Surgical Therapy for Inflammatory Bowel Disease
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Questions and Answers

Which of the following is NOT a common surgical procedure for ulcerative colitis?

  • Proctocolectomy with ileal pouch/anal anastomosis (IPAA)
  • Strictureplasty (correct)
  • Proctocolectomy with permanent ileostomy
  • Total proctocolectomy

    • What is the primary reason why most patients with Crohn's disease eventually require surgery?

  • To remove the diseased segments of the colon
  • To prevent the development of short bowel syndrome
  • To address complications such as obstructions or lack of response to therapy (correct)
  • To cure the disease permanently

    • What is a potential complication of repeated surgical removals of sections of the small intestine due to Crohn's disease?

  • Short bowel syndrome (correct)
  • Iron deficiency anemia
  • Strictureplasty
  • Ulcerative colitis

    • Which of the following is a potential benefit of strictureplasty compared to resection of diseased segments in Crohn's disease?

    <p>Lower risk of developing short bowel syndrome (D)</p> Signup and view all the answers

    What is the main goal of nutrition therapy for patients with inflammatory bowel disease (IBD)?

    <p>To ensure adequate nutrition without worsening symptoms (B)</p> Signup and view all the answers

    What is one reason why patients with IBD may reduce their food intake?

    <p>To reduce diarrhea and other symptoms (A)</p> Signup and view all the answers

    Which of the following is a possible consequence of malabsorption in patients with IBD?

    <p>Iron deficiency anemia (D)</p> Signup and view all the answers

    In addition to iron deficiency anemia, what other potential nutritional deficiency can occur in patients with IBD, particularly those with ostomies or diarrhea?

    <p>Zinc deficiency (B)</p> Signup and view all the answers

    What are the main causes of sleep disturbances in patients with Inflammatory Bowel Disease (IBD)?

    <p>Frequent episodes of diarrhea and pain. (C)</p> Signup and view all the answers

    What is the primary way to help patients with IBD cope with the emotional challenges associated with the disease?

    <p>Encourage patients to participate in stress management techniques. (C)</p> Signup and view all the answers

    What is the most significant challenge in managing IBD in older adults?

    <p>Increased risk of adverse events, hospitalization, and mortality associated with treatments. (C)</p> Signup and view all the answers

    What is a significant complication of IBD that often affects older adults?

    <p>Difficulty managing bowel movements due to physical limitations. (C)</p> Signup and view all the answers

    Which of the following is NOT a common expected outcome for patients with IBD after treatment and management?

    <p>Complete remission of the disease, eliminating all symptoms. (B)</p> Signup and view all the answers

    What is a key aspect of managing IBD that can help patients avoid exacerbations?

    <p>Scheduling activities around rest periods to minimize stress on the body. (B)</p> Signup and view all the answers

    Which of the following conditions might IBD in older adults be confused with?

    <p>Clostridium difficile infection (CDI). (B)</p> Signup and view all the answers

    What is the significance of the second peak in the occurrence of IBD around the 6th decade?

    <p>It highlights the need for increased awareness of IBD in the elderly population. (A)</p> Signup and view all the answers

    What is a potential clinical problem that a patient with IBD may experience?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following medications may contribute to folate deficiency in patients with inflammatory bowel disease (IBD)?

    <p>Sulfasalazine (A)</p> Signup and view all the answers

    What is the primary reason for recommending liquid enteral feedings over parenteral nutrition (PN) during an acute exacerbation of IBD?

    <p>Enteral feedings help maintain gut function and prevent atrophy (B)</p> Signup and view all the answers

    Which of the following is NOT a potential indication for surgery in IBD?

    <p>Inability to control pain with medication (B)</p> Signup and view all the answers

    Which of the following is a nursing intervention that can help prevent skin breakdown in a patient with IBD experiencing diarrhea?

    <p>Using moisturizing skin barrier cream (A)</p> Signup and view all the answers

    What is the primary goal for managing IBD during an acute exacerbation?

    <p>Restoring and maintaining hemodynamic stability (C)</p> Signup and view all the answers

    What dietary modification is recommended for patients with IBD who experience diarrhea?

    <p>Keeping a food diary to identify problem foods (D)</p> Signup and view all the answers

    What is a potential side effect of corticosteroids, commonly used to manage IBD?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following statements about ileal disease is TRUE?

    <p>It causes reduced absorption of cobalamin and bile acids (C)</p> Signup and view all the answers

    What is a common nursing intervention for patients with IBD who are experiencing perianal irritation?

    <p>Using soothing compresses or ointments (D)</p> Signup and view all the answers

    Why is it important for patients with IBD to understand the chronicity of their illness?

    <p>To better manage stress and adjust their lifestyle (B)</p> Signup and view all the answers

    What is a key component of teaching patients with IBD about managing their condition?

    <p>Explaining the importance of rest and diet management (B)</p> Signup and view all the answers

    What is the role of cholestyramine in managing IBD?

    <p>To bind unabsorbed bile salts and control diarrhea (D)</p> Signup and view all the answers

    Which of the following is NOT a recommended nursing intervention for a patient with IBD experiencing diarrhea?

    <p>Restricting fluid intake to decrease stool frequency (B)</p> Signup and view all the answers

    What is the role of a dietitian in managing IBD?

    <p>Providing nutritional counseling and recommending diet modifications (A)</p> Signup and view all the answers

    What is a recommended resource for patients with IBD seeking information and support?

    <p>Crohn's and Colitis Foundation of America (D)</p> Signup and view all the answers

    Study Notes

    Surgical Therapy for Inflammatory Bowel Disease (IBD)

    • Ulcerative Colitis (UC): Surgery is indicated for complications outlined in a table (Table 47.19). Procedures include proctocolectomy with ileal pouch-anal anastomosis (IPAA) or proctocolectomy with permanent ileostomy. Proctocolectomy is curative as UC only affects the colon.

    • Crohn's Disease: Surgery is often required for complications like obstructions or lack of response to other treatments (Table 47.19). The most common procedure is resecting diseased segments and reconnecting the healthy parts (reanastomosis). Recurrence at the anastomosis site is common. Repeated surgery can lead to short bowel syndrome (SBS).

    • Short Bowel Syndrome (SBS): Occurs when too little small intestine remains due to surgery or disease, impairing nutrition and hydration. Lifetime fluid and/or parenteral nutrition (PN) may be needed.

    • Strictureplasty: A procedure for Crohn's disease that opens narrowed areas obstructing the bowel, preserving the intestine and reducing short bowel syndrome risk. Recurrences are uncommon.

    Nutrition Therapy for IBD

    • Goals of Diet Management: Adequate nutrition without worsening symptoms, correction/prevention of malnutrition, replacement of fluid and electrolyte losses, and prevention of weight loss.

    • Malnutrition in IBD: Common in IBD patients, making personalized diets crucial.

    • Diet Considerations: Balanced, nutritious diet with adequate calories, protein, and other nutrients. Consult a registered dietitian for guidance.

    • Causes of Nutrition Problems: Reduced oral intake, blood loss, and impaired absorption, influenced by disease location. Diarrhea and inflammatory mediators can also reduce appetite.

    • Iron Deficiency Anemia: Frequent in IBD patients due to blood loss and malabsorption, potentially requiring oral or intravenous iron supplements.

    • Zinc Deficiency: Possible with ostomies or diarrhea. Zinc supplements may be needed.

    • Cobalamin and Bile Acid Deficiencies: Terminal ileum disease can impair absorption, leading to anemia (requiring cobalamin injections) and osmotic diarrhea (treated with cholestyramine).

    • Drug-Induced Nutrition Problems: Medications like sulfasalazine or methotrexate may cause folate deficiency. Corticosteroids increase the risk of osteoporosis, requiring calcium and possibly potassium supplements.

    • Enteral Nutrition (EN): Preferred over parenteral nutrition (PN) during acute exacerbations to support the GI tract. High in calories and nutrients, easily absorbed.

    • Food Triggers: No universal triggers; food diaries help identify trigger foods. Patients are advised to avoid or limit problematic foods causing GI distress.

    Nursing Management for IBD

    • Assessment: Table 47.20 outlines subjective and objective data collection (including health history, medications, symptoms, and physical findings).

    • Clinical Problems: Impaired bowel elimination, malnutrition, difficulty coping, and pain are common concerns.

    • Goals: Reduced acute exacerbations, normal fluid/electrolyte balance, pain/discomfort relief, adherence to treatment, nutritional balance, and improved quality of life.

    • Acute Care: Focus is on hemodynamic stability, pain control, fluid/electrolyte balance, and nutritional support. Monitor intake/output, stool characteristics, blood in stool/vomitus, and vital signs. Educate on position changes with orthostatic hypotension. Prioritize meticulous perianal skincare. Consult with nutritionists.

    • Postoperative Care: Similar to general postoperative care for bowel surgeries (outlined in Chapter 20).

    • Ambulatory Care: Importance of patient education about the chronic nature of IBD, including rest, diet, perianal care, drug action/side effects, symptom recognition, when to seek care, and stress reduction techniques. Resources like the Crohn's and Colitis Foundation are recommended. Build rapport, encourage self-care, and discuss smoking cessation in Crohn's patients. Help set realistic goals.

    • Dealing with Disease Complications: Assess and address concerns related to fatigue, sleep disturbances, nutrition deficiencies, and anxiety. Recommend stress management techniques and support groups.

    • Evaluation: Expected outcomes include reduced diarrhea, normal body weight, pain/discomfort relief, and effective coping mechanisms.

    Geriatric Considerations for IBD

    • Second Peak in Occurrence: Sixth decade of life. Clinical course and natural history similar to younger patients but proctitis/left-sided UC might be more common.

    • Diagnostic Challenges: Can be confused with other conditions like colitis, diverticulitis, or Clostridium difficile infection (CDI) in older adults.

    • Increased Risks: Drug therapy and surgery have higher risks for adverse events, hospitalization, and mortality. Immunomodulator and biologic therapies have increased risk of infection and cancer. IBD patients are at higher risk for anemia and malnutrition and fluid loss from diarrhea.

    • Functional Limitations: May need assistance with managing fecal urgency and frequent trips to the bathroom.

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    Description

    This quiz covers surgical interventions for Inflammatory Bowel Disease (IBD), focusing on Ulcerative Colitis and Crohn's Disease. Understand the indications for surgery, common procedures involved, and the complications that may arise post-surgery, such as Short Bowel Syndrome. Test your knowledge on the critical concepts from this essential area of gastrointestinal surgery.

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