Chapter 41: Managing Intestinal & Rectal Disorders

Managing Intestinal & Rectal Disorders details the management of a wide spectrum of intestinal and rectal disorders, beginning with abnormalities of fecal elimination such as constipation (defined as fewer than three weekly bowel movements or passage of hard, dry stools, often treated by increasing fiber and fluids) and diarrhea (increased frequency and liquidity of stool, classified as acute, persistent, or chronic, requiring careful fluid and electrolyte management due to dehydration risk). It also addresses fecal incontinence, the involuntary passage of feces, and the chronic functional disorder, Irritable Bowel Syndrome (IBS), characterized by recurrent abdominal pain associated with altered defecation patterns, for which treatment may involve diet modification like the low-FODMAP approach. A significant section focuses on malabsorption disorders, identifying Celiac disease as an autoimmune response to consumption of gluten leading to intestinal mucosal damage and malabsorption, necessitating lifelong strict adherence to a gluten-free diet, confirmed by serologic tests and biopsy. The chapter thoroughly compares Inflammatory Bowel Disease (IBD), encompassing Crohn's disease (transmural inflammation often showing skip lesions) and Ulcerative Colitis (superficial mucosal inflammation of the colon and rectum), covering their distinct pathophysiology, systemic complications, and medical management through aminosalicylates, corticosteroids, and immunomodulators. Critical care concepts are presented, including conditions causing an acute abdomen, such as appendicitis and peritonitis (inflammation of the abdominal cavity lining, frequently caused by organ perforation and potentially leading to sepsis). Diverticular disease is reviewed, differentiating between diverticulosis (the presence of saclike out-pouchings) and diverticulitis (inflammation of those diverticula), with management varying from diet therapy to hospitalization and surgery based on the Modified Hinchey Classification. Mechanical or functional intestinal obstructions (small and large bowel) are detailed, emphasizing the risks of strangulation, necrosis, and the importance of nasogastric decompression and surgical correction for complete blockages. For severe or intractable disease, surgical interventions involving ostomies (ileostomy or colostomy) are necessary, requiring specialized nursing care for stoma management, skin integrity, and body image acceptance. Advanced nutritional support via parenteral nutrition (PN) is covered, outlining its indications for patients unable to tolerate oral or enteral feeding, the use of central venous access devices (CVADs), and the critical need for meticulous infection control and fluid balance monitoring during infusion of the nutrient-dense admixtures. Finally, the chapter discusses colorectal cancer, its risk factors, screening protocols (including colonoscopy recommendations beginning as early as age 45), staging systems, and multidisciplinary treatment involving surgery (e.g., segmental resection, abdominoperineal resection) and adjuvant chemotherapy. Common anorectal disorders such as hemorrhoids, fissures, and abscesses are also addressed, focusing on pain and symptom relief.