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
