Lower GI: Ulcerative Colitis and Crohn's Disease

Question 1

What is Ulcerative Colitis?

Answer 1

• Chronic inflammatory disease of the colon, characterized by periods of remissions and exacerbations

Question 2

What is the patho of UC?

Answer 2

• Abnormal immune response causes inflammation in the mucosal layer of the colon, which leads to continuous ulcerations
• Pseudopolyps may be present
• Involves ONLY the colon

Question 3

What are the risk factors for UC?

Answer 3

• Autoimmune disorders
• Genetics
• Jewish descent
• Stress

Question 4

What are the s/s of UC?

Answer 4

• Diarrhea with blood or pus (10-20 liquid stools/day)
• Abdominal pain/cramping
• Fecal urgency
• Fatigue
• Weight loss
• Fever
• Anemia
• Dehydration
• Tenesmus (always feeling like you need to shit)

Question 5

What lab results indicate UC?

Answer 5

• ↑ WBC, CRP, ESR

* ↓Hgb/Hct, albumin, potassium, magnesium

Question 6

What is CRP?

Answer 6

• C-reactive protein
• Protein made by the liver
• A high CRP test result is a sign of acute inflammation

Question 7

What is ESR?

Answer 7

• Erythrocyte sedimentation rate
• Blood test that measures how quickly erythrocytes (red blood cells) settle at the bottom of a test tube that contains a blood sample.
• A faster-than-normal rate may indicate inflammation in the body.

Question 8

What dx tests are done for UC?

Answer 8

• Guaiac test

* Colonoscopy w/ biopsy

Question 9

What medications are used for tx of UC?

Answer 9

• Sulfasalazine
• Aminoacylates
• Corticosteroids
• Immunosuppressants
• Antidiarrheals

Question 10

What surgery tx is used for tx of UC?

Answer 10

• Colectomy with appropriate ostomy

* Fecal microbiota transplant

Question 11

What are we monitoring as part of our nursing care for UC pts?

Answer 11

• I/Os
• Electrolytes (risk of hypokalemia)
• CBC levels
• Complications (peritonitis, sepsis)

Question 12

What is our pt teaching for UC?

Answer 12

• NPO during exacerbations
• Consume high calorie, low fiber diet (if ongoing UC)
• Avoid caffeine, alcohol, lactose
• Eat smaller, more freq meals

Question 13

What are the complications associated with UC?

Answer 13

• Toxic megacolon
• Perforation
• Hemorrhage
• Arthritis
• Colorectal

Question 14

What is Crohn’s Disease?

Answer 14

• Chronic inflammatory disease that can involve the entire GI tract and all layers of the bowel wall.
• Most common in the distal small intestine or proximal colon
• Characterized by periods of remissions and exacerbations

Question 15

What is the patho for Crohn’s Disease?

Answer 15

• Genetic, immune and environmental factors cause inflammation, which leads to the development of patchy ulcerations and granulomas in the GI tract
• Causes scarring and narrowing of the intestinal lumen, and places the pt at risk for fistulas

Question 16

What are the risk factors associated with Crohn’s Disease?

Answer 16

• Autoimmune disorders
• Genetics
• Smoking
• NSAID use

Question 17

What are the s/s of Crohn’s Disease?

Answer 17

• Diarrhea (5-6 loose stools/day)
• Steatorrhea
• RLQ pain
• Weight loss
• Anemia
• Fever
• Fatigue

Question 18

What labs results are indicative of Crohn’s Disease?

Answer 18

• ↓ Hct/Hgb and albumin

* ↑ ESR, CRP, WBC

Question 19

What dx tests are used for Crohn’s Disease

Answer 19

• Colonoscopy
• EGD (visual endoscopy)
• CT/MRI

Question 20

What is the medication tx for Crohn’s?

Answer 20

• 5-aminosalicylic acid (sulfasalazine)
• Corticosteroids
• Immunosuppressants
• Antidiarrheals

Question 21

What is the surgical tx for Crohn’s?

Answer 21

• Small bowel resection
• Colectomy
• w/ appropriate Ostomy

Question 22

What are we monitoring in our nursing care for a Crohn’s patient?

Answer 22

• I/Os
• Electrolytes
• CBC levels
• Complications

Question 23

What are the complications of Crohn’s to be aware of?

Answer 23

• Peritonitis
• Intestinal obstruction
• Fistulas
• Nephrolithiasis/Cholelithiasis
• Arthritis
• Retinitis

Question 24

What is our pt teaching for Crohn’s?

Answer 24

• Bowel rest (NPO) with TPN during severe exacerbations
• Consume a high calorie, low fiber diet
• Eat small, freq meals

Question 25

Which is more dangerous, UC or Crohn’s?

Answer 25

* Crohn’s | * Affects both colon and small intestines

Question 26

How does Crohn’s cause intestinal obstruction?

Answer 26

• Continual exacerbations at the same sites can cause compound scarring, shrinking the intestinal lumen at that area

Question 27

What is cobblestoning of the mucosa with Crohn’s?

Answer 27

• Longitudinal and circumferential fissures and ulcers separate islands of mucosa, giving it an appearance reminiscent of cobblestones

Question 28

True or False | Perianal skin tags are associated with UC.

Answer 28

• False, they are associated with Crohn’s

Question 29

As Crohn’s can effect ileum absorption, what deficits can result?

Answer 29

* Vit B12 * Iron def * Folate def * Vits A, D, E, K

Question 30

What are fistulas with Crohn’s?

Answer 30

* Crohn's disease may cause sores, or ulcers, that tunnel through the intestine and into the surrounding tissue, often around the anus and rectum and may get infected * These abnormal tunnels, called fistulas, are a common complication of Crohn's disease

Question 31

What is an external enterocutaneous fistula?

Answer 31

* Fistula between the intestine and the skin * If contents of the intestine leak out, the same enzymes in the gut that digest food will create the fistula and make contact the skin and cause it to become very red, painful and prone to infection

Question 32

What is an enteroenteric fistula?

Answer 32

* Fistula between adjacent intestines | * These fistulas link parts of the intestines together, bypassing sections of the bowel

Question 33

What are some ways Crohn’s is different than UC?

Answer 33

* CD has thickening of bowel walls, UC thins * CD has no obvious blood in stool, UC does * CD has asymmetrical inflammation, UC is symmetrical * CD location is different, can be esophageal, stomach, duodenal, jejunum or ileum. UC is colon only * CD inflammation affects all layers of bowel, UC is just mucosal * CD stooling is less freq (5-6) than with UC (10-20)