Module 5 – Neoplasia
Key Terms
Abdominal distension: accompanies bowel hypermotility (high activity) and
the accumulation of fluids in the peritoneal cavity.
Antiemetic’s: anti-nausea and anti-vomiting drugs.
Antispasmodics: drugs that treat bowel muscle spasm.
Colonoscopy: An endoscope with a camera is inserted into the rectum up as
far as the terminal ileum, so that the full length of the large intestine can be
examined.
Colorectal cancer (or bowel cancer): is the term used to encompass cancers
of the large intestine (colon) and through to the rectum.
Colorectal polyps: A polyp is a finger-like projection arising from the
mucosal epithelium.
Corticosteroids: often refers to synthetic steroids like hydrocortisone.
Natural corticosteroids include cortisol and aldosterone.
Crohn's disease: colitis of the large intestine or enteritis of the small
intestine
Diarrhoea: loose bowel actions
Diverticula disease: out pouching’s of colonic mucosa through the muscle
layers of the colon wall.
Diverticulitis: is defined as an inflammation of one or more diverticula
Duodenal ulcers: ulceration of the duodenal mucosa and wall
Failure to thrive: poor physical growth of children sometimes due to
malnutrition
Gastric ulcers: ulceration of the gastric (stomach) mucosa and wall
Haematemesis: vomiting of blood
Intestinal obstruction: obstruction of the small or large intestine.
Mechanical obstruction caused by a physical blockage e.g. tumour. Or
obstruction caused by no intestinal motility, which may be a side effect of
some drugs.
Malnutrition: a lack of nourishment from inadequate amounts of kilojoules,
protein, vitamins or minerals.
Starvation: is an extreme state of malnutrition
Stress ulcers: Is an acute form of peptic ulcer that tends to accompany
severe illness, systemic trauma or neural injury. Emotional stress may cause
stress ulcer. Usually multiple sites of ulceration are distributed within the
stomach or duodenum
Ulcerative colitis: is an inflammatory disease that causes ulceration,
abscess formation and necrosis of the colonic and rectal mucosa
Vomiting (emesis): is the forceful emptying of stomach and intestinal
contents (chyme) through the mouth
Colorectal Cancer
Risk Factors:
¨ Genetics and lifestyle factors
¨ Pre-existing colon polyps (highly associated with adenocarcinoma)
Tumour Characteristics:
¨ Right (ascending) colon: Large, bulky
¨ Left (descending, sigmoid) colon: Small, button-like masses
¨ Rectal carcinoma: Located up to 15 cm from the anus, spreads
transmurally (to vagina in women, prostate in men)
Clinical Manifestations:
¨ Pain
¨ Bloody stools
¨ Change in bowel habits
Diagnosis & Treatment:
¨ Fecal occult blood test
¨ Colonoscopy
¨ Surgical removal
¨ Chemotherapy and radiotherapy (often used)
Inflammatory Bowel Diseases
Ulcerative Colitis
Chronic inflammatory disease of the colonic and rectal mucosa
Causes:
o Ulceration
o Abscess formation
o Necrosis
Symptoms:
o Cramping pain
o Bleeding
o Frequent diarrhea
o Dehydration
o Weight loss
o Alternating periods of remission and exacerbation
Crohn’s Disease
Similar to ulcerative colitis but affects both large and small
intestines and ulceration tends to involve all the layers of the lumen.
Key Features:
o "Skip lesions" (patchy inflammation)
o Granulomas
Symptoms:
o Abdominal tenderness
o Diarrhea
o Weight loss
Peptic Ulcers
Mucosal inflammation and ulceration
Causes:
o Excessive secretion of gastric acid
o Disruption of protective mucosal barrier
Types:
1. Gastric ulcers:
Develop near parietal cells, in the antrum
Become chronic
Normal or decreased gastric secretions
Pain after eating
2. Duodenal ulcers (most common):
Most common peptic ulcers
Associated with increased numbers of paretal cells in
stomach (acid secretion), high gastrin levels, rapid
gastric emptying
Pain occurs when stomach is empty; relieved with
food/antacids
Heal spontaneously but often recur
3. Stress ulcers:
Acute form of peptic ulcers
Linked to severe illness, trauma, neural injury
Emotional stress causes ulcers
Multiple sites of ulceration in the stomach/duodenum
Malnutrition & Starvation
Malnutrition:
o Lack of nourishment from inadequate essential nutrients
(kilojoules, protein, vitamins, minerals)
Starvation:
o Extreme state of malnutrition.
o Short-term (3-4 days): Body utilizes stored glucose
o Long-term: Breakdown of ketone bodies, fatty acids →
Proteolysis (protein breakdown) → Death if untreated
Intestinal Disorders
Intestinal Obstruction
Prevents normal movement of chyme through intertinal tract
Causes:
o Intussusception
o Volvulus
o Abdominal hernia
o Paralytic ileus
Vomiting (Emesis)
Forceful stomach emptying by gastrointestinal contraction
via reverse peristalsis of the oesophagus
Types:
o General vomiting: Preceded by nausea/retching
o Projectile vomiting: Direct stimulation of vomiting center in
the brain
Diarrhea
Causes:
o Osmotic diarrhea: Excess fluid drawn into intestinal lumen
o Secretory diarrhea: Excess secretion of fluids by intestinal
mucosa
o Excessive gastrointestinal motility
Concerns in children:
o Fluid imbalance → Severe dehydration → Potentially fatal
o Common cause: Rotavirus
Gastrointestinal Bleeding
Manifestations:
o Haematemesis: Vomiting blood
o Melaena: Dark, tarry stools
o Haematochezia: Frank red rectal bleeding
o Occult bleeding: Detected only by stool/vomit tests
Abdominal distension accompanies bowel hypermotility (high
activity) and the accumulation of fluids in the peritoneal cavity.
Abnormal abdominal distension may indicate underlying disease
e.g. bowel obstruction.
Diverticula & Diverticulosis
Diverticula
Diverticula: Outpouchings of colonic mucosa through muscle
layers of colon wall
Diverticulosis: Presence of outpouchings (multiple diverticula)
Risk factors:
o Diet high in refined foods
o Low-fiber intake
Diverticulitis
Inflammation of one or more diverticula
Pathogenesis remains unclear
Causes:
o Fecal material/undigested food blocking a diverticulum
(obstruction)
o Mucous secretion → Colonic Bacterial overgrowth →
Infection/perforation
Symptoms:
o Fever
o Nausea & vomiting
o Abdominal pain
o Rectal bleeding
Complications:
o Intestinal bleeding
o Fistulas
o Abscesses
o Colonic obstruction
o Bowel perforation with peritonitis
Assessment:
o history, physical examination and investigation for
inflammatory disease (fever, nausea, vomiting, pain) and
haemorrhagic disease.
o E.g. PR bleeding, low Hb, pain on defecation
Routine investigations:
o Lab tests urinalysis, Hb, white cell count, blood cultures,
urea & electrolytes
o Imaging x-ray if suspected bowel obstruction or perforation,
and CT Scan.
Treatment:
o Medical:
Nil by mouth
IV fluids
antibiotics
Monitor fluid intake on fluid balance chart
Administer analgesia
Observation of vitals
dminister o2 theraph
record bowel actions
- Antibiotics amoxycillin+clavulanate is often used with
metronidazole (flagyl).
o Surgical:
Hartmann’s procedure (for severe sigmoid
diverticulitis)