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Inflammation spring 2013 narrated(1)
1. Inflammatory Bowel Disease
• General term used for:
– Ulcerative colitis
– Crohn’s disease
– Both are characterized by extraintestinal and
systemic features but are very distinctive
3. Ulcerative Colitis
• Area of chronic inflammation of mucosa and
• submucosa in the rectum and spread to the
• cecum that results in poor absorption of
nutrients
• Periods of exacerbations and remission
• Can range in severity from mild to severe
13. • May affect quality of life; patient may be fearful
to leave house
• Complications include: hemorrhage, abscess
formation, malabsorption, bowel obstruction,
bowel perforation, increased risk for colon
cancer.
• Diagnosed by colonoscopy; barium enema can
show differences between UC and Crohn's
14. Ulcerative Colitis
• Collaborative Management :
– Medical management:
• Rest is required to decrease intestinal activity
• Diet therapy
– Low-residue, high protein diet with vitamins and iron; in
severe cases, nothing by mouth to rest the bowel; TPN
will be ordered in severe cases
– Avoid gas-forming foods, milk products, and foods with
whole grains, nuts, alcohol, ETC
15. • Medications –
• Aminosalicylates – deliver 5-ASA to the affected
area– read these drugs!
– Glucocorticoid – prednisone = given during an
exacerbation to decrease the inflammation process of the
bowel –
– Immunomodulators
– Antidiarrheals – Dangerous! Toxic Megacolon
– New
– Fecal bacterial transplantation therapy
16.
17. Cont. Collaborative Care
• Surgery
– Total proctocoloctomy (removal of colon) with permanent
ileostomy – is curative
– Kock ileostomy
– Ileoanal anastomosis with ileoanal resevoir
– Review NUR 111 Elimination – for ostomy care!
– Post op care
• Encourage patient to talk about concerns related to
disease process and its effect on lifestyle
21. Coping with flares
• The above website will take you to a slide
show on how to cope with UC flare ups.
22. Crohn’s disease
• Chronic inflammation of GI mucosa occurring
anywhere from mouth to anus but most common
in terminal ileum
• Characterized by exacerbations and remissions
• Leads to thickening and scarring, a narrowed
lumen, malabsorption
• Lesions extend to all thickness of bowel wall and
are prone to fistulas, ulcerations and abscesses
• Lesions have a “cobblestone appearance” with
sections of normal mucosa between lesions called
“skip” lesions.
23.
24.
25. • Evidence is mounting that Crohn's disease
is not an autoimmune disease, but an
immune response to a bacteria - most
likely candidate being "mycobacterium
avium paratuberculosis
26. Crohn’s disease
• Manifestations: vary patient to patient – common:
– Diarrhea(5 to 6 liquid to semi formed stools/day) is
most common symptom(usually without blood);
steatorrhea (fatty stool) may occur
– Abdominal pain n RLQ and distention
– Low-grade fever
• Others:
– Weight loss
– Malnutrition More that with UC
– Fatigue, malaise
– Dehydration
– Complications
27.
28. Crohn’s disease
• Collaborative Management:
– Diagnostic – see Ulcerative Colitis (UC)
– Medical management: similar to UC
• Diet:
– Provide prescribed diet: usually high calorie, high protein;
– Encourage intake of prescribed nutritional supplements
– Daily weight, maintain calorie count, and monitor I and O
– During severe exacerbations: NPO and TPN
• Medications:
– Same as UC with the following:
» Budesonide (Entocort EC); metronidazole (Flagyl)
29. Crohn's disease Ulcerative colitis
Defecation
Often porridge-like[3],
sometimes steatorrhea
Often mucus-like
and with blood[3]
Tenesmus Less common[3] More common[3]
Fever Common[3] Indicates severe
disease[3]
Fistulae Common[4] Seldom
Weight loss Often More seldom
Symptoms in Crohn's disease vs. ulcerative colitis [ v · d · e ]
30. Crohn’s disease
• Surgical:
– Avoided if possible; not curative, mostly just
used to treat complications
– Performed if not improved medically
– Allow patient to express fears and anxiety
about course of illness and possibility of
surgical intervention
31. Nursing Diagnoses
• Diarrhea related to inflammation of the bowel
mucosa
• Acute pain
• Knowledge deficit
• Imbalanced nutrition: Less than body requirements
• Impaired skin integrity
• Risk for FVD
• PC: anemia
• Differential Features of UC and Crohn’s Disease
