GI

Question 1

What is Inflammatory Bowel Disease (IBD) ?

Answer 1

• 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)

Question 2

explain patho for IBD disorders

Answer 2

UNKNOWN

• TX relies on medications to treat inflammation and maintain remission
• SX only in pts who DONT respond to tx

Question 3

what is Ulcerative colitis

Answer 3

• 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

Question 4

what is Crohn’s Disease?

Answer 4

• 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

Question 5

Age IBD commonly occurs

Answer 5

BIMODAL:
-first peak- 
between 15 and 40 years 
-second peak-
 between 50 and 80 years

Question 6

what would lab results reveal in pt with exacerbation of IBD?

Answer 6

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

Question 7

What type of diet should IBD pts be on?

Answer 7

High-calorie – High-protein – Low-residue diet

Question 8

what is the etiology of ulcerative colitis?

Answer 8

-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

Question 9

what are Pseudopolyps?

Answer 9

tongue like projections into bowel lumen

- suggest UC

Question 10

what is the etiology of crohns disease?

Answer 10

-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

Question 11

What is Toxic megacolon ?

Answer 11

Colonic dilation greater than 5cm

• suggests ulcerative colitis
• SEVERE Dilation and paralysis of the colon Associated with perforation
• ^ Risk for colon cancer

Question 12

What are aphthous ulcers?

Answer 12

earliest lesions seen in Crohn disease

• oral ulcers
• canker sores

Question 13

what are main symptoms of ulcerative colitis?

Answer 13

– Bloody diarrhea > 4wks
– Abdominal cramping to constant pain associated with perforation
– Tenesmus = urgency with defecation
– Rectal bleeding

Question 14

what is Tenesmus ?

Answer 14

painful spasm of anal sphincter with an urgent desire to defecate without significant production of feces

Question 15

what are the main symptoms/ clinical manifestations of crohns disease

Answer 15

-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

Question 16

IBD surgical care:

Answer 16

Ileostomy

Question 17

What Aminosalicylate is used for crohns & ulcerative coilitis?

Answer 17

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

Question 18

What Antimicrobials are used for crohns ?

Answer 18

-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 )

Question 19

why are corticosteriods used for both crohns & ulcerative coilitis tx?

Answer 19

• Decrease inflammation
• Used to achieve remission
• Helpful for acute flareups

Question 20

What types of drugs are the main stays of treatment for ulcerative coilitis?

Answer 20

Aminosalicylate & corticosteriods

Question 21

What would np prescribe for pt with IBD who DID NOT respond to aminosalicylates, antimicrobials, or corticosteroids ?

Answer 21

Immunosuppressant
• its Suppresses immune response
• Requires regular CBCmonitoring

Question 22

What are some major Gerontologic Considerations for Inflammatory Bowel Disease?

Answer 22

-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

Question 23

What are the Common presentations of Children with Crohn disease (CD)

Answer 23

• intestinal and/or extraintestinal manifestations

- abdominal pain, weight loss, diarrhea, hematochezia, and growth failure

Question 24

what are some Extraintestinal manifestations of crohns disease?

Answer 24

arthritis, eye and skin disorders, biliary tract involvement, and kidney stones, may occur and tend to be more frequent with colonic involvement.

Question 25

what skin conditions may occur with IBD?

Answer 25

erthyema nodosum and pyoderma gangrenosum