ppt

1. INFLAMMATORY BOWEL DISEASES
IBD
ULCERATIVE
COLITIS
CROHN’S
DISEASE

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

8. Ulcerative colitis
Ulcer
pseudopolyps

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