2. DEFINITION
ï” CD is a condition of chronic granulomatous inflammation
potentially involving any location of the GIT from mouth to
anus.
ï” UC is an non granulomatous inflammatory disorder that
affects the rectum and extends proximally to affect variable
extent of the colon.
9. PATHOPHYSIOLOGY(UC)
Inflammation of the mucosa and sub mucosa
â
Hyperemic and edematous mucosal lining
â
Multiple abscesses develop in the crypts of the Lieberkuhn
â
Abscesses break through the crypts into sub mucosa leaving
ulceration
â
Destroy the mucosal epithelium, causing bleeding and diarrhea
â
Granulation tissue develops and the mucosa becomes thickened
â
Shortening in colon
15. CDUCFeature
GITOnly colonLocation
Skip lesionsContinuous, begins distallyAnatomic distribution
Rectal spareInvolved in >90%Rectal involvement
Only 25%UniversalGross bleeding
75%RarePeri-anal disease
YesNoFistulization
50-75%NoGranulomas
DISTINGUISHING CHARACTERISTICS OF CD AND UC
16. MANAGEMENT OF IBD
Non-pharmacological
ï” Initial treatment is non operative Stop Smoking
(for Crohnâs disease)
ï” Smoking preventable in ulcerative colitis except
(cholangitis and scleropathy)
ï” Nutrition
24. NURSING MANAGEMENT
Data collection:
ï” Complete history including onset, duration, frequency
and severity
ï” Determines allergies and intolerances
ï” Assess nutritional status and sign of dehydration
ï” Assess skin excoriation
ï” Assessment of emotional status, coping skills, and
verbal, non verbal behaviors
ï” Assess anxiety level, sleep disturbances and insight
25. Nursing diagnosis, planning and
implementation
ï” Acute pain related to increased peristalsis and cramping
ï” Diarrhea related to inflammatory process
ï” Risk for deficient fluid volume related to diarrhea and
insufficient fluid intake
ï” Impaired skin integrity related to frequent loose stools
ï” Imbalanced nutrition: less than body requirement
related to malabsorption
26.
27. DEFINITION:
Malabsorption results from impaired
absorption of fats, carbohydrates, proteins,
minerals, and vitamins. Lactose intolerance is
the most common malabsorption disorder,
followed by IBD, celiac disease.
28. ETIOLOGY OF MALABSORPTION
ï” Biochemical or enzyme deficiencies
ï” Disturbed lymphatic and vascular circulation
ï” Bacterial proliferation
ï” Small intestinal mucosal disruption
ï” Surface area loss
30. Defects in intra-luminal phase
ï” Decreased pancreatic enzymes
ï”Chronic pancreatitis, cystic fibrosis, Z-E syndrome
ï” Insufficient bile salts
ï”Biliary obstruction
ï”Resection and /or diseases of terminal ileum
ï”Bacterial overgrowth
ï” Produce significant steatorrhea. Protein and CHO
digestion is affected less
31. Defects in mucosal phase
ï” Deficiency of brush border enzymes like Lactase
ï” Short bowel syndrome
ï” Malabsorption of all nutrients; fats, CHO, and proteins
32. Absorptive phase
ï” Majority of nutrients are directly absorbed from
epithelial cells into blood stream
ï” Chylomicrons and lipoproteins are absorbed through
lymphatics; lymphatic obstruction can impair their
absorption
ï” Leads to steatorrhea and protein losing enteropathy
33. Clinical manifestations
ï Steatorrhea (bulky, light colored stools) TGâs
ï Diarrhea Fats, CHO, Water
ï Weight loss; muscle wasting Fats, Proteins, CHO
ï Anemia Iron, B12, folate
ï Paresthesias, tetany, Calcium, Vit D
ï Bone pain pathological fractures, deformities Calc
ï Bleeding tendencies Vitamin K
ï Edema Proteins
34. DIAGNOSTIC EVALUATION
ï” STOOL EXAMINATION : for fat malabsorption and
parasites detection
ï” CT scan and biopsy
ï” Small bowel barium enema
ï” D-Xylose test
ï” Lactose tolerance test(hydrogen breath test)
ï” CBC
ï” PT
ï” serum electrolytes, cholesterol, vitamin A, calcium
35. Laboratory findings
ï” Increase in fecal fats
ï” Decreased albumin and proteins
ï” Decreased Ca, Iron, B12, red cell folate
ï” Prolonged prothrombin time
ï” Abnormal D-Xylose absorption
ï” Decreased Vitamin A, carotene levels
ï” D-xylose excretion is decreased in urine
37. TREATMENT OF CAUSATIVE DISEASES
ï” A gluten free diet
ï” Lactose free diet
ï” Protease and lipase supplements are the therapy for
pancreatic insufficiency
ï” Antibiotics are the therapy for bacterial overgrowth
ï” Corticosteroids
ï” Anti-inflammatory agents (mesalamine)
38. NUTRITIONAL SUPPORT
ï” Supplementing various minerals, such as calcium,
magnesium, iron, and vitamins
ï” Calorie replacement also is essential
ï” Medium-chain triglycerides can be used
ï” Parenteral nutrition in massive intestinal resection and
regional enteritis (Crohnâs)
39. NURSING MANAGEMENT
NURSING ASSESSMENT:
ï” health history of the patient
ï” assess vitals
ï” characteristics of stool
ï” assess dehydration
ï” assess knowledge regarding macro and micro nutrients
ï” assess intake output
40. NURSING DIAGNOSIS:
ï” Diarrhea related to malabsorption of bowel
ï” Risk for deficient fluid volume related to excessive
losses through normal routes
ï” Anxiety related to physiological factors as
evidenced by somatic complains
41. OUTCOMES:
ï” reduction in frequency of stools
ï” maintain adequate fluid volume
ï” reduce anxiety by proper use of support system
NURSING INTERVENTIONS
ï” Determine onset and pattern of diarrhea
ï” Observe and record stool frequency and characteristics
ï” Provide bed rest and remove stool promptly.
ï” Observe for excessive dry skin and mucous membranes
42. ContdâŠ
ï” Decreased skin turgor and capillary refill
assessment
âą Observe and note behavioral clues (irritability,
restlessness)
âą Encourage verbalization
âą Provide a calm, restful environment
âą Encourage staff to project caring attitude
