GI- diverticulitis, ulcerative colitis, crohns Flashcards
what is ulcerative colitis?
Chronic inflammation of the rectum and sigmoid colon with periods of remission and exacerbation
patho of ulcerative colitis
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.
s/s of ulcerative colitis
Diarrhea May contain blood or purulence Abdominal and Rectal pain Abdominal cramping Rectal bleeding Tenesmus (urgency to defecate) Weight loss Anorexia Fatigue Malaise Fever Anemia *almost exact same as crohns
UC complications
-Intestinal malabsorption
-Electrolyte imbalances, Dehydration, Anemia
-GI Bleed
-Toxic megacolon (dilation of colon and colonic ileus)
-Perforated colon
-Intestinal abscess
-Osteoporosis
-Extraintestinal complications
Increased risk for colorectal cancer
—-1/3 of all UC deaths related to ulcerative colitis.
Esp if dx >10 years
-Anxiety and Depression
Extraintestinal Symptoms of UC
--Manifestations can involve nearly any organ system—including musculoskeletal, dermatologic, hepatopancreatobiliary, ocular, renal, and pulmonary. Examples: -Inflammation of skin, eyes, liver, and joints. -Arthritis -Hepatic and biliary diseases -Oral and skin lesions -Eye and vision problems -Muscle pain -CAUSE IS UNKNOWN
drug to look out for causing exacerbation of UC
NSAID
UC patient history assessment
-Family history
-Current and previous therapy for Ulcerative Colitis
-Past surgeries
-Nutrition history
-Food intolerances
-Unintentional weight loss
-Bowel Elimination
>Frequency, Pattern, Color, Consistency, Characteristics…
-Pain
>Abdominal and/or rectal
-Antibiotic use over last few months
»Rule out c.diff
-International travel
-NSAID use
>Can cause an exacerbation of ulcerative colitis
-Extraintestinal symptoms
Abdominal physical assessment for UC
Assess bowel sounds, tenderness, distention…
Last BM
BM pattern
UC - monitor for what 2 vital signs in particular
Fever & Tachycardiamay be sign of worsening or complication: sepsis, bleeding, electrolyte imbalance, dehydration
Labs for UC
- Hemoglobin & Hematocrit: Decreased, secondary to chronic blood loss.
- WBC: Increased
- C- reactive protein & Erythrocyte sedimentation rate (ESR): Increased, indicative of inflammation
- Electrolytes (Na, K, Cl-): Decreased, secondary to diarrhea and malabsorption
- Serum albumin: Decreased, secondary to loss of protein in stool
- Stool Study: Evaluate for WBC; rule out other disorders, bacteria, viruses,…
Increased labs w/ UC
WBC, C reactive, ESR
Decreased Labs w/ UC
Hemoglobin, hematorcrit, electrolyte, serum albumin
Diagnostics for UC
MRI, Colonoscopy, CT, Barium Enema
What does barium enema show w/ UC?
- 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.
management for UC
relieve symptoms, decrease GI motility, decrease inflammation, and promote intestinal healing, nutrition therapy, bowel rest/npo
potential food triggers for UC
alcohol, caffeine, raw vegetables, high fiber foods, lactose, carbonated beverages, pepper, nuts, corn, dried fruits. Smoking may also contribute to worsening symptoms.
TPN and UC- when do we use it? how do we use it?
TPN for severely ill and malnourished —> Risks b/c of dextrose = high osmolarity = central line needed
When do we use surgery for UC?
Surgery performed for complications (i.e toxic megacolon, bowel perforation, colon cancer…)
Surgical options for UC
- Restorative Proctocoloectomy with ileostomy pouch-anal anastomosis
- Total proctocolectomy with permanent ileostomy.
what is a Total proctocolectomy with permanent ileostomy.
Removal of colon, rectum, and anus. Surgical closure of the anus.
Permanent ileostomy.
What is Restorative Proctocoloectomy with ileostomy pouch-anal anastomosis
- -GOLD standard in surgical treatment for UC
- 2 stage procedure—removal of colon and most of rectum, leaving the anus and anal sphincter intact. Create an internal pouch with remaining 1.5 ft of small intestine (ileo-anal 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 reversal of the ileostomy within 1-2 months after stage 1.
what is ileostomy adaptation?
small intestine take on role of large intestine
absorption of Na and water better > stool volumes decrease > stool becomes thicker (paste) > yellow-brown or yellow-green color.
what is effluent?
initial output from ileostomy
-caustic and sweet, green
What is Crohn’s disease? what part of intestine is it most common to effect?
Chronic inflammatory disease of the small intestine, colon, or both.
- -It can affect the entire GI tract, from mouth to anus.
- -Most commonly affects the terminal ileum.
- Slow, unpredictable progression.
- Periods of remission and exacerbations.
w/ crohn’s how will the intestine appear?
cobblestone, strictures, deep ulcerations
how do you end up w/ obstruction when you have crohn’s
Inflammation & Edema > fibrosis and scar tissue > narrowing > obstruction
what causes crohn’s ? when is it often diagnosed?
no one knows!
15-35
crohn’s s/s
-Diarrhea- **Steatorrhea (fatty diarrhea)
-Abdominal pain- **Constant, RLQ and around umbilicus.
(Can be in the LLQ if the colon is also affected.)
-Fever: Secondary to **when a patient has a fistula, abscess, or severe inflammation.
-Weight loss: **Secondary to malabsorption, Anorexia, increased catabolism,…
more likely to have GI bleed w/ UC or Crohn’s?
UC
more likely to have cancer w/ UC or Crohn’s
UC
More common to have malabsorption and malnutrition: UC or Crohn’s
Crohn’s
More likely to have fistula and perirectal abscesses: UC or Crohn’s
Crohn’s
____ ____ can exacerbate Crohn’s
bacterial infections
patient history assessment w/ crohn’s
- Recent bacterial infection: Bacterial infections can exacerbate
- Nutritional Status: Unintentional weight loss
- Detailed history on signs symptoms: Signs and symptoms vary from person to person
- Bowel Elimination: Frequency, Pattern, Color, Consistency, Characteristic
bowel sounds w/ crohn’s - what does high pitched mean? What does decreased or absent mean?
Bowel sounds may be decreased or absent in severe inflammation or with obstruction.
High pitched sounds may be present over narrowing
neuro assessment for crohn’s
depression
skin assessment for crohn’s
Perineal assessment for ulcers, fissures, or fistulas.
Labs for crohn’s
- same as UC + Folic acid and Vitamin B12
why have increased WBC w/ crohn’s
possibly increased from fistula or abscess
why have low electrolytes and serum albumin w/ crohn’s?
malabsorption and diarrhea
diagnostic test for crohn’s
MRI
3 aspects of nutrition therapy for Crohn’s
Bowel Rest/NPO
TPN
Nutritional supplements (Ensure)
cal/day needed for fistula management
3000 cal/day for healing
When do we see fistula’s w/ crohn’s?
acute exacerbation
When do we do surgery for crohn’s ?
performed when medical interventions are not effective or from complications
–>Complications include fistula, perforation, obstruction, abscess, stricture, etc.
surgery for crohn’s
resection
stricturoplasty
ostomy
