Cronhns&

Ulcerative Colitis

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.

Pictures!!

Clinical Manifestations

Crohns• Onset is usually insidious

with nonspecific complaints of diarrhea,fatigue abdominal pain weight loss and fever,dehydration,malnutrition,anemia 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.

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

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

Sigmoidoscopy and Colonoscopy•

•

Tests

Crohn’s• 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

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

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 I&O at least 1500mL per day• Support Support Support!!

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 Crohn’s disease in remission.

Review Questions

1) What is the lifethreating complication that can occur in UC?

a) Abdominal distention

b) Low grade temp

c) Toxic megacolon

d) All of the above

2) A high ____ and _____ diet should be consumed with Crohn’s and Ulcerative Colitis.