Inflammatory Bowel Disease

Inflammatory Bowel Disease

1. Crohn's Disease

   • Etiology and Pathophysiology (Lewis, 2014)
     • Complications (CCFA, 2011)
       • fistula
         • ulcers that cause tunnels (fistula) to another part of the intestine, skin or ogan
       • stricture
         • narrowing of the intestine caused by scarring
           • can lead to intestinal blockage
       • abscess
         • collection of pus
           • can develop in the abdomen, pelvis, or anal are
       • perforated bowel
         • hole along intestinal wall
           • due to chronic inflammation that weakens the wall
       • malnutrition
         • due to malabsorption
           • includes mineral and vitamin deficiencies
     • Causes
     • inflammation of segments of the GI tract
       • commonly seen in the terminal ileum and the colon
     • skip lesions; patchy inflammation
       • normal bowel in between diseased portions
     • cobblestone appearance
       • due to deep ulcerations that penetrate through inflamed mucosa
     • inflammation extend through all layers of bowel wall
   • Nursing Process
   • Diagnosis
     • History and Physical
       • Patient History; age, sex, and race.
       • Lifestyle; smoking, diet, NSAID use. All are aggravating factors.
       • Medical History; appendectomy
       • Abdominal exam; Inspection, Palpation, Auscultation
   • Collaborative care
     • Medication
     • Surgery
     • Nutritional Therapy

2. Ulcerative Colitis

   • Nursing process
   • Etiology and Pathophysiology
     • Inflammation of mucosa and submucosa
       • Exacerbation and remission
       • spreads continuously beginning from rectum to colon
     • Abscesses develop and break through the submucosa causing ulcerations
       • destroy mucosal epithelium
         • fluid and electrolyte loss
         • bleeding and diarrhea
         • can cause pseudopolyps
         • Thickening
           • shortening of colon
     • Causes
       • inflammatory response
         • tumour necrosis factor a
       • intestinal microbiota (cite article)
     • Complications
   • Collaborative care
     • Medication
       • Vitamins
         • correct anemia and promote healing
           • Vit. D, calcium, iron, magnesium
       • 5-Aminosalicylates
         • Decrease GI inflammation
           • e.g. Sulphasalazine (Salazopyrin)
       • Antimicrobial
         • prevention or treatment of secondary infection
           • e.g. Metronidazole
             • medication taken as directed
       • Corticosteroids
         • decrease inflammation
           • e.g. cortisone, prednisone, budesonide
             • SE: insomnia, headache, nausea, weight gain and increased blood glucose
       • Immunosuppresants
         • suppress immune response
           • e.g. azathioprine (Imuran), cyclosporine (Neoral)
     • Surgery
       • Can effectively eliminate UC because colon and rectum can be removed (Bartle et al., 2013, as cited in Bettany & Gardiner, 2013)
         • Last option
         • Permanent ileostomy or stoma
           • challenge for the individual
       • Indications
         • Fails to respond to treatment
         • Frequent and debilitating exacerbations
         • massive bleeding, perforations, strictures or obstruction
         • dysplasia is occurring
         • development of carcinoma
       • Types
         • Total proctocolectomy with permanent ileostomy
           • removal of colon, rectum, and anus, with closure of the anus
           • Formation of ostomy or stoma
         • proctocolectomy with ileoanal reservoir
           • Patient requirements
             • absence of colorectal cancer
             • small intestine free of disease
             • competent anorectal sphincter
             • physical status can handle lengthy surgery
             • motivated and can understand self-care instructions
     • Nutritional Therapy
       • goal: to provide adequate nutrition without exacerbating symptoms
       • Acute phase: NPO
       • High-calorie, high-protein, low-residue diet
         • avoid cold and high fiber foods
           • No whole grain bread or cereals
           • No processed or fried meats
           • No nuts, beans, legumes, seeds
           • No raw vegetables or fruits, fruit skins, pulp
           • No rich deserts
       • No smoking and avoid alcohol
         • Smoking increases GI motility
   • Diagnosis
     • History and physical
       • Family history
       • Lifestyle
     • Blood Studies
       • CBC, electrolytes, BUN, creatinine, albumin
       • Not diagnostic of UC
       • Detect inflammation
       • Determine nutritive and hydrative state
     • barium Enema
       • Distinguish between UC and Crohn's
       • Show areas with inflammation or ulcerations
       • Useful in detecting mucosal abnormalities
     • Sigmoidoscopy
       • Used to examine rectum, sigmoid colon, distal descending colon
       • Obtain biopsies
       • Monitor disease
     • Colonoscopy
       • Gold standard
       • Caution for those with severe UC; risk of perforation
       • Visualization of bowel wall and terminal ileum (Laufer, 2006, as cited in Bettany & Gardiner, 2013)
         • Lesions
         • Inflammation
         • Ulcerations
       • Consider risk posed to older adults (Smith, 2013, as cited in Bettany & Gardiner, 2013)
         • Sedation
         • Bowel preparation
         • Bleeding
     • Culture and sensitivity
       • Stool examined for blood, pus, and mucus
       • To rule out infectious causes of inflammation

3. 10,000 new cases in Canada annually (Lewis, 2014)

4. an autoimmune disease that refers to two disorders of the GI tract

   • Crohn's Disease
     • a chronic IBD of unknown origin that can affect any GI parts; from the mouth to the anus (Lewis, 2014)
   • Ulcerative Colitis
     • a chronic IBD characterized by inflammation and ulceration of the rectum and the colon (Lewis, 2014)

5. occur during teenage years and early adulthood but second peaks in the fifties or seventies

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