# Inflammatory Bowel Disease
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**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.
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