ibd and diverticulitis Flashcards
What is Inflammatory Bowel Disease (IBD)?
Chronic inflammation of the GI tract with periods of remission and exacerbation. Includes Crohn’s disease and Ulcerative Colitis (UC).
What causes IBD?
Exact cause unknown, but it is an autoimmune disease caused by an inappropriate immune response to environmental and bacterial triggers in a genetically susceptible person.
What is the strongest risk factor for IBD?
Family history (genetic predisposition).
What lifestyle factors increase the risk of IBD?
- Urban living - Diet (high in refined sugars, total fats, polyunsaturated fatty acids, omega-6 fatty acids) - NSAID use - Antibiotics - Oral contraceptives
What are the main symptoms of Crohn’s disease?
- Diarrhea - Cramping abdominal pain - Weight loss (if small intestine is inflamed, leading to malabsorption) - Rectal bleeding
What are the main symptoms of Ulcerative Colitis (UC)?
- Bloody diarrhea - Abdominal pain
How do the severity levels of UC differ?
Mild UC: - 4 semi-formed stools per day with small amounts of blood Moderate UC: - Up to 10 stools/day - Increased bleeding - Systemic symptoms: fever, malaise, mild anemia, anorexia Severe UC: - 10-20 bloody stools/day with mucus - Fever, rapid weight loss (>10% TBW), anemia, tachycardia, dehydration
What are the goals of nursing care for IBD?
- Rest the bowel 2. Control inflammation 3. Correct malnutrition 4. Provide symptomatic relief 5. Improve quality of life
Is there a cure for IBD?
No cure; treatment focuses on symptom management.
What surgical treatments are available for UC?
- Proctocolectomy with ileal pouch/anal anastomosis (IPAA) 2. Proctocolectomy with permanent ileostomy
What surgical treatments are available for Crohn’s disease?
- Resection of diseased segments with reanastomosis (can lead to Short Bowel Syndrome (SBS)) 2. Strictureplasty to open narrowed areas that obstruct the bowel
What are the key diagnostic tests for IBD?
- CBC (checks for iron deficiency anemia from blood loss, high WBCs for toxic megacolon/perforation) 2. Serum electrolytes (Na+, K+, Cl-, Bicarb, Mg depletion from diarrhea & vomiting) 3. Hypoalbuminemia (severe disease due to malnutrition/protein loss) 4. Increased ESR, CRP, and WBCs (reflect inflammation) 5. Imaging: Double-contrast barium enema, small bowel series, transabdominal US, CT, MRI 6. Colonoscopy to examine entire large intestine
What medications are prescribed for UC?
- Corticosteroids for symptom relief 2. Aminosalicylates or biologic therapy
What medications are used for both UC and Crohn’s?
- 5-aminosalicylic acid (5-ASA): suppresses proinflammatory cytokines and inflammation mediators 2. Biologics: block specific proteins that cause inflammation 3. Corticosteroids: decrease inflammation of intestinal mucosa 4. Immunosuppressants (require regular CBC monitoring for bone marrow suppression, risk of infection & bleeding)
What is diverticula?
Saccular dilation or outpouchings of mucosa that develop in the colon.
Where is diverticula most commonly found?
Left (descending, sigmoid) colon at weak points where blood vessels pass through the muscle layer.
What is diverticulosis?
The presence of multiple, non-inflamed diverticula (more common in vegetarians).
What is diverticulitis?
Inflammation of one or more diverticula, leading to perforation into the peritoneum.
What are risk factors for diverticulitis?
Low-fiber diet, high intake of red meat and refined carbs, obesity, inactivity, smoking, excess alcohol use, NSAID use. More common in Western, industrialized populations.
What symptoms do most patients with diverticulosis experience?
Many have no symptoms; some may experience abdominal pain, bloating, flatulence, and changes in bowel habits.
What are serious complications of diverticulosis?
Diverticular bleeding or progression to diverticulitis.
What are symptoms of diverticulitis?
- Acute LLQ pain - Abdominal distention - Decreased or absent bowel sounds - Nausea, vomiting - Systemic signs of infection (fever, high WBC count) - Older adults may be afebrile with normal WBC count and little tenderness.
What are key nursing interventions for diverticulitis?
- Give IV fluids and electrolyte replacement as ordered. - NPO status, move to clear liquids with improvement. - Administer IV fluids and antibiotics as ordered. - Observe for abscess, bleeding, and peritonitis. - Monitor WBC count. - Implement pain management measures. - Bedrest and strict intake and output monitoring. - Provide frequent oral care and water-soluble lubricant for lips. - NG suctioning (check every 4 hours for patency).
What client education should be provided for diverticulosis/itis?
- High-fiber diet (fruits and vegetables, decrease red meat and fat). - Encourage fluid intake of at least 2L/day. - Avoid straining, vomiting, bending, heavy lifting, tight clothing. - Encourage smoking cessation.
What is the surgical treatment for severe diverticulitis?
Resection of the involved colon with primary anastomosis.
What surgical procedure may be required if primary anastomosis isn’t possible?
Temporary diverting colostomy, which may later be reversed after healing.
How is diverticulosis usually found?
Routine sigmoidoscopy or colonoscopy.
How is diverticulitis diagnosed?
- Physical assessment - CBC (check for infection/inflammation) - CT scan with oral contrast (preferred imaging method) - Abdominal X-ray, ultrasound, or MRI - Stool testing for occult blood
