Bowel dysfunction after surgery.

The functions of the lower parts of the bowel, namely the colon and rectum, are predominantly the absorption of fluids and elimination of faeces and flatus. Bowel surgery may be carried out in the treatment of colorectal cancer, inflammatory bowel disease or diverticular disease, and may involve the formation of a permanent or temporary stoma. The type of colorectal surgery carried out depends on the condition and where the problem occurs. Surgery can alter not only the bowel's anatomy but also its functioning. Bowel dysfunction can manifest as constipation, faecal incontinence or diarrhoea. Nurses are well placed to assist patients to resolve many of these problems as well as stoma issues.

Clinical Guidelines for Management of Gastrointestinal Symptoms in Cancer Patients: The Japanese Society of Palliative Medicine Recommendations.

Background: Gastrointestinal symptoms, including nausea, vomiting, bowel obstruction, ascites, constipation, and anorexia, are common and often refractory in advanced cancer patients. The palliation of gastrointestinal symptoms is important in improving the quality of life of cancer patients, as well as that of their families and caregivers. Currently published clinical guidelines for the management of gastrointestinal symptoms in cancer patients do not comprehensively cover the topics or are not based on a formal process for the development of clinical guidelines. Methods: The Japanese Society for Palliative Medicine (JSPM) developed comprehensive clinical guidelines for the management of gastrointestinal symptoms in cancer patients after a formal guideline development process. Results: This article summarizes the recommendations along with their rationale and a short summary of the development process of the JSPM gastrointestinal symptom management guidelines. We established 31 recommendations, all of which are based on the best available evidence and agreement of expert taskforce members. Discussion: Future clinical studies and continuous guideline updates are required to improve gastrointestinal symptom management in cancer patients.

Complications of Solid Organ Transplantation: Cardiovascular, Neurologic, Renal, and Gastrointestinal.

Despite improvements in overall graft function and patient survival rates after solid organ transplantation, complications can lead to significant morbidity and mortality. Cardiovascular complications include heart failure, arrhythmias leading to sudden death, hypertension, left ventricular hypertrophy, and allograft vasculopathy in heart transplantation. Neurologic complications include stroke, posterior reversible encephalopathy syndrome, infections, neuromuscular disease, seizure disorders, and neoplastic disease. Acute kidney injury occurs from immunosuppression with calcineurin inhibitors or as a result of graft failure after kidney transplantation. Gastrointestinal complications include infections, malignancy, mucosal ulceration, perforation, biliary tract disease, pancreatitis, and diverticular disease. Immunosuppression can predispose to infections and malignancy.

Mastocytosis.

Mastocytosis is a rare and underdiagnosed disorder characterized by mast cell proliferation in the tissues and organs of the body. The gastrointestinal manifestations of the disease can be noted in approximately 70%-80% of those patients diagnosed with the disorder. Symptomatic manifestations of systemic mastocytosis can either be triggered spontaneously or be precipitated by a variety of situations, stimuli, and exposures. Common gastrointestinal complaints include abdominal pain, diarrhea, nausea, vomiting, and gastrointestinal reflux disease. Substantial numbers of mast cells have been noted in patients who have been diagnosed with gastritis, ulcerative colitis, and Crohn disease. Irreversible, with symptoms that run the gamut from the merely annoying to the severely life-threatening, mastocytosis is a disease that prevents an individual from leading a normal life. As the prevalence of gastrointestinal symptomatology in those patients who have been diagnosed with mastocytosis is so significant, it is an important and relevant disease of which gastroenterology nurses should be cognizant.

Gastrointestinal Disturbances in the Elderly.

Gastrointestinal (GI) age-related changes create alterations in the body's ability to digest, absorb, and excrete nutrients, medications, and alcohol and disrupts GI immunity responses. All older adults exhibit some degree of swallowing difficulty, also known as senescent swallowing. The effects of chronic disease and sustained use of alcohol, tobacco, and medications often exacerbate age-related GI dysfunction. Older adults often have nonspecific complaints, warranting a thorough health history and physical examination, including prescription and over-the-counter medications. Colorectal cancer screening tests should be discussed with all older adults because of the high incidence of colorectal cancer in this patient population.

Late gastrointestinal effects of pelvic radiation: a nurse-led service.

There are currently at least 2 million people in the UK living with and following a cancer diagnosis. Typically four out of every ten people with cancer will receive radiotherapy, but a large proportion of people who have pelvic radiotherapy may go on to develop gastrointestinal (GI) symptoms. This includes rectal bleeding and faecal incontinence, which can have a huge impact on quality of life. These problems often go under-reported by patients and are also under-recognised or under-treated by health professionals. Cancer survivorship is a growing topic that is likely to have a major impact on the NHS, with increasing numbers of patients presenting. A late GI effects of pelvic radiotherapy clinic was set up to address these growing needs of patients with GI symptoms following radiotherapy. This article also shares insights from a doctoral study that is underway looking at people's experiences of living with symptoms following their treatment, in order to improve awareness of the major impact that this can have.

Gastrointestinal care for older people.

This article discusses gastrointestinal (GI) healthcare in older people. It outlines the physiological changes that occur in the GI tract as a result of ageing, and discusses common GI disorders in older people. These GI disorders include dysphagia, gastrointestinal reflux disease, colorectal cancer, diverticular disease, constipation and anaemia. Healthcare professionals should be aware of the factors that may influence gastrointestinal health in older people, including nutrition, hydration and alcohol use, which are important considerations when delivering person-centred care.

Gluten-Related Disorders: Celiac Disease, Gluten Allergy, Non-Celiac Gluten Sensitivity.

Gluten is a protein complex found in the endosperm portion of wheat, rye, and barley. "Gluten-related disorder" is a term used to describe conditions related to ingestion of gluten-containing foods. Gluten has been implicated as the cause of a variety of gastrointestinal (GI) and extraintestinal symptoms. These symptoms are often non-specific and variable, making it difficult for the primary care provider to diagnose the cause and develop a management plan. Recently, gluten-related disorders have received much attention in the popular press, and the sale of gluten-free foods has become a multi-billion dollar business. It is important for pediatric primary care providers to understand the potential role of gluten in GI health and symptomatology so appropriate screening, diagnostic testing, and management can be provided.

Oral care in hepatology nursing: nurses' knowledge and education.

This study aimed, for the first time, to explore hepatology nurses' knowledge and education in the oral care and oral health assessments of patients with liver cirrhosis. Liver cirrhosis can be associated with lifestyles and behaviors that contribute to oral neglect and untreated oral inflammation. This inflammation can represent foci for systemic infections, with increases in morbidity and mortality rates. A questionnaire consisting of 26 closed- and open-ended questions was used to determine among hepatology nurses the extent of knowledge, education, and current practices in oral healthcare among hepatology nurses. The study involved a sample of 94 nurses employed in different gastroenterology and hepatology units, with a response rate of 73%. The results indicated that respondents lacked substantial oral care education, both in connection with their initial training and after qualifying as nurses. The respondents had inadequate knowledge of basic oral health, the equipment used for oral care, and medications' adverse effects on oral health. These results indicate a need for educational updates in cooperation with dentists and for the promotion of specific oral assessment guides in patients with liver cirrhosis.

Prognostic factors of surgically-treated patients with cancer of the right colon: a ten years' experience of a single universitary institution / Fatores prognósticos de pacientes com câncer de cólon direito tratados cirurgicamente: experiência de 10 anos de uma instituição universitária

BACKGROUND: Colorectal cancer is one of the most common malignancies in the world. There are many controversies in the literature about the prognostic value of primary tumor location. Many studies have shown higher survival rates for tumors in the right colon, and worse prognosis for lesions located more distally in the colon. AIM: To analyze the results of surgical treatment of right-sided colon cancers patients operated in one decade period and identify the prognostic factors that were associated with lower overall survival in stages I-IV patients. METHODS: A retrospective review from the prospectively collected database identified 178 patients with right-sided colon cancer surgically treated with curative intent. Demographic factors (gender and age), tumor factors (site, T stage, N stage, M stage, histological type and tumor differentiation), and lymph node yield were extracted to identify those associated with lower overall survival. RESULTS: Mean age was 65 (±12) years old, and 105 (56.1%) patients were female. Most common affected site was ascending colon (48.1%), followed by cecum (41.7%) and hepatic flexure (10.2%). Mean length of hospital stay was 14 (±2.8) days. T stage distribution was T1 (4.8%), T2 (7.5%), T3 (74.9%), and T4 (12.8%). Nodal involvement was present in 46.0%, and metastatic disease in 3.7%. Twelve or more lymph nodes were obtained in 87.2% of surgical specimens and 84.5% were non-mucinous tumors. Mean survival time was 38.3 (±30.8) months. Overall survival was affected by T stage, N stage, M stage, and final stage. Lymph node involvement (OR=2.06) and stage III/IV (OR=2.81) were independent negative prognostic factors. CONCLUSION: Right-sided colon cancer presented commonly at advanced stage. Advanced stage and lymph node involvement were factors associated with poor long term survival. .

RACIONAL: Câncer colorretal é o tipo mais comum das neoplasias gastrointestinais. Há muitas controvérsias na literatura acerca do valor prognóstico do sítio da neoplasia. Muitos estudos revelam maiores taxas de sobrevida para tumores em cólon direito, com piora do prognóstico à medida que as lesões se situam mais distalmente. OBJETIVO: Analisar os resultados do tratamento cirúrgico de pacientes com câncer de cólon direito estádios I-IV operados em um período de dez anos e identificar os fatores prognósticos que foram associados com menor sobrevida global. MÉTODOS: Em 10 anos, 187 pacientes foram submetidos à colectomia direita com intenção curativa. Foram estudados os seguintes fatores: gênero, idade, localização do tumor, o número de linfonodos obtidos no espécime, comprometimento linfonodal, estádio T e presença de metástases à distância. Estes fatores foram avaliados quanto à possibilidade de serem indicadores prognósticos na sobrevida em cinco anos. RESULTADOS: A idade média foi de 65 (±12) anos e 105 (56,1%) eram mulheres. A localização, mas comum foi o cólon ascendente (48,1%), seguido do ceco (41,7%) e o ângulo hepático (10,2%). A média de tempo de internação hospitalar foi 14 (±2.8) dias. A distribuição do estádio T foi T1 (4,8%), T2 (7,5%), T3 (74,9%) e T4 (12,8%). Acometimento linfonodal ocorreu em 46,0% e metástases à distância em 3,7%. Um mínimo de 12 linfonodos ressecados foram obtidos em 87,2% dos espécimes cirúrgicos. Em 84.5% os tumores eram não-mucinosos. A média de sobrevida foi de 38,3 (±30.8) meses. A sobrevida geral foi afetada pelo estádio T, N, M e pelo estádio final. O acometimento linfonodal (RR=2,06) e os estádios III/IV (RR=2,81) foram fatores prognósticos negativos independentes. CONCLUSÕES: Estádio avançado e envolvimento linfonodal foram os fatores associados com a pior sobrevida em longo prazo. .

In-hospital weight loss, prescribed diet and food acceptance / Perda de peso hospitalar, dieta prescrita e aceitação de alimentos

BACKGROUND: Weight loss and malnutrition may be caused by many factors, including type of disease and treatment. AIM: The present study investigated the occurrence of in-hospital weight loss and related factors. METHOD: This cross-sectional study investigated the following variables of 456 hospitalized patients: gender, age, disease, weight variation during hospital stay, and type and acceptance of the prescribed diet. Repeated measures analysis of variance (ANOVA) was used for comparing patients' weight in the first three days in hospital stay and determining which factors affect weight. The generalized estimating equation was used for comparing the food acceptance rates. The significance level was set at 5%. RESULTS: The most prescribed diet was the regular (28.8%) and 45.5% of the patients lost weight during their stay. Acceptance of hospital food increased from the first to the third days of stay (p=0.0022) but weight loss was still significant (p<0.0001). Age and type of prescribed diet did not affect weight loss during the study period but type of disease and gender did. Patients with neoplasms (p=0.0052) and males (p=0.0002) lost more weight. CONCLUSION: Weight loss during hospital stay was associated only with gender and type of disease. .

RACIONAL: A perda de peso e a desnutrição podem ser desencadeadas por vários fatores, além de estar relacionada com o tipo de doença e com a terapia empregada. OBJETIVO: Investigar a ocorrência de perda de peso e fatores relacionados, durante a internação. MÉTODO: Estudo transversal com 456 pacientes hospitalizados, sendo estudadas as seguintes variáveis: sexo, idade, doença, evolução de peso, tipo e aceitação da dieta prescrita. Para comparar o peso entre os três primeiros dias de internação e para o estudo dos fatores que interferiram na alteração do peso, foi utilizada a Análise de Variância (ANOVA) para medidas repetidas. Para comparar a proporção de respostas na aceitação da dieta, foi utilizado o método das Equações de Estimação Generalizadas (EEG), com nível de significância de 5%. RESULTADOS: A dieta mais prescrita foi a geral (28.8%) e 45.5% dos pacientes perderam peso durante a internação. A aceitação da dieta hospitalar melhorou do 1º para o 3º dia de internação (p=0.0022), mas mesmo assim, a perda foi significativa (p<0.0001). Verificou-se que a idade e o tipo de dieta prescrita não influenciaram na perda de peso no período; mas, o tipo de doença e o sexo, apresentaram influência nos pacientes portadores de neoplasias (p=0.0052) e o sexo masculino (p=0.0002) apresentou mais perda de peso. CONCLUSÃO: A perda de peso no decorrer da internação foi relacionada apenas ao sexo e ao tipo de doença. .