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kol- Med Surg 320 Spring > GI- diverticulitis, ulcerative colitis, crohns > Flashcards

GI- diverticulitis, ulcerative colitis, crohns Flashcards

1
Q

what is ulcerative colitis?

A

Chronic inflammation of the rectum and sigmoid colon with periods of remission and exacerbation

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2
Q

patho of ulcerative colitis

A

Intestinal mucosa is hyperemic (increased blood flow), edematous, and reddened.

GI bleeding may be present from ulcers or erosions to the mucosal lining.

Continued edema causes mucosal thickening –>narrowed colon –>bowel obstruction.

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3
Q

s/s of ulcerative colitis

A 
Diarrhea
May contain blood or purulence
Abdominal and Rectal pain
Abdominal cramping
Rectal bleeding
Tenesmus (urgency to defecate)
Weight loss
Anorexia
Fatigue
Malaise
Fever
Anemia


*almost exact same as crohns
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4
Q

UC complications

A

-Intestinal malabsorption
-Electrolyte imbalances, Dehydration, Anemia
-GI Bleed
-Toxic megacolon (dilation of colon and colonic ileus)
-Perforated colon
-Intestinal abscess
-Osteoporosis
-Extraintestinal complications
Increased risk for colorectal cancer
—-1/3 of all UC deaths related to ulcerative colitis. 
Esp if dx >10 years
-Anxiety and Depression

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5
Q

Extraintestinal Symptoms of UC

A 
--Manifestations can involve nearly any organ system—including musculoskeletal, dermatologic, hepatopancreatobiliary, ocular, renal, and pulmonary.  
Examples:
-Inflammation of skin, eyes, liver, and joints.
-Arthritis
-Hepatic and biliary diseases
-Oral and skin lesions
-Eye and vision problems
-Muscle pain
-CAUSE IS UNKNOWN
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6
Q

drug to look out for causing exacerbation of UC

A

NSAID

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7
Q

UC patient history assessment

A

-Family history
-Current and previous therapy for Ulcerative Colitis
-Past surgeries
-Nutrition history
-Food intolerances
-Unintentional weight loss
-Bowel Elimination
>Frequency, Pattern, Color, Consistency, Characteristics…
-Pain
>Abdominal and/or rectal
-Antibiotic use over last few months
»Rule out c.diff
-International travel
-NSAID use
>Can cause an exacerbation of ulcerative colitis
-Extraintestinal symptoms

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8
Q

Abdominal physical assessment for UC

A

Assess bowel sounds, tenderness, distention…
Last BM
BM pattern

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9
Q

UC - monitor for what 2 vital signs in particular

A

Fever & Tachycardiamay be sign of worsening or complication: sepsis, bleeding, electrolyte imbalance, dehydration

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10
Q

Labs for UC

A
  • Hemoglobin & Hematocrit: Decreased, secondary to chronic blood loss.
  • WBC: Increased
  • C- reactive protein & Erythrocyte sedimentation rate (ESR): Increased, indicative of inflammation
  • Electrolytes (Na, K, Cl-): Decreased, secondary to diarrhea and malabsorption
  • Serum albumin: Decreased, secondary to loss of protein in stool
  • Stool Study: Evaluate for WBC; rule out other disorders, bacteria, viruses,…
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11
Q

Increased labs w/ UC

A

WBC, C reactive, ESR

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12
Q

Decreased Labs w/ UC

A

Hemoglobin, hematorcrit, electrolyte, serum albumin

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13
Q

Diagnostics for UC

A

MRI, Colonoscopy, CT, Barium Enema

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14
Q

What does barium enema show w/ UC?

A
  • Able to show complications, mucosal patterns, and depth of disease.
  • In early stages, may show incomplete filling as a result of inflammation and fine ulcerations.
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15
Q

management for UC

A

relieve symptoms, decrease GI motility, decrease inflammation, and promote intestinal healing, nutrition therapy, bowel rest/npo

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16
Q

potential food triggers for UC

A

alcohol, caffeine, raw vegetables, high fiber foods, lactose, carbonated beverages, pepper, nuts, corn, dried fruits. Smoking may also contribute to worsening symptoms.

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17
Q

TPN and UC- when do we use it? how do we use it?

A

TPN for severely ill and malnourished —> Risks b/c of dextrose = high osmolarity = central line needed

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18
Q

When do we use surgery for UC?

A

Surgery performed for complications (i.e toxic megacolon, bowel perforation, colon cancer…)

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19
Q

Surgical options for UC

A
  • Restorative Proctocoloectomy with ileostomy pouch-anal anastomosis
  • Total proctocolectomy with permanent ileostomy.
20
Q

what is a Total proctocolectomy with permanent ileostomy.

A

Removal of colon, rectum, and anus. Surgical closure of the anus.
Permanent ileostomy.

21
Q

What is Restorative Proctocoloectomy with ileostomy pouch-anal anastomosis

A
  • -GOLD standard in surgical treatment for UC
  • 2 stage procedure—removal of colon and most of rectum, leaving the anus and anal sphincter intact. Create an internal pouch with remaining 1.5 ft of small intestine (ileo-anal pouch/j-pouch/ s-pouch/pelvic pouch) which is connected to the anus.
  • Patient is given a temporary ileostomy to allow for healing of the pouch. In which the second stage is reversal of the ileostomy within 1-2 months after stage 1.
22
Q

what is ileostomy adaptation?

A

small intestine take on role of large intestine

absorption of Na and water better > stool volumes decrease > stool becomes thicker (paste) > yellow-brown or yellow-green color.

23
Q

what is effluent?

A

initial output from ileostomy

-caustic and sweet, green

24
Q

What is Crohn’s disease? what part of intestine is it most common to effect?

A

Chronic inflammatory disease of the small intestine, colon, or both.

  • -It can affect the entire GI tract, from mouth to anus.
  • -Most commonly affects the terminal ileum.
  • Slow, unpredictable progression.
  • Periods of remission and exacerbations.
25
Q

w/ crohn’s how will the intestine appear?

A

cobblestone, strictures, deep ulcerations

26
Q

how do you end up w/ obstruction when you have crohn’s

A

Inflammation & Edema > fibrosis and scar tissue > narrowing > obstruction

27
Q

what causes crohn’s ? when is it often diagnosed?

A

no one knows!

15-35

28
Q

crohn’s s/s

A

-Diarrhea- **Steatorrhea (fatty diarrhea)
-Abdominal pain- **Constant, RLQ and around umbilicus.
(Can be in the LLQ if the colon is also affected.)
-Fever: Secondary to **when a patient has a fistula, abscess, or severe inflammation.
-Weight loss: **Secondary to malabsorption, Anorexia, increased catabolism,…

29
Q

more likely to have GI bleed w/ UC or Crohn’s?

A

UC

30
Q

more likely to have cancer w/ UC or Crohn’s

A

UC

31
Q

More common to have malabsorption and malnutrition: UC or Crohn’s

A

Crohn’s

32
Q

More likely to have fistula and perirectal abscesses: UC or Crohn’s

A

Crohn’s

33
Q

____ ____ can exacerbate Crohn’s

A

bacterial infections

34
Q

patient history assessment w/ crohn’s

A
  • Recent bacterial infection: Bacterial infections can exacerbate
  • Nutritional Status: Unintentional weight loss
  • Detailed history on signs symptoms: Signs and symptoms vary from person to person
  • Bowel Elimination: Frequency, Pattern, Color, Consistency, Characteristic
35
Q

bowel sounds w/ crohn’s - what does high pitched mean? What does decreased or absent mean?

A

Bowel sounds may be decreased or absent in severe inflammation or with obstruction.
High pitched sounds may be present over narrowing

36
Q

neuro assessment for crohn’s

A

depression

37
Q

skin assessment for crohn’s

A

Perineal assessment for ulcers, fissures, or fistulas.

38
Q

Labs for crohn’s

A
  • same as UC + Folic acid and Vitamin B12
39
Q

why have increased WBC w/ crohn’s

A

possibly increased from fistula or abscess

40
Q

why have low electrolytes and serum albumin w/ crohn’s?

A

malabsorption and diarrhea

41
Q

diagnostic test for crohn’s

A

MRI

42
Q

3 aspects of nutrition therapy for Crohn’s

A

Bowel Rest/NPO
TPN
Nutritional supplements (Ensure)

43
Q

cal/day needed for fistula management

A

3000 cal/day for healing

44
Q

When do we see fistula’s w/ crohn’s?

A

acute exacerbation

45
Q

When do we do surgery for crohn’s ?

A

performed when medical interventions are not effective or from complications
–>Complications include fistula, perforation, obstruction, abscess, stricture, etc.

46
Q

surgery for crohn’s

A

resection
stricturoplasty
ostomy

kol- Med Surg 320 Spring (43 decks)

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