Flashcards in Inflammatory Bowel Disease Deck (31)
Inflammatory Bowel Disease
Characterized by chronic, recurrent inflammation of the GI tract
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
Inflammation of any segment of the GI tract from mouth to anus
Clinical Manifestations of IBD
IBD Local Complications
Perforation (with possible peritonitis)
Colonic dilation (toxic megacolon)
High risk for colorectal cancer
C. Diff infection
Inflammation of peritoneum
Rigid, hard washboard abdomen with pain and fever
Can be life threatening
Dilated colon accompanied by bloating and sometimes fever, abdominal pain, or shock
More common with ulcerative colitis
Crohn's Disease Clinical Manifestations
Crampy abdominal pain
-Weight loss when small intestine involved
-Fever or other systemic symptoms
Crohn's Disease Pattern of inflammation/Complications
Inflammation involves all layers of bowel wall
Can occur anywhere in GI tract
Abscesses (peritonitis, fistulas)
Small intestinal cancer
Cobblestone appearance, normal bowel appears present between diseased portions
Ulcerative Colitis Pattern of Inflammation
Diarrhea with large fluid & electrolyte loss
Breakdown of cells
Areas of inflamed mucosa
Ulcerative Colitis Clinical Manifestations
In Severe Forms:
-Rapid weight loss of more than 10% of total body weight
Blood Studies Include
CBC, WBC, Serum electrolyte levels, Serum protein levels, ESR, C-Reactive Protein
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.
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.
Used to treat IBD. Drugs like metronidazole and ciprofloxacin.
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.
Suppresses immune response and maintain remission after corticosteroid induction therapy.
Other drug therapies
Goals of Drug Treatment
Induce and maintain remission.
Reduce quantity and quality of severity of flare ups.
Overall, IBD patients need to eat a balanced, healthy diet w/ sufficient calories, protein, nutrients.
Goals of Diet Management
Provide adequate nutrition w/o exacerbating symptoms
Correct and prevent malnutrition
Replace fluid and electrolyte losses
Prevent weight loss
Nutritional deficiencies are due to
Decreased oral intake
Malabsorption of nutrients (depends on location of inflammation)
Medications that can contribute to nutritional problems
Sulfasalazine: daily folic acid supplements indicated
Corticosteroids: Ca supplements to prevent osteoporosis, potassium supplements
Vit D Deficiency is common
During acute exacerbations...
Regular diet may not be tolerated
Liquid enteral feedings preferred (high in calories/nutrients, lactose free, easily absorbed)
Regular foods are reintroduced gradually
Exacerbations are debilitating and frequent (massive bleeding, perforation, strictures, obstruction, dysplasia, carcinoma)
*Surgery is indicated if treatment fails
Ileostomy: monitoring of stoma viability, mucocutaneous juncture, peristomal skin integrity
Second peak of disease onset occurs in 60s
Distal colon is usually invovlved in ulcerative colitis
Diagnosis can be difficult