INFLAMMATORY BOWEL CONDITIONS

Inflammatory Bowel Disease (IBD)

a. Crohn’s disease
b. Ulcerative Colitis

Inflammatory Bowel Disease (IBD)

• A group of chronic disorders resulting in inflammation or ulceration of the bowel
lining
• Cause: unknown
• Triggered by environmental agents (pesticides, food additives, tobacco,
radiation), NSAIDS, allergies, immune disorders
• Predisposing factors:
o 15 -30 y.o. ; 50-70 y.o.
o Genetic

Crohn’s Disease (Regional Enteritis)

• Chronic inflammation of the GIT wall that extends through all layers
• Prevalence: Adolescents or young adults; smokers

Ulcerative Colitis
• A recurrent ulcerative and inflammatory disease of the mucosal and submucosal
layers of colon and rectum
• Prevalence: Caucasians, Jews

Crohn’s Disease Ulcerative Colitis

Part affected Ileum, ascending colon Rectum, colon (mucosal &

(transmural inflammation) submucosal inflammation)

Characteristic of discontinuous continuous

lesion
Predominant Crampy RLQ abdominal Diarrhea, passage of mucus
symptoms pain, diarrhea, steatorrhea, and pus, LLQ pain,
anorexia, weight loss, intermittent tenesmus, rectal
malnutrition, anemia bleeding, anorexia, weight
loss, anemia, fever, vomiting
Complications Intestinal obstruction, perianal Anemia, abscesses, toxic
dse, F&E imbalances, fistulas, megacolon, perforation,
fissures, abscesses bleeding

Risk of increased increased

developing colon
cancer

Other Accompanied by systemic

characteristics manifestations
High mortality rate

Crohn’s Disease (Regional Enteritis)

• Assessment and Diagnostic findings:
 o Proctosigmoidoscopy (rectosigmoid area inflammation)
o Stool examination
▪ (+) occult blood
▪ (+) steatorrhea
o Barium swallow (most conclusive): classic “string sign” on x-ray
o Endoscopy, colonoscopy, intestinal biopsies
o Barium enema: ulcerations, fissures & fistulas
o CT scan: bowel wall thickening and fistula formation
o Decreased Hct and Hgb
o Increased WBC and ESR
o Decreased albumin and protein levels

Ulcerative Colitis
• Assessment and Diagnostic findings:
o Systemic manifestations: tachycardia, hypotension, tachypnea, fever and
pallor
o Stool: (+) for blood
o CBC: low Hct & Hgb, increased WBC
o Low albumin
o Sigmoidoscopy, colonoscopy : inflamed mucosa with exudate and
ulceration
o Barium enema: shortening of bowel
o CT scan, MRI, ultrasound: abscesses and perirectal involvement

Management Goals for IBD

• Reduce inflammation
• Suppress inappropriate immune responses
• Provide rest to the bowel
• Improve quality of life
• Prevent or minimize complications

Management for IBD

• Nutritional Therapy
o Oral fluids
o Low residue, high-protein, high-calorie diet
o Vitamin supplementation
o Iron replacement
o Avoid foods/activities that exacerbate diarrhea
o Parenteral nutrition

• Pharmacologic Therapy
o Sedatives and antidiarrheal agents - peristalsis (rest the bowel)
o Aminosalicylates: sulfasalazine: to decrease inflammation
o Prednisone; hydocortisone; budesonide (Entocortec): if severe and
fulminant
o Immunomodulators: natalizumab (Crohn’s); infliximab (ulcerative colitis)
 • Surgical (Crohn’s disease)
o Laparoscope-guided strictureplasty – the
blocked or narrowed sections of the intestines
are widened, leaving the intestine intact
o Small bowel resection
o Total colectomy with
ileostomy
o Intestinal transplant

• Surgical (Ulcerative colitis)

o Total colectomy with ileostomy
o Proctocolectomy with ileostomy
o Restorative proctocolectomy with
ileal pouch anal anastomosis (IPAA)

NURSING INTERVENTIONS
a. Maintain normal elimination patterns
• Ready access to bathroom, commode, or bedpan
• CFAC of stools
• Bed rest
• Administer anticholinergic agents 30 mins before a meal
b. Relieve pain
• Pain assessment
• Interventions for pain
c. Maintain fluid intake
• Accurate I&O
• Monitor daily weight
• Assess for s/s of FVD
d. Maintain optimal nutrition
• Small frequent feeding
• Parenteral nutrition
• Glucose monitoring
e. Promote rest
• Activity restrictions
• Active or passive ROM exercises
f. Reduce anxiety
g. Enhance coping measures
• Stress reduction techniques
• Counseling
h. Prevent skin breakdown
• Perianal care
• Relieve pressure on bony prominences
i. Monitor and manage potential complications
j. Patient teaching