1. Liver - plays a major role in the digestive process. It is responsible for the production of bile and the metabolism of nutrients. Bile salts aid in the breakdown of lipids into smaller particles. 2. Mechanical obstruction - the bowel is physically blocked by problems outside the intestine (e.g., adhesions), in the bowel wall (e.g., Crohn's disease), or in the intestinal lumen (e.g., tumors). 3. Nonmechanical obstruction (also known as paralytic ileus or adynamic ileus) - does not involve a physical obstruction in or outside the intestine. Instead, peristalsis is decreased or absent as a result of neuromuscular disturbance, resulting in a slowing of the movement or a backup of intestinal contents 4. Mechanical obstruction can result from: - • Adhesions (scar tissue from surgeries or pathology) • Benign or malignant tumor • Complications of appendicitis • Hernias • Fecal impactions (especially in older adults) • Strictures due to Crohn's disease (an inflammatory condition) or previous radiation therapy • Intussusception (telescoping of a segment of the intestine within itself) • Volvulus (twisting of the intestine) (see Fig. 56-1) • Fibrosis due to disorders such as endometriosis • Vascular disorders (e.g., emboli and arteriosclerotic narrowing of mesenteric vessels) 5. Intestinal Obstruction Assessment - Tachycardia · High pitched bowel sounds •Obstipation •Abdominal distention • Abdominal cramping •Nausea •Vomiting •Abdominal pain • Diarrhea · Abdominal rigidity 6. Intestinal Obstruction • Interventions: - • Monitor vital signs to determine fluid volume status · Assess abdomen for bowel sounds and distention •Monitor fluid and electrolytes •Manage nasogastric tube •Keep patient NPO • Provide frequent oral care • Monitor Intake and output •Administer medication for pain · Ambulate patient • Post-operative care 7. Intestinal Obstruction Interventions: continued - • Consult dietician to ensure nutritional needs are met • Provide emotional and spiritual support for the patient and family • Patient and family education regarding disorder and treatment • Conduct a cultural assessment in order to ensure that the cultural needs are being met • Coordination of discharge care with case management to assure post- discharge needs are addressed •Home care 8. Colorectal Cancer Assessment: - • Rectal bleeding •Change in stool consistency or shape (most common signs) • Blood in stool Anemia 9. Colorectal Cancer: Laboratory Assessment - •Fecal occult blood test (FOBT) •Carcinoembryonic antigen (CEA) 10. Colorectal Cancer: Imaging Assessment - •Sigmoidoscopy •Colonoscopy 11. Irritable Bowel Syndrome Health teaching - -30 to 40 g of fiber daily -Promote normal bowel function 12. Irritable Bowel Syndrome hydrogen breath test or (small-bowel bacterial overgrowth breath test) - When small-intestinal bacterial overgrowth or malabsorption of nutrients is present, an excess of hydrogen is produced. Some of this hydrogen is absorbed into the bloodstream and travels to the lungs where it is exhaled. Patients with IBS often exhale an increased amount of hydrogen. Teach the patient that he or she will need to be NPO (may have water) for at least 12 hours before the hydrogen breath test. At the beginning of the test, the patient blows into a hydrogen analyzer. Then, small amounts of test sugar are ingested, depending on the purpose of the test, and additional breath samples are taken every 15 minutes for 1 to 5 hours 13. Cardinal Signs of peritonitis - abdominal pain, tenderness, and distension. In the patient with localized peritonitis, the abdomen is tender on palpation in a well-defined area with rebound tenderness in this area. With generalized peritonitis, tenderness is widespread