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NSG 320 (mcp) > Gastrointestinal (GI): Ulcerative Colitis & Crohn's Disease > Flashcards

Gastrointestinal (GI): Ulcerative Colitis & Crohn's Disease Flashcards

1
Q

What is Ulcerative Colitis (UC)

A

Chronic inflammation of the rectum and sigmoid colon.

In SEVERE cases, it can extend throughout the entire colon.

Periods of remission and exacerbations.

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2
Q

Ulcerative Colitis (UC) Pathophysiology:

A

Intestinal mucosa is hyperemic (increased blood flow), edematous, and reddened.

GI bleeding may be present from ulcers or erosions to the mucosal lining.

Continued edema causes mucosal thickeningnarrowed colonbowel obstruction.

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3
Q

Ulcerative Colitis (UC) Cause and Onset:

A

Unknown cause
Likely genetics, immunology, and environmental factors.

Diet and stress were previously thought to be possible causes, research has found that it may aggravate but does not cause.

Often diagnosed between ages 15-35 years of age.

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4
Q

Ulcerative Colitis (UC) S/S (11)

What main Sign differentiates this from other GI symptoms?

A
  1. Diarrhea
    - May contain blood or purulence
  2. Fever (Signifies Inflammatory process)
  3. Abdominal and Rectal pain
  4. Abdominal cramping
  5. Rectal bleeding
  6. Tenesmus (urgency to defecate)
  7. Weight loss
  8. Anorexia
  9. Fatigue
  10. Malaise
  11. Anemia
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5
Q

Ulcerative Colitis (UC) + Complications (9)

What complication causes 1/3rd of all deaths r/t UC?

A
  1. Intestinal malabsorption
    - Electrolyte imbalances
    - Dehydration
    - Anemia
  2. GI Bleed
  3. Toxic megacolon (dilation of colon and colonic ileus)
  4. Perforated colon
  5. Intestinal abscess
  6. Osteoporosis
  7. Extraintestinal complications
  8. Increased risk for colorectal cancer
    - 1/3 of all deaths related to ulcerative colitis.
  9. Anxiety & Depression
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6
Q

Ulcerative Colitis (UC) + Complications:
Extraintestinal Complications
Cause?
Examples (6)

A

CAUSE IS UNKNOWN
Manifestations can involve nearly any organ system—including musculoskeletal, dermatologic, hepatopancreatobiliary, ocular, renal, and pulmonary.

Examples:

  1. Inflammation of skin, eyes, liver, and joints.
  2. Arthritis
  3. Hepatic and biliary diseases
  4. Oral and skin lesions
  5. Eye and vision problems
  6. Muscle pain
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7
Q

Ulcerative Colitis (UC) + Patient History:

A
  1. Family history
  2. Current and previous therapy
  3. Past surgeries
  4. Nutrition history
  5. Food intolerances
  6. Unintentional weight loss
  7. Bowel Elimination (Characteristics…)
    • Frequency
    • Pattern
    • Color
    • Consistency
  8. Pain
    • Abd. and/or rectal
  9. Antibiotic use over last few months
  10. Rule out c.diff
  11. International travel
  12. NSAID use
    - Can cause an exacerbation of ulcerative colitis
  13. Extraintestinal symptoms
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8
Q

Ulcerative Colitis (UC) + Physical Assessment:

A

Mild cases may have a “normal” physical exam.

  1. Abdominal assessment
    - Assess bowel sounds, tenderness, distention…
    - Last BM
    - BM pattern
  2. Vital Signs
    - Fever & Tachycardia
    →may be signs of worsening or complication
  3. Neurological Assessment
    - May note fear, anxiety, and depression
  4. Extraintestinal complications
    - Assess oral mucosa, skin, joints…
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9
Q

Ulcerative Colitis (UC) + Labs (6)

A
  1. Hemoglobin & Hematocrit
    - Decreased, secondary to chronic blood loss.
  2. WBC
    → Increased
  3. CRP & ESR
    → Increased, indicative of inflammation
  4. Electrolytes (Na, K, Cl-)
    → Decreased, secondary to diarrhea and malabsorption
  5. Serum albumin
    → Decreased, secondary to loss of protein in stool
  6. Stool Study
    → Evaluate for WBC
    (R/Oother disorders, bacteria, viruses…)
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10
Q

Ulcerative Colitis (UC) + Diagnostics (4)

A
  1. MRI
    - Allows visualization of bowel lumen, bowel wall, mesentery, and surrounding bowel organs.
  2. Colonoscopy
  3. CT Scan
  4. Barium enema
    - Able to show complications, mucosal patterns, and depth of disease.
    - In early stages, may show incomplete filling as a result of inflammation and fine ulcerations.
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11
Q

Ulcerative Colitis (UC) + Management

A

Measures are to relieve symptoms, decrease GI motility, decrease inflammation, and promote intestinal healing.
Bowel rest/NPO
TPN for severely ill and malnourished
Nutrition therapy
Identification of food triggers
Diet is not a major factor in the inflammatory process
Each patient varies on food intolerances. Keep a food journal.
Potential food triggers: alcohol, caffeine, raw vegetables, high fiber foods, lactose, carbonated beverages, pepper, nuts, corn, dried fruits. Smoking may also contribute to worsening symptoms.

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12
Q

Ulcerative Colitis (UC) + Pharmacological

A
  1. Aminosalicylates (5-ASAs)Mesalamine, sulfasalazine
    - Anti-inflammatory effect on the intestinal lining
    - Maintain remission
  2. Antidiarrhealsdiphenoxylate, atropine, loperamide
    - Caution used due to side effects of colon dilation and toxic megacolon.
  3. Glucocorticoidsprednisone, prednisolone, topical steroids (rectal)
    - For acute exacerbations
  4. Immunomodulators; infliximab, adalimumab, vedolizumab
    - Alter immune response, Immunosuppression.
    - NOT effective alone for treatment of UC
    - Synergistic effect when combined with a steroid.
  5. Supplements
    - Flaxseed, selenium, vitamin C, iron
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13
Q

Ulcerative Colitis (UC) + Surgical Management

A

Surgery performed for complications
(i.e toxic megacolon, bowel perforation, colon cancer…)

  1. Restorative Proctocolectomy with ileostomy pouch-anal anastomosis
    - GOLD standard in surgical Tx for UC

Total proctocolectomy with permanent ileostomy.
Removal of colon, rectum, and anus. Surgical closure of the anus.
Permanent ileostomy.

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14
Q 
Ulcerative Colitis (UC) + Surgical Management 
Restorative Proctocolectomy with ileostomy pouch-anal anastomosis
A

2 stage procedure

1) removal of colon and most of rectum, leaving the anus and anal sphincter intact.
2) Create an internal pouch with remaining 1.5 ft of small intestine (ileoanal pouch/j-pouch/ s-pouch/pelvic pouch) which is connected to the anus.

Patient is given a temporary ileostomy to allow for healing of the pouch.
In which the second stage is a reversal of the ileostomy within 1-2 months after stage 1.

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15
Q

Ulcerative Colitis (UC) + Ilieostomy Care & Mx

A

Ileostomy output will appear liquid green when the ostomy is new.
After time, ileostomy adaptation occurs, the small intestines will begin to take on functions of the colon.
Ileostomy adaptationabsorption of Na and waterstool volumes decreasestool becomes thicker (paste)yellow-brown or yellow-green color.

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16
Q

What Crohn’s Disease?

A

Chronic inflammatory disease of the small intestine, colon, or both.

  • Can affect the entire GI tract, from mouth to anus.
  • Most commonly affects the terminal ileum.

Slow, unpredictable progression.

Periods of remission and exacerbations.

17
Q

What Crohn’s Disease (CD)?

A

Chronic inflammatory disease of the small intestine, colon, or both.

  • Can affect the entire GI tract, from mouth to anus.
  • Most commonly affects the terminal ileum.

Slow, unpredictable progression.

Periods of remission and exacerbations.

18
Q

Crohn’s Disease (CD) + Pathophysiology

A

Inflammation that causes thickened bowel wall.
Strictures and deep ulcerations
- Cobblestone appearance
- Increases risk for fistula

Inflammation & Edema → fibrosis and scar tissue → narrowing → obstruction

19
Q

Crohn’s Disease (CD) + Cause & Onset

A

Unknown cause

Often diagnosed between ages 15-35 years of age.

20
Q

Crohn’s Disease (CD) + S/S (6)

A

The symptoms and complications of Crohn’s Disease are very similar to that of Ulcerative colitis.

  1. Diarrhea
  2. Steatorrhea (fatty diarrhea)
  3. Abdominal pain
  4. Constant, RLQ, and around the umbilicus.
    - Can be in the LLQ if the colon is also affected.
  5. Fever
    - Common when a patient has a fistula, abscess, or severe inflammation.
  6. Weight loss
    - Secondary to malabsorption, Anorexia, increased catabolism…
21
Q

Crohn’s Disease (CD) + S/S (6)

A

The symptoms and complications of Crohn’s Disease are very similar to that of Ulcerative colitis.

  1. Diarrhea
  2. Steatorrhea (fatty diarrhea)
  3. Abdominal pain
  4. Constant, RLQ, and around the umbilicus.
    - Can be in the LLQ if the colon is also affected.
  5. Fever
    - Common when a patient has a fistula, abscess, or severe inflammation.
  6. Weight loss
    - Secondary to malabsorption, Anorexia, increased catabolism…
22
Q

Crohn’s Disease (CD) + Complications

A

The symptoms and complications of Crohn’s Disease are very similar to that of Ulcerative colitis.

Differences:

  1. GI bleed is less likely with Crohn’s Disease (CD)
  2. Small bowel and colon cancer less likely
  3. Severe malabsorption and malnutrition more common
  4. Fistula formation more common
  5. Perirectal abscess more common
23
Q

Crohn’s Disease (CD) + Patient History

A
  1. Recent bacterial infection
    - Bacterial infections can exacerbate
  2. Nutritional Status
    - Unintentional weight loss
  3. Detailed history on signs symptoms
    - Vary from person to person
  4. Bowel Elimination
    - Frequency, Pattern, Color, Consistency, Characteristics…
24
Q

Crohn’s Disease (CD) + Physical Assessment

A
  1. Abdominal assessment
    - Assess bowel sounds, tenderness, distention, masses, peristalsis…
    - Bowel sounds may be decreased or absent in severe inflammation or with obstruction.
    - High pitched sounds may be present over narrowing
  2. Skin assessment
    - Perineal assessment for ulcers, fissures, or fistulas.
  3. Neurological
    - May note depression
25
Q

Crohn’s Disease (CD) + Labs (6)

A
  1. Hemoglobin & Hematocrit
    - Decreased, secondary to slow bleeding & malnutrition.
  2. Folic Acid and Vitamin B12
    - Decreased, secondary to malabsorption
  3. WBC
    - Possibly Increased from fistula or abscess
  4. CRP and ESR
    - Increased, indicative of inflammation
  5. Electrolytes (Mg, K)
    - Decreased, secondary to diarrhea and malabsorption
  6. Serum albumin
    - Decreased, secondary to malabsorption
26
Q

Crohn’s Disease (CD) + Diagnostics

A
  1. MRI
    - Allows visualization of bowel lumen, bowel wall, mesentery, and surrounding bowel organs.
  2. X-ray
    - Able to visualize narrowing, ulcerations, strictures, or fistulas.
27
Q

Crohn’s Disease (CD) + Management

A

Non-Surgical Management is similar to that of Ulcerative Colitis.

  1. Nutritional Therapy
    - Bowel Rest/NPO
    - TPN
    - Nutritional supplements (Ensure)
  2. Fistula Management
    - Fistulas are common with acute exacerbation of CD.
    - 3000cal/day for healing
    - Monitor for worsening infection, sepsis,…
  3. Infection management
    - Incision and Drainage–Abscess
  4. Skin care/Wound Care
    - Barrier creams, drains, pouching systems,
    - Negative Pressure Wound Therapy
28
Q

Crohn’s Disease (CD) + Pharmacological

A

Crohn’s and Ulcerative Colitis share similar pharmacological treatment, in addition to the following.

ImmunosuppressiveAzathioprine and mercaptopurine
Chemotherapy and ImmunosuppressantMethotrexate

Monoclonal Antibody Drugsinfliximab, adalimumab, natalizumab
Inhibit tumor necrosis factor, decreases inflammatory response.
NOT for use in patients with hx of heart disease, cancer, or multiple sclerosis.

AntibioticsCiprofloxacin and Metronidazole
Tx of abscess, fistula, or infection.

Supplements
Vitamin B12, folic acid,…

Aminosalicylates (5-ASAs)Mesalamine, sulfasalazine
Mixed research findings on effectiveness.

29
Q

Crohn’s Disease (CD) + Pharmacological

A

Crohn’s and Ulcerative Colitis share similar pharmacological treatment, in addition to the following.

  1. Immunosuppressive
    - Azathioprine and mercaptopurine
  2. Chemotherapy and Immunosuppressant
    - Methotrexate
  3. Monoclonal Antibody Drugs
    - infliximab, adalimumab, natalizumab
    - Inhibit tumor necrosis factor, decreases inflammatory response.
    - NOT for use in patients with hx of heart disease, cancer, or multiple sclerosis.
  4. Antibiotics
    - Ciprofloxacin and Metronidazole
    - Tx of abscess, fistula, or infection.
  5. Supplements
    - Vitamin B12, folic acid,…
  6. Aminosalicylates (5-ASAs)Mesalamine, sulfasalazine
    - Mixed research findings on effectiveness.

NSG 320 (mcp) (24 decks)

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