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Cronhns
&
Ulcerative
Colitis
What are these diseases?
Crohns
• Inflammation of segments
of the GI tract in any part.
Primarily the small
intestine or colon.
• Affects ages 15-30yrs
• In the early stages tiny
ulcers form on various
parts of the intestinal wall,
over time horizontal rows
of these ulcers fuse with
vertical rows causing
mucus to take on a
cobblestone appearance
Ulcerative Colitis
• Twice that of Crohns
• Common enteric
bacterium E.coli
• Confined to the mucosa
and submucosa of the
colon, starts in the left
then moves to the right.
• Tiny abscesses form
which grow and produce
purulent drainage,
capillaries become friable
and blood causing
diarrhea and pus.
Pictures!!
Clinical Manifestations
Crohns
• Onset is usually insidious
with nonspecific
complaints of
diarrhea,fatigue abdominal
pain weight loss and
fever,dehydration,malnutri
tion,anemia and increased
peristalsis
Ulcerative colitis
• Diarrhea is a predominate
sign
• Usually 15-20 liquid
stools a day containing
blood, mucus and pus.
• Abdominal cramps
• Involuntary leakage of
stools
• May include toxic
megacolon ( toxic dilation
of large bowel) a
lifethreating condition.
What should we look for in
Crohns??
Subjective
• Weakness
• Loss of appetite
• Abdominal pain and
cramps
• Low grade fever
• Stress
Objective
• Complaints of diarrhea
• 3-4 semisolid stools
daily containing
mucus and blood
What should we look for in
Ulcerative Colitis?
Subjective
• Rectal bleeding
• Abdominal distention
• Lethargy
• Unpredictable bowel
movements
Objective
• Weight loss
• Abdominal distention
• Fever
• Leukocytosis
• Tachycardia
Sigmoidoscopy and Colonoscopy
•
Tests
Crohn’s
• Colonoscopy with
multiple biopsies of
the colon
• Granulomas in the
biopsy specimen
confirm Crohns
Ulcerative Colitis
• Barium studies of the
intestine
• Sigmoidoscopy
• Colonoscopy with
possible biopsy
• Radiological
examination of the
abdomen
How you would treat these
diseases?
Drug therapy
Diet therapy
(1) drugs that affect the inflammatory
response. Corticosteriods
(2) Antibacterial drugs
(3) Drugs that affect the immune
system
(4) Antidiarrheal preparations. Lomotil
-Remission pills such as Mesalmine
•
Surgical Interventions
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Iiestomy
Proctocolectomy
Colon resection
Kock pouch
Exclude milk products and
highly spicy foods
• High protein and high calorie
diet
• Exclude caffeine
Interventions as a nurse
• Nutrition, fluid balance, elimination, medications,
psychological aspects and sexuality must be
considered.
• Thorough assessment of patients bowel
elimination.
• Oral diets of 2500mL per day for fluid loss
• Monitor weight
• Record I&O at least 1500mL per day
• Support Support Support!!
Prognosis
• A patient with chronic
ulcerative colitis is
directly related to the
number of years they have
had the disease.
• List of food that are
known to cause
constipation,diarrhea,
blockage,odors, and flatus
is helpful for the patient
• Crohns disease is a
chronic disorder and has a
high rate of recurrence in
pats under 25 yrs.
• Prognosis depends on the
extent of
involvement,duration of
illness, and success of
medical intervention. No
known therapy will
maintain a patient with
Crohn’s disease in
remission.
Review Questions
1) What is the
2) A high ____ and
lifethreating
_____ diet should be
complication that can
consumed with
occur in UC?
Crohn’s and
Ulcerative Colitis.
a) Abdominal distention
b) Low grade temp
c) Toxic megacolon
d) All of the above