Inflammatory bowel disease (IBD) refers to two chronic conditions that cause inflammation in the gastrointestinal tract: Crohn's disease and ulcerative colitis. Crohn's disease can impact any part of the GI tract and causes transmural inflammation, while ulcerative colitis only affects the colon and causes superficial mucosal inflammation. Both conditions cause abdominal pain and diarrhea but have different patterns of involvement in the GI tract. Diagnosis involves imaging tests like barium studies and endoscopy to distinguish between the two types based on their distinct presentations. Treatment focuses on controlling inflammation with medications, immunosuppressants, or surgery for severe cases.

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OVERVIEW OF THE DISEASE
A group of chronic disorder that result in inflammation or ulceration or both of the bowel
lining. Inflammatory bowel disease (IBD) is uncommon in Asia but the recent literature
has shown that the disease is increasing in both incidence and prevalence.
TWO TYPES OF INFLAMMATORY BOWEL DISEASE
CROHN’S DISEAS
Crohn’s disease is a chronic inflammatory condition of the gastrointestinal tract. When
reading about inflammatory bowel diseases, it is important to know that Crohn’s disease
is not the same thing as ulcerative colitis, another type of IBD. The symptoms of these

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two illnesses are quite similar, but the areas affected in the gastrointestinal tract (GI tract)
are different.
Crohn’s most commonly affects the end of the small bowel (the ileum) and the beginning
of the colon, but it may affect any part of the gastrointestinal (GI) tract, from the mouth
to the anus. Ulcerative colitis is limited to the colon, also called the large intestine.
ULCERATIVE COLITIS
Ulcerative colitis is a chronic disease of the large intestine, also known as the colon, in
which the lining of the colon becomes inflamed and develops tiny open sores, or ulcers,
that produce pus and mucous. The combination of inflammation and ulceration can cause
abdominal discomfort and frequent emptying of the colon.

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PATHOPHYSIOLOGY
Crohn’s Disease
 It begins with edema and thickening of the mucosa
 Ulcers appear on inflamed mucosa
 Clusters of ulcers form cobblestone appearance
 As inflammation extends into peritoneum, abscess, fistula and fissures forms
 As the disease advances, bowel wall thickens and becomes fibrotic
 Intestinal lumen narrows and diseased bowel loops are formed
Ulcerative Colitis
 Mucosa becomes edematous and inflamed
 Multiple ulcerations, desquamation, diffuse inflammation results to bleeding
 Abscesses form and infiltrate the crypts
 Bowel shortens and thickens because of muscle hypertrophy and fat deposits

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DIFFERENCE BETWEEN CROHN’S DISEASE
CROHN’S DISEASE
 Transmural thickening
 Deep penetrating granulomas
 Occurs anywhere in GI tract in segmental pattern. Usually occurs in ileum
 Entire thickness of bowel wall with granuloma
 Diarrhea unrelieved by defecation, maybe nonbloody
 abdominal mass, spasm and tenderness is common
 Crampy abdominal pain
 Weight loss/ anorexia
 Nutritional deficits
 Steatorrhea
 Extraintestinal manifestations such as arthritis, conjunctivitis and
erythema nodosum

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ULCERAIVE COLITIS
 Mucosal ulceration
 Minute, mucosal ulcerations
 Only in colon. It starts distally in continuous pattern. Usually occurs in rectum.
 Only mucosa and sub mucosa is affected without granulomas
 Severe/ bloody diarrhea with passage of mucus and pus. 10 to 20 liquid stool each
day
 Abdominal pain with intermittent tenesmus and rectal bleeding
 Hypocalcemia and anemia are frequent
 Extraintestinal manifestations such as uveitis and liver disorder as well as arthritis
and erythema nodosum
DIAGNOSTIC STUDY
Cronhs disease
Barium studies
 Regional, discontinuous skip lesions
 Narrowing of colon
 Thickening of bowel wall
 Mucosal edema
 Stenosis, fissures and fistulas

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Sigmoidoscopy
 Unremarkable unless accompanied by perianal fistula
Colonoscopy
 Distinct ulcerations separated by normal mucosa
Ulcerative colitis
 Diffuse lesions
 no narrowing of colon
 No mucosal edema
 Stenosis is rare
 Shortening of colon
 Dilation of bowel loops
 Abnormal inflamed mucosa
 Friable mucosa with pseudopolyps, exudates and ulcerations

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MEDICAL MANAGEMENT
OTHER DRUG INCLUDE:
 Antidiarrheal, antiperistaltic and sedatives
 Antibiotics
 Immunomodulators such as azathioprine, mercaptopurine and cyclosporine
 Monoclonal antibodies such as infliximab
 Anti cytokine therapy

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SURGICAL MANAGEMENT
Intestinal resection and anastomosis in Crohn’s disease
Strictureplasty
If Crohn’s disease is severe, total colectomy and ileostomy may be needed

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ULCERATIVE COLITIS
NURSING DIAGNOSIS
 Acute pain related to increase peristaltic and GI inflammations
 Imbalanced nutrition less than body requirements related to decrease intake,
increased nutrition loss through diarrhea and decreased absorption of nutrients
 Diarrhea related to irritated bowel and intestinal hyperactivity
 Anxiety related to social embarrassment and unfamiliar environment
 Risk for impaired skin integrity related to diarrhea and altered nutritional status
 Ineffective coping related to chronic disease, lifestyle changes and stress

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NURSING INTERVENTION
 Maintaining normal elimination pattern
 Relieving pain
 Maintaining fluid intake
 Maintaining optimal nutrition
 Promoting rest
 Reducing anxiety
 Enhancing coping measures
 Preventing skin breakdown
 Monitoring potential complications