GI Flashcards
What is Inflammatory Bowel Disease (IBD) ?
- Immunologically related disorders characterized by chronic, recurrent inflammation of the intestinal tract
- Periods of remission interspersed with periods of exacerbation
2 major disorders= Ulcerative colitis (UC), and Crohn disease (CD)
explain patho for IBD disorders
UNKNOWN
- TX relies on medications to treat inflammation and maintain remission
- SX only in pts who DONT respond to tx
what is Ulcerative colitis
- inflammation and ulceration of the colon and rectum ONLY
- ONLY mucosal layer involved
- begins in the rectum and spreading up the colon in a continuous pattern
what is Crohn’s Disease?
- inflammation of segments of the GI tract- ENTIRE gastrointestinal tract from mouth to perianal area!!!
- Characterized by transmural inflammation and by SKIP LESIONS (Segments of normal bowel occurring between diseased portions)
- All layers in the bowel involved
Age IBD commonly occurs
BIMODAL: -first peak- between 15 and 40 years -second peak- between 50 and 80 years
what would lab results reveal in pt with exacerbation of IBD?
CBC:
–iron deficiency and blood loss
- ^ WBC –sign of toxic mega colon or perforation
- ^Erythrocyte Sedimentation Rate reflects chronic inflammation
Serum electrolyte levels - test for dehydration
Serum protein levels:
-HYPOALBUMIN due to poor nutrition and protein loss
What type of diet should IBD pts be on?
High-calorie – High-protein – Low-residue diet
what is the etiology of ulcerative colitis?
-Multiple abscesses develop in the intestinal glands
– Abscesses break through into the submucosa, leaving ulcerations
-Ulcerations destroy the mucosal epithelium, causing bleeding and diarrhea =
–> Fluid and electrolyte losses –> Protein loss
–>Pseudopolyps
what are Pseudopolyps?
tongue like projections into bowel lumen
- suggest UC
what is the etiology of crohns disease?
-Inflammation involves all layers of the bowel wall
- SKIP LESIONS = Segments of normal bowel occurring between diseased portions
- Ulcerations are deep and longitudinal
- Ulcerations penetrate between islands of inflamed edematous mucosa, causing the classic COBBLESTONE APPEARANCE
-Narrowing of the lumen with stricture development
– May cause bowel obstruction
– Inflammation goes through entire wall
-Microscopic leaks can allow bowel contents into peritoneal cavity = PERITONITIS
What is Toxic megacolon ?
Colonic dilation greater than 5cm
- suggests ulcerative colitis
- SEVERE Dilation and paralysis of the colon Associated with perforation
- ^ Risk for colon cancer
What are aphthous ulcers?
earliest lesions seen in Crohn disease
- oral ulcers
- canker sores
what are main symptoms of ulcerative colitis?
– Bloody diarrhea > 4wks
– Abdominal cramping to constant pain associated with perforation
– Tenesmus = urgency with defecation
– Rectal bleeding
what is Tenesmus ?
painful spasm of anal sphincter with an urgent desire to defecate without significant production of feces
what are the main symptoms/ clinical manifestations of crohns disease
-Depends on the anatomic site of involvement, extent of the disease process, and presence/absence of complications
– Diarrhea (nonbloody or bloody)
-Colicky abdominal pain
– Malabsorption – fatigue, weight loss & anemia
IBD surgical care:
Ileostomy
What Aminosalicylate is used for crohns & ulcerative coilitis?
Sulfasalazine (Azulfidine)
- Principal drug used
- Decreases GI inflammation through direct contact with GI mucosa
- Effective in achieving and maintaining remission
- for Mild to moderately severe attacks
What Antimicrobials are used for crohns ?
-metronidazole (10 or 20 mg/kg/day)
or
combo of metronidazole and ciprofloxacin 500 mg twice daily to prevent/ secondary infection
-NOT for isolated small intestinal disease (i.e. ulcerative coilitis )
why are corticosteriods used for both crohns & ulcerative coilitis tx?
- Decrease inflammation
- Used to achieve remission
- Helpful for acute flareups
What types of drugs are the main stays of treatment for ulcerative coilitis?
Aminosalicylate & corticosteriods
What would np prescribe for pt with IBD who DID NOT respond to aminosalicylates, antimicrobials, or corticosteroids ?
Immunosuppressant
• its Suppresses immune response
• Requires regular CBCmonitoring
What are some major Gerontologic Considerations for Inflammatory Bowel Disease?
-Occurs around 50s
• Distal colon is usually involved in ulcerative colitis
• Less recurrence of Crohn’s disease in older patients treated with surgical resections
• The colon rather than the small intestine tends to be involved in Crohn’s disease
• Older adults are more vulnerable to inflammation
• Careful assessment of fluid/electrolyte status required
What are the Common presentations of Children with Crohn disease (CD)
- intestinal and/or extraintestinal manifestations
- abdominal pain, weight loss, diarrhea, hematochezia, and growth failure
what are some Extraintestinal manifestations of crohns disease?
arthritis, eye and skin disorders, biliary tract involvement, and kidney stones, may occur and tend to be more frequent with colonic involvement.
what skin conditions may occur with IBD?
erthyema nodosum and pyoderma gangrenosum
