Diseases of the Colon: A Case for Getting a Colonoscopy

Brenda F. Johnson, MSN

Every year research presents us with new medications and recommendations for our health. Our GI tract is designed to keep us healthy, hydrated, and well nourished. We take it for granted the intricacies that take place within us and it is our responsibility to eat properly to preserve balance which includes seeing a doctor if there are any abnormal symptoms. The following information on colon diseases is taken from the SGNA book Gastroenterology Nursing 4: A Core Curriculum.

Colon Cancer

Colon cancer is perhaps the scariest diagnosis one could receive. There are tests that can be performed to help detect the possibility of cancer, however, a colonoscopy allows cancer to be identified in early stages, increasing life expectancy.

Colon cancer ranks second after lung cancer (in men) and breast cancer (in women) as the most common cancer.. Risk of colon cancer increases as we age, especially between the ages of 50 and 80, and 95% of those are adenocarcinomas (Intestinal gland cells that line the colon). The most common sites to find colon cancer is in the cecum, ascending colon and sigmoid. It can not be said enough that once a patient has symptoms, the cancer is usually in the late stages since there isn't any early warning signs. That is why screening colonoscopies are so important, finding cancer in early stages saves lives.

Risk factors for colon cancer are a diet high in red meat and fat. Low fiber diets also contribute to colon cancer. The latter risk factors are controllable, while age and family history of colon cancer is not, this is where nurses can help educate patients to increase fiber and fresh vegetables into their diet. Having ulcerative colitis for more than seven years or breast and genital cancer can also increase the possibility of colon cancer.

Diverticulosis/Diverticulitis

One of the most common colon issues with the large intestine is diverticular disease.

Diverticulosis is merely a herniation of a weak spot in the mucosa. Think of it as a outpouching, a small pocket. These small pockets do not cause any problems for up to 85% of patients. Most doctors do not recommend amending diet as they once did, eliminating seeds such as strawberries, peanuts, etc. Instead, they advise high fiber diets to decrease intracolonic pressure.
Diverticulitis is inflammation of the pockets, usually in the sigmoid area of the colon. The patient presents with a fever and left lower quadrant pain. Diverticulitis can result in rupture of the inflamed diverticulum, therefore early treatment is crucial. The doctor will prescribe rest, antibiotics, high fiber diet, and pain management.

Polyps

Polyps are excess tissue that protrude into the lumen of the colon, like a skin tag. There are pedunculated - have a stalk, and sessile - flat and attached to the bowel wall. Most polyps do not present with any signs or symptoms, nonetheless, on a rare occasion some will bleed. Removing polyps greatly reduces cancer - another reason to have screening colonoscopies. Below are a few genetic polyp conditions:

Peutz-Jeghers syndrome - autosomal-dominant trait, with brown pigmentation on the lips, skin and oral mucosa coupled with hamartomatous polyps (benign).
Gardner's syndrome - Not only do these patients have many adenomatous polyps but osteomas on the skull, mandible, and long bones.
Familial polyposis coli - an autosomal dominant trait, with hundreds of adenomatous polyps throughout the colon.

Colitis

Colitis can be mild inflammation to acute inflammatory episodes.

Ischemic colitis - Emboli are not just for the brain or heart, the mesenteric inferior mesenteric artery that feeds the descending or sigmoid colon. These obstructions are usually traced to an artificial mitral valve, an atrium that is fibrillating, or vascular surgery.
Ulcerative Colitis - This is a chronic inflammatory process that forms abscesses that lead to necrosis.
Crohn's Disease - This disease process is the close cousin to ulcerative colitis. Where UC is only in the large intestine, crohn's involves the entire GI tract. Both present with diarrhea, rectal pain, fever, weight loss, and tiredness.
Pseudomembranous colitis - also known as C-diff, when an acute infectious process forms pseudomembranous plaques over ulcerations.

Further Colon Issues

Angiodysplasia - Sometimes there are capillaries or arteries close to the mucosal surface that look like a spider web formation, just like the one we can get on our legs, face, etc. These can bleed especially if the patient is on blood thinners.
Irritable bowel syndrome - IBS is the most common bowel issue in the United States. This one is a motility disorder in which the patient has cramping , abdominal distention and alternate diarrhea with constipation.
Cow's milk enterocolitis - Babies can develop this as soon as birth. The protein in cow's milk make the children vomit, have diarrhea, slow weight gain, and irritability.
Parasitic infestations - There are several parasites that are contacted by contaminated food or water; amebiasis, trypanosomiasis, and trichuriasis. Once diagnosed, these can be treated with medications and prevented with better sanitation.
Hirschsprung's disease - lack of nerve innervation (intramural ganglia) in the colon creates a failure of contracting segments and sphincters. As a result obstructions occur because the colon is so distended nothing moves. The obstruction in children with Hirschsprung's often causes death.
Hemorrhoids - internal or external hemorrhoids are vascular masses that often bleed.
Anal fissure - Thin tear of the anal mucosa, it can be extremely painful. It is often caused by trauma from a large firm stool.
Anorectal fissure - A hollow tract that is created between the anal canal to the perianal skin. There is purulent drainage, odor, pain, and itching.

This list of colon diseases is not all inclusive, but it covers most. There is endless information regarding colonic diseases, which is the reason for this series of articles. Many patients get colonoscopies at a young age due to early onset disease processes, for the rest, getting one when appropriate can save lives. We as nurses must encourage our patients in proper diet for colon health and when a colonoscopy is in order. The third article in this series will cover the preps patients must take to cleanse the bowel for the best exam possible.

Reference

Carpenter Aquino, Amy MS. Gastroenterology Nursing: A Core Curriculum. Ed. 4. The Society of Gastroenterology Nurses and Associates, Inc, 2008. Print.