Crohns & Colitis - 8 Flashcards
What medication was Kelly initially prescribed for her ulcerative colitis?
Prednisone
Prednisone is a corticosteroid used to reduce inflammation.
What are the symptoms Kelly experienced that improved with prednisone?
- Abdominal cramps
- Diarrhea
- Urgency to move her bowels
- Rectal bleeding
What maintenance therapy was Kelly placed on after her prednisone treatment?
5-ASA maintenance therapy
What percentage of people with Crohn’s disease will require surgery?
Approximately 70% to 80%
What percentage of people with ulcerative colitis will require surgery?
Approximately 20% to 40%
What condition may lead to the need for surgery in IBD patients?
Severe symptoms, complications, or inadequate control with drug therapy
What is a common feature of most operations performed for IBD?
- Performed by a surgeon
- Requires incisions on the abdomen
- Requires general anesthetic
- Hospital stay averages 7 to 10 days
What is an ostomy?
A procedure that brings an opening in the intestine out through the abdominal wall
What is the difference between an ileostomy and a colostomy?
- Ileostomy: last part of the small intestine (ileum) is brought out
- Colostomy: large intestine (colon) is brought out
Is there a standard surgical procedure for IBD?
No, surgeries are individualized based on patient circumstances
What is the expected recovery time after IBD surgery?
Average of 6 weeks
True or False: A stoma is painful to touch.
False
What is required to collect stool from a stoma?
An appliance or bag
What is a colectomy?
The surgical removal of the large intestine
What are the common concerns regarding living with a stoma?
- Self-consciousness about the appliance
- Stool consistency
- Odor and gas
What can help manage odor from a stoma appliance?
Proper fitting of the appliance and air fresheners
What should individuals with an ileostomy be cautious about regarding fluids?
Increased risk of dehydration and kidney stones
What is important to consider before starting sexual activity for someone with a stoma?
Not to have a full appliance
What is the role of an enterostomal therapy nurse (ET nurse)?
- Help with appliance selection
- Educate on stoma care
- Reduce potential problems
Fill in the blank: Surgery for IBD does not necessarily mean that you will have to wear a _______.
bag
What is the typical stool consistency after several weeks for someone with an ileostomy?
Porridge or toothpaste consistency
What factors can affect the gas output from a stoma?
- Air swallowing
- Mouth breathing
- Smoking
- Chewing gum
- Carbonated drinks
What is a pelvic pouch procedure?
A surgical procedure that has replaced ileostomy in most cases of ulcerative colitis
What is the psychological effect of having a stoma for many patients?
The idea is often worse than the reality
What should you disclose to your partner after intestinal surgery?
Indicate the surgery for an intestinal problem and that part of your intestine has been brought out through the skin, requiring stool to be collected in a secure bag or appliance.
True or False: A stoma can interfere with intimacy and sexual relations.
False
What is the pelvic pouch procedure also known as?
Ileal pouch-anal anastomosis (IPAA)
What percentage of patients are very satisfied with the pelvic pouch procedure?
More than 90%
What happens during the pelvic pouch procedure?
The colon and most of the rectum are removed, and the lower end of the small intestine is fashioned into a large-capacity pouch attached to the remaining rectum.
What is usually done with the small intestine above the pouch after pelvic pouch surgery?
It is brought out to the skin as a temporary ileostomy.
Fill in the blank: Patients typically have ______ bowel movements per day after pelvic pouch surgery.
4 to 12
What can cause gas after pelvic pouch surgery?
Gas can be embarrassing and may lead patients to feel they need to move their bowels more frequently.
What dietary supplement may help individuals with very loose stools after pelvic pouch surgery?
Soluble fiber, such as psyllium
What can happen if stool is not cleaned off well after a bowel motion?
The skin can become red, itchy, painful, or even break down.
What is a common complication following the pelvic pouch procedure?
Bowel obstruction
What is pouchitis?
An inflammation of the inner lining of the pouch occurring in approximately 10% to 15% of patients after pelvic pouch surgery.
True or False: Antibiotics are usually effective in treating pouchitis.
True
What is the primary concern for patients undergoing surgery for Crohn’s disease?
The potential for the disease to recur in previously unaffected segments of intestine.
What is the most common operation performed for Crohn’s disease?
Small intestinal resection
What is short bowel syndrome?
A condition resulting from the removal of too much intestine, leading to inability to maintain nourishment and fluid balance.
What is an ileocecal resection?
Surgical removal of the last part of the ileum and the first part of the colon as a single piece.
Fill in the blank: Patients may require ______ if they develop chronic pouchitis.
Regular antibiotic treatment
What is a potential outcome of bowel obstruction following surgery?
Increased pain and discomfort for the patient.
What can lead to pouch leaks and abscesses after pelvic pouch surgery?
Suturing or stapling where the pouch is created or attached to the rectum can leak or come apart.
What role do probiotics play in the management of pouchitis?
They may prevent recurrent episodes of pouchitis.
What may be necessary for patients with severe chronic pouchitis?
Surgical removal of the pelvic pouch and potential formation of an ileostomy.
What is a small intestinal resection?
Removal of only the affected segment of the small intestine without removing any of the large intestine.
What is an ileocolic resection?
Resection of part of the large intestine along with the terminal ileum, commonly when Crohn’s disease affects the cecum and ascending colon.
What is anastomosis?
The surgical connection of two unattached ends of the intestine to reestablish continuous flow.
What is the purpose of creating a temporary stoma?
To divert intestinal contents away from the anastomosis to promote healing.
What is strictureplasty?
A procedure to open narrowed segments of the intestine without removing them.
What risks are associated with strictureplasty?
Risks include leak, infection, and recurrent obstruction.
What is a colectomy?
Removal of all or part of the large intestine.
What is a right hemicolectomy?
Removal of the right half of the colon.
What is a left hemicolectomy?
Removal of the left half of the colon.
What is a subtotal colectomy?
Removal of all of the large intestine except for the rectum and possibly the lower end of the sigmoid colon.
What is a total proctocolectomy?
Removal of the entire colon and rectum.
What is the pelvic pouch procedure?
An operation to create a pouch from the small intestine after removal of the colon and rectum.
True or False: Ulcerative colitis can recur after a total proctocolectomy.
False.
What is indeterminate colitis?
A condition where Crohn’s disease cannot be differentiated from ulcerative colitis after examination.
What is the purpose of physical examinations and tests in Crohn’s disease?
To investigate the presence of fistulas and abscesses.
What is a fistulotomy?
An incision along the length of a fistula to allow it to heal from the inside out.
What is a seton in the context of fistula treatment?
A string or band placed through a fistula to keep it open for controlled drainage.
What is the failure rate of surgical flap operations for fistulas?
Approximately 40% to 50%.
What is the combined approach for managing perianal Crohn’s disease?
A combination of surgical drainage and medical treatment for Crohn’s disease.
What is the role of stem cell therapy in treating perianal fistulas?
To promote tissue healing through the potential of stem cells to develop into healing factors.
What is a new approach to the treatment of perianal fistulas in Crohn’s disease?
Stem cell therapy
Stem cells are used for their potential to produce factors that lead to tissue healing and closure of fistula tracts.
How are stem cells administered for treating Crohn’s disease fistulas?
Injected into the inside and outside openings of the fistulas by a surgeon during an examination under anesthesia.
Where has stem cell therapy for Crohn’s disease fistulas been approved?
European Union
It is still undergoing clinical testing to determine its effectiveness and safety.
What procedure may provide the best outcome for patients with severe perianal fistulas?
Diverting loop (temporary) ileostomy.
What are the benefits of a diverting loop ileostomy?
Reduces drainage from fistulas, reduces abscess formation, may lead to healing of fistulas or surgical wounds.
What happens if a patient with anal sphincter damage has a temporary ileostomy?
It may be converted to a more permanent end ileostomy.
What is the recommended surgical procedure to reduce cancer risk for patients with an end ileostomy?
Removal of the rectum.
What is a significant risk associated with leaving the rectum after surgery?
Risk of cancer of the rectum.
What type of surgery involves multiple small incisions and a camera?
Laparoscopic surgery.
What are the advantages of laparoscopic surgery?
Leaves small scars, reduces pain, allows faster discharge from hospital.
What types of surgeries can be performed laparoscopically for IBD?
- Colectomy
- Small intestinal or ileocolic resection
- Removal of the rectum (proctectomy)
- Pelvic pouch procedure.
What can cause a laparoscopic surgery to be converted to an open approach?
Adhesions from previous surgery or complexity of Crohn’s disease.
What is the recurrence risk for patients undergoing surgery for Crohn’s disease?
Approximately 1 out of every 3 patients will have a recurrence of symptoms within 3 to 5 years if untreated.
What is the best way to reduce the risk of recurrence of Crohn’s disease after surgery?
Not to smoke cigarettes.
What medications are commonly used to reduce the risk of recurrent Crohn’s disease after surgery?
- 5-aminosalicylic acid (5-ASA)
- Antibiotics
- Azathioprine
- 6-mercaptopurine (6-MP).
What is the effect of 5-ASA medications on the risk of recurrence?
Reduces the risk by about 10% to 12%.
What is a concern for women regarding pregnancy after surgery for IBD?
Increased difficulty in conceiving due to inflammation and scarring.
What procedure may affect a woman’s ability to get pregnant after surgery for ulcerative colitis?
Pelvic pouch procedure.
What is a common follow-up procedure after surgery to assess Crohn’s disease?
Colonoscopy within the first 12 months.
What is the significance of early signs seen by colonoscopy after surgery?
They can occur before symptoms recur, allowing for early treatment.
What is the role of parents in treating children with IBD?
Translating complex information to their children and helping them make treatment decisions.
What condition does Lauren, the case study subject, have?
Crohn’s disease.
What treatment did Lauren initially receive for her Crohn’s disease?
Budesonide and methotrexate.
What happened to Lauren’s symptoms after she missed 9 months of TNF-alpha blocker therapy?
Her symptoms started to come back and worsened.
What did an MRI scan reveal about Lauren’s condition?
A 4-inch (10 cm) segment of thickening in the terminal ileum due to fibrosis.
What is the expected outcome for Lauren after surgery?
A very good outcome due to the limited segment of Crohn’s disease.
What does the gastroenterologist say about the effectiveness of other biologic drugs for Lauren?
He is not highly confident that they will have a major impact on her symptoms due to scarring.
Scarring can limit the effectiveness of biologic drugs in treating Crohn’s disease symptoms.
What is the condition of Lauren’s Crohn’s disease?
It is limited to a relatively short segment of small intestine.
This localization can influence treatment options and outcomes.
What does the gastroenterologist expect the outcome of surgery to be for Lauren?
He tells her she will likely have a very good outcome from surgery.
Surgery can provide significant relief and extended periods of good health.
What are the potential long-term benefits of surgery for Lauren?
She can get married and have children, possibly without even being on medication.
Surgery can lead to improved quality of life and reduced dependency on medication.
What does Lauren express interest in regarding her treatment?
She is quite interested in the surgical option and asks for a referral to a colorectal surgeon.
Seeking a surgical solution indicates her willingness to pursue significant treatment changes.
True or False: There is no chance that Crohn’s disease can come back after surgery.
False.
There is always a chance that Crohn’s disease can recur post-surgery.
