Med-Surg Vocabulary

1. Abscess: An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms for those close to the skin include: redness, pain, warmth, and swelling that when pressed feels like it is fluid filled. The area of redness often extends beyond the swelling. Carbuncles and furuncles are types of abscess that often involves hair follicles with carbuncles being larger.

They are usually caused by a bacterial infection. Often many different types of bacteria are involved in a single infection. In the United States and many other areas of the world the most common bacteria present is methicillin-resistant Staphylococcus aureus. Rarely parasites can cause abscesses and this is more common in the developing world. Diagnosis is usually made based on what it looks like and is confirmed by cutting it open. Ultrasound imaging may be useful in cases in which the diagnosis is not clear. In abscesses around the anus, computed tomography (CT) may be important to look for deeper infection.

Standard treatment for most skin or soft tissue abscesses is cutting it open and drainage. There does not appear to be any benefit from also using antibiotics in most people who are otherwise healthy. A small amount of evidence supports not packing with gauze the cavity that remains after drainage. Closing this cavity right after draining it rather than leaving it open may speed healing without increasing the risk of the abscess returning. Sucking out the pus with a needle is often not sufficient.

Skin abscesses are common and have become more common in recent years. Risk factors include intravenous drug use with rates reported as high as 65% in this population.

2. Colostomy:

A colostomy is a surgical procedure in which a stoma is formed by drawing the healthy end of the large intestine or colon through an incision in the anterior abdominal wall and suturing it into place. This opening, in conjunction with the attached stoma appliance, provides an alternative channel for feces to leave the body. It may be reversible or irreversible depending on the circumstances.

Some common reasons are:

A section of the colon has been removed, e.g. due to colon cancer requiring a total mesorectal excision, diverticulitis, injury, etc., so that it is no longer possible for feces to exit via the anus.

A portion of the colon (or large intestine) has been operated upon and needs to be 'rested' until it is healed. In this case the colostomy is often temporary and is usually reversed at a later date, leaving the patient with a small scar in place of the stoma. Children undergoing surgery for extensive pelvic tumors commonly are given a colostomy in preparation for surgery to remove the tumor, followed by reversal of the colostomy. Fecal incontinence that is non-responsive to other treatments.

Options

Illustration depicting various types of colostomy. Placement of the stoma on the abdomen can occur at any location along the colon, but the most common placement is on the lower left side near the sigmoid where a majority of colon cancers occur. Other locations include the ascending, transverse, and descending sections of the colon.

Types of colostomy:

• Loop colostomy: This type of colostomy is usually used in emergencies and is a temporary and large stoma. A loop of the bowel is pulled out onto the abdomen and held in place with an external device. The bowel is then sutured to the abdomen and two openings are created in the one stoma: one for stool and the other for mucus.

• End colostomy: A stoma is created from one end of the bowel. The other portion of the bowel is either removed or sewn shut (Hartmann's procedure).

• Double barrel colostomy: The bowel is severed and both ends are brought out onto the abdomen. Only the proximal stoma is functioning.

• Colostomy surgery that is pre-planned usually has a higher rate of long-term success than surgery performed in an emergency situation.

People with colostomies must wear an ostomy pouching system to collect intestinal waste. Ordinarily the pouch must be emptied or changed a couple of times a day depending on the frequency of activity; in general the further from the anus (i.e., the further 'up' the intestinal tract) the ostomy is located the greater the output and more frequent the need to empty or change the pouch

3. Constipation: Constipation (also known as costiveness or dyschezia) refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation. Severe constipation includes obstipation (failure to pass stools or gas) and fecal impaction, which can progress to bowel obstruction and become life-threatening.

Constipation is a symptom with many causes. These causes are of two types: obstructed defecation and colonic slow transit (or hypomobility). About 50% of patients evaluated for constipation at tertiary referral hospitals have obstructed defecation. This type of constipation has mechanical and functional causes. Causes of colonic slow transit constipation include diet, hormonal disorders such as hypothyroidism, side effects of medications, and rarely heavy metal toxicity. Because constipation is a symptom, not a disease, effective treatment of constipation may require first determining the cause. Treatments include changes in dietary habits, laxatives, enemas, biofeedback, and in particular situations surgery may be required.

Constipation is common; in the general population incidence of constipation varies from 2 to 30%. In the United States expenditures on medications for constipation are greater than $250 million per year

4. Diverticulitis: Diverticulitis es la inflamación de un divertículo

Epidemiología

Afecta mayoritariamente a personas mayores y de edad avanzada aunque puede atacar también a pacientes jóvenes.

En los países occidentales la diverticultis es más común en el lado izquierdo relacionado con el colon sigmoideo (95% de los pacientes), mientras que la enfermedad se presenta más comúnmente en el lado derecho en Asia y África. La prevalencia de la enfermedad diverticular se ha incrementado desde un 10% estimado en 1920 a entre 35% y 50% a fines de los 60. Se espera que un 65% de aquellas personas mayores de 85 años tengan alguna forma de enfermedad diverticular en el colon. Menos del 5% de las personas menores de 40 años son afectadas por esta enfermedad.

Entre el 10% y el 25% de los pacientes con diverticulosis desarrollarán diverticulitis en alguna etapa de su vida.

Etiología

Se cree que el desarrollo de los divertículos del colon es el resultado de la elevación de las presiones internas del colon. El colon sigmoideo tiene el diámetro más pequeño de todo el colon y, por lo tanto, es la parte que está más sometida a presiones elevadas, de acuerdo con las leyes de Laplace. El estrés y la ansiedad, en combinación con una dieta desequilibrada en pacientes de edades superiores a los 50 años, pueden desencadenar esta enfermedad.

Adicionalmente, las dietas bajas en fibra no soluble (también conocida como "fibra poco digerible") predisponen a los individuos a enfermedades diverticulares. Igualmente, el bloqueo mecánico de un divertículo (debido a las heces) conduce a la infección del divertículo. Son realmente necesarios los chequeos para disminuir las posibilidades de contraer esta enfermedad.

Fisiopatología

Un divertículo es una evaginación de la pared intestinal. También puede ser definido como un saco o bolsa anormal que sale de la pared de un órgano hueco como, por ejemplo, el colon. El término divertículo verdadero indica que la bolsa está constituida por todas las capas de la pared abdominal (los divertículos verdaderos son raros), en tanto que el divertículo falso carece de una porción de la pared normal del intestino. A medida que se envejece, aumentan las probabilidades de que aparezcan divertículos.

Cuadro clínico

Los pacientes suelen presentar cuadros clínicos clásicos con dolor en fosa iliaca izquierda, fiebre y aumento de la concentración de las células blancas en la sangre. También pueden presentar diarrea, náuseas y sangrado rectal.

Diagnóstico

El diagnóstico diferencial (es decir, para identificar qué enfermedad está afectando al paciente) incluye distinguir la diverticulitis de un posible cáncer de colon o de una enfermedad inflamatoria intestinal, colitis isquémica y síndrome del intestino irritable, así como un variado número de procesos urológicos y ginecológicos. Algunos pacientes reportan sangrado por el recto.

En el mundo de la medicina moderna, a los pacientes que presentan estos síntomas, por lo general se les hace un estudio con tomografía computarizada, o TC. La TC tiene una precisión del 98% para diagnosticar la diverticulitis. También puede identificar a los pacientes con diverticulitis más avanzada, como aquellos con abscesos asociados. La TC de 16 cortes en la actualidad permite realizar colonoscopia virtual (no invasiva), es decir, reconstrucciones en 3D por el interior del intestino que son casi idénticas a las imágenes obtenidas por medio de colonoscopia tradicional. La TC posibilita asimismo el drenaje guiado radiológicamente de abscesos asociados, ahorrándole posiblemente al paciente una cirugía inmediata.

Otros estudios, enema con bario y la colonoscopia, son contraindicados en la fase aguda de la diverticulitis debido al riesgo de perforación.

Tratamiento

El tratamiento es distinto si es una diverticulitis complicada o no complicada. Un episodio inicial de diverticulitis aguda se trata generalmente con tratamiento médico conservador, incluyendo descanso del

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