Exam 2 Crohns and Ulcerative Colitis

Question 1

Crohn’s Disease: all the layers

Answer 1

Usually diagnosed in adolescence or young adulthood; more in smokers than nonsmokers
Seen age 15 to 35 and 50 -70
Seen equal in men and women
Family history does pre disposed you
Most seen in those with Jewish ance.
NSAID do make it worse
Cause is unknown

Question 2

Usually diagnosed in adolescence or young adulthood; more in smokers than nonsmokers
Seen age 15 to 35 and 50 -70
Seen equal in men and women
Family history does pre disposed you
Most seen in those with Jewish ance.
NSAID do make it worse
Cause is unknown

Answer 2

Crohn’s Disease: all the layers

Question 3

Pain – widespread pain; right lower abdominal pain, also have diarrhea that’s painful
Scar tissue and granulomas – have constricted lumen because of the scar tissue
Eating – cause peristalsis, resulting in cramping pain after meals, have a lot of weight loss, malnutrition is very common
Ulcers – because of the inflammation, cause angry intestine, that result in chronic diarrhea
Perforation of inflamed intestine – enteral abdominal, causes breaks, anal abscess
Fever and leukocytosis - an increase in the number of white cells in the blood, especially during an infection.
Diarrhea, abdominal pain, steatorrhea – excessive fat in the feces, anorexia, weight loss, nutritional deficiencies

Answer 3

Clinical Manifestations:

Question 4

widespread pain; right lower abdominal pain, also have diarrhea that’s painful

Answer 4

Crohn’s Disease pain

Question 5

have constricted lumen because of the scar tissue

Answer 5

Crohn’s Disease Scar tissue and granulomas

Question 6

Crohn’s Disease Scar tissue and granulomas

Answer 6

have constricted lumen because of the scar tissue

Question 7

Crohn’s Disease pain

Answer 7

widespread pain; right lower abdominal pain, also have diarrhea that’s painful

Question 8

cause peristalsis, resulting in cramping pain after meals, have a lot of weight loss, malnutrition is very common

Answer 8

CD eating

Question 9

CD eating

Answer 9

cause peristalsis, resulting in cramping pain after meals, have a lot of weight loss, malnutrition is very common

Question 10

because of the inflammation, cause angry intestine, that result in chronic diarrhea

Answer 10

CD Ulcers

Question 11

CD Ulcers

Answer 11

because of the inflammation, cause angry intestine, that result in chronic diarrhea

Question 12

enteral abdominal, causes breaks, anal abscess

Answer 12

CD Perforation of inflamed intestine

Question 13

CD Perforation of inflamed intestine

Answer 13

enteral abdominal, causes breaks, anal abscess

Question 14

an increase in the number of white cells in the blood, especially during an infection.

Answer 14

CD Fever and leukocytosis

Question 15

CD Diarrhea, abdominal pain, steatorrhea

Answer 15

excessive fat in the feces, anorexia, weight loss, nutritional deficiencies

Question 16

excessive fat in the feces, anorexia, weight loss, nutritional deficiencies

Answer 16

CD Diarrhea, abdominal pain, steatorrhea

Question 17

localized flexion of pus surrounded by inflammation

Answer 17

CD Abscess

Question 18

CD Abscess

Answer 18

localized flexion of pus surrounded by inflammation

Question 19

abnormal connection or passageway between two epithelial lined organ or vessels

Answer 19

CD Fistula

Question 20

CD Fistula

Answer 20

abnormal connection or passageway between two epithelial lined organ or vessels

Question 21

Fissure

Answer 21

crack or a tear inside

Question 22

an abnormal connection that develops between the intestinal tract or stomach and the skin

Answer 22

Enterocutaneous

Question 23

Enterocutaneous

Answer 23

an abnormal connection that develops between the intestinal tract or stomach and the skin

Question 24

Non-bloody diarrhea, crampy abdominal pain, insidious onset of weight loss, fatigue, low grade fever
Proctosigmoidoscopy – to see if rectosigmoid area is inflamed
Stool sample – look for steatorrhea
Barium study of upper GI – show string sign or the xray of the thermal area
Endoscopy, Colonoscopy, Intestinal Biopsy
Barium enema – show cobblestone appears, fistula, fissures
CT scan – bowel wall thickening, fistula
CBC, Hemoglobin, Electrolytes, Erythrocyte Sedimentation Rate, Albumin and Protein

Answer 24

CD Assessment and Diagnostic Findings:

Question 25

CD Assessment and Diagnostic Findings:

Answer 25

Non-bloody diarrhea, crampy abdominal pain, insidious onset of weight loss, fatigue, low grade fever
Proctosigmoidoscopy – to see if rectosigmoid area is inflamed
Stool sample – look for steatorrhea
Barium study of upper GI – show string sign or the xray of the thermal area
Endoscopy, Colonoscopy, Intestinal Biopsy
Barium enema – show cobblestone appears, fistula, fissures
CT scan – bowel wall thickening, fistula
CBC, Hemoglobin, Electrolytes, Erythrocyte Sedimentation Rate, Albumin and Protein

Question 26

CBC, Hemoglobin, Electrolytes, Erythrocyte Sedimentation Rate, Albumin and Protein

Answer 26

CBC – looking for infection
Hemoglobin – blood loss
Electrolytes – gastro intentional loss
ESR – increase inflammation
Albumin and Protein

Question 27

Intestinal Obstruction or Stricture Formation
Perianal Disease
Fluid and Electrolyte Imbalances
Malnutrition from malabsorption
Fistula and Abscess Formation
Increased risk for colon cancer

Answer 27

Complications of Crohn’s:

Question 28

Complications of Crohn’s:

Answer 28

Intestinal Obstruction or Stricture Formation
Perianal Disease
Fluid and Electrolyte Imbalances
Malnutrition from malabsorption
Fistula and Abscess Formation
Increased risk for colon cancer

Question 29

What is the biggest know of CD

Answer 29

nonbloody diarrhea

Question 30

Ulcerative Colitis: - just inner lining

Answer 30

Recurrent ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum
Most prevalent in Caucasians; most in those of Jewish ancestry
Increased incidence of colon cancer
Increased systemic complications and high mortality rate

Question 31

Recurrent ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum
Most prevalent in Caucasians; most in those of Jewish ancestry
Increased incidence of colon cancer
Increased systemic complications and high mortality rate

Answer 31

Ulcerative Colitis: - just inner lining

Question 32

Lesions occur one right after another abscesses to form
-Usually starts rectum and spread proximal until it involves the whole colon
-Results in bowel narrowing shortening and thickening
Inflammatory process affects only the inner lining so don’t often see fistulas, obstruction, fissures

Answer 32

UC Pathophysiology

Question 33

Diarrhea, passage of mucus and pus, my have bloody diarrhea
Bleeding may be mild or severe – see pallor, anemia, fatigue
May have left lower quadrant pain
Tenesmus – painful straining during the bowel mvmt
Always feel like they have to use the restroom
Pale, anemia
Anorexia, weight loss, fever, vomiting, dehydration, cramping, feeling of urgency for defecation, passage of 10-20 liquid stools per day
Rebound tenderness in right lower quadrant

Answer 33

Predominant symptoms:

Question 34

Predominant symptoms:

Answer 34

Diarrhea, passage of mucus and pus, my have bloody diarrhea
Bleeding may be mild or severe – see pallor, anemia, fatigue
May have left lower quadrant pain
Tenesmus – painful straining during the bowel mvmt
Always feel like they have to use the restroom
Pale, anemia
Anorexia, weight loss, fever, vomiting, dehydration, cramping, feeling of urgency for defecation, passage of 10-20 liquid stools per day
Rebound tenderness in right lower quadrant

Question 35

Mild, server, and fulminant (ful. Means sudden with great intensity)

Answer 35

Classified as:

Question 36

skin lesion, eye lesions, joint abnormalities, liver disease

Answer 36

Extraintestinal symptoms:

Question 37

Extraintestinal symptoms:

Answer 37

skin lesion, eye lesions, joint abnormalities, liver disease

Question 38

Hydration and nutritional status – malnutrition, anorexia
Abdominal distention tenderness and bowel sounds, could be looking for obstruction, perforation, bleeding = these s/s hypotension, tachycardia, tachypneic, pale
Cbc, h&h, xray, albumin, electrolytes,
If they have perforation contraindicated in scoping
Stool sample, Hematocrit and Hemoglobin, WBC, Albumin, Electrolytes
Abdominal x-ray
Sigmoidoscopy and colonoscopy
Barium enema – mucosal abominates, fistulas, or focal striatulas
Complications of Ulcerative colitis:
Toxic megacolon
Risk for perforation
Increased risk for colon cancer

Answer 38

To Determine Severity of the Disease, Assess for:

Question 39

To Determine Severity of the Disease, Assess for:

Answer 39

Hydration and nutritional status – malnutrition, anorexia
Abdominal distention tenderness and bowel sounds, could be looking for obstruction, perforation, bleeding = these s/s hypotension, tachycardia, tachypneic, pale
Cbc, h&h, xray, albumin, electrolytes,
If they have perforation contraindicated in scoping
Stool sample, Hematocrit and Hemoglobin, WBC, Albumin, Electrolytes
Abdominal x-ray
Sigmoidoscopy and colonoscopy
Barium enema – mucosal abominates, fistulas, or focal striatulas
Complications of Ulcerative colitis:
Toxic megacolon
Risk for perforation
Increased risk for colon cancer

Question 40

NPO, IV, or TPM, promote bowel rest and decrease peristalsis, trying to correct malnutrition, want to control pain, need to address inflammation, record I&O daily weight, want to decrease diarrhea

Answer 40

Management Of Inflammatory Bowel Disease: Acute exacerbation

Question 41

Management Of Inflammatory Bowel Disease: Acute exacerbation

Answer 41

NPO, IV, or TPM, promote bowel rest and decrease peristalsis, trying to correct malnutrition, want to control pain, need to address inflammation, record I&O daily weight, want to decrease diarrhea

Question 42

1. 5-aminosalicylic acid drugs (Ex. Sulfasalazine) – used for anti inflammation but can cause kidney, want to increase fluids
2. Corticosteroids (Ex. Prednisone) –immunosuppression, risk of infection
3. Immunosuppressant agents (Ex. Imuran, Purinethal) – increase potential for infection
4. Biologic Therapy (Ex. Remicade) – blocks inflammation works well for mod to ser pain ibd
5. Antibiotics and Antidiarrheals prn – will do tb skin test cuz of immunosuppressant

Answer 42

Management Of Inflammatory Bowel Disease: meds

Question 43

5-aminosalicylic acid drugs (Ex. Sulfasalazine) –

Answer 43

used for anti inflammation but can cause kidney, want to increase fluids

Question 44

Corticosteroids (Ex. Prednisone)

Answer 44

immunosuppression, risk of infection

Question 45

increase potential for infection

Answer 45

Immunosuppressant agents (Ex. Imuran, Purinethal) –

Question 46

blocks inflammation works well for mod to ser pain ibd

Answer 46

Biologic Therapy (Ex. Remicade) –

Question 47

will do tb skin test cuz of immunosuppressant

Answer 47

Antibiotics and Antidiarrheals prn

Question 48

Assess – bowel sounds, fluid/electrolytes, infection AND Monitor
NUTRITION: Provide high caloric, high protein, low fat, low fiber diet
Nutritional supplements – vitamin b12

Answer 48

Watch for s/s of infection and that is what you want to teach

Question 49

Monitor for: rectal bleeding, blood production to prevent hypovolemia monitor blood pressure, monitor coagulation H&H, vitamin K available to increase clotting factors
Will want to monitor for perforation all the time s/s acute abdominal pain. Tender, distended, shock septic
Will always want to monitor for obstruction bone all distention, absent or decrease bowel sounds, decrease mental, may have fever or infection, tachycardia, hypotension, dehydration, and electrolyte imbalances

Answer 49

Surgery