Ulcerative Colitis

Question 1

What is a chronic IBD that causes inflammation in the digestive tract and can involve the entire colon and isn’t patchy but a continuous inflammation t/o?

Answer 1

Ulcerative colitis

Question 2

Where is ulcerative colitis most commonly located?

Answer 2

Rectum and/or sigmoid colon

Question 3

What are the onset of ages for ulcerative colitis?

Answer 3

15-35 and again @ 50-70

Question 4

Ulcerative colitis can go into what for months or even years?

Answer 4

Remission

Question 5

S/S of ulcerative colitis?

Answer 5

Stools containing blood/mucus, LLQ pain/tenderness that can be relieved by defecation, fever and possible anorexia, fatigue or weakness

Question 6

How many stools a day can a pt. w/ ulcerative colitis have?

Answer 6

15+ liquid stools

Question 7

What are some common multi-system effects that can occur w/ IBD?

Answer 7

Sclerosing cholangitis, uveitis, skin/mucous membrane lesions, anemia, ankylosing spondylitis, or arthritis

Question 8

What is inflammation/scarring that can lead to narrowing of bile ducts and may need a liver transplant?

Answer 8

Sclerosing cholangitis

Question 9

What is an inflammation of the middle layer of the eye uvea?

Answer 9

Uveitis

Question 10

What is an inflammatory arthritis affecting the spine and large joints, also known as “poker spine”?

Answer 10

Ankylosing spondylitis

Question 11

Albumin/protein levels are usually what?

Answer 11

Decreased

Question 12

CBC, BMP, albumin/protein, ESR and liver function tests are all what?

Answer 12

Important lab studies

Question 13

A stool analysis should be taken from?

Answer 13

The blood, mucus and/or infection site

Question 14

Colonoscopy, sigmoidoscopy, barium enema or EGD are?

Answer 14

Diagnostic tests

Question 15

What are some complications?

Answer 15

Hemorrhage, toxic megacolon, perforation, peritonitis, colorectal cancer

Question 16

What complication can appear w/ fever, increase HR/RR, decrease BP, abd pain, very distended abd, hypoactive to eventually absent bowel sounds?

Answer 16

Toxic megacolon

Question 17

What is the paralysis of the colon that can result in increased perforation that can lead to peritonitis?

Answer 17

Toxic megacolon

Question 18

Toxic megacolon is more common in what IBD and when taking what?

Answer 18

Ulcerative colitis; anti-diarrheals

Question 19

When a pt. is showing cancer signs after having long-standing (>10yrs) s/s of UC, when chronic UC doesn’t respond to other therapies, or when there are life-threatening complications like hemorrhage, perforation, or toxic megacolon what is done?

Answer 19

Surgery

Question 20

What are the 3 most common surgeries?

Answer 20

Total proctocolectomy w/ permanent ileostomy (Brooke)
Total colectomy w/ continent ileostomy (Kock)
Restorative proctocolectomy w/ ileal pouch-anal anastomosis (RPC-IPAA)

Question 21

What procedure removes the entire colon, rectum and anus so pt is left w/ s.intestine?

Answer 21

Total proctocolectomy w/ ileostomy

Question 22

How do the stools look like in the total proctocolectomy w/ ileostomy procedure?

Answer 22

Initially loose liquidy, dark green containing some blood to a more paste yellow-green yellow-brown mushy type

Question 23

What is the procedure that takes out the entire L.intestine (colon) and creates a pouch w/ a cath out to drain?

Answer 23

Total colectomy w/ continent ileostomy (Kock)

Question 24

How much can the pouch of the Kock procedure initially hold? and how much will it stretch to?

Answer 24

50-75ml; 500-1000ml

Question 25

What procedure eliminates the need for permanent ileostomy?

Answer 25

RPC-IPAA

Question 26

What procedure removes the entire colon and most of rectum leaving anus and anal sphincter intact, an internal pouch is created from terminal ileum that is sutured directly to the anus and a temp loop ileostomy is created then closed after 1-3mon?

Answer 26

RPC-IPAA

Question 27

What is important to teach if a pt has had a RPC-IPAA procedure?

Answer 27

Meticulous peri-anal care bc of possible leakage @ night

Question 28

In postop when would a NGT be removed it if was placed for/after surgery?

Answer 28

When bowel pt has positive bowel sounds and flatus appears