Week 5 - inflammatory bowel disease Flashcards
What part does ulcerative colitis affect?
rectum and colon
What part does crohn’s affect?
mouth to anus
What diagnostic tests are used for IBS?
- Hx &Physical
- Endoscopy
-Capsule endoscopy - Barium Studies - xray
- FOBT- measures amount of blood in stool
- Blood work:
-CBC
-ESR, C-reactive protein- inflammation
-Electrolytes
What are the main differences btwn Crohn’s & ulcerative colitis?
- blood
- crohn’s - non-bloody
-ulcerative - bloody diarrhea - Location
- crohn’s - mouth to anus (often illium)
- ulcerative - starts distally in rectum and moves up intestine - Curative or not
- crohn’s - flare ups post surgery- not curative- needs multiple surgeries
- ulcerative- curative post surgery
In ulcerative colitis, complications are related more to inflammation and dialatation. What are these complications and why?
- Hemorrhage d/t perforation - mucosal lining issues
- colonic dilatatian - colon too dilated
- Toxic megacolon - big dilation and paralysis leads to perforation
- Colerectal cancer higher risk if UC for >10 years
in Crohn’s disease complications usually occur d/t deep longitudinal ulcers. Crohn’s = cobblestone appearance. What are the complications and why?
- Strictures/obstructions - d/t deep ulcers
- intra-abdominal abscess d/t perforation
- Malabsorption
- *Fistulas btwn bowel & bladder =feces in urine + UTI
What is a cardinal feature in Crohn’s?
Fistulas btwn bowel & bladder = feces in urine
What are theExtra-intestinal Complications of Ulcerative Colitis and Crohn’s ? ie) not in the bowel
- DVT - thrombolytic events
- Eye issues
- Joint issues- arthritis
- Spine issues
- Skin issues
In the acute phase of UC and Crohn’s why do we monitor amount, type, colour, severity of diarrhea?
b/c it helps us know how /what kind of fluids to replace
What are 3 interventions we can do for someone’s nutrition and fluid & electrolyte balance?
-IV (D5W1/2NS with K+) – short term
-Total Parenteral Nutrition (TPN) – short term
-Enteral nutrition (elemental)
What is the main non-medical intervention we can do for people with acute flare up of IBS?
bowel rest- NPO
What are the 4 things we do when someone has acute flare up of IBS?
- monitor/adjust nutrtion & fluid and electrolytes
- Daily weights
- Perianal care - meticulous
- help relieve symptoms, anxiety & stress
What are the 6 things we monitor for in people with Acute flare up of IBS?
-Dehydration
-Fatigue
-Skin breakdown
-Ineffective coping strategies
-Intra/ extraintestinal complications
-Blood in stool
What is the MAIN drug used for UC?
***5-ASA - Sulphasalazine – long term (works best in large intestine to decrease inflammation)
What drugs/vitamins are used to help during maitenence phase of IBS?
-5-ASA - Sulphasalazine – long term
-Corticosteroid Drugs -prednisone
-Immunosuppressant’s –cyclosporine (Neoral)
-Immunomodulators- infliximab (Remicade)
-Vitamins- oral iron (ferrous gluconate), IV iron (iron dextran)
- Antidiarrheal- diphenoxylate (Lomotil)
What drug can be used for not only chronic care but mild-moderate flare ups in UC?
***5-ASA - Sulphasalazine
What drug is good for both crohn’s and UC and what is a downside to it?
Immunomodulators- infliximab (Remicade)
- hard on the body
What diet teachings do we give patients with IBS?
-Avoid triggers -Need a food diary
-Often avoid dairy –(but ok in moderation)
-Eat high Calorie, high protein low fat
-Nutritional supplements - like boost
-Low residue diet - NOT high fibre & veggies
What surgery is performed for UC?
Total Proctocolectomy (with Permanent ileostomy)
Total Proctocolectomy - Ileoanal Reservoir (Pelvic Pouch) –
Which UC surgery can be done in steps?
Total Proctocolectomy - Ileoanal Reservoir (Pelvic Pouch)
What do we pay particular attention to post proctolectomy and why?
Peri-anal wound care
must have meticulous care for good healing and kept very clean
What is important to teach people who have Ilioanal Resivoir so that they have good control?
Anal sphincter control
-via kegal exercises
Nutrition/Diet are important post UC surgery. What do we teach regarding this?
- low fibre diet
- good amount of protein
- lots of calories
