Inflammatory Bowel

Question 1

These following flashcards are based off the recorded blackboard lectures that are posted

Question 2

what is irritable bowel syndrome ?

Answer 2

Chronic abdominal pain or discomfort and alteration of bowel problems

Question 3

what are some clinical manifestations of irritable bowel syndrome?

Answer 3

diarrhea or constipation

Question 4

do we know what causes irritable bowel syndrome?

Answer 4

we do not know the exact reason, but it can be from history of gi infections, psychologic stressors or dietary intolerances

Question 5

how do we diagnosis someone with irritable bowel syndrome?

Answer 5

reviewing the presence of abdominal pain or discomfort at least 1 day a week for 3 months

and with 2 or more associated with change in stool frequency or stool form

Question 6

notes
there are IBS categories
ibs with constipation (IBS-C)
ibs with diarrhea (IBS-D)
ibs mixed
ibs unsubtyped

Question 7

who do we normally see irritable bowel syndrome more often in?
gender wise

and typically for men we usually will see what type of ibs form?

Answer 7

women

they will have diarrhea more often

Question 8

what are some other clinical manifestation these patients will experience?
not the main ones, but just additional symptoms

Answer 8

abdominal pain
nausea
flactuance
mucus in stool
sensation of incomplete evacuation

fatigue
headache
sleep problems

Question 9

there is no single effective therapy, the treatment is based on what their symptoms are.

what do we give to those with diarrhea ?
what do we give those with constipation ?

what might we give to help with the pain?

Answer 9

anti-diarrheal
laxatives

opioid, antispasmodics, antidepreaants

Question 10

what type of diet will patients who have irritable bowel syndrome typically be on?

Answer 10

FODMAP diet

Question 11

what is inflammatory bowel disease?

Answer 11

chronic, inflammation of GI tract characterized by periods of remissions are interspersed with periods of exacerbation
(autoimmune)

Question 12

what are the 2 classification of inflammatory bowel disease?

Answer 12

ulcerative colitis
crohns disease

Question 13

what is ulcerative colitis?

Answer 13

inflammation in just the colon

Question 14

what is crohns disease?

Answer 14

inflammation from the start of the mouth to the anus

all of the gi tract, from start to end

Question 15

what are some environmental factors that can cause an alteration of your flora in your gut that can lead to inflammation ?

Answer 15

diet, smoking, stress
high intake of the American diet

NSAIDS, antibiotics
genetics

Question 16

what is the main difference between crohns disease and ulcerative colitis?

Answer 16

crohns is everything in the gi

ulcerative colitis is just the colon

Question 17

what can we see in crohns patients?

Answer 17

they will have skip lesions, where there is normal tissues between areas of inflammation

like one part is fine, then the next is not, then the following is type of situation

Question 18

does crohns affect all layers of the bowel wall? and how is this an issue?

Answer 18

yes it does

its an issue because it can cause leakage in the parts where it doesn’t affect, like that skipping lesions part

Question 19

what layer does ulcerative colitis only affect?

Answer 19

mucosal layer ( innermost )

Question 20

how does crohns disease look like under examination?

Answer 20

cobblestone appearance from deep ulcerations

Question 21

due to all the inflammation that is going along the entire gi tract for patients who have crohns disease, what can they have?

and what does it end up causing ?

Answer 21

strictures

bowel obstruction

Question 22

remember as ive been mentioning before
a patient with crohns disease will have inflammation that will normally skip throughout the body.
this will cause what and form what?

Answer 22

leaks- abscess formation in pertioneal cavity

Question 23

typically what other condition or symptom will patients have near the end of the rectum when they have crohns disease?

Answer 23

fistulas

Question 24

for ulcerative colitis typically patients will have ____ and _____loss due to the fact that they can not?

Answer 24

diarrhea

electrolyte loss

can not absorb through inflamed tissue

Question 25

what will we see in the patients stool when they have ulcerative colitis?

Answer 25

protein loss

Question 26

ulcerative colitis can develop something called ___ which is what?

Answer 26

pseudopolyps tongue like projections into bowel(reaction to the inflammation)

Question 27

which condition has bloody diarrhea? between crohns and ulcerative colitis

Answer 27

ulcerative colitis

Question 28

in ulcerative colitis in each condition, tell me how many stools they have per day ? mild moderate severe as this progresses, how does it affect these patients? (big thing)

Answer 28

4 stools 5-10 stools 10-20stools they are bleeding, so anemia, anorexia, dehydration and tachycardia is massive concern

Question 29

what are some complications we are concerned with patients with inflammatory bowel syndromes?

Answer 29

hemorrhage stricutres perforation abscess fistulas cdi colonic dilation

Question 30

anyone with inflammatory bowel disease, they are at a high risk for what?

Answer 30

colorectal cancer

Question 31

typically when we officially diagnose someone with an inflammatory bowel syndrome condition, we always end up doing this ____every ____ in order to prevent colorectal cancer

Answer 31

screening every 2 years

Question 32

what are diagnostic studies for a person with inflammatory bowel disease?

Answer 32

CBC - anemia electrolyte levels - diarrhea serum albumin - poor nutrition WBC - inflammation stool - blood, pus, mucus, infection

Question 33

something important to note, when a patient has low albumin levels, what does that indicate typically?

Answer 33

poor nutrition

Question 34

what is a diagnostic study we typically we use for patients with crohns and describe to me what it is doing?

Answer 34

capsule endoscopy patient swallows a small capsule that has a camera and then it'll take pictures as it goes through your gi tract

Question 35

notes goals of treatment of inflammatory bowel disease - rest the bowel - control inflammation - combat infection - correct malnutrition - relieve symptoms - improve quality of life

Question 36

there are multiple types of drug treatment we can use to help aid a patient who has inflammatory bowel disease however, typically we have two approaches, which are?

Answer 36

step up step down

Question 37

what is the step up approach?

Answer 37

use less toxic therapy more toxic medication are stated when initial therapies do not work

Question 38

what is step down approach?

Answer 38

use immunosuppressant and biologic and therapy first

Question 39

what are the 5 medications that we are going to use for patients who have inflammatory bowel disease?

Answer 39

5-aminosalicylates antimicrobials corticosteroids immunosuppressants biologic & targeted therapies

Question 40

what is the action of 5-aminosalicyaltes?

Answer 40

decreased inflammation by suppressing proinflammatory cytokines and other inflammatory mediators

Question 41

what is the action of antimicrobials ?

Answer 41

treat or prevent secondary infection

Question 42

what is the action of corticosteroids?

Answer 42

decrease inflammation, helps with flare ups. short term use due to side effects

Question 43

something important that I forgot to mention with 5-aminoslauctes, these are cousins to aspirin, so if a patient is allergic to this, what do we tell them?

Answer 43

dont take it! its a cousin to it

Question 44

what is the action of immunosuppressants ? what is the medication name?

Answer 44

suppress immune response methotrexate

Question 45

what is the function/action of biologic and targeted therapies?

Answer 45

TNF- induce and maintain remission targeted therapy - special use

Question 46

what is the medication name for biologic and targeted therapies ?

Answer 46

TNF - Humira and remicaid

Question 47

what are the side effects of immunosuppressants? so we have to do what?

Answer 47

require CBC monitoring and liver/pancreas - suppress bone marrow and inflammation liver and pancreas

Question 48

what do we tell patients who are wanted to be mothers or get pregnant about methotrexate?

Answer 48

it cause birth defects and should not be used

Question 49

what are some side effects of patients taking biologic and targeted therapy ?

Answer 49

uti, uri, headhace, nausea, hepatitis, tb, cancers

Question 50

what do we have to education patients on biologic and targeted therapy ? (2)

Answer 50

no live vaccines early signs and symptoms of infection ( remember they are tumor necrosis factor medications, they destroy cancer cells and we are suppress it, so it can be very intense and infection is very likely to occur )

Question 51

we can use surgery to help patients with inflammation bowel syndrome, however patients with ulcerative colitis, when we remove the entire colon, what happens?

Answer 51

they are cured! remember they just have colon issues, so if we remove the entire colon and give them like an ostomy bag, they are totally fine

Question 52

for patient with crohns disease, the best type of surgery for them would be what?

Answer 52

removal or resection of the strictures ( scarring in the gi tract that is causing more inflammation) but they aren't cured, just aided

Question 53

we worry a lot about nutrition with patients with bowel disease, so what do we want to do ?

Answer 53

fluid and electrolyte balance weigh gain good diet

Question 54

patients who have blood loss, we recommend patients to have ?

Answer 54

iron-deficiency anemia zinc drink orange juice they will poop dark tarry stools

Question 55

what are the 2 main nutritions we are worried for?

Answer 55

bile acid b12 (cobamine)

Question 56

patients who are on sulfasalazine we need to give them daily what? patients who are on corticostierds we need to give them what? (2)

Answer 56

folic acid potassium and calcium ( reason for this is because of the risk of osteoporosis )

Question 57

notes nursing implementation acute care - hemodynamic stability - pain control - fluid and electrolyte balance - nutritional support - accurate I&o - personal hygiene - postoperative care patient education - disease and management - perianal care - drug action and side effects - when to see medical care - stress reduction and strategies - importance of rest and diet