removed from a patient with colonic carcinoma

V. Pathophysiology
Pathophysiology of Colon Cancer

Predisposing factors:

Age (56% >70yrs

old)

Colorectal polyps

Family history

Previous colorectal
cancer

Ulcerative colitis
/colonic crohns
disease

Diagnostic test:

Fecal occult blood

test

SigmoIdoscopy

Digital Rectum
Exam

If treated
Surgical
Surgical
Treatment:
Treatment:
Colonoscopy
Colonoscopy
Reduction
likelihood
likelihood
Reduction
Virtual
Chemotherapy
Colonoscopy
If
treated
of
regrowth
of
regrowth
Polypectomy
Radiation Therapy

Etiology:
Unknown

Abnormal
proliferation of cells
in the colon area

Arising from
epithelial lining of the
intestine

Benign polyps occur

Precipitating factors:
Patient broke her right leg
due to falling on the stairs
Precipitating factors:

Diet high fat/low

fiber

Smoking

Alcohol drinking

Lack of exercise

Signs and Symptoms:

Rectal bleeding

Bloody stools

Abdominal pain

Fatigue

Constipation

Diarrhea

Nausea and
Vomiting

If not treated
Uncontrolled
Diagnostic test:
Continuous
Increase
plorifetation
in
ofMetatases
Proliferation
of of
cancer
cancer
cells
cells
proliferation
in
SigmoIdos
Increase in size ot the
Development
polyps
COLON
CANCER
malignant
Exposure
tumor
Continues
Formation
Complications
Ifto
not
DEATH
carcinogens
increase
treated
of
newoccur
tumor
in size copy
cells
in of
the
size
polyps
other
in
that
organs
area
of cells
in
the
tumor