Alterations in Nutrition, Elimination and

Sexuality –Large Bowel Dysfunction

Unit No: 400814

Prepared by Gabrielle Metelli -2009

University of Western Sydney. UANE&S 1

2009

Objectives

• Develop an understanding of the pathophysiology of intestinal

and rectal disorders.
• Describe the clinical manifestations of the disorders and the
relationship to pathophysiology.
• Discuss diagnostic techniques.
• Develop an understanding of related pharmacology.

University of Western Sydney. UANE&S 2

2009

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 Diarrhoea

Definition:
• The frequent passage of loose, liquid stools.

Diarrhoea - Acute

• Lasts less than 4 days

• Caused by infectious agent
• Viral
• Bacterial
• Parasitic

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2009

Diarrhoea- Chronic Diarrhoea - Clinical

Lasts for at least 4 weeks Manifestations
• Caused by • Explosive watery diarrhoea
• Laxative abuse • Tenesmus
• Coeliac disease • Abdominal cramping and pain
• Inflammatory bowel • Fever
disease • Nausea
• Small bowel resection • Vomiting
• Tumours • Malaise

Diarrhoea - Severe
• Life threatening dehydration

• Electrolyte disturbances

• Acid-base disturbances

University of Western Sydney. UANE&S 4

2009

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 Diverticular Disease - Pathophysiology
• Diverticulosis
• multiple uncomplicated diverticular
• Diverticulitis
• multiple inflamed diverticular

Diverticular Disease - Prevention

• Diet
• Low fat
• Low refined sugar
• High fibre and fluids

University of Western Sydney. UANE&S 5

2009

Irritable bowel syndrome (IBS)

• Also known as spastic bowel or functional colitis
• Motility disorder of the lower GI tract
– Functional disorder with no identifiable organic cause
– Characterized by abdominal pain with constipation, diarrhoea, or both
• IBS is common, affecting up to 20% of people in Western civilization
• Usually affects young people
• A higher prevalence of IBS in women than in me (LeMone & Burke, 2008; NIH, 2007)

Pathophysiology
• CNS regulation of the motor and sensory functions of the bowel is altered
• IBS is characterized by visceral hypersensitivity and hyperactivity of the GI
tract.
– Hypersecretion of colonic mucus is a common feature of the syndrome.
• Psychologic factors such as depression or anxiety have been linked to IBS
• (LeMone & Burke, 2008; NIH, 2007)

University of Western Sydney. UANE&S 6

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 Irritable Bowel Syndrome
Manifestations Diagnosis
• Abdominal pain • Diagnosed based on the presence of
• Altered bowel elimination abdominal pain or discomfort that
has two of the following three
– Constipation
characteristics:
– Diarrhoea
– relieved by defecation;
– Mucous stools – associated with a change in
• Abdominal bloating and frequency of elimination;
flatulence – associated with a change in stool
form
• Abdominal tenderness,
especially over sigmoid colon • Primary purpose
– rule out other causes of abdominal
• Possible nausea, vomiting pain and altered faecal elimination
• Colonoscopy, and/or
• (LeMone & Burke, 2008; NIH, 2007)
• Small-bowel series and
• Barium enema
• Sigmoidoscopy
• (LeMone & Burke, 2008; NIH, 2007)

University of Western• Sydney. UANE&S 7

2009

Irritable Bowel Syndrome

Medications Nutrition

• Not curative • Additional dietary fibre

• Manage the manifestations of IBS • Other dietary changes are specific
• Bulk-forming laxatives to individual triggers for IBS
• Anticholinergic drugs manifestations eg.,
– limiting lactose, fructose, or
• 5-HT4-receptor agonist sorbitol intake
• Anti-diarrhoeal agents – reducing the intake of gas-
• Antidepressants & selective forming foods
serotonin reuptake inhibitors – limiting intake of caffeinated
(SSRIs), drinks
• (LeMone & Burke, 2008; NIH, 2007)

• (LeMone & Burke, 2008; NIH, 2007)

University of Western Sydney. UANE&S 8

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 Inflammatory Bowel Disease
ƒ Crohn’s disease and ulcerative colitis are autoimmune diseases
= Inflammatory Bowel Disease (IBD)
ƒ IBD characterised by chronic inflammation with periods of
exacerbation and remission
ƒ No known cause or cure (LeMone & Burke, 2008)

Pathophysiology
• Crohn’s disease
• Any area of GIT
• Multiple skip lesions involving all layers
• Cobblestone appearance
• Ulcerative colitis
• Only involves rectum and colon
• Inflammation is continuous and affects primarily the mucosal layer
• Ulcerations and pseudopolyps (LeMone & Burke, 2008)

University of Western Sydney. UANE&S 9

2009

Inflammatory Bowel Disease

Clinical Manifestations Management
• Crohn’s disease • Goals of treatment
• Diarrhoea – intermittent • Rest the bowel
• Colicky abdominal pain • Control inflammation
• Weight loss • Combat infection
• fever • Correct malnutrition
• Ulcerative colitis • Alleviate stress
• Diarrhoea – frequent • Provide symptomatic relief
• Blood and mucous • Improve quality of life
• Mild cramping • (LeMone & Burke, 2008)
• Anorexia
• (LeMone & Burke, 2008)

University of Western Sydney. UANE&S 10

2009

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 Inflammatory Bowel Disease
Drug Therapy

• Aminosalicylates
• Antimicrobials
• Corticosteroids
• Immunosuppressants
• Biological therapy

• (LeMone & Burke, 2008)

University of Western Sydney. UANE&S 11

2009

Colorectal Cancer
• Adenocarcinoma
• Slow growing
• Occurs in colon or rectum
Incidence
• Equal incidence
• Ascending colon
• Sigmoid colon
• rectum
• Lower incidence
• Caecum
• Transverse colon
• Lowest incidence
• Descending colon

University of Western Sydney. UANE&S 12

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 Colorectal Cancer

Risk Factors Pathophysiology

• Sex • Adenomatous polyp
• Increasing age • Arising from mucosa
• Family history • Invasive
• Lifestyle factors • Metastasis
• Polyps
• Inflammatory bowel disease

University of Western Sydney. UANE&S 13

2009

Colorectal Cancer
Clinical Manifestations Tests
• Change in bowel habits • Faecal occult blood
• Occult blood in stool • Digital rectal examination
• Tenesmus • Sigmoidoscopy
• Flatulence • Colonoscopy
• Indigestion • CT scan / MRI
• Pain
• Iron deficiency anaemia
• Obstruction

University of Western Sydney. UANE&S 14

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 Colorectal Cancer -
Prevention Treatment
• Diet • Surgery
• Low fat • Chemotherapy
• Low refined sugar • Radiation
• High fibre • Biological and targeted therapy
• Adequate Vitamin A, C & E
intake
• Aspirin
• NSAID
• Folic acid

University of Western Sydney. UANE&S 15

2009

Haemorrhoids - Haemorrhoids - Clinical

Pathophysiology Manifestations

• Asymptomatic • Haemorrhoidal veins

• Bleeding • External
• Prolapse • Internal
• Pain
• Pruritus

University of Western Sydney. UANE&S 16

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 References
* Brown, D., & Edwards, H. (Eds.). (2008). Lewis’s medical-surgical nursing
assessment and management of clinical problems. (2nd ed.).
Sydney: Elsevier.
* Crisp, J., & Taylor,C. (Eds.). (2005). Potter and Perry’s fundamentals of
nursing. Sydney: Elsevier.
* Lehne, R. A., Moore, L., Crosby, L., & Hamilton, D. (2007).
Pharmacology for nursing care. (6th ed.). Upper Saddle River, New
Jersey : Prentice -Hall.
* Lemone, P., & Burke,K. (2008). Medical surgical Nursing : Critical
thinking in client care (4th. ed.). Upper Saddle River, New Jersey :
Prentice-Hall.
* Marieb, E. N. (2007). Human anatomy and physiology (7th ed.).
California: Pearson Education.
* National Institutes of Health [NIH] (2007). Irritable bowel syndrome (NIH
Publication No. 07-693). Washington DC: US Government Printing
Office
* Porth, C. M. (2005). Pathophysiology: Concepts of altered health states
(7th ed.). Philadelphia: Lippincott.
* Sarikas, S. N. (2007). Laboratory investigations in anatomy and
physiology. San Francisco: Pearson.
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