RCS 6080 Medical and Psychosocial Aspects of Rehabilitation Counseling

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RCS 6080 Medical and Psychosocial Aspects of
Rehabilitation Counseling

• Gastrointestinal Conditions
• Ostomy Surgeries

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Type of Gastrointestinal conditions

• Irritable Bowel Syndrome (IBS)
• Diverticulosis/Diverticulitis
• Inflammatory Bowel Diseases
• Ulcerative Colitis
• Crohns Disease

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Irritable Bowel Syndrome (IBS)

• Irritable bowel syndrome is a disorder
  characterized most commonly by cramping,
  abdominal pain, bloating, constipation, and
  diarrhea.
• IBS causes a great deal of discomfort and
  distress, but it does not permanently harm the
  intestines and does not lead to a serious
  disease, such as cancer. Most people can control
  their symptoms with diet, stress management, and
  prescribed medications. For some people, however,
  IBS can be disabling. They may be unable to work,
  attend social events, or even travel short
  distances.

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IBS

• As many as 20 percent of the adult population, or
  one in five Americans, has symptoms of IBS,
  making it one of the most common disorders
  diagnosed by doctors.
• It occurs more often in women than in men, and it
  begins before the age of 35 in about 50 percent
  of people.

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Causes of IBS

• Researchers have yet to discover any specific
  cause for IBS.
• One theory is that people who suffer from IBS
  have a colon (large bowel) that is particularly
  sensitive and reactive to certain foods and
  stress.
• The immune system, which fights infection, may
  also be involved
• Some implication of Serotonin

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What makes the symptoms of IBS worse?

• large meals
• bloating from gas in the colon
• Medicines
• wheat, rye, barley, chocolate, milk products, or
  alcohol
• drinks with caffeine, such as coffee, tea, or
  colas
• stress, conflict, or emotional upsets

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Diagnosis of IBS

• There is no specific test for IBS, although
  diagnostic tests may be performed to rule out
  other diseases. These tests may include stool
  sample testing, blood tests, and x rays.
  Typically, a doctor will perform a sigmoidoscopy,
  or colonoscopy.

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Treatment for IBS

• No cure for IBS MDs treat symptoms
• For Constipations use of laxatives
• Antispasmotic to control colon spasms
• Antidepressants
• (Antispasmotics antidepressants can cause
  constipation)
• Muscle relaxants for bladder intestines

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Stress IBS

• Stress can stimulate colon spasms in people with
  IBS
• Colon is partially controlled by autonomic
  nervous system
• Stress management strategies may help reduce
  colon spasms

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Diet IBS

• For many people careful eating reduces IBS
  symptoms
• Keep a journal on what foods make symptoms worse
• Increasing dietary fiber may improve symptoms
• Drink 6-8 glasses of water per day

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IBS Summary

• IBS is a disorder that interferes with the normal
  functions of the colon. The symptoms are crampy
  abdominal pain, bloating, constipation, and
  diarrhea.
• IBS is a common disorder found more often in
  women than men.
• People with IBS have colons that are more
  sensitive and reactive to things that might not
  bother other people, such as stress, large meals,
  gas, medicines, certain foods, caffeine, or
  alcohol.
• IBS is diagnosed by its signs and symptoms and by
  the absence of other diseases.
• Most people can control their symptoms by taking
  medicines (laxatives, antidiarrhea medicines,
  antispasmodics, or antidepressants), reducing
  stress, and changing their diet.
• IBS does not harm the intestines and does not
  lead to cancer. It is not related to Crohns
  disease or ulcerative colitis.

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Diverticulosis/Diverticulitis

• Many people have small pouches in their colons
  that bulge outward through weak spots, like an
  inner tube that pokes through weak places in a
  tire. Each pouch is called a diverticulum (pl.
  diverticula).
• The condition of having diverticula is called
  diverticulosis. About 10 percent of Americans
  over the age of 40 have diverticulosis. The
  condition becomes more common as people age.
  About half of all people over the age of 60 have
  diverticulosis.

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Diverticulitis

• When the pouches become infected or inflamed, the
  condition is called diverticulitis. This happens
  in 10 to 25 percent of people with
  diverticulosis.
• Diverticulosis and diverticulitis are also called
  diverticular disease.

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Complications

• Bleeding
• When diverticula bleed, blood may appear in the
  toilet or in your stool. Bleeding can be severe,
  but it may stop by itself and not require
  treatment
• Abscess, Perforation Peritonitis
• The infection causing diverticulitis often clears
  up after a few days of treatment with
  antibiotics. If the condition gets worse, an
  abscess may form in the colon.
• A large abscess can become a serious problem if
  the infection leaks out and contaminates areas
  outside the colon. Infection that spreads into
  the abdominal cavity is called peritonitis.

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Complications

• Fistula
• A fistula is an abnormal connection of tissue
  between two organs or between an organ and the
  skin.
• When diverticulitis-related infection spreads
  outside the colon, the colon's tissue may stick
  to nearby tissues. The organs usually involved
  are the bladder, small intestine, and skin.
• Intestinal obstruction
• The scarring caused by infection may cause
  partial or total blockage of the large intestine.
  When this happens, the colon is unable to move
  bowel contents normally. When the obstruction
  totally blocks the intestine, emergency surgery
  is necessary. Partial blockage is not an
  emergency, so the surgery to correct it can be
  planned.

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Causes of Diverticular Disease

• The dominant theory is that a low-fiber diet is
  the main cause of diverticular disease.
• Diverticular disease is common in developed or
  industrialized countriesparticularly the United
  States, England, and Australiawhere low-fiber
  diets are common. The disease is rare in
  countries of Asia and Africa, where people eat
  high-fiber vegetable diets
• Diverticulitis occurs when diverticula become
  infected or inflamed. It is not certain what
  causes the infection. It may begin when stool or
  bacteria are caught in the diverticula. An attack
  of diverticulitis can develop suddenly and
  without warning

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Diagnosis of Diverticular Disease

• Medical History
• Physical/digital exam of the rectum
• X-rays

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Treatment of Diverticular Disease

• Diverticulosis
• High Fiber Diet
• Mild pain medications
• Serious attack can lead to hospitalization and
  surgery

• Diverticulitis
• Tx is focused on clearing up infection
• Antibiotics (oral)
• Hospitalization
• Liquid diet
• IV antibiotics
• Surgery

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Points to Remember

• Diverticulosis occurs when small pouches, called
  diverticula, bulge outward through weak spots in
  the colon (large intestine).
• The pouches form when pressure inside the colon
  builds, usually because of constipation.
• Most people with diverticulosis never have any
  discomfort or symptoms.
• The most likely cause of diverticulosis is a
  low-fiber diet because it increases constipation
  and pressure inside the colon.
• For most people with diverticulosis, eating a
  high-fiber diet is the only treatment needed.
• You can increase your fiber intake by eating
  these foods whole grain breads and cereals
  fruit like apples and peaches vegetables like
  broccoli, cabbage, spinach, carrots, asparagus,
  and squash and starchy vegetables like kidney
  beans and lima beans.
• Diverticulitis occurs when the pouches become
  infected or inflamed and cause pain and
  tenderness around the left side of the lower
  abdomen

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Ulcerative Colitis

• Ulcerative colitis is a disease that causes
  inflammation and sores, called ulcers, in the
  lining of the rectum and colon. Ulcers form where
  inflammation has killed the cells that usually
  line the colon, then bleed and produce pus.
  Inflammation in the colon also causes the colon
  to empty frequently, causing diarrhea.

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Ulcerative Colitis

• Ulcerative colitis can occur in people of any
  age, but it usually starts between the ages of 15
  and 30, and less frequently between 50 and 70
  years of age. It affects men and women equally
  and appears to run in families, with reports of
  up to 20 percent of people with ulcerative
  colitis having a family member or relative with
  ulcerative colitis or Crohns disease. A higher
  incidence of ulcerative colitis is seen in Whites
  and people of Jewish descent

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Symptoms of Ulcerative Colitis

• anemia
• fatigue
• weight loss
• loss of appetite
• rectal bleeding
• loss of body fluids and nutrients
• skin lesions
• joint pain
• growth failure (specifically in children)

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Causes of Ulcerative Colitis

• People with ulcerative colitis have abnormalities
  of the immune system, but doctors do not know
  whether these abnormalities are a cause or a
  result of the disease. The bodys immune system
  is believed to react abnormally to the bacteria
  in the digestive tract.
• Ulcerative colitis is not caused by emotional
  distress or sensitivity to certain foods or food
  products, but these factors may trigger symptoms
  in some people. The stress of living with
  ulcerative colitis may also contribute to a
  worsening of symptoms.

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Diagnosis of UC

• Physical Exam/Medical History
• Blood tests for anemia or high white blood cell
  count
• Stool sample
• Colonoscopy or sigmoidoscopy are most accurate
• X-rays with barium enema

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Treatment of UC

• Antibiotics (Aminosalicylates) given orally,
  suppository or by enema
• Coritcosteriods strong anti-inflammatory
  medication
• Immunomodulators (for individuals who do not
  respond to antibiotics or steroids). Increases
  immune system.
• Hospitalization
• Attempts to stop diarrhea and replenish
  fluids/electolytes
• Surgery (Ostomies)
• About 5 of people with UC develop colon cancer

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Crohns Disease

• Crohns disease is an ongoing disorder that
  causes inflammation in any area of the GI tract,
  from the mouth to the anus, but it most commonly
  affects the lower part of the small intestine,
  called the ileum.

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Causes of Crohns Disease

• Several theories exist about what causes Crohns
  disease, but none have been proven
• Research shows that the inflammation seen in the
  GI tract of people with Crohns disease involves
  several factors the genes the patient has
  inherited, the immune system itself, and the
  environment.

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Symptoms of Crohns Disease

• The most common symptoms of Crohns disease are
  abdominal pain, often in the lower right area,
  and diarrhea. Rectal bleeding, weight loss,
  arthritis, skin problems, and fever may also
  occur. Bleeding may be serious and persistent,
  leading to anemia. Children with Crohns disease
  may suffer delayed development and stunted
  growth. The range and severity of symptoms varies.

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Diagnosis of Crohns Disease

• Similar tests as Ulcerative Colitis
• Physical exam
• Lab tests
• Colonoscopy
• X-rays
• Biopsy

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Complications of Crohns Disease

• Intestinal Blockage due to scarring and
  thickening of intestinal wall
• Can also effect surrounding tissues such as
  bladder, vagina, or skin (fistulas)
• Deficiencies in proteins, calories, vitamins
• Other conditions arthritis, gall and or kidney
  stones, skin disease, inflammation in mouth or
  eyes

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Drug treatment

• Anti-Inflammation Drugs
• Cortisone/Steroids
• Immune System Supressors
• Medication to block bodys inflammation response
  (Infliximab or Remicade)
• Antibiotics
• Anti-Diarrheal and Fluid Replacements

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Other treatments

• Nutritional supplementation
• Needed particularly for children with Crohns
  disease for proper growth

• Surgery
• 2/3 to 3./4 of all people with Crohns disease
  will require surgery at some point in their lives
• Surgery can help, but it is not a cure
• (see ostomy part of lecture)

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Ostomy Surgeries

• Numerous medical conditions, including congenital
  defects, trauma, inflammatory bowel disease
  (IBD),and bowel and bladder cancer, can be
  treated by ostomy surgeries
• These surgeries close the normal route of
  elimination of bodily wastes and create a new
  opening (stoma)

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Ostomy Surgeries

• GI Stomas
• Jejunostomy
• Ileostomy
• Cecostomy
• Colostomy

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Colostomy

• Colostomy A surgically created opening in the
  abdominal wall through which digested food
  passes.
• Temporary colostomy
• Permanent colostomy
• Reasons for surgery Cancer, diverticultis
  trauma, imperforate anus
• Vocational impact restrict heavy lifting

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Ileostomy

• A surgically created opening in the abdominal
  wall through which digested food passes. The
  Ileum (the lowest part of the small intestine) is
  brought through the abdominal wall to form a
  stoma. A Ileostomy is performed when a disease
  or injured colon cannot be treated successfully.
• Vocational implication restrict heavy lifting.

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Jejunostomy

• Can be used for either feeding or removal of
  stool, depending on if the stoma is at the
  beginning or end of the Jejunum.
• Feeding A tube is placed into the jejunum
  versus the stomach (gastrostomy). People with a
  jejunostomy can eat and drink by mouth. The
  device is an insurance mechanism for nutrition.
  It can be temporary or permanent.
• Stool removal in certain instances a
  jejunostomy is conducted similarly to the
  Ileostomy. Again, this usually temporary.

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Cecostomy

• A tube that goes through the skin into the
  beginning of the large intestine to help remove
  gas or feces by injecting a solution (antegrade
  enema) that flushes the gas and stool out of the
  rectum.
• Can be temporary or permanent.

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Urinary Stomas

• When a urinary stoma is created, the urine does
  not go to the bladder. The urine is rerouted
  through an opening on the abdomen (stoma) created
  by a surgeon.
• VesicostomyAn opening in the bladder created to
  connect the bladder to an opening on the lower
  abdomen.
• Ureterostomy The ureter (or ureters) is
  attached to the skins surface through a small
  opening in the abdomen.
• Ileal conduit A small section of the ileum
  (small intestine) is used to create a passage for
  the urine to exit the body. This section of the
  small intestine, called a conduit, is attached to
  the abdominal wall to create a stoma. The urine
  flows from the kidneys, through the ureters, and
  out the stoma

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Psychosocial/Vocational implications

• Vocational Implications
• Ostomy surgery itself does not present obstacles
  to most vocational functioning underlying
  disease process may influence RTW
• Changes in body image
• Economic costs of living with an ostomy can be
  considerable when complications from the stoma or
  disease process develop
• Provide information and education to the person
  in a manner that relays a message of acceptance

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Additional Resources and Information from the Web

• United Ostomy Association (www.uoa.org)
• International Ostomy Association
  (www.ostomyinternational.org)
• World Ostomy Resource (www.powerup.com.au/takkenb
  /OstomySites.htm)
• Crohns Colitis Foundation of America
  (www.ccfa.org)
• Oley Foundation (www.oley.org)