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34 Cards in this Set
- Front
- Back
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Definition
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*IBD is used to describe two separate diseases, Ulcerative Colitis and Crohn's Disease
*Chronic inflammatory condition that affects small intestine, large intestine, or both *Characterized by remissions and exacerbations |
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Incidence
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1 million Americans suffer from IBD
Ulcerative Colitis U.C. any age but peaks at 15-25 and again 60-80 years old, both sexes equal risk Crohn's any age but common 15-30 y.o., slightly higher incidence in women Both high incidence in Jewish & upper middle class urban population |
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Risk Factors/Causes
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*Extensive research done: etiology unknown
*Infectious process (virus, autoimmune) *Autoimmune *Food allergies *Hereditary 15% 1st degree relative *Psychosocial (stress or psychological factors |
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Pathophysiology:Ulcerative Colitis
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*Inflammation is diffuse and involves only the mucosa and submucosa of the bowel w/ alternating periods of exacerbations and remissions
*Disease begins in rectum and spreads up colon in a continuous pattern *Mucosa of colon is hyperemic (excessively reddened) and edematous. |
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Pathophysiology:Ulcerative Colitis
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*Abscesses develop and break through the intestinal glands into the submucosa leaving ulcerations.
*Mucosal epithelium is destroyed causing bleeding and diarrhea. *Lose fluids and electrolytes due to decreased mucosal surface for absorption. |
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Pathophysiology:Ulcerative Colitis
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*Breakdown of cells leads to protein loss.
*Areas of inflammed mucus develop pseudopolyps the mucosa becomes thickened and the colon shortens. |
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Manifestations: Ulcerative Colitis
Acute crisis or chronic disorder |
*Abdominal Pain
-Mild (cramps) -Severe (abdominal pain - perforation - death) *Bloody diarrhea (mucous) Classic sign -Mild: 1-2 semi formed stools w/ small amts of blood. -Moderate: 4-5 stools/day -Severe: 10-20 stools/day that contains mucus and blood |
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Manifestations: Ulcerative Colitis
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*Additional: Dehydration, fever, weight loss, anemia, tachycardia, and dehydration
*Intestinal: -Hemorrhage major complication -Strictures narrowing of area -Toxic megacolon 5% of patients boardlike abdomen -Colonic Dilation -Perforation (usually occurs with toxic megacolon) |
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Manifestations: Ulcerative Colitis
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*Extraintestinal:
-1/3 have at least one manifestation (may be only presenting sx) Arthritis Finger Clubbing Stiff back Skin rashes ulcers of the mouth liver disease peptic ulcer disease |
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Classification: Ulcerative Colitis
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Mild - gradual onset mild cramps, frequent stools, small amount rectal bleeding
Moderate - 4-5 loose, bloody stools pain keeps them from sleeping, low grade fever, extraintestinal symptoms Severe - explosive diarrhea, lots of urgency, increased fever, wt. loss, dehydration, low B/P, increased pulse Intractable - 30-50 bowel movements/day |
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Diagnostic Studies: Recall
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*Colonoscopy visualize colon & inflammation
*New virtual colonoscopy *Sigmoidoscopy *Barium Enema *CBC *Stool for blood and C&s |
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Treatment: Medical
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**Goals**
Rest Bowel Reduce inflammation Reduce immune response Prevent complications |
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Treatment: Nutritional
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**Goals**
Provide adequate nutrition without exacerbating symptoms Correct metabolic and nutritional deficits Replace fluid and electrolyte losses Prevent weight loss |
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Treatment: Nutritional
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Acute phase: NPO
IV fluids and electrolyte replacement May need TPN (daily weights) When permitted start clear liquids, then full liquids, then high calorie, high protein, low residue diet with vitamin and iron supplements |
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Treatment: Pharmacological
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*Antimicrobial (flagyl)
*Corticosteroids (solumedrol, prednisone) *Anticholinergic (banthine) decrease GI motility and relax smooth muscles from spasms *5-Aminosalicylates (azulfadine, rowasa (topical enema, steroid enema reduce inflammation @ the site)) |
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Treatment: Pharmacological
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*Sedatives (valium, dalmane) reduce anxiety
*Antidiarrheal (Lomotil) *Immunosuppressives (Imuran) suppress immune response *Immunomodulators (Remicade) IV *Hematinics & Vitamins (Iron, B12, zinc, folate) |
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Reasons for Surgical Tx.
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*Failure to respond to therapy
*Exacerbations are frequent and debilitating *Massive bleeding, strictures, obstruction. *Dysplasia (pre-cancerous cell) *Carcinoma |
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Treatment: Surgical
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*Total Proctocolectomy with permanent ileostomy
*Total proctocolectomy with continent ileostomy. (koch pouch) *Total colectomy and ileal reservoir (2 surgeries) |
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Sequelae/Complications of U.C.
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*GI Bleeding
*Abscess, fissure (cracks in bowel), fistula *Fluid and electrolyte imbalance *Toxic megacolon *Anemia (from GI bleeding) *Intestinal Obstruction *Colon Cancer (10+ years with ulcerative colitis increases risk of colon cancer) |
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Pathophysiology: Crohn's Disease
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*Inflammation of segments of GI tract
*Any part of colon, most often terminal ileum and jejunum. *Inflammation involves all 4 layers of bowel wall *Areas of inflammation are discontinuous |
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Pathophysiology: Crohn's Disease
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*Ulcerations deep and longitudinal penetrate between islands of edematous mucosa causing classic COBBLESTONE APPEARANCE.
*Bowel wall thickens and the lumen narrows leads to stricture development. *Abscesses and fistula tracts develop (ex: bowel-bladder Risk for infection) |
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Incidence/Risk Factors
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*Cause unknown (? genetic, environmental)
*Most often between ages of 15-30. *In older adults morbidity and mortality increases. *Slightly higher incidence in females. *Jewish, upper middle class urban population *Lower incidence than Ulcerative Colitis |
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Manifestations: Crohn's Disease
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*Onset insidious
*Abdominal pain in RLQ relieved by defecation **Diarrhea usually non-bloody** MAJOR difference between U.C. and Crohn's disease *Systemic (fever, fatigue, wt. loss) |
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Manifestations: Crohn's Disease
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*Chronic Disorder
*Unpredictable periods of recurrence & remission *Attacks are intermittent *Diarrhea and pain subside spontaneously |
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Diagnostic Studies
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*History and Physical
*Barium Studies *Laboratory studies *Endoscopy w/ biopsy |
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Treatment: Medical
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**Goals**
-Control inflammation -Relieve manifestations -Correct metabolic and nutritional problems -Promote healing |
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Treatment: Nutritional
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*High calorie, high vitamin, high protein, low residue, milk free
*vitamin deficiencies d/t lack of absorption (vit. B12) *TPN daily weights |
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Treatment: Pharmacological
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*Antidiarrheals (lomotil)
*Sulfasalazine (azulfidine) most popular drug *Corticosteroids (prednisone) *Immunosuppressives (Imuran) lots of side effects |
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Pharmacological
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*Infliximab (Remicade)
*Metronidazole (Flagyl)S/E metallic taste in mouth (give hard candy) no alcohol w/ flagyl 24-48 hrs after discontinuing the drug. If alcohol taken violently ill with vomiting *Fish oil (helps prevent reoccurrences of inflammation) |
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Treatment: Surgical
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*Severe symptoms
*Unresponsive to therapy *Life threatening complications *Conservative intestinal resection with anastomosis of healthy bowel 75% pts require surgery - 20 yrs 90% pts require surgery - 30 yrs |
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Sequelae/Complications of Crohn's
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*Perianal abscess
*Fistulas *Fissures *Obstruction *Pancreatitis *Carcinoma - increased risk of colon cancer and gallstones *Gallstones |
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Nursing Care Plan
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**Teaching**
*diet and rest *Perianal care (lots of diarrhea, hemorrhoids) *Medications *Symptoms of recurrence of disease *When to seek medical care *Diversional activities |
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Current Trends/Research
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*Inflammatory Bowel Disease Act (2004)
-Expand and enhance IBD research NIH -Establish an IBD prevention and epidemiology program at CDC -Require federal studies to identify barriers that IBD patients encounter when seeking insurance coverage and applying for Social Security Disability |
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Current Trends/Research
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*Article from RN magazine
*Crohn's and Colitis Foundation of America *National Institute of Diabetes & Digestive & Kidney Diseases www.niddk.nih.gov |
