Lower GI (Inflammatory Bowel Disease - UC/Crohn's) Flashcards
What are the Inflammatory Bowel Diseases (IBD)
Ulcerative Colitis
Crohn’s Disease
What do Crohn’s Disease and Ulcerative Colitis have in common?
- Chronic inflammation of the intestine
- Periods of remission and exacerbation
- Cause unknown
- Autoimmune disorders
- No cure (ex: Colon removal in UC)
- S/S = Diarrhea, Weight loss, Abdominal Pain, Fever and Fatigue
- Treatment = Medications to reduce inflammation/ Maintain remission/ Surgery
What characteristics are unique to Crohn’s Disease?
- Occurs anywhere from Mouth to Anus (Most commonly, Terminal ileum and colon)
- SKIP LESIONS (Ulcerations are deep, COBBLESTONE appearance)
What characteristics are unique to Ulcerative Colitis?
- Starts at rectum and spreads UP colon
- Continuous pattern
IBD Goals of treatment
- Rest Bowel (NPO, IV hydration, During flare)
- Control Inflammation
- Combat infection
- Correct malnutrition
- Alleviate stress
- Provide symptomatic relief using drug therapy
- Improve quality of life
Why is Nutrition compromised in IBD?
- Decreased food intake
- Increased energy consumption at rest
- Steroid use
- Malabsorption
- Exudative enteropathy
Nutritional therapy: IBD
Acute phase = NPO
(No flare, No NPO)
When taking PO -> Increase Calories and protein. Decrease residue (ruffage/fiber) with vitamin and iron supplements
No universal food trigger IBD
Food Diary to ID individual triggers
Avoid Smoking
Consider enteral (GI) /parenteral (IV) feedings
When the gut works….
USE IT!
Unless active flare :)
What are the advantages of TPN?
- Allows for positive nitrogen balance while resting the bowel
- Vitamins, Minerals, E-lytes, glucose, amino acids, etc can be added
What do we need to give TPN?
Central Line
TPN is…
Nutritionally complete
Non-use of gut causes?
Intestinal mucosal atrophy
- leads to Bacteremia and infections
TPN contains?
Dextrose - 15-25% (Monitor glucose q6) Amino Acids Electrolytes Vitamins Minerals Trace elements
How to start and stop TPN
Start Slowly and end Slowly (Pancreatic beta cells need time to adapt to increasing/ decreasing insulin output)
What is PPN?
Partial Parenteral Nutrition
- Rarely used due to ease of obtaining central access
- Large volume necessary for PPN
- Lack of benefit from short term PN
IBD drug therapy
Sulfasalazine (Azulfidine) - 5 Aminosalicylates
- a GI anti inflammatory agent
Also
- Corticosteroids, Immunosuppressants, Biologic and targeted therapy (Immunomodulators)
Drug therapy UC
80% of time drug therapy induces remission
20% Require surgery
Drug therapy: Crohn’s
Most need surgery at some point
No response to drug therapy?
Hospitalization indicated
Aminosalicylates
Decrease inflammation
Antimicrobials
Prevent/treat secondary infection
Corticosteroids
Decrease inflammation
Immunosuppressants
Suppress immune system
Biologic and targeted therapy
Inhibit cytokine tumor necrosis factor (TNF)
Prevent migration of leukocytes from blood to inflamed tissue
Complications of IBD
Hemorrhage
Strictures
Perforation
Sometimes surgery is indicated
UC surgery
Total proctocolectomy is curative
Most common surgery for UC
Total proctocolectomy and ileal anal reservoir (IPAA)
IPAA
Colon is removed
Temporary ileostomy is formed (while j pouch is healed)
Ileum is rerouted to rectum
after healing rectum is used (will be watery stool)
Can a UC patient have a permanent ileostomy?
Yes, Total proctocolectomy with permanent ileostomy can be performed
Is there a continent ileostomy used in UC?
Yes, Total proctocolectomy with continent ileostomy
- Kock pouch used
- No bag
- Must self Catheterize
T/F: Crohn’s can be cured by surgery
False! Crohn’s disease is not cured by surgery
Crohn’s disease surgery
Usually related to complications
- Fistulas
- Strictures
- Obstructions
- Bleeding
Recurrence after surgery is very high
Intestinal resection with anastomosis of healthy bowel
IBD: Patient teaching
Importance of Rest and Diet management Drug action and SE Symptoms of recurrence of disease When to seek medical care Diversional activities to reduce stress
Pt Teaching: Post Colon surgery
Call provider if they experience:
- Wound drainage
- Wound opening
- Wound redness or changes to the skin surrounding the ostomy
- No bowel movement or lack of gas/stool from the rectum for more than 24 hours
More post surgery teaching
Call provider if:
- Increased abdominal pain
- Vomiting
- Abdominal swelling
- High ostomy output
- Dark or no urine
- Fever greater than 101.5
- Patient is not able to take anything by mouth for more than 24 hours
