Crohns disease Flashcards
What is crohn’s disease?
Autoimmune chronic inflammatory disease that affects anywhere in GI tract from mouth to anus. Affects all layers of the bowel wall and inflammation is in patches.
What is ulcerative colitis?
Inflammatory disease in large intestine/rectum/anus that affects innermost bowel layers (submucosa and mucosa). Creates continuous/uniform inflammation
S+S of Crohn’s disease?
Depend on area of disease. When exacerbated it causes abdomen pain, weight loss, fatigue, diarrhea, fever, nutritional problems, dehydrated, and electrolyte imbalances
What is an abscesses and fistula?
A- pocket of infection (pus filled)
F- abnormal tunnelling into the tissue
Complications from CD?
Nutritional deficiencies, bleeding(=anemia), joint conditions like arthritis, obstruction (stool or gas can’t pass b/c of inflammation), abdominal bloating, N/V, abscesses, and fistulas
How to dx CD?
Symptoms, hx of CD, phsycial exam (abdominal assessment specifically), stool samples, colonoscopy, CT scan, MRI, intestinal ultrasound, and blood work
What does fecal calprotectin measure and what does intestinal ultrasound look for?
FC- measures level of inflammation in stool
IU- looks for inflammation and complications (like fistulas)
What does a colonoscopy do?
See where inflammation occurs
Blood work for CD?
Electrolytes can be malnourished or dehydrated, elevated inflammatory markers (CRP, WBC, hemoglobin, hematocrit, RBC sedimentation rate)
Goals for management of CD?
Reduce and control inflammation, relieve symptoms, maintain remission, treat complications, correct nutritional deficiencies, maintain fluid/electrolytes, and improve quality of life
Nutritional treatment for CD?
Want to enhance nourishment and weight gain. Have a diet that’s high in calories/protein and low residue (fibre). Can also put them NPO/TPN for bowel to rest/heal. Take vitamin supplements or might need tube feed
When is surgery used?
For emergency situations like bleeding or obstructions, or when complications develop. Surgery involves removing part of bowel that’s diseased, and might have an ostomy
What is short bowel syndrome?
Occurs when large segment of the small intestine is removed which prevents adequate surface absorption of nutrients in order to maintain life unless TPN is used
What is an ileostomy?
Entire large intestine is removed and the ileum of the small bowel is brought through the abdominal wall to surface of a skin to form a stoma. Can be permanent or temporary, and not everyone requires an ostomy.
What to assess the stomach for and how often?
Assess every shift, and fresh stomas need assessed more frequently. Look at colour (pink to beefy red), edema (normal post op), any bleeding (can be present at suture sites)
What to assess peristomal skin for?
Dry, intact, and free of redness. Assess amount of stool and characteristics (make sure none is on peristomal skin)
Complications post ostomy?
Retraction, peristomal hernia, prolapse, necrosis, and peristomal skin issues
What is retraction, peristomal hernia, prolapse, and necrosis?
R- stomach gets pulled down into surface of skin and its harder for the appliance/bag to stick onto the skin
PH- intestine bulge through the fascia
P- intestines start to telescope out
N- stomach changes to black (tissues dies because of no blood supply)
How often do you change the appliance (bag)?
Every 4-7 days or when its leaking
Output issues post op?
Can be at risk for obstruction within first 2 months, have a high output, and may become dehydrated
Process to change the appliance?
Empty stool from appliance, remove ostomy bag from flange, remove flange, clean stoma/peristomal skin (no soap), assess stoma, trace/cut out template of the flange, and stick on new flange around sorta (should be 2 mm larger than the stoma)
What are the 3 types of common meds used to treat CD and what do they do? and examples
- Glucocorticoids- suppress immune system, not used long term therapy (just for acute exacerbations), ex. prednisone or hydrocortisone
- Immunomodulators- suppress immune system and used long term, ex. methotrexate or azathioprine
- Biologics- block inflammation/decrease inflammation targeting specific molecules, can also suppress immune system, used long term, ex. infliximab, adalomumab, vedolizumab, risankizumab, ustekinumab
