ulcerative colitis and crohns disease Flashcards
what is IBD?
autoimmune disease (most common ages 15-39)
recurrent inflammation of the intestinal tract
(Periods of remission and exacerbation)
causes of IBD?
unknown.. due to faulty immune system in overdrive
may be triggered by environment, lifestyle (dairy products, nsaid, stress, illness), western diet, and genetics
pathophysiology of UC?
- limited to large colon (starts at rectum and goes up)
- only affects inner lining (mucosa and submucosa)
- continuous pattern
- inflammation (fever) kills cells of the lining which forms ulcers (anemia, pus/mucous/blood in stool, rectal bleeding )
- colon doesnt do its job (reduced absorptive surface)=> dehydration, f/e imbalance, decreased appetite, wt loss, protein loss
UC s and s? (ULCERS)
- uregent BM
- Low RBC, Loss of wt
- Cramp in abdo
- Electrolyte imbalnace, Elevated temo
- Rectal bleeding
-Severe diarrhea w blood pus mucous
complications of UC?
- pseudopolyps, granulation tissue and scar tissue -> narrowing of bowel
- intestine loses its pouch form
- large intestine ruptures, contents leak into abdomen = peritonitis
- toxic megacolon: overly inflammed, colon becomes paralyzed and ruptures
- higher chance of colon cancer
dx test for IBD?
- History and physical examination
- Colonoscopy
- Sigmoidoscopy
- Capsule endoscopy
*Esophagastroduodenoscopy - Barium enema
- CBC, ESR, electrolytes, BUN,* creatinine, albumin
- Culture and sensitivity testing of stool (including Clostridium difficile)
- Stool for occult blood
tx for UC?
- IV fluids with electrolytes
- Blood transfusions
- NPO status
- Nutritional support (parenteral therapy)
- 5-Aminosalicylates
- Antidiarrheal agents
- Antimicrobial therapy
- Immuno-suppressants
- Immuno-modulators
- Corticosteroids
- Surgery if no improvement
when is sx reccomended for UC?
(1) the patient fails to respond to treatment
(2) exacerbations are frequent and debilitating
(3) massive bleeding, perforation, strictures, or obstruction occurs
(4) there are tissue changes that suggest that dysplasia is occurring
(5) carcinoma develops.
what are the types of surgery in UC?
(1) total proctocolectomy with permanent ileostomy
(2) total proctocolectomy with ileoanal reservoir
(3) total Protocolectomy with Continent Ileostomy (Kock pouch)
nursing intervention UC?
- monitor VS
- focus GI assessment
- bowel movement and sounds
- peritonitis +toxic megacolon
(fever, increased HR & RR, hypoactive BS) - NPO w Iv hydration: as s and s go down: Clear fluids and then progress to full, solid
- stoma care post op
- regular colon cancer screening
contraindications w rectal sx?
No rectal temperatures
No enemas
Avoid constipation, straining
Teach client re: avoid the Valsalva maneuver
(2) total proctocolectomy with ileoanal reservoir
- total proctocolectomy
- creating the pouch
- connecting new pouch to anus
pathophysiology of crohns?
- Can affect any part of the GI tract from the mouth to the anus = “GUM TO BUM”
- Transmural – meaning affects all layers of the mucosal wall
- Skip Lesions – meaning areas of normal bowel between areas of affected bowel.
- Cobblestone appearance will occur as deep longitudinal ulcerations penetrate between the edematous mucosa.
- Fistulas – develop between bowel and other sites
complication of crohn’s?
Abscessing Fistula May Form Sepsis
- Abscess: pockets of infection form within intestinal wall
- Fistula: ulcer/abscess creating pockets/channels/passages between intestine to intestine/organ/skin surface
- malnutrition: small intestine not working so absorption. more severe in crohns
- fissures: tears, mainly anal
- stricture: narrowing of wall -> obstruction
s and s of crohns?
- colicky abdo pain (RLQ)
- diarrhea
- fatigue
- weight loss,
- fever
- dehydration
- electrolyte imbalances, anemia,
- increased peristalsis
