Medical Surgical Nursing_ IBD | Lecture notes Nursing

Inflammatory Bowel Disorders (IBD)

Crohn’s disease

also called regional enteritis or ileitis

is an inflammatory bowel disease that causes chronic

inflammation of the gastrointestinal tract.

is characterized by periods of remission and exacerbation

This inflammation often spreads to all layers of the bowel

(Transmural inflammation).

This can happen anywhere in GI but most commonly

occurs in the distal ileum and the ascending colon.

The exact cause of Crohn's disease remains unknown.

Did you know?

- IBD affects between 1.6 and 3.1 million Americans, with most being

diagnosed in their 20’s and 30’s.

How Crohn’s Disease differs from Ulcerative Colitis

Pathophysiology

CAUSE: UNKNOWN

Possibly:

1. Immune related disorder

2. Hereditary

Predisposing Factors: Precipitating Factors:

- All ages: Common in adolescents - Cigarette smoker

and adults (15 and 35 y.o) - Immunocompromised

- Both Male and Female - Normal flora imbalances

- All racial group: American, - Unhealthy lifestyle

European and Jews - Environmental factors: High

polluted area - Prolong NSAIDS used

Genetic/Family history

*Immunocompromised: Foreign pathogens enter the GI tract.

Activation of immune system: T helper cells release cytokines

Attracts macrophages & releases inflammatory substances

Hereditary/unknown cause: Disruptive and uncontrollable

inflammatory response

-S/S: Fever, chills & fatigue

WBC, loss of appetite

Causing epithelial tissue destruction

Inflammation and abscesses of Crypt in GI

*Distal Ileum & Ascending Colon

-S/S: Right lower quadrant pain, secondary anemia, RBC

(Low cobalamin)

Formation of small focal aphthous ulcers (mucosal lesions)

Increased inflammation: Affecting deep mucosa

Development of deep longitudinal and transverse ulcers with

mucosal edema

Formation of granuloma (Cobblestone), fissures & abscess and

more inflammation

-S/S: Hematochezia, steatorrhea, chronic diarrhea, nausea &

vomiting, malabsorption, nutritional deficiency, weight loss, loss

of appetite

Stenosis of the bowel wall

- S/S: Right lower quadrant pain (distal Ilium,

ascending colon)

The inflammation extends into the serosa

May cause perforation & formation of fistula

-S/S: Intraabdominal abscess and bleeding

DIAGNOSTIC TEST

•Blood Test/CBC

•Stool Analysis

•Colonoscopy

•Tissue biopsy

•Abdominal Ultrasound

DIAGNOSTIC TEST

•Computed tomography (CT) scan

•Upper gastrointestinal (GI) endoscopy

•Barium swallow & X-ray

MANAGEMENT

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Inflammatory Bowel Disorders (IBD) Crohn’s disease  also called regional enteritis or ileitis  is an inflammatory bowel disease that causes chronic inflammation of the gastrointestinal tract.  is characterized by periods of remission and exacerbation  This inflammation often spreads to all layers of the bowel (Transmural inflammation).  This can happen anywhere in GI but most commonly occurs in the distal ileum and the ascending colon.  The exact cause of Crohn's disease remains unknown. Did you know?

IBD affects between 1.6 and 3.1 million Americans, with most being diagnosed in their 20’s and 30’s. How Crohn’s Disease differs from Ulcerative Colitis Pathophysiology CAUSE: UNKNOWN Possibly:

Immune related disorder
Hereditary Predisposing Factors: Precipitating Factors:

All ages: Common in adolescents - Cigarette smoker and adults (15 and 35 y.o) - Immunocompromised
Both Male and Female - Normal flora imbalances
All racial group: American, - Unhealthy lifestyle European and Jews - Environmental factors: High polluted area - Prolong NSAIDS used Genetic/Family history  *Immunocompromised: Foreign pathogens enter the GI tract.  Activation of immune system: T helper cells release cytokines  Attracts macrophages & releases inflammatory substances  Hereditary/unknown cause: Disruptive and uncontrollable inflammatory response -S/S: Fever, chills & fatigue WBC, loss of appetite  Causing epithelial tissue destruction  Inflammation and abscesses of Crypt in GI *Distal Ileum & Ascending Colon -S/S: Right lower quadrant pain, secondary anemia, RBC (Low cobalamin)  Formation of small focal aphthous ulcers (mucosal lesions)  Increased inflammation: Affecting deep mucosa  Development of deep longitudinal and transverse ulcers with mucosal edema  Formation of granuloma (Cobblestone), fissures & abscess and more inflammation -S/S: Hematochezia, steatorrhea, chronic diarrhea, nausea & vomiting, malabsorption, nutritional deficiency, weight loss, loss of appetite  Stenosis of the bowel wall - S/S: Right lower quadrant pain (distal Ilium, ascending colon)  The inflammation extends into the serosa  May cause perforation & formation of fistula -S/S: Intraabdominal abscess and bleeding

DIAGNOSTIC TEST

Blood Test/CBC
Stool Analysis
Colonoscopy
Tissue biopsy
Abdominal Ultrasound DIAGNOSTIC TEST
Computed tomography (CT) scan
Upper gastrointestinal (GI) endoscopy
Barium swallow & X-ray MANAGEMENT

 There is currently no cure for Crohn's disease, and there is no single treatment that works for everyone.  One goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms.

Antibiotics
Antidiarrheal medication: Ex. Loperamide
Biologics: include monoclonal antibodies to suppress the immune response. Ex. Infliximab (Remicade)
Bowel rest: Ex. parenteral nutrition and IV fluids
Corticosteroids: Anti-inflammatory, Ex. Cortisone, prednisone
Immunomodulators: These drugs calm inflammation by suppressing an overactive immune system Ex. azathioprine and cyclosporine.
Surgery: Surgery won’t cure Crohn’s disease SURGERY A. Strictureplasty: Widens narrowed areas of the intestine that could lead to blockages. The surgeon doesn’t remove any part of the intestine. B. Fistula removal: Closes, opens, removes, or drains a fistula that doesn’t heal with medication. C. Colectomy: Removes the colon when it's badly diseased but leaves the rectum. D. Proctolectomy: Removes the colon and rectum when both are badly damaged. *End ileostomy: This kind of proctolectomy reroutes the end of the small intestine through a small hole in the belly, called a stoma. Waste then drains into an ostomy bag outside this hole. E. Bowel resection: Removes part of the small or large intestine that’s been damaged by Crohn’s and connects the two healthy ends. F. Abscess drainage: The surgeon cuts into an infection in the belly, pelvis, or around the anus and puts in a tube to drain pus G. Ileostomy: Reroutes stool, either temporarily or permanently, through a hole in the belly called a stoma. You may get an ileostomy to let your intestine heal after another operation, to reduce inflammation, or so you can get another surgery on your rectum or anus. Stool drains into an ostomy bag or a special pouch your surgeon creates to connect to your anus. COMPLICATIONS Manifestations may extend beyond the GI tract and can include:
Joint disorders (Ex. arthritis)
Skin lesions (Ex. erythema nodosum)
Ocular disorders (Ex. conjunctivitis)
Oral ulcers
GI & colon Cancer
Peritonitis
Intestinal obstruction
Fluid and electrolyte imbalances
Malnutrition ULCERATIVE COLITIS  is an idiopathic inflammatory bowel disease (IBD) that causes inflammation and ulcers in the innermost lining of your large intestine (colon) and rectum.  The disease may be acute and chronic with unpredictable relapses and remissions.  is considered to be an autoimmune disease.  Inflammation usually starts in the rectum Pathophysiology CAUSE: UNKNOWN or AUTOIMMUNE Predisposing Factors: Precipitating Factors: -All ages: 15 & 30 years old, -Unhealthy diet and lifestyle or older than 60. -Emotional stress -Both Male and Female -Frequent use of NSAIDS -All racial group: Jewish and -Prolonged antibiotic used northern part of Europe and America -Environmental: Living in -Genetic/hereditary urban area and well developed -With other immune disorders countries/highly populated area  Autoimmune: Immune System attacks the lining of the of the superficial mucosa and submucosa of the rectum.  Activation of immune response

S/S: Fever, chills, fatigue  inflammation and irritation of the inner lining of the bowel  Formation of open sores or ulcers  Edema and increased inflammation  Causing more lesions or ulcer and abscess formation  Hyperplastic Inflammatory Mucosa (Pseudopolyps)
S/S: Diarrhea Bloody mucous and pus in the stool Abdominal pain and cramping Rectal pain Rectal bleeding Bowel incontinence and urgency Tenesmus Weight loss Dehydration  *Rectum to Large Intestine  Paralytic Ileus/ **Toxic Megacolon -S/S: Profuse diarrhea, abd distention

Ulcerative Proctitis (rectum only)
Proctosigmoiditis (rectum and the lower end of colon)**
Limited/Distal Colitis (left side of the colon)
Pancolitis/Extensive Colitis (entire colon) DIAGNOSTIC TEST  Blood Test/CBC  Stool Analysis  Sigmoidoscopy  Colonoscopy  Abdominal Ultrasound DIAGNOSTIC TEST  Tissue Biopsy  CT Scan & MRI  Barium enema and X-rays MANAGEMENT  There’s no cure for ulcerative colitis, but treatments can calm the inflammation.  The goal of medication is to induce and maintain remission, and to improve the quality of life A. PHARMACOLOGIC THERAPY
Anti-inflammatory A. 5-Aminosalicylates: Sulfasalazine (Azulfidine) B. Corticosteroids: prednisone & budesonide 2. Immunosupressants /Immunomodulators A. Azathioprine, methotrexate B. Cyclosporine (Gengraf, Neoral) C. Tofacitinib (Xeljanz)
Biologics: infliximab (Remicade), adalimumab (Humira), golimumab (Simponi)
Janus kinase (JAK) inhibitors: stop one of your body’s enzymes (chemicals) from triggering inflammation. developed to treat autoimmune disease Ex. tofacitinib (Xeljanz)
Anti-diarrheal medications: Loperamide

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DIAGNOSTIC TEST