UNIT 8 IBD Crohns Disease and Ulcerative Disease CHAPTER 52

Question 1

Which of the following Disease Processes Fall under Inflammatory Bowel Disease? SELECT ALL THAT APPLY

A. Crohns Disease
B. Irritable Bowel Syndrome
C.Ulcerative Colitis
D. GERD
E. Gastritis

Answer 1

A. Crohns Disease
C.Ulcerative Colitis

Question 2

Does a pt with Ulcerative Colitis have 5-6 loose stools non bloody

A. Yes
B. No

Answer 2

B. No

10-20 liquid, bloody stools per day

Question 3

What is Ulcerative Colitis?

Answer 3

Ulcerative colitis (UC) is a disease that creates widespread chronic inflammation of the rectum and rectosigmoid colon but can extend to the entire colon when the disease is extensive.

location : Begins in the rectum and proceeds in a continuous manner toward the cecum

Surgical procedure rate: 20%-40%

UC is a disease that is associated with periodic remissions and exacerbations (flare-ups) and is often confused with Crohn’s disease.

Question 4

S/S of Ulcerative Colitis

Answer 4

Remissions and exacerbations
* 10-20 bloody, liquid stools/day with mucus
* Urge comes on quickly
* Nutritional deficiencies
* Hemorrhage
* LLQ Abd pain
* Weight loss
* Tenesmus: Rectal fullness, unable to pass stools, straining during BM’s
* 1/3 require surgery: Curative in UC, not in Crohn’s

Dx- barium enema, Barium enema: May help differentiate CD vs UC; C olonoscopy Sigmoidoscopy/Bx: Mucosal
Inflammation
Tx- meds such as antidiarrheal, corticosteroids (anti-inflammatory), nutrition, surgery

Question 5

What is Cronhs disease?

Answer 5

Inflammatory disease of small intestine
(mainly) although it can be anywhere in
GI tract

Inflammation causes thickening-
leads to fistulas and/or bowel
obstruction

Crohn’s disease (CD) is a chronic inflammatory disease of the small intestine (most often), the colon, or both. It can affect the GI tract from the mouth to the anus but most commonly affects the terminal ileum. CD is a slowly progressive and unpredictable disease with involvement of multiple regions of the intestine with normal sections in between (called skip lesions on x-rays). Like ulcerative colitis (UC), this disease is recurrent, with remissions and exacerbations.

Question 6

What percentage of patients with Crohn’s disease require surgery?
.
A. 70
B. 80
C. 100
D. 20

Answer 6

A. 70

Question 7

Signs and symptoms of Crohn’s disease?

Answer 7

S/S- diarrhea, abd pain, fever, anorexia, visible
peristalsis, anemia – with fistula, signs of poor
nutrition such as brittle nails and hair
(malabsorption)
- FATT STOOLS 5-6 FATTY STOOLS (Steatorhea)

• Crohn’s ileitis, Aphthous ulcers, weight loss

Tx- meds – adalimumab (Humira), diet high in
calories, protein, vitamin and low in fiber

• 70% require surgery

Question 8

Does malabsorption occur in an apt with Crohn’s disease?
A. Yes
B. No

Answer 8

A. Yes

Question 9

What is a key sign of malnutrition?

A. albumin level of 2.0
B. Potassium level of 4.9
C. Sodium level of 157
D. white blood cell count of 15,000

Answer 9

A. albumin level of 2.0

Question 10

What is the therapeutic effect of this crowns disease medication and the patient teaching tied to it

Adalimumab

Answer 10

A group of biologic response modifiers (BRMs), also known as monoclonal antibody drugs, have been approved for use in CD when other drugs have been ineffective. These drugs inhibit tumor necrosis factor (TNF)–alpha, which decreases the inflammatory response. Examples of commonly used drugs for patients with CD include infliximab, adalimumab, natalizumab, and certolizumab pegol.

These agents are not given to patients with a history of cancer, heart disease, or multiple sclerosis (Winter & Burakoff, 2017).

Question 11

What is the earliest lesion in Crohn’s disease?

Answer 11

The earliest lesion in Crohn’s disease is the aphthous ulcer, which overlies Peyer’s patches in the small bowel, and lymphoid follicles in the large bowel. These lymphoid aggregates are the site of luminal antigen sampling by innate immune cells.

Question 12

What does an elevated C reactive protein or ESR indicate with a pt with Crohn’s?

Answer 12

C- reactive protein and ESR may be elevated to indicate inflammation.

NORMAL RANGE
Erythrocyte Sedimentation Rate- Male: 15 mm/hr Female: up to 20 mm/hr

C-reactive protein -6 mg/mL

Question 13

Multi drug therapy for Crohns

Answer 13

Dx: Abdominal CT, EGD/Colonoscopy, Labs, C-diff toxin
* Treat: dehydration (IVF)
* Pregnancy test in women of childbearing age
* Be vigilant for acute complications: Perforation, obstruction
* IV corticosteroids
* Diet as tolerated, unless a candidate for surgery
* After 2-3 days on IV steroids will transition to po
* Surgery: Surgical resection of affected area

Question 14

What is the normal range for Albumin?

Answer 14

Both Sexes: 3.5-5 g/dL