IBD
- 2. DEFINITION CD is a condition of chronic granulomatous inflammation potentially involving any location of the GIT from mouth to anus. UC is an non granulomatous inflammatory disorder that affects the rectum and extends proximally to affect variable extent of the colon.
- 6. ETIOLOGY Immunology Initiating pathogen Environmental Factors Genetic factors
- 7. SYMPTOMS UC: Rectal bleeding or bloody diarrhea Pain of colonic origin, often left sided and related to defecation CD: Diarrhea Recurrent abdominal pain Anorectal lesions, Anorexia, Anemia Malnutrition (weight loss) Fever
- 9. PATHOPHYSIOLOGY(UC) Inflammation of the mucosa and sub mucosa ↓ Hyperemic and edematous mucosal lining ↓ Multiple abscesses develop in the crypts of the Lieberkuhn ↓ Abscesses break through the crypts into sub mucosa leaving ulceration ↓ Destroy the mucosal epithelium, causing bleeding and diarrhea ↓ Granulation tissue develops and the mucosa becomes thickened ↓ Shortening in colon
- 12. PATHOPHYSIOLOGY(CD) Distortion of mucosal crypts Transmural inflammation Epithelioid granulomas Fissures, ulcers and fistulas seen
- 14. INVESTIGATIONS Endoscopy Colonoscopy Histopathology Radiology Hematological tests and microbiological stool test for infection
- 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 Initial treatment is non operative Stop Smoking (for Crohn’s disease) Smoking preventable in ulcerative colitis except (cholangitis and scleropathy) Nutrition
- 17. PHARMACOLOGICAL Aminosalycilates (5-ASA): sulfasalazine, mesalazine, olsalazine Corticosteroids : Budesonide, prednisolone, methylprednisolone Immunosuppressant's: azathioprine , 6- mercaptopurine Antibiotics : metronidazole, ciprofloxacin Anti diarrheal : loperamide
- 18. PHARMACOLOGICAL Antispasmodic agent: Dicyclomine Immunoglobulin - İnfliximab Miscellaneous( Total or supplementary parenteral nutrition, fish oils, sodium cromoglycate, lidocaine, nicotine trans dermally) Surgical management
- 21. Croh’ns UC Proctocolectomy & ileostomy Rectal &anal dissection Colectomy with ileorectal anastomosis Ileostomy with intraabdominal pouch Ileocecal resection Segmental resection Colectomy & ileorectal anastomosis Temporary loop ileostomy Proctocolectomy Stricturoplasty
- 23. ETIOLOGY:
- 24. NURSING MANAGEMENT Data collection: Complete history including onset, duration, frequency and severity Determines allergies and intolerances Assess nutritional status and sign of dehydration Assess skin excoriation Assessment of emotional status, coping skills, and verbal, non verbal behaviors Assess anxiety level, sleep disturbances and insight
- 25. Nursing diagnosis, planning and implementation Acute pain related to increased peristalsis and cramping Diarrhea related to inflammatory process Risk for deficient fluid volume related to diarrhea and insufficient fluid intake Impaired skin integrity related to frequent loose stools Imbalanced nutrition: less than body requirement related to malabsorption
- 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 Biochemical or enzyme deficiencies Disturbed lymphatic and vascular circulation Bacterial proliferation Small intestinal mucosal disruption Surface area loss
- 29. PATHOPHYSIOLOGY
- 30. Defects in intra-luminal phase Decreased pancreatic enzymes Chronic pancreatitis, cystic fibrosis, Z-E syndrome Insufficient bile salts Biliary obstruction Resection and /or diseases of terminal ileum Bacterial overgrowth Produce significant steatorrhea. Protein and CHO digestion is affected less
- 31. Defects in mucosal phase Deficiency of brush border enzymes like Lactase Short bowel syndrome Malabsorption of all nutrients; fats, CHO, and proteins
- 32. Absorptive phase Majority of nutrients are directly absorbed from epithelial cells into blood stream Chylomicrons and lipoproteins are absorbed through lymphatics; lymphatic obstruction can impair their absorption Leads to steatorrhea and protein losing enteropathy
- 33. Clinical manifestations Steatorrhea (bulky, light colored stools) TG’s Diarrhea Fats, CHO, Water Weight loss; muscle wasting Fats, Proteins, CHO Anemia Iron, B12, folate Paresthesias, tetany, Calcium, Vit D Bone pain pathological fractures, deformities Calc Bleeding tendencies Vitamin K Edema Proteins
- 34. DIAGNOSTIC EVALUATION STOOL EXAMINATION : for fat malabsorption and parasites detection CT scan and biopsy Small bowel barium enema D-Xylose test Lactose tolerance test(hydrogen breath test) CBC PT serum electrolytes, cholesterol, vitamin A, calcium
- 35. Laboratory findings Increase in fecal fats Decreased albumin and proteins Decreased Ca, Iron, B12, red cell folate Prolonged prothrombin time Abnormal D-Xylose absorption Decreased Vitamin A, carotene levels D-xylose excretion is decreased in urine
- 36. MANAGEMENT pharmacological management dietary management nursing management
- 37. TREATMENT OF CAUSATIVE DISEASES A gluten free diet Lactose free diet Protease and lipase supplements are the therapy for pancreatic insufficiency Antibiotics are the therapy for bacterial overgrowth Corticosteroids Anti-inflammatory agents (mesalamine)
- 38. NUTRITIONAL SUPPORT Supplementing various minerals, such as calcium, magnesium, iron, and vitamins Calorie replacement also is essential Medium-chain triglycerides can be used Parenteral nutrition in massive intestinal resection and regional enteritis (Crohn’s)
- 39. NURSING MANAGEMENT NURSING ASSESSMENT: health history of the patient assess vitals characteristics of stool assess dehydration assess knowledge regarding macro and micro nutrients assess intake output
- 40. NURSING DIAGNOSIS: Diarrhea related to malabsorption of bowel Risk for deficient fluid volume related to excessive losses through normal routes Anxiety related to physiological factors as evidenced by somatic complains
- 41. OUTCOMES: reduction in frequency of stools maintain adequate fluid volume reduce anxiety by proper use of support system NURSING INTERVENTIONS Determine onset and pattern of diarrhea Observe and record stool frequency and characteristics Provide bed rest and remove stool promptly. Observe for excessive dry skin and mucous membranes
- 42. Contd… Decreased skin turgor and capillary refill assessment • Observe and note behavioral clues (irritability, restlessness) • Encourage verbalization • Provide a calm, restful environment • Encourage staff to project caring attitude