Ulcerative colitis

Question 1

Definition

Answer 1

A type of inflammatory bowel disease that causes inflammation & ulcers in the inner lining of colon and rectum

Question 2

Etiology

Answer 2

Unknown but seems to be autoimmune triggering the body to inflame the colon in response to

• Environment source: diet (high fat), milk allergy, stress, illness, NSAID usage
• Genetic factors

Question 3

Pathophysiology

Answer 3

• A “flare up” occurs which causes inflammation in the large intestine
• Inflammation kills the cells of the lining
• Forms ulcers which bleed & release pus/mucus
• Colon can’t do its job by absorbing water & minerals
• GI contents entering from small intestine that is liquid going through colon will mix with blood pus, blood and mucus
• Inflammation causes the colon to want to empty frequently

Question 4

Clinical manifestations

Answer 4

“ULCERS”

Urgent BMs
Low RBCs (anemia), loss of weight
Cramps in abdomen (very pain) 
Electrolyte imbalance, elevated temperature 
Rectal bleeding 
Severe diarrhea w/ blood, pus and mucus

Question 5

Complications

Answer 5

• With have flare-ups and period of emotion which results in continuous inflammation in healing resulting in: pseudopolyps, scar tissue & narrowing
• With severe cases: haustra (loses pouch like form) and appear as smooth “lead-pipe sign”
• Rupture: repetitive ulceration results in small holes… leaks contents into abdominal cavity resulting in peritonitis -> septic shock
• Toxic Megacolon: overwhelming inflammation dilates colon and becomes paralyzed… ruptures

Question 6

Diagnosis

Answer 6

• Colonoscopy: examine colon w/ scope

* Barium enema: x-ray used to asses colon… enema of contrast given into rectum to line colon

Question 7

Treatment

Answer 7

Surgery (severe cases)
• Proctocolectomy where ostomy is placed
• Ileoanal anastemosis (J-pouch)

Medications
Diet

Question 8

Nursing interventions

Answer 8

Monitoring vital signs
- Bowel movement & sounds
- Focus GI assessment
Abdominal pain, bloating, fever, tachycardia, hyperactive or diminished bowel sounds = peritonitis + toxic megacolon

NPO w/ IV hydration per MD order

Diet education
- foods that can cause flare ups such as high–fiber food, hard to digest (nuts popcorn, raw + veg), dairy, spicy or high-fats

Regular colon cancer screenings

Question 9

Medications

Answer 9

Goal: control flare-ups and maintain remission

Anti-inflammatory

• 5-aminosalicylates: first line tx for mild to moderate e.g., sulfasalazine
• Corticosteroids: not used for long term e.g., prednisone

Immuno-suppressors used when other meds not working or pt needs to be off steroids

• Suppressors: “Imuran” suppresses immune response, can affect enzymes
• Modulators: “Humria” * TNF-blockers , increased risk for TB