Inflammatory Bowel Disease

Revised and presented by:

Ms. Shirin Rahim
AKUSONAM
Acknowledgement: AHN team
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 Objectives
By the end of the session learners will be able to
• Discuss inflammatory bowel disorders including ulcerative
colitis and chron’s disease in terms of their
• causes,
• pathophysiology
• manifestation
• diagnostic tests
• medical and surgical management
• Apply nursing process to provide care to the clients with above
disorders.
• Develop a teaching plan for a client experiencing above
disorders.

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 Inflammatory Bowel Disease (IBD)

A term mainly used to describe two conditions,

ulcerative colitis and Crohn's disease.
Both are long-term (chronic) conditions that
involve inflammation of the gut.

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 IBD: Etiology
• Unknown
• Familial tendency
• Infections
• Autoimmune antibody mediated reaction.
• Psychological factors (stress)

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 Ulcerative Colitis

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 Ulcerative Colitis (UC): Description

• Widespread ulcerative and inflammatory disease of the

mucosal layers of rectum which spreads up to colon.

• Associated with periodic remission and exacerbations

(flare-ups) of marked inflammation, edema and ulcer
formation

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 UC:Pathophysiology

Mild condition ----Intestinal mucosa is Hyperemia, edematous and

reddened erythematous, with loss of the normal vascular pattern and
often with scattered hemorrhagic areas

Severe condition ---- breaks in the mucosal barrier are created

Mucosal Lining bleeds and erosions/ulcers and abscess occur

Tissue necrosis (cell death)

Continuous thickening and edema leads to narrowed colon and partial
bowel obstruction
Intestinal functions of digestion and absoprbtion is lost ultmately

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 UC: Clinical Manifestations:

• Stool contain blood & mucus

• left lower quadrant pain and tenderness
• Low grade fever
• Malaise, Anorexia, Weight loss
• Dehydration, 10-20 liquid stools/day;
• Fever associated with tachycardia indicates peritonitis,
dehydration and bowel perforation

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 Crohn’s Disease

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 Crohn’s Disease: Description
• Occurs anywhere along the GI tract. Most
commonly affects terminal ileum

• Patches of inflammation develop in segments of

intestine involving all the layers

• The bowel may perforate and create an internal or

external fistula into another loop of intestine or
onto the skin.

• Inflammation leads to scarring and stenosis which

may result in partial obstruction
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 Crohn’s Disease

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 Crohn’s Disease: Pathopsysiology
It is subacute and chronic inflammation that extends through all layers (ie,
transmural lesion) of the bowel wall from the intestinal mucosa.

edema and thickening of the mucosa.

perforation begin to appear on the inflamed mucosa. These lesions are not in
continuous contact with one another and are separated by normal tissue.

Fistulas, fissures, and abscesses form as the inflammation extends into

the peritoneum.

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 Crohn’s disease:
Clinical Manifestations
• Lower right quadrant pain (usually constant)
• Diarrhea (soft stools)
• Colon spasm ----- decrease PO intake, malnutrition,
weight loss
• Malabsorption of vital nutrients---- anemia, fluid &
electrolyte imbalances
• Steatorrhea (fatty diarrheal stool)
• Abscesses and fistulas

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 IBD: Diagnostic Tests
CBC:
• High WBC, ESR
Biochemistry:
• Low Na, K and Cl levels
• Hypoalbuminemia
Stool cultures:
• Bacterial growth
• Colonoscopy (most definitive for diagnosis)l
Sigmoidoscopy
• Visualization of lesion
Barium enemas
• Identify lesion , obstruction and passage of intestinal lumen
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 IBS: Treatment Goals

• Reduction of inflammation
• provide physical and emotional rest
• preventing complications, enhancing QoL

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 IBS: Medical Management
• Anti-Inflammation Drugs.
• Immune System Suppressors (Azathioprine )
• Antibiotics
• Anti-Diarrheal
• Fluid Replacement
• Electrolyte replacement

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 Surgical Management:
Ulcerative Colitis
May require Total proctocolectomy (removal of entire
colon, rectum and anus) or collectomy and placement of
permanent Ileostomy

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 Surgical Management: Ulcerative
Colitis
Post operative care:
1. Patient is kept NPO and NG tube to LWS
(tube removed after 1-2 days)
2. Ostomy care
3. Assess ostomy output
4. Replace ostomy losses with ORT and IV
fluids with additional 500 ml or more to
prevent dehydration

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 IBD: Complications
• Hemorrhage/ Perforation
• Toxic mega colon
• Abscess formation
• Mechanical Intestinal obstruction
• Fluid & electrolyte imbalance
• Malnutrition due to inadequate
dietary intake, intestinal loss of
protein, fats
• Fistula (In chrons’ dx)
• Colorectal cancer

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 IBD: Nursing Process
Goal
Prevention of fluid volume deficit
Maintenance of optimal nutrition and weight
Avoidance of fatigue
promoting effective coping

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 IBD: Nursing Process
Diagnosis:
• Pain
• Fluid Volume Deficit
• Nutrition Less than body requirement
• Powerlessness
• Impaired skin integrity
Nursing Intervention:
1. Nutritional Therapy
» low residue, high protein and calorie diet with vitamin and
iron supplements
» Instruct client to limit diarrhea causing foods (lactose
intolerance, smoking, alcohol, caffeinated beverages,
pepper)
» Daily Weight, caloric count
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» Patients with severe s/s are kept NPO and put on TPN 23
 IBD: Nursing Process
2. Fluid electrolyte balance
» dehydration and electrolyte imbalances require IV
fluid therapy
» I/O monitoring (COCA of stool)
» Skin care
» Record # of stools and type
» Vitals and Pain Management
3. Coping Strategies
4. Pain control
» Pharmacological & non pharamcological
interventions

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 Summarization

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 Difference between Ulcerative Colitis and Chron’s
Disease

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 Difference b/w Ulcerative Colitis and Chron’s
Disease
Characteristics Ulcerative Colitis Chron’s Disease

Areas of Begins in the rectum and proceeds Most often in terminal ileum with
involvement in a continuous manner towards patchy involvement throughout all
cecum layers of the bowel

Mucosal wall involved Trans-mural involving entire wall

thickening
Cause Unknown Unknown

Number of stools 10-20 liquid/day, bloody stool 5-6 soft, loose stool/day, non bloody

Complication Nutritional deficiency, Nutritional deficiency

Hemorrhage Perforation and Fistulas (common)

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 Difference b/w Ulcerative Colitis and
Chron’s Disease

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 References
Black, J M & Hawks J (2005) Medical – Surgical Nursing: clinical
management for positive outcomes (7th ed.). Philadelphia:
W.B. Saunders

Ignatavicius, D.D., & Workman, M.L. (2009). Medical- surgical

nursing: Critical thinking for collaborative care. (5th ed.).
St. Louis: Elsevier Saunders.

Smeltzer, S. C., & Bare, B.G. (2008). Brunner and Suddarth’s

text book for medical-surgical nursing. (9th ed)
Philadelphia: Lippincott.

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 Thank you

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