IBD vs IBS: Inflammatory Bowel Disease

IBD vs IBS

• Inflammatory Bowel Disease (IBD) is characterized by chronic inflammation and damage to the GI tract, exacerbated by triggers
• There are two types of IBD
• IBD may be diagnosed via imaging scans
• IBD is associated with in increased risk of colon cancer
• Irritable Bowel Syndrome (IBS) is a gut-brain disorder where symptoms can vary
• No inflammation is involved in IBS
• Patients with IBS show normal colon exams
• IBS is not linked to increased risk of colon cancer

Inflammatory Bowel Disease

• Long-standing chronic inflammation affects the layers of the digestive tract
• Two types of IBD are Ulcerative Colitis and Crohn's Disease
• Symptom duration of IBD varies
• IBD is characterized by diarrhea, rectal bleeding, abdominal pain, fatigue, and weight loss
• Tenesmus, or the urge to defecate, is a symptom of IBD

Crohn's Disease

• Crohn's and Ulcerative Colitis ulcerations lead to scarring, which results in nutrient malabsorption
• Crohn's can affect the GI tract from mouth to anus, most commonly the terminal ileum/colon
• Transmural inflammation, which affects all layers and can penetrate the bowel wall, is characteristic of Crohn's
• "Skip lesions" are patchy areas of inflammation
• Crohn's is associated with 5-6 soft, loose, non-bloody stools daily
• Treatment for Crohn's includes diet, medications, and surgery (not curative)

Ulcerative Colitis

• Ulcerative Colitis primarily affects the large intestine, specifically the mucosa and submucosa layers
• Patients with Ulcerative Colitis tend to have 10-20 liquid, watery, bloody, or mucus stools daily
• Diet modifications, medications, and surgery (curative) are treatment options

Symptoms of Ulcerative Colitis

• Involves only mucosa and submucosa
• Diarrhea (more than 20 stools a day) can occur
• Blood, mucus, and pus can occur
• Abdominal pain and tenderness can occur
• Pain is worse in the left lower quadrant

Crohn's Disease Symptoms

• Affects any portion of the GI tract, from mouth to anus and involves all layers of the bowel
• Lesions can cause deep ulcerations and a cobblestone appearance
• Issues with malabsorption and nutritional deficits presents
• Stools are typically soft or semiliquid
• Pain is worse in the right lower quadrant

IBD Nursing Management

• Focuses on addressing remission and exacerbation as chronic care issues
• Long-term concerns: malabsorption/malnutrition can occur
• Iron deficiency anemia may require diet modifications, oral supplements, or transfusions
• Smoking cessation is indicated
• Immunosuppression treatments may be used
• May use Antibiotics and corticosteroids
• Surgery may be indicated

Irritable Bowel Syndrome

• Is a common GI complaint with Four subtypes: IBS-C, IBS-D, IBS-M, and IBS-Unclassified
• IBS-C (constipation dominant)
• IBS-D (diarrhea dominant)
• IBS-M (mixed, or alternating from diarrhea to constipation)
• IBS-Unclassified (meets IBS diagnostic criteria but cannot be accurately categorized)
• It's a functional disorder of the intestines
• The exact cause is unknown
• There are no definitive diagnostic tests

Diagnostic Testing: Endoscopy

• Upper Endoscopy includes esophagus, stomach, and duodenum
• Colonoscopy includes large intestine and terminal ileum

USPSTF Screening Recommendations: Colonoscopy

• Adults aged 50 to 75 years: The USPSTF recommends screening for colorectal cancer
• Adults aged 45 to 49 years: The USPSTF recommends screening for colorectal cancer
• Adults aged 76 to 85 years: Clinicians may selectively offer screening, considering the patient's overall health, prior history, and preferences

Diverticulitis

• Diverticulitis starts with an outpouching or diverticula (diverticulosis)
• Trapped food or fecal matter triggers inflammation and infection
• Diet can prevent flares, with inpatient vs outpatient differences.
• Symptoms include fever, LLQ pain, altered bowel habits, and pain/cramping
• Education includes eating a high-fiber diet, eleminating nuts and seeds etc, limiting fiber during flares, avoid straining, bending, lifting

Colorectal Cancer

• Involves the rectum and large intestine
• The most common site of metastasis is the liver High-risk individuals: have a strong family history of colon cancer or polyps, have a personal history of colon cancer, polyps, inflammatory bowel disease, or radiation to the abdomen/pelvis
• Treatment includes;
• surgery to remove the tumor and some portions of the colon like performing a colectomy and hemicolectomy
• chemotherapy if the tumor can't be removed
• radiation therapy which is performed to decrease tumor size

Pathophysiology of Hepatitis

• Liver inflammation, with many causes, results in decreased liver detoxification, protein, or clotting factor production
• It alters the storage of vitamins, fat, and glucose

Clinical Manifestations of Hepatitis

• Abdominal pain, irritability, and pruritus
• Malaise, fever, and N/V
• Jaundice
• Elevated AST, ALT, bilirubin, and ammonia
• Decreased albumin

Nursing Management of Hepatitis

• Education focuses on small, frequent meals, a low-fat diet with moderate protein, vaccination for Hep A/B, and monitoring liver function
• Interventions include administering antiemetics and viral suppressants, along with encouraging activity with rest periods

Cholecystitis

• Inflammation of the gallbladder caused by an obstruction of bile flow (gallstones = cholelithiasis)
• Most affected are asymptomatic
• RUQ "colicky" intermittent pain can occur, can radiate to back, may have rebound tenderness, positive Murphy's sign and occurs after eating a large meal
• Fever and tachycardia if infection occurs
• Jaundice and N/V are possible symptoms

Management and Nursing Considerations for Cholecystitis

• The management includes NPO to prevent gallbladder from releasing bile (pain), IV hydration + electrolytes, pain management, and IV antibiotics
• Medications to "dissolve" gallstones can be used for 2 years
• Surgery (laparoscopic cholecystectomy most common)
• Promote bedrest in semi-Fowler's position, as laying flat can exacerbate pain
• A nasogastric tube to suction can be used
• Education focuses on avoiding fatty foods, fried foods, ice cream, dairy, red meats, and heavy alcohol
• Encourage low saturated fats, such as rice, potatoes, pasta, yogurt, fruits, lean meat, and whole grains