Fig. 33. Care of patient with gastrointestinal hemorrhage

The general properties of excrements

Examination of feces properties through inspection (which can be easily done by the nurse) is of great help in diagnostics of some diseases including gastroenteric. A healthy person’s daily amount of feces depends on quality and amount of food and is 100-120 gr on the average. If absorption is disturbed and the speed of movement in the intestinal tract is increased (enteritis), the amount of feces can be up to 2500 gr but in case of constipation feces are scanty.

Normally defecation takes palce once a day, usually at the same time.

Density of feces and their form depend on the amount of water, fat and fiber. Normally feces ares sausage-shaped, the density id average. In cases of constipation feces become very dense and in case of hyperkinetic constipation it takes the form of dense small balls – scybalous stool. In cases of diarrhea feces are usually liquid with particles of not digested food and various admixtures: in case of cholera – rice-water stool with flakes of slime, in case of abdominal typhoid – pea-soup stool. When fermentative processes prevail in the intestinal tract, excrements are incoherent, frothy.

The colour of feces depends on presence of bilious pigments in it. If bile does not get into the intestinal tract, feces are grey. The colour of feces also depends on the food taken: dairy food gives light yellow color, meat – dark colour, green vegetables give greenish color, bilberry – brown colour, liver and blood sausage – give black color. Some medicinal substances also give the feces a special colour: animal charcoal, bismuth, iron give the feces black color, santonin and rhubard – give brown or reddish.

The smell of feces depends mainly on substances produced at decomposition of fibers. When the food is mainly vegetable, fermentative processes prevail and feces have a sourish smell. When the food is dairy, feces have almost no smell, in case of putrescent growths the odor is sharp putrefactive.

it is possible to find different visible admixtures: helminths (worms) – ascarides, threadworms and joints of tape-worms; not digested remains of food can also be found in normal feces, more often it is particles of vegetable food or bits of cartilage, etc. on case of disturbed digestion of fats feces are brilliant, fat by sight; slime can be mixed with feces if it is from upper parts of the intestinal tract, and can be on the feces surface if it from the lower parts. In cases of mucocolitis slime as dense white ribbons can be excreted. It is possible to find matter, if there is a lot of it and it is mixed with slime, as in cases of dysentery, when clods of yellowish slime with streaks of blood are excreted. Stones which have got into feces from the gall-bladder and pancreas, are possible to find after an attack of colic by washing out feces in a sieve.

Enemas

The main purpose of enemas (Greek klysma – washing) is medical influence but they can also be given with diagnostic purposes.

Medicinal enemas are used for the following purposes: 1) mechanical defecation of the large intestine (cleansing enemas); 2) colon lavage (siphon enemas), medicinal influence on the large intestine; 3) introduction of water, medicines, nutrients into the organism through the rectum (medicinal, nutrient enemas).

Diagnostic enemas allow to find out the capacity of the large intestine, to introduce contrast media for carrying out of roentgen examination of the large intestine.

There are two ways of introducing liquid into the rectum: from the tank placed above the level of the body – hydraulic way; by pumping with the help of special devices – a forcing way.

To give a hydraulic (cleansing) enema it is necessary to have the following: 1) a tank for the liquid to be introduced (Esmarch's irrigator, a glass funnel, a rubber mug) with the capacity of 1- 5 litres; 2) a rubber tube conducting liquid, about 1.5 m long, with a diameter of not less than 1 cm; 3) intestinal cannula, which is to be introduced into the lumen of rectum, made of different materials (thick-walled rubber, ebonite, plastic), not less than 15 cm long, with a rounded intestinal end; 4) a thermometer for measuring the temperature of the liquid. A special connecting hose with a stopcock is placed between the rubber tube and the cannula to regulate the amount of liquid entering the rectum (it is possible to use a clip regulating the diameter of the rubber tube). On the average 1-2 l of boiled water of 12-42°С depending on the kind of constipation is calculated for an adult: in case of hypokinetic constipation – the temperature must be lower, of hyperkinetic constipation – higher, having a relaxing effect. Usually water with the temperature of 37°С is used, a soap solution is added to increase the effect: 1 tablespoon of a soap chips + 2 tablespoons of glycerin or vegetable oil.

The device for cleansing enema consists of the following parts:

1. Esmarch's irrigator – a glass tank with the capacity of up to 2 l (it can be replaced by a rubber or a metal one);

2. A thick-walled rubber tube 1.5 m long, with a diameter of 1 cm, which is put on the tubule of Esmarch's irrigator;

3. A connecting hose with a stopcock for regulating liquid current;

4. A glass, ebonite or rubber cannula.

Cleanisng enemas are given in the following cases:

1. constipation and stool retention of various origin;

2. poisonings of external and internal origin;

3. before operations, childbearing and roentgen examination of abdominal and small pelvis organs, as well as before medicinal, nutritient enemas and rectal drip.

Contra-indications to cleansing enemas are:

1. acute inflammatory, suppurative and helcoid processes in the anus area, especially acute appendicitis;

2. peritonitis;

3. gastrorrhagia and enterorrhagia, especially bleeding hemorrhoids and putrescent colon cancer;

4. first days after operations on abdominal and small pelvis organs;

5. anal fissure, incompletely closed anus and Prolapsus of the rectum.

Liquid introduced through enema has a mechanical, temperature and chemical effect both on peristalsis and defecation and on fecal masses loosening them and facilitating their removal (Fig.34).