Unit 3: Inflammatory Bowel Disease (IBD) Flashcards
Inflammatory Bowel Disease (IBD)
umbrella term for Crohn’s Disease and Ulcerative Colitis
- chronic in nature
- cannot be cured w/ medications; but there are medications that help control the disease and treat or prevent exacerbations
Pathophysiology of Inflammatory Bowel Disease (IBD)
-exact cause of IBD unknown
-linked to genetics, environmental conditions, and defects in immune regulation
>genetic predisposition may manifests as an overactive immune response to bacteria located in the GI tract
>may be then triggered by an environmental response such as infection, medication, or smoking
>the immune system usually attacks foreign invaders, but in IBD, the immune response has an inappropriate response in the GI tract causing inflammation; affects the ability to absorb nutrients resulting in diarrhea and weight loss
Clinical Manifestations of IBD
- mild to severe
- periods of remission and exacerbations
Similarities between Crohn’s Disease and Ulcerative Colitis
- persistent diarrhea
- abdominal pain or cramps
- fever
- weight loss
- fluid imbalances
- malnutrition
- mouth ulcers
- anemia
- blood from rectum
- joint, skin, or eye irritations
- delayed growth
Extraintestinal Manifestations in IBD
- uveitis (intraocular inflammatory disorder)
- sclerosing cholangitis (inflammation of hepatic ducts)
- nephrolithiasis (renal stones)
- cholelithiasis (gallstones)
- joint disorders
- skin disorders
- oral ulcerations
Crohn’s Disease
can affect any portion of the GI tract from mouth to anus
- transmural, affecting all layers of the bowel
- not uniform in appearance
- noted for having skip lesions w/ normal-appearing bowel between lesions
- lesions cause deep ulcerations between layers of edematous tissue, creating cobblestone appearance
- w/ exacerbation, the intestines become more scarred = less ability to absorb nutrients; nutritional deficits
- complications: fistulas, abscesses, and peritonitis
- diarrhea
- stool typically soft or semiliquid; do not usually contain blood unless there has been a perforation
- abdominal pain in RLQ
Fistula
abnormal tracts between two or more body areas
Ulcerative Colitis
affects the large intestine and involves only the mucosa and submucosa
- dpreads uniformly beginning at the rectum and spreading upward toward the cecum
- diarrhea; often w/ more than 20 stools; losses of several liters of fluid per day
- blood, mucus, and pus in stool
- abdominal pain and tenderness in LLQ
- tenesmus (spasms of anal sphincter and persistent desire to empty bowel)
- crypt abscess
- abscesses may form in ulcerated areas
- scar tissue; interfering w/ absorption of nutrients
Tenesmus
spasms of the anal sphincter and persistent desire to empty the bowel
-seen in ulcerative colitis
Crypt Abscess
- seen in ulcerative colitis
- releases secretions that result in purulent discharge from the bowel mucosa
Primary Goal of IBD
- rest the bowel
- control the inflammation
Goals of IBD
- rest the bowel
- control the inflammation
- combat infection
- correct malnutrition
- alleviate stress
- provide symptomatic relief
- improve quality of life
Treatments for IBD
- medications
- surgery
- correction of nutritional deficits
- involve psychosocial needs
- IBD cannot be cured w/ medications, but there are medications that can help with controlling the disease and treat or prevent exacerbations
Diagnostics for IBD
-Colonoscopy
-Sigmoidoscopy
-Barium Enemas
>Others: Complete blood count (CBC), serum electrolytes, serum albumin, and stool samples for pathogens
Colonoscopy
- may assist in differentiating Crohn’s disease and ulcerative colitis
- In Crohn’s Disease: detects early mucosal changes including inflammation, stricture, and fistulae
- In Ulcerative colitis: swollen, friable bowel mucosa w/ multiple ulcerations
Barium Enema
provide data regarding the depth of the disease involvement
Medical Management For IBD: Fluid and Electrolyte management
fluid and electrolyte management is crucial for the patient with ulcerative colitis
- when bowel is inflamed, and the patient is exhibiting severe diarrhea, absorption of fluids and nutrients is compromised
- patient encouraged to rest frequently to decrease bowel motility
IBD: Malnutrition
malnutriton is common w/ IBD
- leads to poor wound healing, decreased muscle mass, and dcreased immune system
- may need to be hospitalized for bowel rest and receive total parenteral nutrition (TPN)
- In Crohn’s disease: monthly vitamin B12 injections may be necessary b/c of the inability of the ileum to absorb this nutrient
- liquid vitamin preparations b/c tablets or capsules may be excreted intact b/c of frequency of diarrhea
- albumin levels to determine nutritional status
- foods to avoid: milk, gluten, caffeine, coca, chocolate, citrus juices, cold or carbonated drinks, nuts, seeds, popcorn, and alcohol
Foods to avoid w/ Inflammatory Bowel Disease
- milk
- gluten
- caffeine
- cocoa
- chocolate
- citrus juices
- cold or carbonated drinks
- nuts
- seeds
- popcorn
- alcohol
Complementary and Alternative Medicines (CAM)
- marijuana, turmeric and curcumin, fish oil, probiotics, aloe vera, Androphigus paniculata, Boswellia, Tripterygium wilfordii Hook F, wheat grass, and wormwood
- acupuncture and moxibustion, mind-body therapies, and exercise
Why is Psychosocial Management included?
exacerbations may occur during times of emotional or physical stress
-inability to control manifestations can disrupt lives
-fear of being away from home b/c of frequency of diarrhea
-eating is associated w/ onset of abdominal pain; causing mealtimes to be unpleasant
-depression and anxiety are common in IBD
-patients may be concerned w/ how others view them; impacts self-esteem
-may be a perceived, or actual, loss of independence, sense of control, privacy, body image, healthy self, peer relationships, self-confidence, productivity, and ways pf expressing sexuality; causes depression
-embarrassment of public bathrooms
-shame with the individuals with ostomies
>thorough assessment of support systems, stress-producing factors, and coping mechanisms
Surgical Management for Crohn’s Disease
reserved for patients for whom medical management has failed, an/or who experience complications from the disease
- when a diseased portion of the bowel is removed, it frequently recurs in another section of the bowel
- surgery does not cure Crohn’s disease
Surgical Management for Ulcerative Colitis
for whom medical management has failed or who have experienced complications may undergo colectomy and be cured of the disease
- standard procedure: Ileal pouch anal anastomosis (IPAA)
- may undergo proctocolectomy w/ permanent ileostomy
Ileal pouch anal anastomosis (IPAA)
- surgical procedure (ulcerative colitis)
- entire colon and rectum are removed, a pouch is created to collect waste, and the patient is able to defecate normally
