Cronhns

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CronhnsUlcerative Colitis
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What are these diseases?

• Crohns
• Inflammation of segments of the GI tract in any
  part. Primarily the small intestine or colon.
• Affects ages 15-30yrs
• In the early stages tiny ulcers form on various
  parts of the intestinal wall, over time
  horizontal rows of these ulcers fuse with
  vertical rows causing mucus to take on a
  cobblestone appearance

• Ulcerative Colitis
• Twice that of Crohns
• Common enteric bacterium E.coli
• Confined to the mucosa and submucosa of the
  colon, starts in the left then moves to the
  right.
• Tiny abscesses form which grow and produce
  purulent drainage, capillaries become friable and
  blood causing diarrhea and pus.

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Pictures!!

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Clinical Manifestations

• Crohns
• Onset is usually insidious with nonspecific
  complaints of diarrhea,fatigue abdominal pain
  weight loss and fever,dehydration,malnutrition,ane
  mia and increased peristalsis

• Ulcerative colitis
• Diarrhea is a predominate sign
• Usually 15-20 liquid stools a day containing
  blood, mucus and pus.
• Abdominal cramps
• Involuntary leakage of stools
• May include toxic megacolon ( toxic dilation of
  large bowel) a lifethreating condition.

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What should we look for in Crohns??

• Subjective
• Weakness
• Loss of appetite
• Abdominal pain and cramps
• Low grade fever
• Stress

• Objective
• Complaints of diarrhea
• 3-4 semisolid stools daily containing mucus and
  blood

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What should we look for in Ulcerative Colitis?

• Subjective
• Rectal bleeding
• Abdominal distention
• Lethargy
• Unpredictable bowel movements

• Objective
• Weight loss
• Abdominal distention
• Fever
• Leukocytosis
• Tachycardia

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Sigmoidoscopy and Colonoscopy

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Tests

• Crohns
• Colonoscopy with multiple biopsies of the colon
• Granulomas in the biopsy specimen confirm Crohns

• Ulcerative Colitis
• Barium studies of the intestine
• Sigmoidoscopy
• Colonoscopy with possible biopsy
• Radiological examination of the abdomen

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How you would treat these diseases?

• Drug therapy
• (1) drugs that affect the inflammatory
  response. Corticosteriods
• (2) Antibacterial drugs
• (3) Drugs that affect the immune system
• (4) Antidiarrheal preparations. Lomotil
• -Remission pills such as Mesalmine
• Surgical Interventions
• Iiestomy
• Proctocolectomy
• Colon resection
• Kock pouch

• Diet therapy
• Exclude milk products and highly spicy foods
• High protein and high calorie diet
• Exclude caffeine

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Interventions as a nurse

• Nutrition, fluid balance, elimination,
  medications, psychological aspects and sexuality
  must be considered.
• Thorough assessment of patients bowel
  elimination.
• Oral diets of 2500mL per day for fluid loss
• Monitor weight
• Record IO at least 1500mL per day
• Support Support Support!!

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Prognosis

• A patient with chronic ulcerative colitis is
  directly related to the number of years they have
  had the disease.
• List of food that are known to cause
  constipation,diarrhea, blockage,odors, and flatus
  is helpful for the patient

• Crohns disease is a chronic disorder and has a
  high rate of recurrence in pats under 25 yrs.
• Prognosis depends on the extent of
  involvement,duration of illness, and success of
  medical intervention. No known therapy will
  maintain a patient with Crohns disease in
  remission.

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?Review Questions?

• 1) What is the lifethreating complication that
  can occur in UC?
• Abdominal distention
• Low grade temp
• Toxic megacolon
• All of the above

• 2) A high ____ and _____ diet should be consumed
  with Crohns and Ulcerative Colitis.