Name:Abdul Razak
Index no:CNNTRGN230028
Date:10/04/2025
Course code: RGN 224: SURGICAL NURSING II
1. Diverticulitis
Diverticulitis is the inflammation or infection of one or more diverticula, which are small, bulging
pouches that can form in the lining of the digestive tract, most commonly in the colon.
Causes:
The primary cause is believed to be increased pressure within the colon, leading to the formation of
diverticula.
1. A low-fiber diet is a significant risk factor, as it can contribute to constipation and increased colonic
pressure.
2. Age is also a factor, as the colon wall weakens with age.
3. Genetic predisposition.
Types:
1. UncomplicatedDiverticulitis: Inflammation without complications like abscess, fistula, or perforation.
2. Complicated Diverticulitis: Includes complications such as abscess, fistula, perforation, or obstruction.
Signs and Symptoms:
1. Left lower quadrant abdominal pain (most common).
2. Tenderness in the lower abdomen.
3. Fever and chills.
4. Nausea and vomiting.
5.Changes in bowel habits (constipation or diarrhea).
6.Rectal bleeding (less common).
Management:
Medical:
1. Bowel rest (clear liquid diet or NPO).
2. Antibiotics (broad-spectrum).
3. Pain management (analgesics).
4. Stool softeners after the acute phase.
* Surgical:
1. Indicated for complicated diverticulitis (abscess, perforation, fistula, or obstruction) or recurrent episodes.
2. Colon resection: Removal of the affected portion of the colon.
3.Abscess drainage: Percutaneous or surgical drainage of abscesses.
4. Hartmann's procedure: Temporary colostomy followed by later reanastomosis.
Pre-op Preparation and Post-op Care:
Pre-operative care:
1.Check patient’s vital signs
2 .Put patient on NPO .
3.Make sure patient signs an informed consent.
4. Introduce patient to survivors.
5.Bowel preparation (laxatives, enemas).
6.Give Antibiotic prophylaxis.
7.Secure an IV and hydrate the patient via the Iv line.
8.Patient education and emotional support.
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Post-operative care :
1.Monitoring vital signs and pain control.
2.Wound care and monitoring for infection.
3.Nasogastric tube management (if applicable).
4. Gradual resumption of oral intake.
5. Perform Stoma care (if colostomy is performed).
6.Encourage early ambulation to prevent complications.
7. Give education regarding diet changes, and stoma care if needed.
Complications:
1.Abscess formation.
2.Perforation leading to peritonitis.
3.Fistula formation (abnormal connection between organs).
4.Bowel obstruction.
5.Sepsis.
6. Strictures.
Hirschsprung’s Disease.
Hirschsprung's disease is a congenital disorder characterized by the absence of ganglion cells (nerve cells) in
the colon, resulting in functional obstruction.
Causes:
1. Failure of ganglion cells to migrate to the distal colon during fetal development.
2.Genetic factors play a role.
Types:
1.Short-segment Hirschsprung's disease: Affects a small portion of the rectum and sigmoid colon.
2.Long-segment Hirschsprung's disease: Affects a larger portion of the colon.
3. Total colonic aganglionosis: Affects the entire colon.
Signs and Symptoms:
1.Failure to pass meconium within 48 hours of birth.
2.Abdominal distension.
3. Vomiting.
4. Constipation.
5. Enterocolitis (inflammation of the colon).
6.Ribbon like stools.
Management:
Surgical management :
1.Pull-through procedure: Removal of the aganglionic segment of the colon and anastomosis of the healthy
colon to the rectum.
2.Staged procedures: In severe cases, a temporary colostomy may be performed, followed by a pull-through
procedure later.
Pre-op Preparation and Post-op Care:
Pre-operative care :
1.Monitor vital signs.
2.Make sure informed consent is signed.
3.Secure an IV line and hydrate patient via it.
4.Reasure the patient to allay fear and anxiety.
5.Introduce the patient to survivors.
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6.Make sure all lab investigations are requested and results available.
7.Put patient on NPO
8. Help patient with bowel preparation (enemas, irrigations).
9. ServeAntibiotic prophylaxis.
10. Give Parental education and support.
Post-op:
1. Monitoring vital signs and pain control.
2. Wound care and monitoring for infection.
3. Stoma care (if applicable).
4. Monitoring for bowel function.
5 Education for parents on stoma care and long-term management.
Complications:
1. Enterocolitis.
2. Anastomotic leak.
3. Strictures.
4. Incontinence.
5 Delayed bowel movements.
Colorectal cancer.
Colorectal cancer is a malignant tumor that originates in the lining of the colon or rectum.
Causes:
1. Age (over 50).
2.Family history of colorectal cancer.
3.Inflammatory bowel disease (Crohn's disease, ulcerative colitis).
4.Diet high in red and processed meats, low in fiber.
5.Smoking and alcohol consumption.
6.Genetic polyposis syndromes (FAP, HNPCC).
Types:
1.Adenocarcinomas (most common).
2.Lymphomas.
3.Sarcomas.
4.Carcinoid tumors.
Signs and Symptoms:
1.Changes in bowel habits (diarrhea or constipation).
2.Rectal bleeding or blood in stool.
3.Abdominal discomfort or pain.
4.Weakness and fatigue.
5.Unexplained weight loss.
6.Sensation of incomplete evacuation.
Management:
Medical:
1. Chemotherapy.
2. Radiation therapy.
3. Targeted therapy.
Surgical:
1. Colon resection: Removal of the affected portion of the colon.
2. Rectal resection: Removal of the affected portion of the rectum.
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3. Colostomy or ileostomy: May be temporary or permanent.
Pre-op Preparation and Post-op Care:
Pre-operative care:
1. Explain the procedure to the patient.
2. Check the patient’s vital signs.
3. Make sure IV line is secured.
4. Introduce the patient to the surgical team members.
5. Help the patient in bowel preparation (laxatives, enemas).
6. Put patient on NPO.
7. Several all prescribed premedications
Post-operative care :
1. Monitoring vital signs and pain control.
2. Wound care and monitoring for infection.
3. Stoma care (if applicable).
4. Monitoring for bowel function.
5. Chemotherapy or radiation therapy (if indicated).
6. Education regarding stoma care, diet, and follow up care.
Complications:
7. Anastomotic leak.
8. Infection.
9. Bleeding.
10. Bowel obstruction.
11. Recurrence of cancer.
12. Stoma complications.
Hemorrhoids
Hemorrhoids are swollen veins in the anus and rectum. Hemorrhoid, also known as piles, are swollen veins
in the lower rectum or anus. They can be internal (inside the rectum) or external (under the skin around the
anus). Common symptoms include itching, discomfort, pain, and bleeding during bowel movements
Causes:
1. Straining during bowel movements.
2. Chronic constipation or diarrhea.
3. Pregnancy.
4. Obesity.
5. Prolonged sitting.
6. Aging.
Types:
1. Internal hemorrhoids: Located inside the rectum.
2.External hemorrhoids: Located under the skin around the anus.
Signs and Symptoms:
1. Rectal bleeding (bright red blood).
2. Anal itching or pain.
3. Discomfort during bowel movements.
4. Prolapse (protrusion of hemorrhoids outside the anus).
5. Anal lumps.
Management:
1. High-fiber diet.
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2. Stool softeners.
3. Sitz baths.
Medical management.
Topical creams and ointments.
Surgical managements:
1.Rubber band ligation: Placement of rubber bands around the base of the hemorrhoids.
2.Sclerotherapy: Injection of a chemical solution to shrink the hemorrhoids.
3.Hemorrhoidectomy: Surgical removal of hemorrhoids.
4.Stapled hemorrhoidopexy: Procedure done to block blood flow to the hemorroids.
Pre-op Preparation and Post-op Care:
Pre-operative care :
1.Explain the procedure to the patient.
2.Help the patient in bowel preparation (enemas).
3 Give Patient education and emotional support.
4.Teach the patient Pain management education.
Post-operative care .
1.Monitor patient’s vital signs.
2. Administer prescribed Pain management.
3.Engage the patient in Sitz baths.
4. Do not give anything by mouth.
5.Wound care.
6.Give diet education to patient.
Fistula-in-Ano
A fistula-in-ano is an abnormal tunnel or tract that connects the anal canal to the perianal skin. It typically
arises from an infected anal gland.
Causes:
1. Infected anal glands (most common)
2. Anal abscesses
3. Crohn's disease
4. Trauma
5. Radiation therapy
6. Tuberculosis
7. Diverticulitis
8. Hidradenitis suppurativa
Types:
1. Intersphincteric: The tract runs between the internal and external sphincter muscles.
2. Transsphincteric: The tract crosses both the internal and external sphincter muscles.
3. Suprasphincteric: The tract extends upward above the puborectalis muscle.
4. Extrasphincteric: The tract begins in the rectum or sigmoid colon and extends outward, bypassing the
sphincter muscles.
Signs and Symptoms:
1. Anal pain and swelling
2. Recurrent anal abscesses
3. Drainage of pus or blood from an opening near the anus
4. Pain during bowel movements
5. Irritation of the skin around the anus
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Management:
Medical management :
1. Antibiotics (for acute infection)
2. Pain relievers
3. Sitz baths.
Surgical:
1. Fistulotomy: Incision and drainage of the fistula tract.
2. Fistulectomy: Complete removal of the fistula tract.
3. Seton placement: A thread is placed through the fistula to promote drainage and healing.
4. Advancement flap procedures: Healthy rectal tissue is used to cover the internal opening of the fistula.
5. LIFT procedure (Ligation of the intersphincteric fistula tract)
Pre-op Preparation:
1.Explain procedure to the patient to allay anxiety and fear.
1. check patients vital signs.
2. Help patient in Bowel preparation (enemas, laxatives)
3. Administer prescribed Antibiotic administration.
4. Give Pain management education.
5. Introduce the patient to the surgical team.
6. Introduce the patient to survivors
7. Assessment of coagulation studies.
post-op Management:
1. Pain control (analgesics)
2. Wound care (sitz baths, dressing changes)
3. Stool softeners to prevent constipation
4. Monitoring for bleeding or infection
5. Dietary management (high-fiber diet)
6. Observation of first bowel movement.
7. Patient education regarding wound care and follow up appointments.
complications:
1. Recurrence of the fistula
2. Infection
3. Incontinence (especially after complex procedures)
4. Delayed wound healing
5. Anal stenosis.
Cholelithiasis (Gallstones)
Cholelithiasis refers to the presence of stones (calculi) in the gallbladder.Cholelithiasis, commonly known as
gallstones refers to the formation of hardened deposits in the gallbladder. These deposits are made of bile
components like cholesterol, bile salts, and bilirubin. Gallstones can vary in size, ranging from tiny grains to
larger stones.
Causes:
1. High cholesterol levels in bile
2. Excess bilirubin in bile
3. Gallbladder emptying problems
4. Female sex, increasing age, obesity, family history, rapid weight loss, and certain medications.
Types:
1.Cholesterol stones (most common)
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2. Pigment stones (bilirubin-based)
3.Mixed stones (containing both cholesterol and pigment)
Signs and Symptoms:
Often asymptomatic
1. Biliary colic (severe, sharp pain in the upper right abdomen)
2. Pain radiating to the back or right shoulder
3. Nausea and vomiting
4. Indigestion
5. Fever (if infection is present)
6. Jaundice (if the common bile duct is blocked)
Management:
Medical management :
1. Pain management (analgesics)
2. Ursodeoxycholic acid (to dissolve cholesterol stones, but not very common)
Surgical:
1. Laparoscopic cholecystectomy (preferred method)
2. Open cholecystectomy (if laparoscopic surgery is not feasible)
3. ERCP (Endoscopic retrograde cholangiopancreatography) for removal of stones in the common bile duct.
Pre-op Preparation:
1. Explain procedure to the patient.
2. Put patient on NPO.
3. Hydrate patient via IV if necessary .
4. Serve prescribed premedications
5. Assessment of coagulation studies.
6. Assessment of baseline vital signs.
7.Patient education concerning the procedure.
post-op Management:
1. Monitor patient vital signs.
2. Serve prescribed Pain control medications (analgesics)
3. Monitorer for sign of bleeding or infection
4. EncourageEarly ambulation.
5. Dietary management (low-fat diet initially)
6. Aseptic Wound care (dressing changes)
7. Monitor the return of bowel sounds.
8. Educate patient regarding activity restrictions and follow up appointments.
Complications:
1. Cholecystitis (inflammation of the gallbladder)
2. Choledocholithiasis (stones in the common bile duct)
3. Pancreatitis
4. Infection
5. Bleeding
6. Bile leak.
7. Injury to the common bile duct.
References
1. Bickle, I. C., & Fleshner, P. R. (2018). Anorectal abscess and fistula. Surgical Clinics of North America,
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98(2), 293-303.
2.Mayo Clinic. (n.d.). Anal fistula. Retrieved from
https://www.mayoclinic.org/diseases-conditions/anal-fistula/symptoms-causes/syc-20351861
3.National Institute of Diabetes and Digestive and Kidney Diseases. (NIDDK). (n.d.). Gallstones. Retrieved
from https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones
4.Townsend, C. M., Beauchamp, R. D., Evers, B. M., & Mattox, K. L. (2017). Sabiston textbook of surgery:
the biological basis of modern surgical practice. Elsevier Saunders.
5.Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's textbook of
medical-surgical nursing. Wolters Kluwer.
6.Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2018). Medical-surgical nursing: Concepts for
interprofessional collaborative care. Elsevier Saunders.
7.Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Harding, M. M. (2017). Medical-surgical
nursing: Assessment and management of clinical problems. Elsevier Saunders.
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