Inflammatory Bowel Disease

1
Inflammatory Bowel Disease

• NPN 200
• Medical Surgical I

2
Inflammatory Bowel Disease

• Inflammation and ulceration of the lining of the
  intestines
• 2 types
• Ulcerative colitis begins in the rectum and
  extends upward with remission and exaberations
• Crohns disease or regional enteritis can
  effect any area but usually the terminal ilium.
  May involve regional lymph nodes and fistulas to
  the bladder, vagina, and perianal area.
• Treatment for both is similar, except for
  surgical approach
• Cause is unknown / more young Jews

3
Ulcerative Colitis

• Patho
• Loose stools with blood and mucus
• Poor absorption of nutrients
• Thickening of colon wall and may form abscesss
• Can have minor problems or may be serious
• Acute episodes may involve bleeding and
  ulcerations
• Chronic stage may have fibrosis, muscle atrophy,
  and narrow and shortened colon

4
Ulcerative Colitis

• Complications of Ulcerative colitis
• Perforation and peritonitis with fistula
  formation
• Toxic megacolon
• Hemorrhage
• risk of colon cancer
• Malabsorption
• Bowel obstruction

5
Ulcerative Colitis

• Subjective symptoms
• Abd cramping and pain
• Nausea
• Loss of appetite
• Irritability
• Anxiety
• weakness

• Objective symptoms
• Bloody diarrhea, with pus and mucus (up to
  10-20/d)
• Spastic rectum and anus
• Weight loss
• Vomiting

6
Ulcerative Colitis

• Diagnosis
• HP
• CT
• Stool exam
• Sigmoidscopy
• Colonoscopy
• Barium enema
• Lab studies

7
Ulcerative Colitis

• Medical treatment
• Steriods
• Immunosuppressants
• Antidiarrheals
• Antibiotics
• Aminosalicylates (5-ASA)
• Iron and Vit B 12

• Low roughage diet
• No milk
• Sometimes TPN
• Surgery - total colectomy with ileostomy is the
  cure but not don until nothing else will work

8
Ulcerative Colitis

• Nursing care
• Report S/S of problems
• Provide emotional support
• Skin care
• Record of stools and type
• Monitor bowel sounds
• Vitals and I/O

• Watch for dehydration
• Monitor H H, E-lytes
• Weigh daily
• Dietary consult
• Watch for complications
• If OR, follow routine

9
Crohns Disease

• Both subjective and objective symptoms are
  relatively identical to colitis
• Assessment are identical
• Diagnostic tests are the same except
• With Crohns will find string sign (segments of
  stricture seperated by normal bowel)
• With colonoscopy will find patchy areas of
  inflammations
• Need biopsy for definitive diagnosis

10
Crohns Disease

• Nursing care
• Identical to colitis
• Watch for internal bleeding
• Medications
• Sulfasalazine for antiinflammatory effects
• Steriods
• Antibiotics
• Anticholinergics
• RX for diarrhea
• Dietary changes
• Restricted fiber diet with no raw fruit or
  vegetables and no nuts or whole grains
• Low fat diet to reduce fatty stools

11
Crohns Disease

• May need surgery for partial removal of diseased
  portion of bowel
• Follow routine care for client with bowel surgery

12
Inflammatory Bowel Disease

• Highly stressful, long term disease process
• Need support from health care and family
• Difficult to follow regimen of medication and
  diet
• Refer client to national organization for support
• Keep regular appointments with physician