What is Crohn’s Disease characterized by?
Subacute and chronic inflammation of the GI tract wall that extends through all layers
Most commonly occurs in the distal ileum and ascending colon.
What are the common age ranges affected by Crohn’s Disease?
Ages 15 to 40 years
Younger individuals are predominantly affected.
What is the pathophysiology of Crohn’s Disease?
Begins with crypt inflammation and abscesses, leading to small, focal ulcers that deepen into characteristic cobblestone appearance
Fistulas, fissures, and abscesses may form as inflammation extends.
What is Ulcerative Colitis?
A chronic ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum
Characterized by unpredictable periods of remission and exacerbation.
What are the clinical manifestations of Ulcerative Colitis?
- Diarrhea (10-20 stools/day)
- Blood, mucus, and pus in stool
- Left lower quadrant cramping and pain
- Urgent need to defecate/tenesmus
- Fever
- Vomiting
- Anemia
- Fatigue, weight loss
- Hypovolemia
- Nutritional deficits
What laboratory tests are used for IBD?
- CBC
- Serum albumin
- ESR
- Electrolyte panel
- Iron and vitamin B12
- Folic acid
- pANCA (increased with UC)
Stool studies include cultures, ova and parasites, and occult blood of stool.
What are the diagnostic tests for IBD?
- Sigmoidoscopy
- Colonoscopy/capsule endoscopy
- Upper GI, Barium enema
- Abdominal x-ray
- Rectal biopsy
- CT scan and MRI
What is the etiology of Inflammatory Bowel Disease (IBD)?
An autoimmune disease involving an immune reaction to a person’s own intestinal tract
Triggered by environmental factors, genetic predisposition, and altered immune response.
What are common surgical indications for bowel diversions?
- Disease
- Injury
- Cancer
- Inflammatory Bowel Disease
- Ulcerative Colitis
- Crohn’s Disease
- Diverticulitis
What is diverticulitis?
Inflammation of diverticula which may result in perforation into the peritoneum, causing abscesses, fistulas, and bleeding
Can be acute or chronic.
What are the clinical manifestations of diverticulitis?
- Acute pain in LLQ
- Constipation
- Nausea
- Fever
- Leukocytosis
- ABD tenderness, palpable mass (with abscess)
What are the preferred imaging tests for diverticulitis?
- CT scan with oral contrast
- Colonoscopy
- Barium enema
- Sigmoidoscopy when suspecting IBD or cancer
What are the goals of pharmacological management in IBD?
To induce and maintain remission
Includes using aminosalicylates, antimicrobials, corticosteroids, immunomodulators, and biologic therapies.
What are the complications associated with Ulcerative Colitis?
- Hemorrhage
- Abscess formation
- Colonic distention leading to Toxic megacolon
- Malnutrition from malabsorption
- Fluid and electrolyte imbalance
- Bowel obstruction and strictures
- Bowel perforation leading to peritonitis
- Increased risk of colon cancer
- Arthritis and extraintestinal disorders
What is the management for a patient with a colostomy?
- Diet education
- Care of ostomy
- Expectations regarding stoma
What are the signs of a potential complication post-laparoscopic cholecystectomy?
- Bleeding
- Nausea
- Vomiting
- Increasing pain
- Distention of abdomen
What is the typical dietary management for a patient with diverticulitis?
High fiber diet, low fat
Stool softeners and anticholinergics may also be used.
What are the nursing interventions for managing TPN?
- Confirming placement
- Monitoring blood glucose levels
- Two RN check
- Bag is good for 24 hours
- Filter usage
What is total parenteral nutrition (TPN)?
IV solutions providing more than normal caloric intake necessary for patients with malnutrition or malabsorption
Each bag may have approximately 2500 calories over 24 hours.
What is the pathophysiology of diverticulosis?
Diverticula form when the mucosal and submucosal layers of the colon herniate through the muscular wall due to high intraluminal pressure, low volume in the colon, and decreased muscle strength
Bowel contents can accumulate and decompose, causing inflammation.
What are the dietary restrictions for chronic Ulcerative Colitis?
- Avoid milk products
- Avoid pepper
- Avoid caffeine
- Avoid alcohol
- Avoid raw vegetables and fruits
- Avoid cold foods
When can bandages be removed after surgery?
The day after surgery
Followed by the ability to shower.
What signs should be reported after surgery?
Loss of appetite, vomiting, increasing pain, distention of abdomen, bile-colored drainage
These are indicators of potential complications.
What is a possible dietary requirement post-surgery?
Low-fat diet for several weeks
This may be necessary after gallbladder removal.
