Gastrointestinal System – Nursing Interventions for Acute Spinal Cord Injury

00:01 Okay, we've got some spinal cord trivia for you. What is the conus medullaris? I mean, we just have fun words in medicine sometimes so what is the conus medullaris? Now, if you've been with us to our series you should know this one but pause the video and see if you can come up with your answer.

00:20 Okay, the conus medullaris, are you ready? That's the very bottom part of the spinal cord where it's kind of bulbous, that's another word that we use.

00:29 So you know that the spinal cord ends about L1 and that's why when we do a lumbar puncture we're gonna do it at like L3 and L4 so we don't risk hitting the spinal cord.

00:39 So the conus medullaris is the bulbular end of the spinal cord.

00:44 Now, if we've got some problems in spinal cord injuries in there we want to talk to you about what the patient will experience if they have that, cuz you got the conus medullaris and then we've got the little kind of stringy ones that come off that, we call that the cauda equina.

01:00 It comes from the latin word to mean horse, I usually remember that because equina sounds like equestrian.

01:07 Now at the very bottom you have the filum terminale which to means sounds like an opera, but really, think of it as terminal or end like an airport terminal, that's the end of the airport, filum terminale is the very end of the fibers.

01:20 So, you've got the conus medullaris, that's the bulb at the end, right? And it usually ends about L1, that our spinal cord ends about L1 and then you've got the cauda equina which is that last section, in the very bottom of that is the filum terminale, so you got the horse's tail in filum terminale.

01:42 Okay, so what happens when we have problems here in the conus medullaris? Well, you'll get some decrease motility in your gut.

01:50 Now, we're looking at the gastrointestinal system, so you can have some slowed moving of your gut, that's never any good because remember that food moving through your gut is supposed to move through in a set period of time.

02:05 The reason is your gut's job is if food is moving through the appropriate time, your gut is pulling water back out of that waste.

02:15 If you slow it down it just hangs out in your gut longer and it removes more water and more water and more water and that's how a patient ends up impacted with like rock hard, cement like stool.

02:29 So, when motility goes down things moves in the system slowly, they don't absorb the correct way, they even have slowed gastric emptying and you're risking a paralytic ileus.

02:41 Now, the gut really doesn't get the love that it needs. I know it's not that pretty, I know, you know, poop comes out of it, right? So, it's not like it's, "Woohoo," it's the really exciting part but we can't live without a well-functioning gut and a paralytic ileus can be extremely problematic that means the gut stopped.

03:02 It's not moving anywhere and this can really put a patient at risk for sepsis and everything else.

03:08 So a neurogenic bowel, remember the thing about genesis is -- creating things neuro, obviously, your nervous system, so a neurogenic bowel means that sometimes patients have lost voluntarily control of their bowel after a spinal cord injury, and let that sink in for a minute.

03:31 If it isn't difficult enough that they've lost motor ability, they've lost sensory ability, their whole life has been turned upside down, but even the most basic of life activities, using the restroom to empty their bowels or empty their bladder can really be completely messed up in a spinal cord injury.

03:53 So, a spinal cord injury above the conus medullaris, the anal sphincter remains tight.

04:00 Okay, that may not sound like a bad idea to you but the idea is the patient can't sense when their rectum is full of stool, okay, so why would that be a problem? You know, so you can't feel it. Well, here's the problem.

04:15 That means that whenever their rectum becomes full, it just empties.

04:20 So they are incontinent of stool. Can you imagine being in a social setting and this timing just happened? Yeah, it's potentially humiliating for a patient.

04:31 So part we need to explain to them, hey, listen, this is what happens because of your spinal cord injury, it's why you can't sense it, so we're gonna help you retrain your bowel so that we minimize the risk of this happening to you out in public.

04:47 Now, spinal cord injury at or below the conus medullaris, okay, and that defecation reflex might be damaged so the patient can end up constipated, they have an increased risk of also being incontinent and get impacted, and impacted means the stool, they become so constipated, there's so much water that's been drawn out of that waste, it is just -- it is rock solid and it's impossible for the patient to pass it on their own.

05:13 So, at or below the conus medullaris you got the reflex damaged, you have increased risk of incontinence, impaction, ileus or a megacolon and those are major GI issues so it's not just the movement and sensory that's a problem, the GI is really at risk with these injuries.