Crohn's and Colitis Canada Presentation PDF

Acute inflammatory bowle disease Crohn’s disease and Ulcerative colitis  Acute inflammatory bowle disease At the end of this lecture, the student will be able to: Define enteritis (Crohn’s disease )and ulcerative colitis. Describe enteritis(Crohn’s disease )and ulcerative colitis wi...

Acute inflammatory bowle disease Crohn’s disease and Ulcerative colitis  Acute inflammatory bowle disease At the end of this lecture, the student will be able to: Define enteritis (Crohn’s disease )and ulcerative colitis. Describe enteritis(Crohn’s disease )and ulcerative colitis with regard to their pathophysiology. Describe clinical manifestations. Identify diagnostic evaluation. Discuss management of patient with enteritis and ulcerative colitis. Explanation of IBD Diseases that inflame the lining of the GI (gastrointestinal) tract Disrupt body’s ability to digest food, absorb nutrition and eliminate waste Crohn’s disease and ulcerative colitis are the two main forms of inflammatory bowel disease (IBD) Review of GI System a finely balanced system of tunnels that starts at your mouth and ends at your anus  Introduction: Crohn’s disease & ulcerative colitis are immunologically related disorders that are referred to as inflammatory bowel diseases (IBD). These disorders are characterized by chronic recurrent inflammation of the intestinal tract. Definition of Crohn’s disease : Is a chronic idiopathic inflammatory disease that can affect any part of the alimentary canal, usually the small and large intestines. Definition of ulcerative colitis : Is a chronic idiopathic inflammatory disease of the mucosa and, less frequently, the submucosa of the colon and rectum Etiology The cause of inflammatory bowel diseases (IBD) remains unknown. Possible causes include: - Viral or bacterial organisms. - Immunologic disorders. - Dietary factors (chemical food additives, heavy metals, low fiber). - Allergy to substances that release inflammatory histamine. - Enzyme overproduction that ulcerates mucous membranes. - Family history of disease. Differences between Crohn’s and Colitis With Crohn’s disease, inflammation can occur anywhere in the GI tract but is usually present in the lower part of the small bowel and the colon Ulcerative colitis only affects portions of the large intestine, including the rectum and anus and typically only inflames the innermost lining of bowel tissue Comparison between Crohn's disease and Ulcerative colitis Characteristics Crohn’s disease Ulcerative colitis Incidence Sex: it affects both Sex: equal between sexes equally. sexes Age:between 15 and Age: Peak at 20 to 35 years of age 40 years of age Location Ileum,right colon Rectum &left colon Comparison between crohn's disease and ulcerative colitis Characteristi Crohn’s disease Ulcerative colitis cs  Early Acute Clinical Mild, nonbloody diarrhea, Frequent bloody diarrhea manifestation Fatigue, anorexia, Vague, Abdominal pain and intermittent abdominal pain cramping that’s relieved with s defecation ,Fatigue,anorexia,weight loss,low grade fever Nausea & vomiting  Comparison between crohn's disease and ulcerative colitis Characteristics Crohn’s disease Ulcerative colitis Progressive Chronic Clinical Severe, constant abdominal pain Malnutrition manifestation and tenderness in RLQ may simulate Dehydration acute appendicitis. pain in LLQ with s Milk products and chemically or palpation mechanically irritating food may Hyperactive bowel aggravate the problem. sounds when inflamed Weight loss, More severe fatigue Moderate fever Skin breakdown in perineal and rectal areas if constant diarrhea Bloody stools Diagnostic evaluation 1. Stool examination to rule out bacillary or amebic dysentery; fecal analysis positive for blood during active disease. 2. Complete blood count hemoglobin and hematocrit may be low due to bleeding, WBC may be increased; increased prothrombin time possible. 3. Flexible proctosigmoidoscopy and/or colonscopy with biopsy confirm diagnosis. 4. Barium enema x-ray to assess extent of disease and detect carcinoma, and strictures. 5. Decreased serum levels of potassium, magnesium, and albumin may be present  Management: General measures: 1. Bed rest, IV fluid replacement, clear liquid diet. 2. For patients with severe dehydration and excessive diarrhea, hyperalimentation is recommended to rest the intestinal tract and restore nitrogen balance. 3. Treatment of anemia—iron supplements for chronic bleeding, blood replacement for massive bleeding. 4. Encourage fluids to 3000 ml/day 5. Prevent skin breakdown by keeping skin clean, using skin protectant sprays 6. Balance rest with activity Cont. 1. Monitor calorie intake vs calorie need 2. May need to be NPO to rest gut with TPN during acute exacerbations 3. Diet is low-fiber, low-fat, high-calorie, high-protein, lactose-free 4. Non-pharmacologic pain management strategies 5. Anti-inflammatory agents 6. Sulfasalazine (Azulfidine) probably due to inhibition of prostaglandin synthesis Corticosteroids for acute forms Complications 1.Perforation, hemorrhage, toxic megacolon 2.Abscess formation, stricture, anal fistula 3.Malnutrition, anemia, electrolyte imbalance 4.Skin lesions (erythema nodosum, pyoderma gangrenosum) 5.Arthritis, ankylosing spondylitis 6.Colon malignancy 7.Liver disease Nursing assessment - Assess frequency and consistency of stools to evaluate volume losses and effectiveness of therapy. - Have the patient describe the location, severity, and onset of abdominal cramping or pain. - Ask the patient if there has been recent weight loss and weigh daily to monitor changes. - Have the patient describe types of foods eaten to elicit dietary exacerbations. Listen for hyperactive bowel sounds, assess weight Nursing diagnoses: 1. Pain related to disease process 2. Altered nutrition, less than body requirements, related to diarrhea, nausea, and vomiting 3. Fluid volume deficit related to diarrhea and loss of fluid and electrolytes 4. Risk for Infection related to disease process, surgical procedures 5. Ineffective individual Coping related to fatigue, feeling of helplessness, and lack of support system 6. Impaired skin integrity R/T diarrhea, poor nutritional intake (and ileostomy drainage if have surgery) Nursing interventions: A. Promoting comfort: - Follow prescribed treatment of reducing or eliminating food and fluid and instituting parenteral feeding or low-residue diets to rest the intestinal tract. - Give sedatives and tranquilizers, as prescribed, not only to provide general rest, but also to slow peristalsis. - Be aware of the possibility of pressure sores because of malnourishment and enforced inactivity, especially if patient is thin. Cleanse the skin gently after each bowel movement. Apply a protective emollient, such as petrolatum jelly, skin sealant, or moisture-barrier ointment. Cont. - Relieve painful rectal spasms (produced by frequent diarrheal stools) with anodyne suppositories, as prescribed. - Report any evidence of sudden abdominal distention—may indicate toxic megacolon. - Reduce physical activity to a minimum or provide frequent rest periods. - Provide commode or bathroom next to bed, because urgency of movements may be a problem Patient education/ health maintenance - Teach patient about chronic aspects of ulcerative colitis and each component of care prescribed. - Encourage self-care in monitoring symptoms, seeking annual checkup, and maintaining health. - Alert patient to possible postoperative problems with skin care, aesthetic difficulties, and surgical revisions. - Inform patients that any early indications of relapse, such as bleeding or increased diarrhea. Encourage patient to become a resource person for others undergoing similar procedure WHERE TO LEARN MORE Crohn’s and Colitis Canada (Canada)– http://www.crohnsandcolitis.ca/ Canadian Digestive Health Information (Canada)– www.cdhf.ca Canadian Society of Intestinal Research (Canada) – www.badgut.org University of Saskatchewan Multidisciplinary Inflammatory Bowel Disease Clinic (Saskatoon)– www.mdibdc.com Crohn’s and Colitis Foundation of America (USA) – www.ccfa.org National Digestive Diseases Information Clearinghouse (USA) – www.digestive.niddk.nih.gov Alberta IBD consortium (Canada) – www.albertaibdconsortium.ca McGill IBD Research Group (Canada)– www.mcgillibd.ca  Feed back Crohn’s disease can be described as a chronic idiopathic inflammatory disease. Which of the following areas in the alimentary canal system may be involved with this disease? Low a. Usually the small and large intestines. b. The entire length of the large colon. c. The sigmoid part of the intestine. d. The entire large colon through the layers of mucosa Which area of the alimentary canal is the most common location for Crohn’s disease? Low a. Ascending colon b. Descending colon c. Sigmoid colon d. Ileum,right colon Cont. Which area of the intestinal tract is the most common site for Ulcerative colitis? Low a. Transvers colon b. Descending part of large intestine c. Mucosa and the submucosa of the colon d. Ileum, and right colon Which of the following factors is believed to be aggravated to Crohn’s disease?Low a. Constipation b. Mechanical irritating food c. Hereditary d. Lack of exercise Thank You! Questions?