Crohn's Disease & Ulcerative Colitis PDF

INFLAMMATORY BOWEL DISEASES CROHN’S DISEASE & WMSU ULCERATIVE COLITIS WESTERN MINDANAO STATE UNIVERSITY  DEFINITION Crohn's disease is a chronic inflammatory bowel Ulcera...

INFLAMMATORY BOWEL DISEASES CROHN’S DISEASE & WMSU ULCERATIVE COLITIS WESTERN MINDANAO STATE UNIVERSITY  DEFINITION Crohn's disease is a chronic inflammatory bowel Ulcerative colitis is another form of inflammatory disease (IBD) that causes inflammation of the digestive bowel disease, but it is limited to the colon (large tract. It can affect any part of the gastrointestinal (GI) intestine) and rectum. It is characterized by tract from the mouth to the anus, but it most commonly inflammation and ulcers in the innermost lining of impacts the small intestine and the beginning of the the colon. Unlike Crohn's disease, which can affect large intestine (colon). The inflammation in Crohn's any part of the GI tract and can cause deeper disease can penetrate deeper into the layers of the bowel tissue damage, ulcerative colitis typically causes wall, leading to complications such as strictures, fistulas, continuous inflammation in the colon. and abscesses.  CAUSES Faulty Immune systems Diet Dairy Products Environmental gfactors Stress Viral or Bacterial Infections Smoking Abuse of NSAIDs Genetics  PATHOPHYSIOLOGY Happens anywhere along the Stays in the colon GIT Inflammation extends “Skip Lesions” cobblestone continuously appearance Starts in the rectum Commonly affects the Ileum Follows a relapsing and Follows a relapsing and remitting course, with remitting course, with periods periods of flare-ups and of flare-ups and remission. remission.  PATHOPHYSIOLOGY Immune Dysregulation (TH1 cells, TNF-α) Chronic Inflammation Ulcerations: Deep sores that form along the GI tract. (Granulomas, Transmural Ulceration) Strictures: Narrowing of the bowel due to scar tissue and fibrosis. Fistulas: Abnormal connections between the intestine and other organs, or between two parts of the intestine. Abscesses: Pockets of infection that can form due to tissue damage. Nutritional Malabsorption PATHOPHYSIOLOGY  PATHOPHYSIOLOGY Immune Dysregulation ( T-helper 2 Th2) Mucosal Inflammation (Starts in the rectum) Ulceration and Erosion (Submucosal Ulcers) Crypt Abscess Formation Loss of Mucosal Barrier Colonic Dysfunction (Diarrhea and bloody stools) Complications (Colon cancer, Strictures ,pseudopolyps) CLINICAL MANIFESTATIONS Patches COMMON CLINICAL MANIFESTATIONS Chronic Inflammation Abdominal Pain Weight Loss Diarrhea Fatigue Fever EXTRA-INTESTINAL MANIFESTATIONS Skin and Eye lesion Joint abnormalities Liver disease  DIAGNOSTIC DIAGNOSTIC Crohn's Disease Ulcerative Colitis EVALUATION Positive for occult blood & steatorrhea Stool Examination Positive for blood, mucus, and pus (fat in stool) Inflamed rectosigmoid Inflamed rectum & rectosigmoid colon Proctosigmoidoscopic Examination  DIAGNOSTIC DIAGNOSTIC Crohn's Disease Ulcerative Colitis EVALUATION "string sign" in terminal ileum & Mucosal irregularities, fistulas, shortened colon, cobblestone ulceration and bowel dilation Barium Study of Lower GI Tract  DIAGNOSTIC DIAGNOSTIC Crohn's Disease Ulcerative Colitis EVALUATION Shows fissures and fistulas Friable, inflamed mucosa with exudate and ulcerations Endoscopy  DIAGNOSTIC DIAGNOSTIC Crohn's Disease Ulcerative Colitis EVALUATION Colonoscopy, Abscesses & perirectal ulceration, lead pipe sign Intestinal Shows fissures and fistulas Biopsy Bowel wall thickening, strictures, and fistula CT Scan, MRI, Ultrasound  LABORATORY LABORATORY EVALUATION Crohn's Disease Ulcerative Colitis Complete Blood Count (CBC) Decreased hematocrit & hemoglobin levels White Blood Cell Count Increased Sedimentation Rate Increased Albumin and Protein Levels Decreased  TREATMENT CROHN’S DISEASE AND ULCERATIVE COLITIS Goal: Treatment for both is aimed to 1. REDUCE inflammation 2. SUPPRESS inappropriate immune response 3. Provide REST for a diseased bowel so that healing may take place 4. PREVENT or minimize complications to improve quality of life  MEDICAL MANAGEMENT 1. Medications 1. Medications - Anti-Inflammatory Drugs, Corticosteroids, Immunosuppressants , Anti-TNF - Anti-Inflammatory Drugs, Corticosteroids, Immunosuppressants , Anti-TNF Agents Agents (Tumor Necrosis Factor) & Antibiotics (Tumor Necrosis Factor), Integrin Inhibitors, JAK Inhibitors (Janus tyrosine kinase) & Antibiotics For Relief: Antidiarrheals & Pain Relievers For Relief : Antidiarrheals & Pain Relievers 2. Nutritional Suppor - Dietary Modifications & Nutritional Supplements ( Enteral Nutrition and Vitamin 2. Nutritional Support and Mineral Supplements) - Dietary Modifications & Nutritional Supplements Vitamin and mineral supplements to address deficiencies, particularly in patients with significant diarrhea or 3. Monitoring and Follow-Up malabsorption (e.g., iron, calcium, vitamin D). - Blood tests, Imaging Studies & Endoscopy 3. Monitoring and Follow-Up 4. Surgery for Crohn’s Disease - Blood tests, Imaging Studies & Endoscopy - Complications such as strictures, fistulas, abscesses, or severe disease that doesn't respond to medical therapy 4. Surgery for Ulcerative Colitis - Severe disease unresponsive to medical treatment, complications such as Resection - Removing affected segments of the intestine perforation, or dysplasia/cancer Strictureplasty - Widening narrowed areas of the intestine without removing segments. Colectomy - Removal of the colon, which can be curative for UC. Options include: Ileostomy - Creation of an opening in the abdomen for waste elimination. Ileoanal Pouch - A pouch created from the small intestine and connected to the 5. Lifestyle Changes anus, allowing for more normal bowel function. 5. Lifestyle Changes MEDICAL MANAGEMENT  PHARMACOLOGIC MANAGEMENT Crohn's disease and ulcerative colitis are both types of inflammatory bowel disease (IBD), but their pharmacologic management differs due to variations in the disease's location and behavior. AMINOSALICYLATES (5ASA) Less effective for Crohn’s disease but may be used in mild to severe cases especially when the disease is confined in the colon. First-line treatment for inducing and maintaining remission in mild-to-moderate cases of ulcerative colitis. mesalamine, sulfasalazine CORTICOSTEROIDS Used for inducing remission in moderate to severe cases of both diseases. oral prednisone and intravenous methylprednisolone IMMUNOMODULATORS Used for maintenance therapy in both disease to reduce corticosteroid dependence. Maintaining remission in patients who are corticosteroid-dependent or who have not responded adequately to aminosalicylates. azathioprine, 6-mercaptopurine (6-MP), and methotrexate ANTIDIARRHEAL AND ANTIPERISTALTIC Slow down gut motility and can be used cautiously in patients with ulcerative colitis and Crohn's disease to manage diarrhea loperamide and diphenoxylate  PREVENTIVE MANAGEMENT CROHN’S DISEASE ULCERATIVE COLITIS Cannot be prevented, but can be manage through: 1.Medications 1. Medications 2.Diet 2. Dietary Management: Mediterranean diet: This diet is rich in fruits, vegetables, Identify triggers whole grains, and healthy fats. Balanced diet Anti-inflammatory diet: fruits and vegetables, and Stay hydrated incorporating anti-inflammatory spices like ginger, 3. Regular Monitoring turmeric, and paprika; limits intake of red meat, full-fat 4. Stress Management dairy products, and fried foods. 5. Exercise Avoiding alcohol: Avoiding or limiting your intake of 6. Supplements alcohol can help reduce or prevent inflammation. Vitamins and minerals (such as vitamin D, calcium, 3. Exercise and B12) if deficiencies are identified. 4.Stress Management 7. Smoking Cessation 5. Education 8. Vaccinations 9. Emotional, mental support  COMPLICATIONS CROHN’S DISEASE vs ULCERATIVE COLITIS Intestinal Complications Intestinal Complications Stenosis, Abscesses and Strictures Toxic megacolon and colorectal are more common. cancer Perforation leading to intra-abdominal Vascular engorgement and highly and perianal abscess and disease vascular granulation tissue. Increased risk for colon cancer from Perforation and bleeding fistula and abscess formation Extraintestinal Complications Extraintestinal Complications Fluid and electrolyte imbalances Fluid and electrolyte imbalances malnutrition from malabsorption, malnutrition from malabsorption, secondary anemia, risk of osteoporosis, secondary anemia, risk of osteoporosis, skin problem and eye problem. skin problem and eye problem.  NURSING MANAGEMENT Nursing Dx: Activity Intolerance Related to Nursing Dx: Acute Pain Related to Increased Generalized Weakness Peristalsis and GI inflammation Nursing Interventions: Nursing Interventions: Assess activity tolerance: Monitor ADL Pain Assessment: Pain Scale (0-10) Promote rest periods: to prevent fatigue Administer medications: Analgesics & antispasmodics Gradual increase in activity: short walks/light exercise Encourage comfort measures: Heat application & Encourage use of assistive devices : wheelchair, relaxation techniques stand-lean stool Positioning: sim’s position Nursing Dx: Anxiety Related to Impending Surgery Nursing Dx: Deficient Fluid, volume related to Nursing Interventions: anorexia, nausea, and Diarrhea Provide Information: clear & concise Nursing Interventions: info(Perioperative) Monitor fluid I & O: accurate records Encourage expression of feelings: fears & concerns Administer Iv Fluid: IV hydration as prescribed Teach relaxation techniques: deep breathing Assess electrolyte levels: Check lab. results exercises Encourage oral hydration solutions: to replenish lost involve family: Support system fluids.  NURSING MANAGEMENT Nursing Dx: Diarrhea related to the inflammatory process Nursing Dx: Ineffective coping related to repeated Nursing Interventions: episodes of diarrhea Monitor stool characteristics: blood or mucus Nursing Interventions: Maintain fluid and electrolyte balance Assess the patient’s coping mechanisms: evaluate Assess nutritional status: small frequent meals & low current coping strategies fiber diet Encourage verbalization of feelings: frustration and Promote rest and stress reduction: to minimize anxiety symptoms exacerbation Health education on disease process: involve family and friends Nursing Dx: Risk for impaired skin integrity related to Nursing Dx: Risk for ineffective therapeutic regimen mgt. malnutrition and diarrhea related to insufficient knowledge concerning the process Nursing Interventions: and mgt. of the disease Maintain hydration: decreased risk of skin breakdown Nursing Interventions: Promote perianal skin care: warm water, mild soap, Health teaching (including family or caregivers) cream/ointment disease process, medications, lifestyle modification Encourage frequent position changes: maintain skin integrity  THANK YOU! WMSU WESTERN MINDANAO STATE UNIVERSITY