Inflammatory Bowel Disease

• General term used for:– Ulcerative colitis

– Crohn’s disease

– Both are characterized by extraintestinal and systemic features but are very distinctive

Famous People with UC

Ulcerative Colitis

• Area of chronic inflammation of mucosa and• submucosa in the rectum and spread to the• cecum that results in poor absorption of

nutrients• Periods of exacerbations and remission• Can range in severity from mild to severe

Causes???????

• Crypt abcessess

Ulcerative Colitis

• Manifestations– Colon becomes edematous and develops

bleeding lesions & ulcers– Scar tissue develops and causes elasticity

and loss of absorption• Diarrhea

– Severe– Bloody

• Vitamin K deficiency

• Weight loss• Anorexia• Malaise• Dehydration and electrolyte imbalances• Anemia• Abdominal tenderness and cramping

Mild Disease

Moderate

Severe and fulminant

• May affect quality of life; patient may be fearful to leave house

• Complications include: hemorrhage, abscess formation, malabsorption, bowel obstruction, bowel perforation, increased risk for colon cancer.

• Diagnosed by colonoscopy; barium enema can show differences between UC and Crohn's

Ulcerative Colitis

• Collaborative Management :– Medical management:

• Rest is required to decrease intestinal activity• Diet therapy

– Low-residue, high protein diet with vitamins and iron; in severe cases, nothing by mouth to rest the bowel; TPN will be ordered in severe cases

– Avoid gas-forming foods, milk products, and foods with whole grains, nuts, alcohol, ETC

• Medications –• Aminosalicylates – deliver 5-ASA to the affected

area– read these drugs! – Glucocorticoid – prednisone = given during an

exacerbation to decrease the inflammation process of the bowel –

– Immunomodulators– Antidiarrheals – Dangerous! Toxic Megacolon– New

– Fecal bacterial transplantation therapy

Cont. Collaborative Care

• Surgery– Total proctocoloctomy (removal of colon) with permanent

ileostomy – is curative– Kock ileostomy – Ileoanal anastomosis with ileoanal resevoir– Review NUR 111 Elimination – for ostomy care!– Post op care

• Encourage patient to talk about concerns related to disease process and its effect on lifestyle

Protocolectomy

Kock Surgery

• Continent Ileostomy

Coping with flares

• The above website will take you to a slide show on how to cope with UC flare ups.

Crohn’s disease• Chronic inflammation of GI mucosa occurring

anywhere from mouth to anus but most common in terminal ileum

• Characterized by exacerbations and remissions• Leads to thickening and scarring, a narrowed

lumen, malabsorption• Lesions extend to all thickness of bowel wall and

are prone to fistulas, ulcerations and abscesses• Lesions have a “cobblestone appearance” with

sections of normal mucosa between lesions called “skip” lesions.

• Evidence is mounting that Crohn's disease is not an autoimmune disease, but an immune response to a bacteria - most likely candidate being "mycobacterium avium paratuberculosis

Crohn’s disease

• Manifestations: vary patient to patient – common:– Diarrhea(5 to 6 liquid to semi formed stools/day) is

most common symptom(usually without blood); steatorrhea (fatty stool) may occur

– Abdominal pain n RLQ and distention– Low-grade fever

• Others:– Weight loss– Malnutrition More that with UC– Fatigue, malaise– Dehydration– Complications

Crohn’s disease

• Collaborative Management:– Diagnostic – see Ulcerative Colitis (UC)– Medical management: similar to UC

• Diet: – Provide prescribed diet: usually high calorie, high

protein; – Encourage intake of prescribed nutritional supplements– Daily weight, maintain calorie count, and monitor I and O– During severe exacerbations: NPO and TPN

• Medications:– Same as UC with the following:

» Budesonide (Entocort EC); metronidazole (Flagyl)

Crohn's disease Ulcerative colitis

DefecationOften porridge-like[3],sometimes steatorrhea

Often mucus-likeand with blood[3]

Tenesmus Less common[3] More common[3]

Fever Common[3] Indicates severe disease[3]

Fistulae Common[4] Seldom

Weight loss Often More seldom

Symptoms in Crohn's disease vs. ulcerative colitis   [ v · d · e ]

Crohn’s disease

• Surgical:– Avoided if possible; not curative, mostly just

used to treat complications– Performed if not improved medically– Allow patient to express fears and anxiety

about course of illness and possibility of surgical intervention

Nursing Diagnoses

• Diarrhea related to inflammation of the bowel mucosa

• Acute pain• Knowledge deficit• Imbalanced nutrition: Less than body

requirements• Impaired skin integrity• Risk for FVD• PC: anemia• Differential Features of UC and Crohn’s Disease

Website for children and teens