Inflammatory Bowel Disease

Question 1

Inflammatory Bowel Disease

Answer 1

Characterized by chronic, recurrent inflammation of the GI tract
Autoimmune disease

Question 2

Ulcerative Colitis

Answer 2

Inflammation and ulceration of the colon and rectum
Works its way from rectum up to the cecum
First layer of large intestine
Sloughing off of layer

Question 3

Crohn’s Disease

Answer 3

Inflammation of any segment of the GI tract from mouth to anus

Question 4

Clinical Manifestations of IBD

Answer 4

Diarrhea
Bloody stools
Weight loss
Abdominal pain
Fever
Fatigue

Question 5

IBD Local Complications

Answer 5

Hemorrhage
Strictures
Perforation (with possible peritonitis)
Fistulas
Colonic dilation (toxic megacolon)
High risk for colorectal cancer
C. Diff infection
Liver failure

Question 6

Peritonitis

Answer 6

Inflammation of peritoneum
Rigid, hard washboard abdomen with pain and fever
Can be life threatening

Question 7

Toxic Megacolon

Answer 7

Dilated colon accompanied by bloating and sometimes fever, abdominal pain, or shock
More common with ulcerative colitis

Question 8

Crohn’s Disease Clinical Manifestations

Answer 8

Diarrhea
Crampy abdominal pain
Less Common
-Weight loss when small intestine involved
-Rectal bleeding
-Fever or other systemic symptoms

Question 9

Crohn’s Disease Pattern of inflammation/Complications

Answer 9

Inflammation involves all layers of bowel wall
Can occur anywhere in GI tract
Skip Lesions
Strictures
Abscesses (peritonitis, fistulas)
Nutritional problems
Small intestinal cancer

Question 10

Skip Lesions

Answer 10

Cobblestone appearance, normal bowel appears present between diseased portions

Question 11

Ulcerative Colitis Pattern of Inflammation

Answer 11

Diarrhea with large fluid & electrolyte loss
Breakdown of cells
Areas of inflamed mucosa

Question 12

Ulcerative Colitis Clinical Manifestations

Answer 12

Bloody Diarrhea
Abdominal Pain
In Severe Forms:
-Fever
-Rapid weight loss of more than 10% of total body weight
-Anemia
-Tachycardia
-Dehydration

Question 13

Diagnostic Studies

Answer 13

H&P examination
Blood Studies
Stool Cultures
Imaging Studies
Endoscopy

Question 14

Blood Studies Include

Answer 14

CBC, WBC, Serum electrolyte levels, Serum protein levels, ESR, C-Reactive Protein

Question 15

Sulfasalazine

Answer 15

Decreases GI inflammation and is effective in achieving and maintaining remission for mild to moderately severe attacks. Contains sulfapyridine so it reaches the colon for absorption.

Question 16

Aminosalicyaltes

Answer 16

For mild to moderate Crohn’s disease, especially when the colon is involved, but are more effective for ulcerative colitis. Help achieve and maintain remission.
*may cause yellowish discoloration of skin, avoid sunlight until photosensitivity is determined.

Question 17

Antimicrobials

Answer 17

Used to treat IBD. Drugs like metronidazole and ciprofloxacin.

Question 18

Corticosteroids

Answer 18

Decrease inflammation and used to achieve remission.
Helpful for acute flare ups.
Given for shortest possible time because of s/e associated with long-term use.

Question 19

Immunosuppressants

Answer 19

Suppresses immune response and maintain remission after corticosteroid induction therapy.

Question 20

Other drug therapies

Answer 20

Biologic Therapy

Question 21

Goals of Drug Treatment

Answer 21

Induce and maintain remission.

Reduce quantity and quality of severity of flare ups.

Question 22

Nutritional Therapy

Answer 22

Dietary Consultant

Overall, IBD patients need to eat a balanced, healthy diet w/ sufficient calories, protein, nutrients.

Question 23

Goals of Diet Management

Answer 23

Provide adequate nutrition w/o exacerbating symptoms
Correct and prevent malnutrition
Replace fluid and electrolyte losses
Prevent weight loss

Question 24

Nutritional deficiencies are due to

Answer 24

Decreased oral intake
Blood loss
Malabsorption of nutrients (depends on location of inflammation)

Question 25

Medications that can contribute to nutritional problems

Answer 25

Sulfasalazine: daily folic acid supplements indicated
Corticosteroids: Ca supplements to prevent osteoporosis, potassium supplements
Vit D Deficiency is common

Question 26

During acute exacerbations…

Answer 26

Regular diet may not be tolerated
Liquid enteral feedings preferred (high in calories/nutrients, lactose free, easily absorbed)
Regular foods are reintroduced gradually

Question 27

Surgical Therapy

Answer 27

Exacerbations are debilitating and frequent (massive bleeding, perforation, strictures, obstruction, dysplasia, carcinoma)
*Surgery is indicated if treatment fails

Question 28

Postoperative Care

Answer 28

Ileostomy: monitoring of stoma viability, mucocutaneous juncture, peristomal skin integrity

Question 29

Gerontologic Considerations

Answer 29

Second peak of disease onset occurs in 60s
Distal colon is usually invovlved in ulcerative colitis
Diagnosis can be difficult

Question 30

Sed Rate

Answer 30

ESR (erythrocyte sedimentation rate)

test that indirectly measures how much inflammation is in the body; how long it takes to separate

Question 31

C-Reactive Protein

Answer 31

Substance produced by the liver that increases with inflammation; considered a non-specific “marker” for disease