LEC 11: Inflammatory Bowel Disease Flashcards
What is the primary role of the small intestine?
- To absorb nutrients from the food we eat
- Is 15 to 20 ft long
What is the primary role of the large intestine?
- To absorb water and rom our stool
- Is 3 to 5 ft long
What are the 2 types of inflammatory bowel disease?
- Crohn’s Disease (CD)
- Ulcerative Colitis (UC)
Crohn’s Disease (CD)
- Affect small and large intestine
- Affects full thickness of the bowel wall
- Inflammation is patchy with spots of ulceration and normal tissue (skip lesions)
- Rectal bleeding
- Fistulas, strictures, and abscesses common
- Toxic megacolon unusual
- Sever nutritional deficits’ malabsorption issues
- Weight loss is severe
- Surgery will not cure
Ulcerative Colitis (UC)
- -Limited to large intestine, rectum, and anus, possible terminal ileum
- Affects lining of the large bowel
- Inflammation starts distally and spreads continuously up colon
- Rectal bleeding
- Fistulas, strictures, and abscesses rare
- Toxic megacolon rare
- Weight loss common; less nutritional deficits
- Surgery will cure
What causes IBD?
- Genetics
- Environment
- Immune respomnse
Who gets IBD?
- Age factors
- All ages
- Peaks 15 to 35; 50 to 70
- Gender
- Both genders
- Genetics
- 20% blood relative
- Population
- More common in Caucasians and those with Jewish heritage
What are the symptoms of IBD?
- Abdominal pain
- Rectal bleeding an urgency
- Stools: loos, bloody, mucousy
- Cramping prior to bowel movement
- Increased gas production
- Fatigue, weakness
- Weight loss
- Anemia
- Malnutrition/ dehydration
Intestinal Obstruction
- Occurs when there is a partial or complete blockage of the intestine that prevents intestinal contents from passing though the GI tract 2. Symptoms include: - Nausea - Vomiting - Abdominal pain - Distension - Inability to pass flatus or stool - Hyperactive bowel sounds above obstruction 3. Goals for care: - Relieve the obstruction - Normal fluid and electrolyte imbalance - Maintenance of adequate nutrition 4. Treatment: - NPO - Removal of gas and fluid from intestine with a nasogastric tube - Possible surgery
How do you diagnose IBD?
- History/ symptoms - Physical exam - Blood work (C-Reactive protein, Erythrocyte sedimentation rate, WBC count, Hemoglobin) - Stool samples ( C&S and parasites; fecal calprotectin) - Colonoscopy with biopsies - Medical imaging (Barium swallow, CT scan)
What does the hemoglobin blood test assess for?
Want to assess for anemia from blood loss
What are the 3 disease management options?
- Drugs 2. Diet 3. Surgery
What is the goal of drug therapy?
- Reduce and control inflammation 2. Induce and maintain remission 3. Improve the quality of life *Medications are the first line of therapy and they fenerally target inflammation *Medications are for life
Types of drugs used for IBD?
a. Aminosalicylates - Decreases inflammation b. Glucocorticoids - Decreases inflammation and suppresses activity of immune system c. Immunomodulators/ Immunospuppresents - Decrease inflammation and suppress the immune system d. Biologis and Biosimilars - Block inflammation or decrease inflammation targeting specific molecules
Diet
a. Well balanced diet - Eat all food groups -May avoid trigger foods b. Dietary Supplements - Encouraged/ may be needed - Multivitamin - Calcium - Vitamin D - Vitamin B12 c. Probiotics - Microbiome - Promote good gut bacteria d. Omega 3 fatty acids - Anti-inflammatory effects e. FODMAPs - Sugar molecules - Causes GI symptoms - May avoid or reduce
Surgical Interventions: Crohn’s Disease
- 65 to 75% require sugery at some time - 33 to 50% may need surgery again - Surgery is not a cure’ helps manage the complications
Surgical Interventions: Ulcerative Colitis
- Less common: 25 to 40% require surgery - Surgery completely eliminates ulcerative colitis - Removal of large intestine and rectum eliminates disease
What are the types of surgical intervention for Crohn’s Disease?
Usually performed because of occurrence of complications - Abscesses - Fistulas - Intestinal obstruction
What are the types of surgical intervention for ulcerative colitis?
Protocolectomy with ileoanal reservoir - Multiphase surgery, need the new reservoir to heal and will then have an ostomy - In about 2 months will reconnect the intestine
General Nursing Considerations
Ultimate management goal = quality of life - Disease education - Maintenance of steroid-free remission - Prevention of complications - Encourage self care - Medication adherence, lifestyle adjustments - Referrals: gastroenterologist, dietician, social worker, psychologist, enterostomal nurse/ wound care nurses - Surgical preparation
Nursing Diagnosis for IBD
- Pain - Risk for depression - Risk for nutritional deficiencies - Risk for weight loss - Risk for sink breakdown - Risk for social withdrwal - Altered body image - Risk for dehydration - Risk for food and electrolyte balance
Preoperative Care for Nursing Management of Surgical IBD patient
a. Fluid, blood, and protein replacement, monitor fluid and electrolyte balance b. Diet therapy or may be NPO c. Rest d. Measures to manage diarrhea e. Psychosocial considerations f. Ostomy teaching (if required)
Postoperative Care for Nursing Management of Surgical IBD patient
a. Priority assessments and considerations: - Vital signs - Ambulation - Pain assessment - Education - GI assessment - Wound care *redness: want it to look beefy red *Leaking: wafer is intact on the skin *Peristome skin *Assessing for effluent (drainage)
