Module 9 p3: IBD and Colon Cancer

IBD includes…

ulcerative colitis and chron’s disease

ulcerative colitis

edema and inflammation of the colon, from the bottom and moves up

chron’s disease

inflammation and ulceration of the GI tract, cobblestone and patchy

IBD risk factors

genetics, diet/smoking/alcohol, NSAIDs/aspirin/corticosteroids, stress

autoimmune disease

results in widespread inflammation and tissue destruction

UC diet to decrease risk

high vegetable intake

chron’s diet to decrease risk

high fiber (not in an exacerbation) and fruit intake

what exacerbates chron’s symptoms?

NSAIDs, aspirin, corticosteroids

UC manifestations

pain, diarrhea, dehydration, electrolyte imbalances, weight loss, fever

chron’s manifestations

fistula formations, ulcers, pain, diarrhea, dehydration, electrolyte imbalances, weight loss, fever

fistulas

tunnels where it shouldn’t be

IBD CBC

low Hgb and Hct, high WBC

IBD sed rate

increased

IBD potassium

decreased (coming out in stool)

albumin and prealbumin

2 weeks to show up in labs, 2 days to show up in labs

UC surgery

total proctolectomy w ileal pouch/ anal anastomosis (IPAA), total proctolectomy w permanent ileostomy

total proctolectomy w ileal pouch/ anal anastomosis (IPAA) 1 of 2

adhere the end of the GI tract and create a stoma

total proctolectomy w ileal pouch/ anal anastomosis (IPAA) 2 of 2

two procedures (8 to 12 weeks apart), can resume control of defecation, pouchitis can happen

total proctolectomy w permanent ileostomy

removal of colon, rectum, and anus

chron’s disease surgery

only performed for these complications

• strictures

• obstructions

• bleeding

• fistula

• toxic megacolon

gold standard for colon cancer

colonoscopy

polyps

95% of colon cancer starts w polyps → removed and biopsied

most common sites of metastasis

pelvic lymph nodes, liver, lungs, bones, brain

colon cancer manifestations

insidious onset, change in bowels (bloody stool), unexplained weight loss (10% in 1 month), abdominal pain, weakness/ fatigue

symptoms from descending colon

bright red blood in the stool

farther into the colon…

more blood in the stool

colon cancer risk factors

age (elders), smoking, african american

diagnostic studies for colon cancer

screening for polyps (45 to 75)

if high risk or found a polyp…

colonoscopy every 5 years

if nothing is found…

colonoscopy every 10 years

CBC (H&H, RBCs, WBCs) colon cancer

if blood is low, transfusion before the surgery

CEA (Carcinoembryonic Antigen)

levels are increased if pt has colon cancer

stage I colon cancer

not grown beyond the wall

stage II colon cancer

through tumor wall

stage III colon cancer

spread to lymph nodes

stage IV colon cancer

cancer spread to distant regions

colon cancer surgery

polypectomy

when is the polypectomy successful?

resected margin of polyp is cancer free, cancer is well differentiated, no lymphatic or blood vessel involvement

surgical options for rectal cancer

-Local excision

-Abdominal-perineal resection (APR) w/ permanent colostomy

-Low anterior resection (LAR)

chemotherapy colon cancer

used to shrink tumor prior to surgery, stage II and III tumors, palliative treatment for nonsurgical tumors

radiation

used with surgery and chemo to reduce tumor size and for symptomatic relief