Inflammatory Bowel Disease (IBD) Overview

• Inflammatory Bowel Disease (IBD) involves a group of chronic conditions causing digestive tract inflammation.
• The 2 main types of IBD include Ulcerative Colitis and Crohn's Disease.

IBD Etiology

• Autoimmune disorder occurs in genetically susceptible persons.
• Multifactorial/unknown causes.
• Familial components exist.
• Abnormal immune responses are typical.
• Infection often presents at onset.
• Psychological stressors are often related to exacerbations.

Ulcerative Colitis (UC) Pathophysiology

• Inflammatory process affects the colon and rectum's mucosa and submucosa.
• Crypt abscesses may form.
• Abscesses can erode the lumen.
• Ulceration and bleeding may result.

Ulcerative Colitis (UC) Analyzing Cues

• Patients experience an urgent/frequent need for bowel movements.
• Loss of weight is seen due to constant diarrhea and low red blood cells (anemia).
• Cramps occur in the lower abdomen that can be very painful.
• Electrolyte imbalances and elevated temperatures are often present.
• Rectal Bleeding may be evident.
• Severe diarrhea contains pus, blood, and mucous.

Crohn's Disease Pathophysiology

• Triggered by etiology.
• Inflammation occurs due to the immune system mistakenly attacking the digestive tract.
• Segmental areas (patches) are affected along the entire wall of the GI tract.
• All layers of the bowel are affected.
• Inflammatory damage to the lining forms ulcers, fistulas, and strictures.
• A "COBBLESTONE" appearance is often observed.

Crohn's Disease Analyzing Cues

• Abdominal pain and tenderness is evident, particularly in the right lower quadrant (RLQ).
• Chronic diarrhea is experienced.
• Weight loss and loss of appetite occur.
• Steatorrhea is present.
• Fatigue is typically observed.

IBD Diagnostic Tests

• Blood tests include complete blood count (CBC), erythrocyte sedimentation rate (ESR), serum albumin, iron, vitamin B12, and folate levels.
• Stool tests include fecal occult blood test (FOBT) and stool culture.
• Endoscopic procedures include colonoscopy, upper endoscopy, and capsule endoscopy.

IBD Pharmacology Therapy

• 5-Aminosalicylates (5-ASA) inhibit prostaglandin production in the bowel to decrease inflammation.
• Antimicrobial agents like metronidazole and ciprofloxacin are used when abscesses occur.
• Antidiarrheals such as diphenoxylate HCl slow GI motility and reduce diarrhea.
• Corticosteroids reduce inflammation.
• Immune Response Modifiers, such as adalimumab, suppress the immune system to reduce inflammation.

IBD Nonpharmacologic Therapy

• A diet high in protein, high in calories and dietary fiber is advised.
• Milk products should be eliminated.

UC Surgical Intervention

• Proctocolectomy with Ileal Pouch-Anal Anastomosis (IPAA) is a common surgery method.
• The surgeon removes the entire colon and rectum, where intestinal parts are inflamed.
• The end of the small intestine (ileum) is used to create a pouch (often called a J-pouch).
• The J-pouch acts like a new rectum, storing waste.
• The pouch is connected directly to the anus, allowing you to pass stool naturally.

Crohn's Disease - Surgical Intervention

• Intestinal Resection with Anastomosis is performed.
• Diseased section is removed after bowel obstruction.
• Damaged parts of the small or large intestine are removed by determining the diseased section.
• Healthy sections are reconnected by stitching or stapling to restore normal flow for food and waste.
• Abdominal incision is closed, and recovery begins where some cases may require temporary stoma to allow healing.

IBD Nursing Actions: Pre/Post OP

• Prepare the patient for surgery.
• Provide post-operative care and teaching.
• Refer the patient to enterostomal therapist and home health care services, as needed.
• Offer emotional support.

IBD Nursing Actions

• Monitor fluid volume, especially during exacerbations, and administer IV fluids as needed; treat diarrhea.
• Promote nutritional intake with a lactose-free diet that is low fat, high protein, high vitamin, and high calorie/patient specific.
• Promote a healthy body image and encourage the patient to reduce stress.