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General info about Inflammatory Bowel Disease
- What? Chronic Inflammation of the GI tract
- --Chron’s or Ulcerative Colitis
- --Autoimmune disease
- Who? Teenager, Young Adult, Peak 6th decade
- Whites (Jewish), susceptibility gene
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Chrone's vs. Ulcerative colitis
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Clinical manifestations of inflammatory bowel disease
- Diarrhea, bloody stools, weight loss, abdominal pain, fever, fatigue
- Chronic with mild to severe exacerbations
- Chron’s: colicky abdominal pain
- Ulcerative Colitis: abdominal cramping w/ diarrhea
- Mild: 1-2 semiformed stools daily, small amt blood
- Moderate: 4-5 stools daily, increased bleeding, systemic symptoms (fever, malaise, anorexia)
- Severe: 10-20 bloody stools/day, fever, weight loss greater than 10%=anemia, tachycardia, dehydration
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Complications assocaited with infammatory bowel disease
- Hemorrhage
- Strictures
- Perforation (peritonitis)
- Fistulas
- Colonic dilation
- --Toxic Megacolon
- --Ulcerative Colitis
- Nutritional deficiencies
- Colorectal Cancer
- Systemic Complications
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Diagnostics involved with IBD
- CBC
- Lytes
- Erythrocyte Sedimentation Rate (ESR)
- Sigmoidoscopy
- Colonoscopy
- Double contrast barium enema
- Capsule endoscopy
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Collaborative care of pt w/IBD
- Goals of treatment
- Rest bowel, no eating for a bit.
- Control inflammation
- Combat infection, ie flagel
- Correct Malnutrition. v fat.
- Alleviate Stress
- Symptomatic relief
- Improve quality of life
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Rx Therapy for pt w/IBD
- Aminosalicylates (decrease inflammation
- --Sulfasalazine (Azulfidine), mesalamine (Pentasa)
- Antimicrobials
- --Metronidazole (Flagyl), Ciprofloxacin (Cipro)
- Corticosteroids (decrease inflammation)
- --Methylprednisolone, prednisone, budesonide (Entocort)
- Immunosuppressants
- --Aziathioprine (Imuran), Methotrexate, Cyclosporine
- Biologic and targeted therapy
- --Infliximab (Remicade), Adalimumab (Humira)
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Surgical therapy for pt w/IBD
- Total Colectomy
- w/ Ileoanal Reservoir
- Total Proctocolectomy
- w/ permanent Ileostomy
- Total Proctocolectomy
- w/ continent Ileostomy
- (Koch Pouch)
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Post surgical care for pt w/IBD
- Postsurgical Care
- Peristomal skin care
- Wound/Ostomy
- (enterostomal) nurse
- Monitor output
- Assess for:
- Obstruction
- Abscess
- Hemorrhage
- Dehydration
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Nutritional tx for pt w/IBD
Nutritional Therapy
- Consult Dietician
- Cobalamin replacement
- Fat malabsorption=Cholestyramine
- Folic Acid
- Calcium (if corticosteroids)
Avoid high fat, cold, high fiber foods
- No smoking
- Parenteral/Enteral Nutrition
- Iron supplements
- Potassium Supplement (corticosteroids)
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