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.
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
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
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
26.
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
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
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
