ULCERATIVE COLITIS Definition Ulcerative colitis is a chronic inflammation that causes chronic inflammation of the digestive tract, specifically

the large intestine (colon). It usually affects the innermost lining of the large intestine (colon) and rectum. In patients with ulcerative colitis, ulcers and inflammation of the inner lining of the colon lead to symptoms ofabdominal pain, diarrhea, andrectal bleeding. Ulcerative colitis is closely related to another condition of inflammation of the intestines called Crohn's disease. Together, they are frequently referred to as inflammatory bowel disease (IBD). Ulcerative colitis and Crohn's diseases are chronic conditions that can last years to decades. Men and women are affected equally. They most commonly begin during adolescence and early adulthood, but they also can begin during childhood and later in life. It is found worldwide, but is most common in the United States, England, and northern Europe. It is especially common in people of Jewish descent. Ulcerative colitis is rarely seen in Eastern Europe, Asia, and South America, and is rare in the black population. For unknown reasons, an increased frequency of this condition has been recently observed in developing nations. First degree relatives of people with ulcerative colitis have an increased lifetime risk of developing the disease, but the overall risk remains small. Pathophysiology The cause of ulcerative colitis is unknown but scientists believe that ulcerative colitis likely involves abnormal activation of the immune system in the intestines. In patients with ulcerative colitis, however, the immune system is abnormally and chronically activated in the absence of any known invader. When the disease is active, the lamina propia of the mucosa becomes heavily infiltrated with a mixture of acute and chronic inflammatory cells. There is a predominant increase in mucosal Ig G production, evidence of complement activation, and activation of macrophages and T cells. This immunological activity is associated with the release of vast array of immune mediators. These mediators directly affect the epithelial function which may increase permeability and lead to ischemia. The continued abnormal activation of the immune systems causes chronic inflammation and ulceration. Causes  Immune system. Some scientists think a virus or bacterium may trigger ulcerative colitis. The digestive tract becomes inflamed when your immune system tries to fight off the invading microorganism (pathogen). It's also possible that inflammation may stem from an autoimmune reaction in which your body mounts an immune response even though no pathogen is present.  Heredity. Because you're more likely to develop ulcerative colitis if you have a parent or sibling with the disease, scientists suspect that genetic makeup may play a contributing role. Risk Factors  Age. Ulcerative colitis can occur at any age, but ulcerative colitis often affects people in their 30s. Some people may not develop the disease until their 50s or 60s.

Sometimes x rays such as a barium enema or CT scans are also used to diagnose ulcerative colitis or its complications. You're at higher risk if you have a close relative. or ulcers on the colon wall. In addition. whose presence indicates ulcerative colitis or inflammatory disease. A physical exam and medical history are usually the first step. it can occur in any race. If you're of Jewish descent. and may make your initial diagnosis more difficult. a stool sample allows the doctor to detect bleeding or infection in the colon or rectum caused by bacteria. studies have reported the development of inflammatory bowel disease with isotretinoin use. with the disease. Although cause and effect hasn't been proved. flexible.    Race or ethnicity. bleeding. Additionally. Nonsteroidal anti-inflammatory medication. Family history. For both tests. The doctor will be able to see any inflammation. sibling or child. A stool sample can also reveal white blood cells. which is a sign of inflammation somewhere in the body. such as a parent. During the exam. Diagnostic tests Many tests are used to diagnose ulcerative colitis. they can cause similar signs and symptoms. which could indicate bleeding in the colon or rectum. Manifestations  Diarrhea mixed with blood mucus  Weight loss  Blood on rectal examination  Abdominal pain  Loss of appetite  fever  Gastrointestinal bleeding  Joint pain  Nausea and vomiting Complications  Severe bleeding  Perforated colon . Although whites have the highest risk of the disease. your risk is even higher. A colonoscopy or sigmoidoscopy are the most accurate methods for making a diagnosis of ulcerative colitis and ruling-out other possible conditions. the doctor inserts an endoscope—a long. Isotretinoin (Accutane) use. Although these medications haven't been shown to cause ulcerative colitis. lighted tube connected to a computer and TV monitor—into the anus to see the inside of the colon and rectum. It is a powerful medication sometimes used to treat scarring cystic acne or acne that doesn't respond to other treatments. these medications can make existing ulcerative colitis worse. or parasites. diverticular disease. or cancer. which involves taking a sample of tissue from the lining of the colon to view with a microscope. or they may uncover a high white blood cell count. such as Crohn's disease. a virus. Blood tests may be done to check for anemia. the doctor may do a biopsy.

The surgeon then attaches the ileum to the inside of the rectum and the anus. or infection 2. The stoma is about the size of a quarter and is usually located in the lower right part of the abdomen near the beltline.decreasing inflammation and reducing the activity of the immune system. creating a pouch. Other drugs may be given to relax the patient or to relieve pain. Waste is stored in the pouch and passes through the anus in the usual manner. Educate the patient on nutrition and how to handle stress in life. Restricting the physical activity of the patient 5.  Corticosteroids . That. called the ileum. 2.  Immunomodulators .the surgeon creates a small opening in the abdomen. 3. Waste will travel through the small intestine and exit the body through the stoma. Surgery  Ileostomy . called a stoma. Keep the patient hydrated and comfortable. joints and eyes An increased risk of colon cancer Toxic megacolo Management A. Nursing Managements 1.      Severe dehydration Liver disease Osteoporosis Inflammation of your skin. They also may help prevent the disease from becoming active again. B. the surgeon removes the colon and the inside of the rectum. In this operation. and attaches the end of the small intestine. in turn. diarrhea. and the patient empties the pouch as needed. 4. Medical Managements 1.These medicines may relieve symptoms and inflammation in the intestines and help IBD go into remission (a period without symptoms). leaving the outer muscles of the rectum.which allows the patient to have normal bowel movements because it preserves part of the anus. to it. Drug therapy  Aminosalicylate . decreases the inflammatory response. Encourage patient to engage on open-ended conversation and attempt to explore how the patient sees the situation.  Ileoanal anastomosis . A pouch is worn over the opening to collect waste.weaken or modulate the activity of the immune system. Smoking cessation Nursing Diagnosis  Impaired tissue integrity  Acute/chronic pain  Risk for infection  Imbalanced nutrition • Diarrhea • Risk for deficient fluid volume • Anxiety • Knowledge deficit .

Excessive fat in the stool binds to calcium. Some of these disorders have autoimmune mechanisms. People of Jewish heritage have an increased risk of developing Crohn’s disease. ileitis.CHRON’S DISEASE Definition Crohn's disease is a chronic transmural inflammatory disease that usually affects the distal ileum and colon. Ulcerative colitis and Crohn's disease have no medical cure. In addition to manifestations related to the GI tract. Once the diseases begin. and bile ducts. and/or abscess formation. About 20 percent of people with Crohn’s disease have a blood relative with some form of inflammatory bowel disease. This can lead to malnutrition. liver. and African Americans are at decreased risk for developing Crohn’s disease. yet their absence does not exclude the diagnosis. but it is more often diagnosed in people between the ages of 20 and 30. It is named after the physician who described the disease in 1932. Chronic inflammation also damages the intestinal mucosa. and stricture formation. most often a brother or sister and sometimes a parent or child. Early endoscopical findings include hyperaemia and oedema of the inflamed mucosa. It also is called granulomatous enteritis or colitis. joints. Pathophysiology The initial lesion starts as an inflammatory infiltrate around intestinal crypts that subsequently develops into ulceration of the superficial mucosa. Acute trans-mural inflammation results in bowel obstruction due to mucosal oedema associated with spasm. These granulomas involve all layers of the intestinal wall and the mesentery and regional lymph nodes. resulting in deficient absorptive ability. and vitamin and nutrient deficiencies. eyes. Crohn's disease and ulcerative colitis are frequently referred to as inflammatory bowel disease (IBD). Crohn’s disease affects men and women equally and seems to run in some families. regional enteritis. mouth. Together. and gallstone formation. Involvement of the terminal ileum interferes with bile acid absorption. The inflammation progresses to involve deeper layers and forms non-caseating granulomas. luminal narrowing. This progresses to discrete deep superficial ulcers located transversely and longitudinally. Crohn's disease is related closely to another chronic inflammatory condition that involves only the colon called ulcerative colitis. Crohn’s disease can occur in people of all age groups. The finding of these granulomas is highly suggestive of CD. fat-soluble vitamin deficiency. or terminal ileitis. It primarily causes ulcerations (breaks in the lining) of the small and large intestines. Chronic trans-mural inflammation thickens the bowel wall and leads to scarring. . they tend to fluctuate between periods of inactivity (remission) and activity (relapse). which leads to steatorrhoea. creating a cobblestone appearance. dehydration. perforation. This may lead to fistulisation. These lesions are separated by healthy areas known as skip lesions. thereby increasing oxalate absorption and predisposing to oxalate kidney stone formation. but can affect the digestive system anywhere from the mouth to the anus. CD may involve multiple extraintestinal organs and systems including skin. sinus tract formation.

including a diet high in fat or refined foods. with the disease.Causes  Immune system. Discuss this with your doctor and get help. which could indicate bleeding in the intestines. The doctor will be able to see any inflammation or . For this test.  Family history. When your immune system tries to fight off the invading microorganism. such as a parent. but you're likely to develop the condition when you're young. it may be that environmental factors. By testing a stool sample. while a colonoscopy allows the doctor to examine the lining of the entire large intestine. most people with Crohn's disease don't have a family history of the disease. revealing inflammation or other abnormalities in the intestine. The doctor may also do a visual exam of the colon by performing either a sigmoidoscopy or a colonoscopy. your risk is even higher. the doctor can tell if there is bleeding or infection in the intestines. the doctor inserts a long. more x rays of both the upper and lower digestive tract may be necessary to see how much of the GI tract is affected by the disease. Cigarette smoking is the most important controllable risk factor for developing Crohn's disease. It's possible that a virus or bacterium may trigger Crohn's disease. it can affect any ethnic group. stop. There are many smoking-cessation programs available if you are unable to quit on your own. However.  Ethnicity. Because Crohn's disease occurs more often among people living in cities and industrial nations. The doctor may do an upper GI series to look at the small intestine. Most people who develop Crohn's disease are diagnosed before they're 30 years old. Smoking also leads to more severe disease and a greater risk of surgery. If these tests show Crohn’s disease. play a role in Crohn's disease. If you're of Eastern European (Ashkenazi) Jewish descent. You're at higher risk if you have a close relative. If you live in an urban area or in an industrialized country. If you smoke. an abnormal immune response causes the immune system to attack the cells in the digestive tract. lighted tube linked to a computer and TV monitor into the anus.  Heredity. sibling or child. a chalky solution that coats the lining of the small intestine. flexible. the person drinks barium. you're more likely to develop Crohn's disease. too. For both of these tests. which is a sign of inflammation somewhere in the body.  Cigarette smoking. Diagnostic Tests Blood tests may be done to check for anemia. Although whites have the highest risk of the disease. A sigmoidoscopy allows the doctor to examine the lining of the lower part of the large intestine. before x rays are taken. People living in northern climates also seem to have a greater risk of the disease. As many as 1 in 5 people with Crohn's disease has a family member with the disease. leading experts to suspect that one or more genes may make people more susceptible to Crohn's disease. The barium shows up white on x-ray film. Crohn's disease can occur at any age. Crohn's is more common in people who have family members with the disease.  Where you live. Risk Factors  Age. Blood tests may also uncover a high white blood cell count.

which may block the flow of digestive contents through the affected part of your intestine. Because the colon can't completely absorb this excess fluid.  Ulcers.  Fistulas. Intensified intestinal cramping also can contribute to loose stools. although a colonoscopy is usually a better test because the doctor can see the entire large intestine.bleeding during either of these exams. Sometimes ulcers can extend completely through the intestinal wall. You may also have ulcers in your mouth similar to canker sores. Other manifestations  Fever  Fatigue  Arthritis  Eye inflammation  Mouth sores  Skin disorders  Inflammation of the liver or bile ducts  Delayed growth or sexual development. Over time. Mild Crohn's disease usually causes slight to moderate intestinal discomfort. Some cases require surgery to remove the diseased portion of your bowel. Manifestations  Diarrhea. between your intestine and skin.  Abdominal pain and cramping. Crohn's disease affects the thickness of the intestinal wall. or your bowel may also bleed on its own. This affects the normal movement of contents through your digestive tract and may lead to pain and cramping. which involves taking a sample of tissue from the lining of the intestine to view with a microscope. you develop diarrhea. parts of the bowel can thicken and narrow. Food moving through your digestive tract may cause inflamed tissue to bleed. Crohn's disease can cause small sores on the surface of the intestine that eventually become large ulcers that penetrate deep into — and sometimes through — the intestinal walls. You can also have bleeding you don't see (occult blood). and in the genital area (perineum) and anus. the pain may be severe and include nausea and vomiting. The inflammation that occurs in Crohn's disease causes cells in the affected areas of your intestine to secrete large amounts of water and salt.  Ulcers. The doctor may also do a biopsy.  Reduced appetite and weight loss. including your mouth and anus. You might notice bright red blood in the toilet bowl or darker blood mixed with your stool. such as the bladder or . in children Complications  Bowel obstruction. Diarrhea is a common problem for people with Crohn's. creating a fistula — an abnormal connection between different parts of your intestine. Abdominal pain and cramping and the inflammatory reaction in the wall of your bowel can affect both your appetite and your ability to digest and absorb food.  Blood in your stool. Chronic inflammation can lead to open sores (ulcers) anywhere in your digestive tract. Inflammation and ulceration may cause the walls of portions of your bowel to swell and eventually thicken with scar tissue. but in more-serious cases. or between your intestine and another organ.

and in some cases. a substance that helps control inflammation. Fistulas around the anal area (perianal) are the most common kind of fistula. This is a crack. These drugs may cause side effects like nausea. anemia is common in people with Crohn's disease. Food and Drug Administration approved the drug for the treatment of moderate to severe Crohn’s disease that does not respond to standard therapies (mesalamine substances. Colon cancer. a problem that can be life-threatening if left untreated. When internal fistulas develop.S. and diarrhea and may lower a person’s resistance to infection. including greater susceptibility to infection. Infliximab. Prednisone is a common generic name of one of the drugs in this group of medications. When patients are treated with a combination of corticosteroids and immunosuppressive drugs. Managements A. Patients who do not benefit from it or who cannot tolerate it may be put on other mesalamine-containing drugs. In the beginning. heartburn. when the disease is at its worst. such as Asacol. Anal fissure. This may lead to a perianal fistula. azathioprine. Some studies suggest that immunosuppressive drugs may enhance the effectiveness of corticosteroids.  Cortisone or Steroids. Immunosuppressive agents work by blocking the immune reaction that contributes to inflammation. This drug is the first of a group of medications that blocks the body’s inflammation response.   vagina. and headache. a fistula may become infected and form an abscess. corticosteroids. Most commonly prescribed are 6-mercaptopurine or a related drug. Additional research will need to be done in .  Immune System Suppressors. Medical Managements 1. Dipentum.  Infliximab (Remicade). Malnutrition. prednisone is usually prescribed in a large dose. Possible side effects of mesalamine-containing drugs include nausea. in the anus or in the skin around the anus where infections can occur. Additionally. food may bypass areas of the bowel that are necessary for absorption. Cortisone drugs and steroids—called corticosteriods— provide very effective results. Diarrhea. immunosuppressive agents) and for the treatment of open. the dose of corticosteroids may eventually be lowered. vomiting. The dosage is then lowered once symptoms have been controlled. Sulfasalazine is the most commonly used of these drugs. Most people are first treated with drugs containing mesalamine. or cleft. Having Crohn's disease that affects your colon increases your risk of colon cancer. Drug Therapy  Anti-Inflammation Drugs. It's often associated with painful bowel movements. is an anti-TNF substance. abdominal pain and cramping may make it difficult for you to eat or for your intestine to absorb enough nutrients to keep you nourished. or Pentasa. draining fistulas. generally known as 5-ASA agents. Drugs that suppress the immune system are also used to treat Crohn’s disease. diarrhea. These drugs can cause serious side effects. the first treatment approved specifically for Crohn’s disease. The U. vomiting. An external fistula can cause continuous drainage of bowel contents to your skin.

A common procedure for Crohn's is strictureplasty. Emphasize the importance of adequate rest. monitor his condition closely. Diarrhea and crampy abdominal pain are often relieved when the inflammation subsides. 2. Provide emotional support to the patient and his family. 3. loperamide. 8. 11. 6. the doctor may prescribe one or more of the following antibiotics: ampicillin. Surgery During surgery. 12. Record fluid intake and output. If the patient is receiving parenteral nutrition. Teach the patient about the prescribed medications. and codeine. 9. cephalosporin. Antidiarrheal and fluid replacements. weigh the patient daily. but additional medication may also be necessary. or metronidazole. Schedule patient care to include rest periods throughout the day. spicy or fried high-residue foods. which widens a segment of the intestine that has become too narrow. Nursing Managements 1. their desires effects and possible adverse reactions. including lactose-containing milk products. 4. Antibiotics are used to treat bacterial overgrowth in the small intestine caused by stricture. surgery may also be used to close fistulas and drain abscesses. or prior surgery. sulfonamide. provide meticulous site care. Give iron supplements and blood transfusion as ordered. If the patient is receiving TPN. Nursing Diagnosis  Bleeding  Impaired tissue integrity  Risk for infection  Acute/chronic pain  Imbalanced nutrition  Diarrhea  Risk for deficient fluid volume  Anxiety  Knowledge deficit . 2. 10. including diphenoxylate. Patients who are dehydrated because of diarrhea will be treated with fluids and electrolytes. Evaluate the effectiveness of medication administration. Antibiotics. 7. 5. In addition. fistulas. Several antidiarrheal agents could be used. For this common problem. tetracycline.  order to fully understand the range of treatments Remicade may offer to help people with Crohn’s disease. Give the patient a list of foods to avoid. your surgeon removes a damaged portion of your digestive tract and then reconnects the healthy sections. Provide good patient hygiene and meticulous oral care if the patient is restricted to nothing by mouth. Administer medications as ordered.

Greazel TAGUICANA. Venice SARIBAY. Roxette SALACUP. Justin Darrell SANCHEZ. Karen BSN III – B Group 5 August 11. Claire VELASCO. Jeslen VALLEJO. Chramilen SOLSOLOY. 2011 . Renz Marion SILVESTRE.Mariano Marcos State University College of Health Sciences Department of Nursing City of Batac ULCERATIVE COLITIS & CHRON’S DISEASE Requirement for RLE 103 Submitted By: ROSARIO. Frenely Mae TESORO.

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