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Chronic Inflammatory Bowel Disease

Definition
 Chronic inflammatory bowel disease is a chronic, ongoing
progressive information of all parts of the digestive tract.
 CTBD is commonly associated with intestine and bowel
inflammation.
 Main type of chronic inflammatory bowel disease are -

1. Crohn's disease
2. Ulcerative colitis.

Crohn's disease

 Crohn's disease is also called regional enteritis and ileitis.

 Crohn's disease is a chronic inflammatory bowel disease that
affects commonly living digestive tract.
 Crohn's disease commonly affects the terminal ileum of the small
intestine.
 The prognosis of crohn disease is poor and causes life
threatening complications.

Causes
 Hereditary
 Family history
 Autoimmune disorder
 Ethnic group
 Age under 30 year
 Cigarette smoking
 Industrialization area
 Infection
 Use NSAID drugs.

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Clinical manifestations
 Right lower quadrant abdominal pain.
 Abdominal tenderness.
 Abdominal pain after meal intake.
 Abdominal fullness and distension.
 Nausea and vomiting.
 Anorexia, weight loss, weakness, fatigue.
 Chronic diarrhoea - 5 - 6 time per day

 Semi solid diarrhoea

 Diarrhoea content mucus or pus.

 Mouth sores
 Loss of electrolytes and fluids
 Malnutrition
 Hepatitis and cholecystitis
 Delay growth or sexual development of a child.

Diagnostic examination
 History collection and physical examination.
 Endoscopic examination ( capsule )
 Blood test - for anaemia and infection.
 Colonoscopy
 Barium enema test
 CT scan and MRI
 Abdominal USG
 Stool examination test
 Balloon assisted enteroscopy.

Medical management

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 Antibiotic drugs - to treat inflammation.

 Corticosteroid drug - used to treat inflammation.
 Antibiotics - to treat vomiting.
 Mild Analgesic - to treat pain.
 Administer IV fluid.
 Antidiarrheal drug - loperamide.
 Anti-inflammatory drug.
 Proton pump inhibitors.

Ulcerative colitis

 Ulcerative colitis is an inflammatory bowel disease characterized

by chronic inflammation and ulcer formation in the colon that
results in poor absorption of nutrients.
 Ulcerative colitis starts from rectum and spreads to the colon
(large intestine) and causes ulcer.
 Ulcerative qualities are a circumferential inflammation of the
colon.

Causes
 Unknown
 Bacterial and viral infection
 Autoimmune reaction
 Food habits
 Stress
 Race or ethnicity
 Family history
 Environmental factors.

Clinical manifestation
 Left lower quadrant abdominal pain.
 Abdominal cramping and abdominal tenderness.

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 Feeling of abdominal fullness and distension.

 Anorexia, weight loss, weakness.
 Diarrhoea - 10 - 20 times per day

 Liquid diarrhoea
 Diarrhoea contains blood and mucus.

 Blood loss and anaemia.

 Melana (blood in stool).
 Low grade fever.
 Loss of electrolytes and fluid.
 Dehydration
 Vitamin K deficiency.

Diagnostic examination
 History collection and physical examination.
 Abdominal USG
 Stool examination
 Barium enema test
 Vitamin test - vitamin K deficiency
 Colonoscopy and sigmoidoscopy
 CT scan and MRI
 Blood test - decrease Hb, increased WBC and increased ESR.

Medical management
 Corticosteroid drug - for inflammation.
 Antidiarrheal drug - metronidazole, tinidazole.
 Antipyretics drug - to treat fever.
 Antiemetic’s drugs - to treat vomiting.
 Antibiotics.
 Amino salicylates ( 5 amino salicylic acid )
 Immunomodulatory - reduce immune attack on colon.

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 Loperamide - To stop diarrhoea.

 Blood transfusion - to treat anaemia.

Surgical management
 Proctocolectomy - remove of entire colon and rectum.
 Restorative proctocolectomy with ileal pouch and anastomosis.
 Ileostomy.
 End to end anastomosis of colon.

Nursing management
 Nurses assess vital signs and physical examinations.
 Monitor sign symptoms of chronic inflammatory bowel disease.
 Assess finding of pain and pain site.
 Monitor fluid and electrolytes balance.
 Nurses find out the severity of diarrhoea and frequency.
 Administer fluid replacement therapy and patient maintain NPO.
 Provide all prescribed medication and other additional treats.
 Maintain hygienic standard and aseptic treatment procedure to
control infection.
 Provide instruction about food habits and lifestyle modification.
 Instruct the client to avoid activity and reduce intestinal activity.
 Nurses monitor patient bowel sound and assess for bowel
perforation, peritonitis and haemorrhage.
 Provide high protein, high vitamin, and high iron and low fibres
diet.
 Instruct avoid alcohol, smoking, gas forming foods and tea or
coffee.
 Prepare client for surgical intervention.
 Provide appropriate post-operative care.
 Provide health education and awareness.

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Key Points
1. Regional enteritis also known as - Crohn's disease.

2. Crohn's disease commonly associated with - Ileum of small

intestine.

3. Crohn's disease abdominal pain site - Right lower

quadrant.

4. Ulcerative colitis abdominal pain site - Left lower quadrant.

5. Ulcerative colitis associated with - Colon.

6. Circumferential infection and ulcer of colon is - Ulcerative

colitis.

7. Ulcerative colitis diarrheal finding - Diarrhoea with blood

and mucus.

8. Crohn's disease diarrheal finding - Diarrhoea with mucus

and pus.

9. Crohn's disease diarrhoea frequency - 5 - 6 times per day.

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10. Ulcerative colitis diarrhoea frequency - 10 - 20 times per

day.

11. Which body system initiative in ulcerative colitis - Immune

system.

12. Which blood cells are against the lining of the large intestine
- WBC.

13. Which people are at high risk of having ulcerative colitis -

Retirees.

14. Ulcerative colitis causes vitamin deficiency - Vitamin K.

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