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GI > Lower GI (Inflammatory Bowel Disease - UC/Crohn's) > Flashcards

Lower GI (Inflammatory Bowel Disease - UC/Crohn's) Flashcards

1
Q

What are the Inflammatory Bowel Diseases (IBD)

A

Ulcerative Colitis

Crohn’s Disease

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2
Q

What do Crohn’s Disease and Ulcerative Colitis have in common?

A
  • 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
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3
Q

What characteristics are unique to Crohn’s Disease?

A
  • Occurs anywhere from Mouth to Anus (Most commonly, Terminal ileum and colon)
  • SKIP LESIONS (Ulcerations are deep, COBBLESTONE appearance)
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4
Q

What characteristics are unique to Ulcerative Colitis?

A
  • Starts at rectum and spreads UP colon

- Continuous pattern

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5
Q

IBD Goals of treatment

A
  • 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
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6
Q

Why is Nutrition compromised in IBD?

A
  • Decreased food intake
  • Increased energy consumption at rest
  • Steroid use
  • Malabsorption
  • Exudative enteropathy
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7
Q

Nutritional therapy: IBD

A

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

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8
Q

When the gut works….

A

USE IT!

Unless active flare :)

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9
Q

What are the advantages of TPN?

A
  • Allows for positive nitrogen balance while resting the bowel
  • Vitamins, Minerals, E-lytes, glucose, amino acids, etc can be added
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10
Q

What do we need to give TPN?

A

Central Line

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11
Q

TPN is…

A

Nutritionally complete

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12
Q

Non-use of gut causes?

A

Intestinal mucosal atrophy

- leads to Bacteremia and infections

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13
Q

TPN contains?

A 
Dextrose - 15-25% (Monitor glucose q6)
Amino Acids
Electrolytes
Vitamins
Minerals
Trace elements
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14
Q

How to start and stop TPN

A

Start Slowly and end Slowly (Pancreatic beta cells need time to adapt to increasing/ decreasing insulin output)

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15
Q

What is PPN?

A

Partial Parenteral Nutrition

  • Rarely used due to ease of obtaining central access
  • Large volume necessary for PPN
  • Lack of benefit from short term PN
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16
Q

IBD drug therapy

A

Sulfasalazine (Azulfidine) - 5 Aminosalicylates
- a GI anti inflammatory agent

Also
- Corticosteroids, Immunosuppressants, Biologic and targeted therapy (Immunomodulators)

17
Q

Drug therapy UC

A

80% of time drug therapy induces remission

20% Require surgery

18
Q

Drug therapy: Crohn’s

A

Most need surgery at some point

19
Q

No response to drug therapy?

A

Hospitalization indicated

20
Q

Aminosalicylates

A

Decrease inflammation

21
Q

Antimicrobials

A

Prevent/treat secondary infection

22
Q

Corticosteroids

A

Decrease inflammation

23
Q

Immunosuppressants

A

Suppress immune system

24
Q

Biologic and targeted therapy

A

Inhibit cytokine tumor necrosis factor (TNF)

Prevent migration of leukocytes from blood to inflamed tissue

25
Q

Complications of IBD

A

Hemorrhage
Strictures
Perforation

Sometimes surgery is indicated

26
Q

UC surgery

A

Total proctocolectomy is curative

27
Q

Most common surgery for UC

A

Total proctocolectomy and ileal anal reservoir (IPAA)

28
Q

IPAA

A

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)

29
Q

Can a UC patient have a permanent ileostomy?

A

Yes, Total proctocolectomy with permanent ileostomy can be performed

30
Q

Is there a continent ileostomy used in UC?

A

Yes, Total proctocolectomy with continent ileostomy

  • Kock pouch used
  • No bag
  • Must self Catheterize
31
Q

T/F: Crohn’s can be cured by surgery

A

False! Crohn’s disease is not cured by surgery

32
Q

Crohn’s disease surgery

A

Usually related to complications

  • Fistulas
  • Strictures
  • Obstructions
  • Bleeding

Recurrence after surgery is very high

Intestinal resection with anastomosis of healthy bowel

33
Q

IBD: Patient teaching

A 
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
34
Q

Pt Teaching: Post Colon surgery

A

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
35
Q

More post surgery teaching

A

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

GI (9 decks)

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