1. Cronhns & Ulcerative Colitis

2. 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.

3. Pictures!!

4. Clinical Manifestations
Crohns
Onset is usually insidious with nonspecific complaints of diarrhea,fatigue abdominal pain weight loss and fever,dehydration,malnutrition,anemia and increased peristalsis
Ulcerative colitis
Diarrhea is a predominate sign
Usually 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.

5. 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

6. 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

7. Sigmoidoscopy and Colonoscopy

8. 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

9. How you would treat these diseases?
Drug 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
Iiestomy
Proctocolectomy
Colon resection
Kock pouch
Diet therapy
Exclude milk products and highly spicy foods
High protein and high calorie diet
Exclude caffeine

10. 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!!

11. 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.

12. Review Questions
1) What is the lifethreating complication that can occur in UC?
Abdominal distention
Low grade temp
Toxic megacolon
All of the above
2) A high ____ and _____ diet should be consumed with Crohn’s and Ulcerative Colitis.