Inflammatory bowel conditions

• 2 types of IBD:

  • Crohn's disease
  • ulcerative colitis
• Inflammatory bowel disease is a group of chronic disorders resulting in inflammation or ulceration of the bowel lining
• IBD is triggered by environmental agents (pesticides, food additives, tobacco, radiation), NSAIDs, allergies, immune disorders
• predisposing factors:

  • 15-30 y.o.: 50-70 y.o.
  • genetic
• Crohn's disease (regional enteritis)

  • chronic inflammation of the GIT wall that extends through all layers
  • prevalence: adolescents or young adults; smokers
• ulcerative colitis:

  • a recurrent ulcerative and inflammatory disease of the mucosal and submucosal layers of colon and rectum
  • prevalence: caucasians and jews
• Crohn's disease or Ulcerative colitis

  Part affected:

  ileum, ascending colon (transmural inflammation) - crohn's disease
• Crohn's disease or Ulcerative colitis

  Part affected:

  rectum, colon (mucosal and submucosal inflammation) - ulcerative colitis
• Crohn's disease or Ulcerative colitis

  characteristic of lesion:

  discontinuous - crohn's disease
• Crohn's disease or Ulcerative colitis

  characteristics of lesion

  continuous - ulcerative colitis
• Crohn's disease - Predominant symptoms:

  • crampy
  • RLQ abdominal pain
  • diarrhea
  • steatorrhea
• Crohn's disease - Predominant symptoms:

  • anorexia
  • weight loss
  • malnutrition
  • anemia
• ulcerative colitis - Predominant symptoms:

  • diarrhea
  • passage of mucus and pus
  • LLQ pain
  • intermittent tenesmus
• ulcerative colitis - Predominant symptoms:

  • rectal bleeding
  • anorexia
  • weight loss
  • anemia
  • fever
  • vomiting
• ulcerative colitis - complications:

  • anemia
  • abscesses
  • toxic megacolon
  • perforation
  • bleeding
• crohn's disease - complications:

  • intestinal obstruction
  • perianal dse
  • f&e imbalances
  • fistulas
  • fissures
  • abscesses
• ulcerative colitis - other characteristics:

  • accompanied by systemic manifestations
  • high mortality rate
• Assessment and Diagnostic findings - crohn's disease:

  • proctosigmoidoscopy (rectosigmoid area inflammation)
  • stool exam - (+) occult blood and steatorrhea
  • barium swallow: classic "string sign" on x-ray
• Assessment and Diagnostic findings - crohn's disease:

  • endoscopy, colonscopy, intestinal biopsies
  • barium enema: ulcerations, fissures, fistulas
  • Ct scan: bowel wall thickening and fistula formation
• Assessment and Diagnostic findings - crohn's disease:

  • decreased HCT and HGB
  • increased WBC and ESR
  • decreased albumin and protein levels
• Assessment and Diagnostic findings - ulcerative colitis:

  • systemic manifestations: tachycardia, hypotension, tachypnea, fever and pallor
  • Stool: (+) blood
  • cbc: low HCT and HGB, increased WBC
• Assessment and Diagnostic findings - ulcerative colitis:

  • low albumin
  • sigmoidoscopy, colonoscopy: inflamed mucosa with exudate and ulceration
• Assessment and Diagnostic findings - ulcerative colitis:

  • barium enema: shortening of bowel
  • ct scan, mri, ultrasound: abscesses and perirectal involvement
• management goals for IBD:

  • Reduce inflammation
  • suppress inappropriate immune responses
• management goals for IBD:

  • provide rest to the bowel
  • improve quality of life
  • prevent or minimize complications
• Management of IBD - nutritional therapy:

  • oral fluids
  • low residue, high-protein, high-calorie
  • vitamin supplementation
• Management of IBD - nutritional therapy:

  • iron replacement
  • avoid food/activities that exacerbate diarrhea
  • parenteral nutrition
• Management of IBD - pharmacologic therapy:

  • sedatives and antidiarrheal agents - peristalsis (rest the bowel)
• Management of IBD - pharmacologic therapy:

  • aminosalicylates / sulfasalazine : decrease inflammation
• Management of IBD - pharmacologic therapy:

  • prednisone / hydocortisone / budesonide (entocortec) : if severe and fulminant
• Management of IBD - pharmacologic therapy:

  • immunomodulators: natalizumab - crohn's
• Management of IBD - pharmacologic therapy:

  • immunomodulators: infliximab - ulcerative colitis
• surgical (crohn's disease)

  • laparoscope-guided strictureplasty - the blocked or narrowed sections of the intestines are widened, leaving the intestine tract
• surgical (crohn's disease)

  • small bowel resection
  • total colectomy with ileostomy
  • intestinal transplant
• surgical (ulcerative colitis)

  • total colectomy with ileostomy
  • proctocolectomy with ileostomy
  • restorative proctocolectomy with ileal pouch anal anastomosis (IPAA)
• nursing interventions - maintain normal elimination patterns:

  • Ready access to bathroom, commode, or bedpan
  • CFAC of stools
  • Bed rest
  • Administer anticholinergic agents 30 mins before a meal
• nursing interventions - relieve pain

  • pain assessment
  • interventions for pain
• nursing interventions - maintain fluid intake

  • accurate i&o
  • monitor daily weight
  • assess for s/s of FVD
• nursing interventions - maintain optimal nutrition

  • small frequent feeding
  • parenteral nutrition
  • glucose monitoring
• nursing interventions - promote rest

  • activity restrictions
  • active or passive ROM exercises