Inflammatory Bowel Disease

Inflammatory Bowel Disease

1. Ongoing Inflammation of all or part of the digestive tract. Autoimmune disease: antigen initiates the inflammation leading to an overactive and sustained inflammatory response

2. Crohn's Disease

   • Affects people 15-40 years of age. Can affect mouth to anus. Affects all layers of the intestine (small and large). Affects all layers of the intestinal wall. Can lead to bowel obstruction, fistulas between organs can occur
   • Symptoms: diarrhea, bloody stools, weight loss, abdominal pain, fever, fatigue, skip lesions, cobblestone appearance, fistulas, strictures, pain, malnutrition.
   • Complications: Bowel obstruction, perforations, ulcers, fistulas, malnutrition, cancer of the small intestine, bleeding, systemic

3. Ulcerative Colitis

   • Complications: Hemorrhage, strictures, perforation, toxic megacolon, colorectal cancer, systemic. Fistulas are rare, occasional strictures, perforations are common, colon cancer, toxic megacolon
   • Inflammation affects the mucosal layer of the intestinal wall. Starts from the rectum and affects the large intestine and moves toward teh cecum.
   • Symptoms: Bloody diarrhea and abdominal pain are primary manifestations.

4. Complications: fistulas, strictures, anal abscess, perforation, electrolyte imbalances, vitamin D deficiency, anemia, dehydration, thromboembolism, gallstones, arthritis, osteoporosis, pyoderma gangrenosum, erythema nodosum, uveitis (red eye) episcleritis. (blood in eye)

5. Diagnostic studies: CBC, iron studies, CMP, ESR, stool cultures, C. Diff, stool tests, CRP, Capsule endoscopy, CT, MRI, small bowel

6. Medications: Aminosalicylates (sulfasalazine), Antibiotics (metrononidazole), steroids (prednisone), immunosuppressants (methotrexate), biologic (infliximab), probiotics (lactobacillus)

   • TAPER PREDNISONE: prednisone can cause adrenal suppression, steroids need to be tapered unless low dose

7. Surgical Interventions: draining of the abcess, repair of the perforation, total proctocolectomy with heal pouch/anal anastamosis, or permanent ileostomy

   • Ileostomy/Colostomy: placement is important,
     • Complications: stoma, or abdominal wall related, parastomal hernia, stoma prolapse, stoma stenosis, stoma retraction

8. Nursing Interventions

   • Correct nutritional deficits: NPO, NG to low intermittent suction, TPN, IV iron and vitamins
   • Diet changes: avoid trigger foods, high fat foods trigger diarrhea, eat high calorie, high protein, take vitamin and mineral supplements (vitamin B12, folic acid, calcium, iron), limit food with insoluble fiber, eat smaller, more frequent meals )