# Inflammatory Bowel Disease --- **Inflammatory bowel disease** is a condition that affects the [[large intestine]]. It comes in one of two kinds, **Chron's disease** and **ulcerative colitis**. While they share some simulariites, they are quite different and their treatments are different as well. ![[IBD.png]] ## Crohn's Disease **Chron's disease** has an unknown cause, but it's believed to be a hyperactive [[adaptive immune system|immune response]] (i.e. there is no off-switch for the inflammatory response). There is no cure. ### Signs & Symptoms Chron's disease primarily affects the ileum and ascending colon, which affects the individual's ability to absorb nutrients. Acute flaireups of Chron's disease can present with: - RLQ pain - abdominal tenderness/crampy pain after eating - diarrhea unrelieved with defecation • Clinical Manifestation- Acute Symptoms • Ileum & ascending colon • RLQ pain and diarrhea unrelieved with defecation • Abd tenderness and crampy pain after eating • Inflamed ulcers leads to weeping, edematous intestines continuously makes irritating discharge • Poor ability to absorb nutrients becasue we absorb a lot in the illium also have peri anal skin tags and hemeroids • Chronic symptoms really need to manage stress • Abdominal pain • Diarrhea • Steatorrhea • Nutritional deficiency need to make sure they're eating bulking stuff • Weight loss • Anorexia. Dx barium studies good CT scan better MRI scan best will see "string sign" • Management • Corticosteroids • Antibiotics • Immunomodulators (methotrexate, cyclosporine) • [[anti-tumor necrosis factors]] (TNF)/monoclonal antibody med • Infliximab (Remicade)-humanized IgG immunoglobulin monoclonal antibody-block immune response-binds/neutralizes to TNF-alpha to decreases inflammation. • Parenteral nutrition avoid caffienen/stimulants • Partial or complete colectomy, with ileostomy or anastomosis ' Complications SBO [[bowel obstruction|small bowel obstruction]] • Right-sided hydronephrosis (kidney problem) • Nephrolithiasis ([[renal calculi|kidney stones]]) • Colon cancer • Cholelithiasis gall stones • Arthritis often in the ankles, knees and hips Uveitis • Erythema nodosum fistulas high risk for blood clots malabsorption issues folate etc ## Ulcerative Colitis Pathophysiology- chronic ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum Periods of exacerbation and remission Edematous and inflamed mucosa Classified as mild, severe, or fulminant -- depending on severity • Bouts of abd cramps and bloody or purulent diarrhea • LLO pain • Intermittent tenesmus having a bowel movement doesn't provide reliefR • Pallor & Anemia • Fatigue • Anorexia & weight loss, hypoalbuminemia Fever • Vomiting • Dehydration & electrolyte imbalance • Six or more liquid stools each day • Skin lesions-erythema nodosum • Eye lesions- uveitis • Joint abnormalities- arthritis Dx • Diagnostic Findings • Abd x-ray • Colonoscopy with biopsy CT, MRI or US • CBC, Albumin, C-reactive protein • Management • Medications- sulfasalazine, corticosteroids, immunomodulators • May need Proctocolectomy with ileostomy- severe symptoms [[ostomy]] this can actually cure the disease sometimes Sulfasalazine Therapeutic class: antirheumatics (DMARD), gastrointestinal anti-inflammatory • Decreases inflammation in UC by acting on inhibition of prostaglandin synthesis , Tablets Common side effects: Headaches, anorexia, diarrhea, NN, rash and fever • Nursing- give with meals; assess for allergies to both sulfonamides and salicylates; monitor CBC & LFT complications Toxic megacolon Perforation Hemorrhage Colon cancer Pyelonephritis Cholangiocarcinoma cancer in the bile duct Arthritis Uveitis Erythema nodosum ## Risk Factors ## Signs & Symptoms ## Diagnostic Tests ## Treatment ## Nursing Considerations for both • Track in **diary bowel patterns**, discomfort, symptoms, complications • Medication monitoring for effectiveness and side effect • Nutrition- depends on course/therapy-may be low-residual (i.e. low fiber), high protein, high calorie • Extra calcium and vitamin D with corticosteroids • Supplementation of vitamins and minerals. UC-probiotics • Avoid food that trigger symptoms • T PN may be need for Crohn's with fistulas, short bowel syndrome, BO. ___