Exam 2 Crohns and Ulcerative Colitis Flashcards by Ngozi Omeke

Crohn’s Disease: all the layers

Usually diagnosed in adolescence or young adulthood; more in smokers than nonsmokers
Seen age 15 to 35 and 50 -70
Seen equal in men and women
Family history does pre disposed you
Most seen in those with Jewish ance.
NSAID do make it worse
Cause is unknown

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Crohn’s Disease: all the layers

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Pain – widespread pain; right lower abdominal pain, also have diarrhea that’s painful
Scar tissue and granulomas – have constricted lumen because of the scar tissue
Eating – cause peristalsis, resulting in cramping pain after meals, have a lot of weight loss, malnutrition is very common
Ulcers – because of the inflammation, cause angry intestine, that result in chronic diarrhea
Perforation of inflamed intestine – enteral abdominal, causes breaks, anal abscess
Fever and leukocytosis - an increase in the number of white cells in the blood, especially during an infection.
Diarrhea, abdominal pain, steatorrhea – excessive fat in the feces, anorexia, weight loss, nutritional deficiencies

Clinical Manifestations:

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widespread pain; right lower abdominal pain, also have diarrhea that’s painful

Crohn’s Disease pain

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have constricted lumen because of the scar tissue

Crohn’s Disease Scar tissue and granulomas

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Crohn’s Disease Scar tissue and granulomas

have constricted lumen because of the scar tissue

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Crohn’s Disease pain

widespread pain; right lower abdominal pain, also have diarrhea that’s painful

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cause peristalsis, resulting in cramping pain after meals, have a lot of weight loss, malnutrition is very common

CD eating

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CD eating

cause peristalsis, resulting in cramping pain after meals, have a lot of weight loss, malnutrition is very common

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because of the inflammation, cause angry intestine, that result in chronic diarrhea

CD Ulcers

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CD Ulcers

because of the inflammation, cause angry intestine, that result in chronic diarrhea

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enteral abdominal, causes breaks, anal abscess

CD Perforation of inflamed intestine

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CD Perforation of inflamed intestine

enteral abdominal, causes breaks, anal abscess

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an increase in the number of white cells in the blood, especially during an infection.

CD Fever and leukocytosis

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CD Diarrhea, abdominal pain, steatorrhea

excessive fat in the feces, anorexia, weight loss, nutritional deficiencies

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excessive fat in the feces, anorexia, weight loss, nutritional deficiencies

CD Diarrhea, abdominal pain, steatorrhea

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localized flexion of pus surrounded by inflammation

CD Abscess

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CD Abscess

localized flexion of pus surrounded by inflammation

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abnormal connection or passageway between two epithelial lined organ or vessels

CD Fistula

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CD Fistula

abnormal connection or passageway between two epithelial lined organ or vessels

Fissure

crack or a tear inside

an abnormal connection that develops between the intestinal tract or stomach and the skin

Enterocutaneous

an abnormal connection that develops between the intestinal tract or stomach and the skin

Non-bloody diarrhea, crampy abdominal pain, insidious onset of weight loss, fatigue, low grade fever
Proctosigmoidoscopy – to see if rectosigmoid area is inflamed
Stool sample – look for steatorrhea
Barium study of upper GI – show string sign or the xray of the thermal area
Endoscopy, Colonoscopy, Intestinal Biopsy
Barium enema – show cobblestone appears, fistula, fissures
CT scan – bowel wall thickening, fistula
CBC, Hemoglobin, Electrolytes, Erythrocyte Sedimentation Rate, Albumin and Protein

CD Assessment and Diagnostic Findings:

Non-bloody diarrhea, crampy abdominal pain, insidious onset of weight loss, fatigue, low grade fever Proctosigmoidoscopy – to see if rectosigmoid area is inflamed Stool sample – look for steatorrhea Barium study of upper GI – show string sign or the xray of the thermal area Endoscopy, Colonoscopy, Intestinal Biopsy Barium enema – show cobblestone appears, fistula, fissures CT scan – bowel wall thickening, fistula CBC, Hemoglobin, Electrolytes, Erythrocyte Sedimentation Rate, Albumin and Protein

CBC, Hemoglobin, Electrolytes, Erythrocyte Sedimentation Rate, Albumin and Protein

CBC – looking for infection Hemoglobin – blood loss Electrolytes – gastro intentional loss ESR – increase inflammation Albumin and Protein

Intestinal Obstruction or Stricture Formation Perianal Disease Fluid and Electrolyte Imbalances Malnutrition from malabsorption Fistula and Abscess Formation Increased risk for colon cancer

Complications of Crohn’s:

Intestinal Obstruction or Stricture Formation Perianal Disease Fluid and Electrolyte Imbalances Malnutrition from malabsorption Fistula and Abscess Formation Increased risk for colon cancer

What is the biggest know of CD

nonbloody diarrhea

Ulcerative Colitis: - just inner lining

Recurrent ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum Most prevalent in Caucasians; most in those of Jewish ancestry Increased incidence of colon cancer Increased systemic complications and high mortality rate

Ulcerative Colitis: - just inner lining

Lesions occur one right after another abscesses to form -Usually starts rectum and spread proximal until it involves the whole colon -Results in bowel narrowing shortening and thickening Inflammatory process affects only the inner lining so don’t often see fistulas, obstruction, fissures

UC Pathophysiology

Diarrhea, passage of mucus and pus, my have bloody diarrhea Bleeding may be mild or severe – see pallor, anemia, fatigue May have left lower quadrant pain Tenesmus – painful straining during the bowel mvmt Always feel like they have to use the restroom Pale, anemia Anorexia, weight loss, fever, vomiting, dehydration, cramping, feeling of urgency for defecation, passage of 10-20 liquid stools per day Rebound tenderness in right lower quadrant

Predominant symptoms:

Mild, server, and fulminant (ful. Means sudden with great intensity)

Classified as:

skin lesion, eye lesions, joint abnormalities, liver disease

Extraintestinal symptoms:

skin lesion, eye lesions, joint abnormalities, liver disease

Hydration and nutritional status – malnutrition, anorexia Abdominal distention tenderness and bowel sounds, could be looking for obstruction, perforation, bleeding = these s/s hypotension, tachycardia, tachypneic, pale Cbc, h&h, xray, albumin, electrolytes, If they have perforation contraindicated in scoping Stool sample, Hematocrit and Hemoglobin, WBC, Albumin, Electrolytes Abdominal x-ray Sigmoidoscopy and colonoscopy Barium enema – mucosal abominates, fistulas, or focal striatulas Complications of Ulcerative colitis: Toxic megacolon Risk for perforation Increased risk for colon cancer

To Determine Severity of the Disease, Assess for:

NPO, IV, or TPM, promote bowel rest and decrease peristalsis, trying to correct malnutrition, want to control pain, need to address inflammation, record I&O daily weight, want to decrease diarrhea

Management Of Inflammatory Bowel Disease: Acute exacerbation

NPO, IV, or TPM, promote bowel rest and decrease peristalsis, trying to correct malnutrition, want to control pain, need to address inflammation, record I&O daily weight, want to decrease diarrhea

1. 5-aminosalicylic acid drugs (Ex. Sulfasalazine) – used for anti inflammation but can cause kidney, want to increase fluids 2. Corticosteroids (Ex. Prednisone) –immunosuppression, risk of infection 3. Immunosuppressant agents (Ex. Imuran, Purinethal) – increase potential for infection 4. Biologic Therapy (Ex. Remicade) – blocks inflammation works well for mod to ser pain ibd 5. Antibiotics and Antidiarrheals prn – will do tb skin test cuz of immunosuppressant

Management Of Inflammatory Bowel Disease: meds

5-aminosalicylic acid drugs (Ex. Sulfasalazine) –

used for anti inflammation but can cause kidney, want to increase fluids

Corticosteroids (Ex. Prednisone)

immunosuppression, risk of infection

increase potential for infection

Immunosuppressant agents (Ex. Imuran, Purinethal) –

blocks inflammation works well for mod to ser pain ibd

Biologic Therapy (Ex. Remicade) –

will do tb skin test cuz of immunosuppressant

Antibiotics and Antidiarrheals prn

Assess – bowel sounds, fluid/electrolytes, infection AND Monitor NUTRITION: Provide high caloric, high protein, low fat, low fiber diet Nutritional supplements – vitamin b12

Watch for s/s of infection and that is what you want to teach

Monitor for: rectal bleeding, blood production to prevent hypovolemia monitor blood pressure, monitor coagulation H&H, vitamin K available to increase clotting factors Will want to monitor for perforation all the time s/s acute abdominal pain. Tender, distended, shock septic Will always want to monitor for obstruction bone all distention, absent or decrease bowel sounds, decrease mental, may have fever or infection, tachycardia, hypotension, dehydration, and electrolyte imbalances

Surgery