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51 terms

Ulcerative colitis/ Crohn's disease

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Define Ulcerative Colitis
IBD characterized by diffuse inflammation of the intestinal mucosa. The result is a loss of surface epithelium with ulceration and possibly abscess formation
Define Crohn's disease
IBD which is also known as regional enteritis. Fistulas can develop, diarrhea is severe and like ulcerative solutes, Crohn's is characterized by remissions and exacerbations.
IBD
Inflammatory bowel disorder
What is an ulcer?
A circumscribed inflammatory and often suppurating lesion on the skin or an internal mucous surface resulting in necrosis of tissue
necrosis
the death of most or all of the cells in an organ or tissue due to a disease, injury, or failure of the blood supply
What ethnicity is U.C. more common in?
Jewish origin*, also people of northern european origin, and is becoming more commonly seen in causcasions.
What ethnicity is Crohn's more common among?
Jews and people of the iddle/northern european origin
Etiology of Ulcerative Colitis
Unknown, immune disfunction, allergy to proteins, infectious process, hereditary link
Etiology of Crohn's disease
Unknown, immune disfunction, allergy to cows milk, infectious process, hereditary link
Peak incidence for U.C.
15-25yrs and also 55-65yrs of age
Peak incidence for Crohn's
The young. 4-15yrs of age for diagnosis
Location for Ulcerative colitis
colon and rectum, common in the left and lower colon (sigmoid colon) but it can affect the entire colon.
Location that Crohn's disease affects
Mostly involves the rt. colon, small intestines (ileum). Patchy layers throughout the bowel.
Symptoms of Ulcerative Colitis
Stools can contain mucous and puss, weight loss, fever, tenesmus, ESR elevation, rectal bleeding, bloody diarrhea.
ESR
erythrocyte sedimentation rate. the rate at which red blood cells settle out in a tube of blood under standardized conditions. It is a test that indirectly measures how much inflammation is in the body.
Define Tenesmus
A continual or recurrent inclination to defecate
Symptoms of Crohn's Disease
Stools contain mucus and pus, weight loss, fever, ESR elevation, steatorrhea, granuloma, ulcers, diarrhea, abdominal pain/cramping.
Pathophysiology of Ulcerative colitis
colon becomes pipeline, a lot of scar tissue
Pathophysiology of crohn's
deep ulcers that form and can go deep into the muscle wall, cobblestone appearance of the bowel, scar tissue formation, fistula formation
Fistulas
an abnormal connection between an organ, vessel, or intestine and another structure. Very dangerous, hard to treat, asepsis!
Diagnosis for IBD's
colonoscopy (can be dangerous because you do not want to perforate the bowel causing its content to flow into the abdomen), capsuleny (swallow camera), CT scan
Complications for IBD's
Intractability (can't control/manage symptoms), Hemorrhage/perforation, abscess (pocket of infection from aspirated lining), toxic megacolon, malabsorption, obstruction, colorectal cancer, fistulas
Define toxic megacolon
paralysis of the colon caused by dilalation of colon and ileus not working.
Fistulas
more common in crown's, nutrition is very important, very dangerous!
Nutrition therapy
low fiber diet, milk products may need to be eliminated, during acute phase, TPN may be needed allowing bowels to rest, with less severe symptoms elemental formuls such as vivonex or ensure may be ordered
What is the most common drug therapy used?
Aminosalicylates (anti-inflammatory)
Sulfasalazine (Azulfidine)
acts by inhibiting prostaglandin synthesis (group of cyclic fatty acids w/hormonelike effects, notably the promotion of uterine contractions) to reduce inflammation (has been around for awhile).
Mesalamine (asacol, pentasa, salofalk, lialda)
used in active to mild UC and sometimes crown's. Lialda is a new form of melamine which only needs to be taken once a day.
Balsalazide (Colazal)
anti inflammatory that is taken daily
Corticosteroids
i.e. prednisone used to treat the inflammation. No effect on cure. Tapered and dc when acute s/s subside.
Budesonide (entocort)
new for crowns, supposed to cause less side effects
Immunosupressant drugs
i.e. imuran, 6 M-P, cyclosporine, methotraxate (rheumatrex)- given with corticosteroids may cause a better response and decrease the amount of steroids needed.
Anti-diarrheal meds
to control diarrhea ie. lomotil, imodium. Given cautiously because they can precipitate colonic dilation and toxic megacolon
Immunoglobulin G (IgG) monoclonal antibody
Infliximab (remicade), humira (adalimumab), and Cimzia (certolizumab pegol). *Used when nothing else is working!!
Infliximab (remicade)
Used more common in Cryhn's- blocks the bodes inflammation response. Used for refractory disease (disease that does not respond to other therapy). Works to decrease inflammation
Huminra (adalimumab) and cimzia (certolizumab pegol)
block tumor necrosis factor, prevention inflammation
Who marks the incision site before surgery?
ET therapist
When is surgery necessary for UC?
for unremitting disease and for complications i.e. perforation or hemorrhage.
What is the most common surgery for U.C.?
Colectomy w/ ileostomy
Two alternative surgeries
continent ileostomy (kock pouch and ileoanal anastomosis w/ a j pouch)
J Pouch
eliminates the need for an ileostomy
Continent ileostomy
an ileostomy that drains into a surgically created pouch or reservoir in the abdomen. Involuntary discharge of intestinal contents is prevented by a nipple valve created from the ileum. This method eliminates the need for the patient to wear an external ouch over the stoma (kock pouch)
Kock pouch
continent pouch gormed byt eh terminal ileum after colectomy. The pouch has a volume of 500mL-1000mL so that feces can be stored temporarily and the patient need to not carry a stoma bag.
How is the spot for the surgery incision determined?
based on how the pt. sits, the skin folds, belt line, etc.
Surgery for crohn's...
performed only in selected cases because of high rate of recurrence. surgery is indicated for obstructions, fistulas, abscess.
Most common sugary for Crohn's
total proctocolectomy (excision of rectum and colon) w/ ileostomy
Assessment
pt. history, s/s, how many stools a day, what they look like, weight, nutritional intake, any abdominal pain, what stress has this disease caused?
Nursing diagnoses
Pain r/t inflammations of the intestinal wall AMB
Diarrhea r/t impaired absorption secondary to mucosal inflammation AMB
Risk for impaired skin integrity r/t diarrhea
Risk for impaired nutrition : less than body requirements r/t limited intake of nutrients AMB
Nutritional Notes
Eliminate foods that could cause diarrhea, nutritional supplements, increase proteins, TPN (very hypertonic!!) Electrolytes, blood sugars, and weight should be measured and recorded. Avoid smoking, caffeine, and alcohol because they are all GI stimulants. Low residue diet.
What are some good recourses for the pt?
Dietrician, ET, social worker, support groups.
Teaching topics
How to clean and change bag, what it should and shouldn't look like, NEVER irrigate, odor control