Inflammatory Bowel Disease Flashcards
Inflammatory Bowel Disease
Characterized by chronic, recurrent inflammation of the GI tract
Autoimmune disease
Ulcerative Colitis
Inflammation and ulceration of the colon and rectum
Works its way from rectum up to the cecum
First layer of large intestine
Sloughing off of layer
Crohn’s Disease
Inflammation of any segment of the GI tract from mouth to anus
Clinical Manifestations of IBD
Diarrhea Bloody stools Weight loss Abdominal pain Fever Fatigue
IBD Local Complications
Hemorrhage Strictures Perforation (with possible peritonitis) Fistulas Colonic dilation (toxic megacolon) High risk for colorectal cancer C. Diff infection Liver failure
Peritonitis
Inflammation of peritoneum
Rigid, hard washboard abdomen with pain and fever
Can be life threatening
Toxic Megacolon
Dilated colon accompanied by bloating and sometimes fever, abdominal pain, or shock
More common with ulcerative colitis
Crohn’s Disease Clinical Manifestations
Diarrhea Crampy abdominal pain Less Common -Weight loss when small intestine involved -Rectal bleeding -Fever or other systemic symptoms
Crohn’s Disease Pattern of inflammation/Complications
Inflammation involves all layers of bowel wall Can occur anywhere in GI tract Skip Lesions Strictures Abscesses (peritonitis, fistulas) Nutritional problems Small intestinal cancer
Skip Lesions
Cobblestone appearance, normal bowel appears present between diseased portions
Ulcerative Colitis Pattern of Inflammation
Diarrhea with large fluid & electrolyte loss
Breakdown of cells
Areas of inflamed mucosa
Ulcerative Colitis Clinical Manifestations
Bloody Diarrhea Abdominal Pain In Severe Forms: -Fever -Rapid weight loss of more than 10% of total body weight -Anemia -Tachycardia -Dehydration
Diagnostic Studies
H&P examination Blood Studies Stool Cultures Imaging Studies Endoscopy
Blood Studies Include
CBC, WBC, Serum electrolyte levels, Serum protein levels, ESR, C-Reactive Protein
Sulfasalazine
Decreases GI inflammation and is effective in achieving and maintaining remission for mild to moderately severe attacks. Contains sulfapyridine so it reaches the colon for absorption.
Aminosalicyaltes
For mild to moderate Crohn’s disease, especially when the colon is involved, but are more effective for ulcerative colitis. Help achieve and maintain remission.
*may cause yellowish discoloration of skin, avoid sunlight until photosensitivity is determined.
Antimicrobials
Used to treat IBD. Drugs like metronidazole and ciprofloxacin.
Corticosteroids
Decrease inflammation and used to achieve remission.
Helpful for acute flare ups.
Given for shortest possible time because of s/e associated with long-term use.
Immunosuppressants
Suppresses immune response and maintain remission after corticosteroid induction therapy.
Other drug therapies
Biologic Therapy
Goals of Drug Treatment
Induce and maintain remission.
Reduce quantity and quality of severity of flare ups.
Nutritional Therapy
Dietary Consultant
Overall, IBD patients need to eat a balanced, healthy diet w/ sufficient calories, protein, nutrients.
Goals of Diet Management
Provide adequate nutrition w/o exacerbating symptoms
Correct and prevent malnutrition
Replace fluid and electrolyte losses
Prevent weight loss
Nutritional deficiencies are due to
Decreased oral intake
Blood loss
Malabsorption of nutrients (depends on location of inflammation)
Medications that can contribute to nutritional problems
Sulfasalazine: daily folic acid supplements indicated
Corticosteroids: Ca supplements to prevent osteoporosis, potassium supplements
Vit D Deficiency is common
During acute exacerbations…
Regular diet may not be tolerated
Liquid enteral feedings preferred (high in calories/nutrients, lactose free, easily absorbed)
Regular foods are reintroduced gradually
Surgical Therapy
Exacerbations are debilitating and frequent (massive bleeding, perforation, strictures, obstruction, dysplasia, carcinoma)
*Surgery is indicated if treatment fails
Postoperative Care
Ileostomy: monitoring of stoma viability, mucocutaneous juncture, peristomal skin integrity
Gerontologic Considerations
Second peak of disease onset occurs in 60s
Distal colon is usually invovlved in ulcerative colitis
Diagnosis can be difficult
Sed Rate
ESR (erythrocyte sedimentation rate)
test that indirectly measures how much inflammation is in the body; how long it takes to separate
C-Reactive Protein
Substance produced by the liver that increases with inflammation; considered a non-specific “marker” for disease
