Inflammatory

Bowel
Disease

Prepared By:
Michael Francis H. Cahandig, RN, MN
Inflammatory Bowel Disease
Inflammatory Bowel
Disease (IBD)

• 2 Types:
• Crohn’s Disease
• Ulcerative Colitis
• The cause of IBD is still
UNKNOWN.
 Etiology
• Ages between 15-30 and 50-70
• (+) Family history: largest
independent risk factor
• Environmental agents such as
pesticides, food additives, tobacco,
and radiation
• NSAIDs found to exacerbate IBD
Crohn’s Disease
 “Regional Enteritis” or
“Granulomatous Enteritis”
Crohn’s • A subacute and chronic inflammation of
Disease the GI tract wall that extends through all
layers (transmural lesion).
• Can occur anywhere in the GI tract, but
commonly occurs in the distal ileum and,
to a lesser degree, the ascending colon.
• Extension of inflammation into the
mucosa causes:
• Abscess formation
• Fistula
• Fissures
 Clinical Manifestations
(Crohn’s)
• RLQ pain
• Diarrhea (unrelieved by defecation)
• Crampy abdominal pain
• Abdominal tenderness & spasm
• Weight loss
• Malnutrition
• Anemia
Chronic Symptoms

• Steatorrhea
• Anorexia
• Nutritional deficits
 Pathophysiology
Begins with edema and thickening of the
mucosa

Ulcers begin to appear on the inflamed mucosa.

These lesions are not in continuous contact with

one another and are separated by normal tissue
(“cobblestone” appearance)
 Pathophysiology

Fistulas, fissures, and abscesses form as the

inflammation extends into the peritoneum

As the disease advances, the bowel wall

thickens and becomes fibrotic, and the
intestinal lumen narrows.
Diseased bowel loops sometimes adhere to
other loops surrounding them.
 Assessment &
Diagnostic Findings

• Proctosigmoidoscopy
• Fecal Occult Blood Test (FOBT)
• Barium study of the upper GI
tract
• Endoscopy
• Colonoscopy
 Assessment &
Diagnostic Findings

• Intestinal biopsies
• Barium enema
• Complete blood count
• Hematocrit & Hemoglobin (usually
decreased)
• WBC (usually elevated)
Complications
Ulcerative Colitis
 Ulcerative Colitis
• Recurrent ulcerative and inflammatory
disease of the mucosal layer of the colon
and rectum
• Begins from the rectum and eventually
affects entire colon
• Characteristics:
• Multiple continuous ulcerations
• Diffuse inflammations
• Desquamation of colonic epithelium
Etiology

• Infection
• Allergy
• Autoimmune
• Incidence:
• Caucasians
• Jews
 Clinical Manifestations

• Diarrhea
• Passage of mucus and pus
• LLQ abdominal pain
• Intermittent tenesmus
• Rectal bleeding
• Anorexia
• Weight loss
• Fever
 Clinical Manifestations

• Vomiting
• Dehydration
• Cramping pain
• The feeling of an urgent need to
defecate
• Passage of 10 to 20 liquid stools
each day
• Rebound tenderness may occur
in RLQ
 Extraintestinal
manifestations:
Clinical • Skin lesions (erythema
Manifestations nodosum)
(Ulcerative • Eye lesions (uveitis)
Colitis) • Joint abnormalities (eg,
arthritis)
• Liver disease
 Pathophysiology

Ulcerations cause bleeding of the

mucosal walls of the intestine
Mucosa becomes edematous and
inflamed
Lesions are contiguous, occurring one
after the other fat deposits.
 Pathophysiology

Abscesses form, and infiltrate is seen in the

mucosa and submucosa, with clumps of
neutrophils found in the lumens of the crypts
Begins in the rectum and spreads proximally to
involve the entire colon.

Eventually, the bowel narrows, shortens, and

thickens because of muscular hypertrophy and fat
deposits.
 Assess for tachycardia,
hypotension, tachypnea, fever,
and pallor
Assessment
and
Diagnostics Assess the level of hydration
and nutritional status
Findings
The abdomen is examined for
bowel sounds, distention, and
tenderness.
 Assessment &
Diagnostic Findings

• Laboratory Tests
• Stool Exam
• Fecal Occult Blood Test
(FOBT)
• Abdominal X-ray Studies
• Sigmoidoscopy or
colonoscopy
• Barium enema
Complications

Toxic megacolon

Perforation

Bleeding
Toxic Megacolon Symptoms
include:
•Fever
•Abdominal pain
and distention
•Vomiting
•Fatigue
 • GOALS:
• Reducing inflammation
• Suppressing inappropriate immune
responses
Medical • Providing rest for a diseased bowel so
Management that healing may take place
• Improving quality of life
• Preventing or minimizing
complications
 Medical Management

• Nutritional Therapy
• Oral fluids and a low-residue,
high-protein, high-calorie diet
with supplemental vitamin
therapy and iron replacement
• IV therapy for dehydration and
fluid & electrolyte imbalance
• BRAT diet (Bananas, Rice,
Applesauce, Toast)
 • Pharmacologic Therapy
• Antidiarrheals
Medical • Antiperistalsis
Management • Aminosalicylates (Sulfasalazine)
• Corticosteroids (Prednisone/Hydrocortisone)
• Immunomodulators (Azathioprine, Mercaptopurine,
Methotrexate, Cyclosporine)
 Surgical
Management
• Laparoscope-guided
strictureplasty
• Intestinal transplant
• Proctocolectomy with ileostomy
• Total Colectomy With Ileostomy
• Continent Ileostomy
• Restorative Proctocolectomy With
Ileal Pouch Anal Anastomosis
 Nursing Diagnosis
• Diarrhea related to the inflammatory process
• Acute pain related to increased peristalsis and GI
inflammation
• Deficient fluid volume related to anorexia, nausea, and
diarrhea
• Imbalanced nutrition, less than body requirements,
related to dietary restrictions, nausea, and
malabsorption
• Activity intolerance related to generalized weakness
• Risk for impaired skin integrity RT malnutrition and
diarrhea
 Nursing Interventions
Maintaining Normal Elimination Patterns

Relieving Pain

Maintaining Fluid Intake

Maintaining Optimal Nutrition

Promoting Rest