Inflammatory Bowel Flashcards
These following flashcards are based off the recorded blackboard lectures that are posted
what is irritable bowel syndrome ?
Chronic abdominal pain or discomfort and alteration of bowel problems
what are some clinical manifestations of irritable bowel syndrome?
diarrhea or constipation
do we know what causes irritable bowel syndrome?
we do not know the exact reason, but it can be from history of gi infections, psychologic stressors or dietary intolerances
how do we diagnosis someone with irritable bowel syndrome?
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
notes
there are IBS categories
ibs with constipation (IBS-C)
ibs with diarrhea (IBS-D)
ibs mixed
ibs unsubtyped
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?
women
they will have diarrhea more often
what are some other clinical manifestation these patients will experience?
not the main ones, but just additional symptoms
abdominal pain
nausea
flactuance
mucus in stool
sensation of incomplete evacuation
fatigue
headache
sleep problems
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?
anti-diarrheal
laxatives
opioid, antispasmodics, antidepreaants
what type of diet will patients who have irritable bowel syndrome typically be on?
FODMAP diet
what is inflammatory bowel disease?
chronic, inflammation of GI tract characterized by periods of remissions are interspersed with periods of exacerbation
(autoimmune)
what are the 2 classification of inflammatory bowel disease?
ulcerative colitis
crohns disease
what is ulcerative colitis?
inflammation in just the colon
what is crohns disease?
inflammation from the start of the mouth to the anus
all of the gi tract, from start to end
what are some environmental factors that can cause an alteration of your flora in your gut that can lead to inflammation ?
diet, smoking, stress
high intake of the American diet
NSAIDS, antibiotics
genetics
what is the main difference between crohns disease and ulcerative colitis?
crohns is everything in the gi
ulcerative colitis is just the colon
what can we see in crohns patients?
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
does crohns affect all layers of the bowel wall? and how is this an issue?
yes it does
its an issue because it can cause leakage in the parts where it doesn’t affect, like that skipping lesions part
what layer does ulcerative colitis only affect?
mucosal layer ( innermost )
how does crohns disease look like under examination?
cobblestone appearance from deep ulcerations
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 ?
strictures
bowel obstruction
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?
leaks- abscess formation in pertioneal cavity
typically what other condition or symptom will patients have near the end of the rectum when they have crohns disease?
fistulas
for ulcerative colitis typically patients will have ____ and _____loss due to the fact that they can not?
diarrhea
electrolyte loss
can not absorb through inflamed tissue
what will we see in the patients stool when they have ulcerative colitis?
protein loss
ulcerative colitis can develop something called ___ which is what?
pseudopolyps
tongue like projections into bowel(reaction to the inflammation)
which condition has bloody diarrhea?
between crohns and ulcerative colitis
ulcerative colitis
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)
4 stools
5-10 stools
10-20stools
they are bleeding, so anemia, anorexia, dehydration and tachycardia is massive concern
what are some complications we are concerned with patients with inflammatory bowel syndromes?
hemorrhage
stricutres
perforation
abscess
fistulas
cdi
colonic dilation
anyone with inflammatory bowel disease, they are at a high risk for what?
colorectal cancer
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
screening
every 2 years
what are diagnostic studies for a person with inflammatory bowel disease?
CBC - anemia
electrolyte levels - diarrhea
serum albumin - poor nutrition
WBC - inflammation
stool - blood, pus, mucus, infection
something important to note, when a patient has low albumin levels, what does that indicate typically?
poor nutrition
what is a diagnostic study we typically we use for patients with crohns
and describe to me what it is doing?
capsule endoscopy
patient swallows a small capsule that has a camera and then it’ll take pictures as it goes through your gi tract
notes
goals of treatment of inflammatory bowel disease
- rest the bowel
- control inflammation
- combat infection
- correct malnutrition
- relieve symptoms
- improve quality of life
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?
step up
step down
what is the step up approach?
use less toxic therapy
more toxic medication are stated when initial therapies do not work
what is step down approach?
use immunosuppressant and biologic and therapy first
what are the 5 medications that we are going to use for patients who have inflammatory bowel disease?
5-aminosalicylates
antimicrobials
corticosteroids
immunosuppressants
biologic & targeted therapies
what is the action of 5-aminosalicyaltes?
decreased inflammation by suppressing proinflammatory cytokines and other inflammatory mediators
what is the action of antimicrobials ?
treat or prevent secondary infection
what is the action of corticosteroids?
decrease inflammation, helps with flare ups.
short term use due to side effects
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?
dont take it!
its a cousin to it
what is the action of immunosuppressants ?
what is the medication name?
suppress immune response
methotrexate
what is the function/action of biologic and targeted therapies?
TNF- induce and maintain remission
targeted therapy - special use
what is the medication name for biologic and targeted therapies ?
TNF - Humira and remicaid
what are the side effects of immunosuppressants?
so we have to do what?
require CBC monitoring
and liver/pancreas
- suppress bone marrow and inflammation liver and pancreas
what do we tell patients who are wanted to be mothers or get pregnant about methotrexate?
it cause birth defects and should not be used
what are some side effects of patients taking biologic and targeted therapy ?
uti, uri, headhace, nausea, hepatitis, tb, cancers
what do we have to education patients on biologic and targeted therapy ? (2)
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 )
we can use surgery to help patients with inflammation bowel syndrome, however
patients with ulcerative colitis, when we remove the entire colon, what happens?
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
for patient with crohns disease, the best type of surgery for them would be what?
removal or resection of the strictures ( scarring in the gi tract that is causing more inflammation)
but they aren’t cured, just aided
we worry a lot about nutrition with patients with bowel disease, so what do we want to do ?
fluid and electrolyte balance
weigh gain
good diet
patients who have blood loss, we recommend patients to have ?
iron-deficiency anemia
zinc
drink orange juice
they will poop dark tarry stools
what are the 2 main nutritions we are worried for?
bile acid
b12 (cobamine)
patients who are on sulfasalazine we need to give them daily what?
patients who are on corticostierds we need to give them what? (2)
folic acid
potassium and calcium
( reason for this is because of the risk of osteoporosis )
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
