Exam 2 Crohns and Ulcerative Colitis Flashcards
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
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
Crohn’s Disease: all the layers
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:
widespread pain; right lower abdominal pain, also have diarrhea that’s painful
Crohn’s Disease pain
have constricted lumen because of the scar tissue
Crohn’s Disease Scar tissue and granulomas
Crohn’s Disease Scar tissue and granulomas
have constricted lumen because of the scar tissue
Crohn’s Disease pain
widespread pain; right lower abdominal pain, also have diarrhea that’s painful
cause peristalsis, resulting in cramping pain after meals, have a lot of weight loss, malnutrition is very common
CD eating
CD eating
cause peristalsis, resulting in cramping pain after meals, have a lot of weight loss, malnutrition is very common
because of the inflammation, cause angry intestine, that result in chronic diarrhea
CD Ulcers
CD Ulcers
because of the inflammation, cause angry intestine, that result in chronic diarrhea
enteral abdominal, causes breaks, anal abscess
CD Perforation of inflamed intestine
CD Perforation of inflamed intestine
enteral abdominal, causes breaks, anal abscess
an increase in the number of white cells in the blood, especially during an infection.
CD Fever and leukocytosis
CD Diarrhea, abdominal pain, steatorrhea
excessive fat in the feces, anorexia, weight loss, nutritional deficiencies
excessive fat in the feces, anorexia, weight loss, nutritional deficiencies
CD Diarrhea, abdominal pain, steatorrhea
localized flexion of pus surrounded by inflammation
CD Abscess
CD Abscess
localized flexion of pus surrounded by inflammation
abnormal connection or passageway between two epithelial lined organ or vessels
CD Fistula
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
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:
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:
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
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:
Predominant symptoms:
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
Mild, server, and fulminant (ful. Means sudden with great intensity)
Classified as:
skin lesion, eye lesions, joint abnormalities, liver disease
Extraintestinal symptoms:
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:
To Determine Severity of the Disease, Assess for:
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
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
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
- 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
- Immunosuppressant agents (Ex. Imuran, Purinethal) – increase potential for infection
- Biologic Therapy (Ex. Remicade) – blocks inflammation works well for mod to ser pain ibd
- 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
