Inflammatory bowel disease Flashcards
1
Q
inflammatory bowel disease
A
- a term encompassing a number of chronic inflammatory disorders leading to damage of the GI tract
- among the most common digestive ailments affecting more than 1.4 million Americans
- IBD includes ulcerative colitis and Crohn’s disease
2
Q
IBD cont
A
- autoimmune disease
- chronic inflammation with remissions and exacerbations
- inflammation and consequences are different for UC and CD
- serious digestive problems
3
Q
etiology
A
- unknown
- genetic and environmental factors
- infectious agents
- altered immune responses
- autoimmunity
- lifestyle (smoking)
- UC possiby due to previous bacteria/viral infection
4
Q
extraintestinal manifestations of IBD
A
- muscoloskeletal: peripheral arthritis, sacroilitis, ankylosing spondylitis, ostesporosis
- dermatologic: erythema nodosum, pyoderma gangrenosum, aphthous stomatitis
- hepatobiliary diease: primary sclerosing cholangitis
- ocular: uveitis, sclerosis, episcleritis
- vascular: thromboembolitic events
- renal: nephrolithiasis
5
Q
therapies used by interdisciplinary team
A
- diagnostic tests
- pharmacologic therapy
- complementary & alternative therapy
- surgery, inlcuding ostomies
6
Q
risk factors
A
- occurs more frequently in US and northern European nations
- American Jews of European decent 4-Xmore likely to develop IBD
- African American and whites> hispanics and asians
- smoking increases risk of CD
- use of NSAIDS and antibiotics increases risk of UC
- peaks at 15-30 years of age
- second peak in 50s
- equally in men and women
7
Q
clinical manifestations of Crohn’s disease
A
-cobblestone appearance of bowel wall with patchy distribution (skip lesions) from mouth to anus
8
Q
Symptoms of CD
A
- fevers, night sweats, weight loss due to nutrition deficit
- abdominal pain
- N/V
- diarrhea and/or constipation
- rectal bleeding
9
Q
clinical manifestations: intestinal complications
A
- intestinal obstruction
- abscesses
- fistulas
- perforation
- massive hemorrhage
- colon cancer
10
Q
physical examination in CD
A
- weight loss and pallor
- clubbing of the fingers
- abdominal distention
- tenderness in the area of involvement
- abnormal bowel sounds
- presence of inflammatory mass are common
- perianal abscess, fistula, skin tags, anal stricture
11
Q
Labs
A
- Anemia: defiencies in iron, vit. B12, folic acid; anemia of chronic disease
- leukocytosis
- thrombocytosis
- elevated ESR ad Creactive protein levels
- decreased serum albumin levels
- prometheus
- urinalysis commonly demonstrates calcium oxalate crystals
- stool analysis for fecal eukocytes
- serologic markers with high specificty for CD
- Anti-saccharomyces antibody (ASCA)
12
Q
imaging studies
A
- plain abdominal X-ray
- barium studies: small bowel enema (enteroclysis/follow through); large bowel enema
- U/S abdomen and pelvis/transrectal U/S
- CT abdomen and pelvis
- MRI
- sigmoidoscopy
13
Q
endoscopy (CD)
A
- upper and ower
- capsule
14
Q
Mild to moderate CD
A
- ACG practice guidelines- definition
- ambulatory pts
- pts. who are able to tolerate oral meds
- pts without manifestations of:dehydration, toxicity, abdominal tenderness,painful mass, obstruction, >10%weight loss
15
Q
Moderate- severe CD
A
- ACG practice guidelines- definition
- pts who have failed to respond to treatment for mild-moderate CD
- pts with more prominent symptoms of: fever, significant weight loss, abdominal tenderness or pain, intermittent nausea or vomiting (w/o obstructive finding), significant anemia
16
Q
severe CD
A
- pts with persistent symptoms despite the introduction of steroids as out pt
- presenting with: high fever, persistent vomiting, evidence of intestinal obstruction,rebound tenderness, cachexia or evidence of abscess
17
Q
CD in remission
A
- pts who are asymptomatic or without inflammation
- pts who have responded to acute medical intervention or have undergone surgical resection without gross evidence of residual disease
- **pts requiring steroids to maintain well-being are considered to be “steroid-dependent” and are usually not considered in remission
18
Q
current goals for CD therapy
A
new approach: top-down
-induce clinical remission
-maintain clinical remission
-improve quality of life
PLUS
-heal mucosa
-decrease hospitalization/surgery/overall costs
-minimize disease related and therapy-related complications
19
Q
Aminosalicylates (5-ASA compunds)
A
-first line of therapy: treats mild-moderate CD & UC
-drug used to: -decrease GI inflammation
-effective in achieving and maintaining remission
-mild to moderate episodes
-causes fewer adverse effects than sulfasalazine
-inexpensive and effective for many pts. that tolerate it
- oral delayed release
Exampes:- Pentasa, apriso: release 5ASA directly into small intestine/colon or ileum
-olsalazine, balsalazide: to colon only
*combined with antibiotics lead to sensitive skin
20
Q
Antibiotics
A
- frequenty used with flareups
- used when abscesss forms
- examples: metronidzole, ciprofloxacin, rifaximin (usually used)
- lots of SE
21
Q
immunomodulators
A
- suppress immune response
- most useful in those who do not respond to aminosalicylates, antibiotics, or corticosteroids
- require regular CBC monitoring
- if body does not tolerate it, leads to adverse reaction which could lead to death
- watch for lymphodema
- promethius test done before giving
- examples: azathioprine
- 6-mercaptopurine-BW& Prometheus test. SE:HA, N/V, diarrhea, fatigue
- cyclosporine: affects kidney function, diabetes, increase cholestero, swollen gums, increase facial hair, HTN, seizures
- tacrolimus
- methotrexate: flu like symtoms, decreased WBC, RBC, damage to liver, diabetes, drinking alcohol
22
Q
corticosteroids
A
- decrease inflammation
- used to achieve remission
- helpful for acute flare ups
- ***if pt on steroids but not showing symptoms, still not considered to be in remission
- examples: prednisone, mehtylprednisolone, hydrocortisone, budesonide (less SE for young men/women)
- severe CD
23
Q
biologic therapies
A
- block a small inflammatory protein called tumor necrosis factor alpha that promotes inflammation in IBD
- induce an maintain remission
- examples: infliximab: only on approved for UC
- natalizumab: only for CD
- adalimumab: approved for both
- certolizumab pegol: only for CD
- do not give immunomodulators and biologics together because they increase the risk for cancer in men under 30
- severe CD
24
Q
once a pt is off 5-ASA
A
they cannot track backwards in meds
25
Q
nursing considerations
A
- nonadherance
- lack of knowledge
- concerns about side effects
- lack of trust in meds
- diminished sense of priority for meds
- burden of taking prescribed med
- treatment cost
26
Q
complementary and alternative therapy
A
- encourage pts to discuss all potential therapies with the primary care provider
- complementary and alternative may interact with prescribed meds
- includes: herbal, OTC
