Crohn’s Disease & Ulcerative Colitis

Submitted To : Ms. Sadia Umad

Submitted By: Group XI
Group Members :

 Tayyaba Akhtar (61)

 Tehreem Irshad (62)
 Uzaira Aslam (63)
 Wajeeha Ijaz( 64)
 Zunaira Anwar ( 65)
 Zobia Iftikhar ( 66)
 Zainab Khudabaksh(67)
 Zahra Shahid (68)
Objectives:

 After this presentation learns will be able to understand about:

 Crohn’s disease & ulcerative colitis
 Anatomy of GIT
 Clinical manifestations of the disease
 Etiology of the disease
 Pathophysiology of the disease
 Diagnostic evaluation
 Medical management of the disease
 Surgical management of the disease
Conti………

 Complications of the disease

 Nursing management of the disease
 Patient education regarding the disease care plan
 Introduction :
 Crohn’s disease and ulcerative colitis are the inflammatory bowel disease.
 These can effect any area of the GIT .
 These are both conditions characterized by chronic inflammation of the GIT .
 Both disease often develop in teenagers and young adults although the disease
occur at any age.
 Both diseases effect men and women equally.
 Both diseases have similar type of contributing factors such as
Environmental
Genetic
An inappropriate response by body’s immune system
Anatomy of
GIT
Definition:
 Crohn’s disease is granulomatous inflammation of terminal ileum and adjoining
colon resulting in ulceration, stricturing ,fistula and abscess formation.
Pathophysiology:
 Biopsy of the colon are taken to confirm the diagnosis .
 Crohn’s disease shows a transmural pattern of the inflammation showing
entire depth of intestinal wall.
 Ulceration is an outcome seen in highly active disease .
 Inflammation is characterized by focal infiltration of the neutrophils a type of
inflammatory cells into the epithelium.
 These neutrophils lead to inflammation or abscess.
 Granulomas known as giant cells are found in 50% cases of crohn’s disease
Etiology:

 Familial
 Genetic disorders
 Environmental factors(intestinal helminths infection)
 Immunological disorders(due to the production of inflammatory
cytokines ,interleukins, chemokines and TNF-alpha )
 Smoking –strong association
 NSAIDs (non steroidal anti-inflammatory drugs )
Clinical Manifestations :
 Symptoms may vary depending upon severity and location of disease ;
 Crampy abdominal pain
 Fatigue
 Pain while passing stool(Tenesmus)
 Persistent watery diarrhea
 Fever
 Loss of appetite
 Unintentional weight loss
 General malaise

Conti……

 Constipation
 Eye inflammation
 Fistulas
 Fissures
 Abscess
 Mouth ulcer
 Rectal bleeding
Diagnostic Tests:
 Physical examination
 Blood test to check anemia and WBC’s count
 Stool examination
 Barium x-ray
 Coloscopy/sigmoidoscopy
 Biopsy from lesions
Medical Management :
Pharmacologic interventions:
Anti-inflammatory drugs (Mesalamine)
Cortisone and steroids
Immune system suppressors (Mercaptopurine/Azathioprine)
Antibiotics
Anti-Diarrheal (Bismuth Imodium)
Fluid replacement (dehydrated patients treated with fluids and electrolytes)
Surgical management:

 Surgery to remove a damage portion of the GIT or to close fistulas or remove

scar tissue .
 Strictureplasty
 Colectomy
 Proctocolectomy
 Fistula removal
 End ileostomy
 Bowl resection
Strictureplasty
Colectomy
Bowel Resection
Complications :

 Intestinal obstruction
 Peritonitis
 Fistula formation
 Extra intestinal manifestation(arthritis, uveitis)
 Slight increase risk of development of carcinoma of colon
Nursing Diagnosis:

 Diarrhea related to inflammatory bowel disease

 Impaired nutrition less than body requirements relate to anorexia and
malabsorption.
 Fluid volume deficit related to disease condition.
 Acute pain related to increase peristalsis and cramping.
 Impaired skin integrity related to frequent loose stools.
 Ineffective coping related to repeated episodes of diarrhea .
NCP for Diahrrea
Nursing interventions:
 Measure vital signs to obtain a baseline date and have record of the health.
 Provide emotional support to the patient and his family to build a trusty
environment.
 If the patient is receiving parenteral nutrition , provide meticulous site care.
 Give iron supplements and blood transfusion as per prescription to prevent
from anemia .
 Administer medication as order.
 Record fluid intake and out daily, weigh the patient daily.
 Evaluate the effectiveness of the medication administration and care plan.
 Give the patient a list of food to avoid ,including lactose containing milk
products and spicy foods.
Ulcerative colitis:

 Ulcerative colitis is a recurrent ulcerative and inflammatory disease of the

mucosal and submucosal layers of colon and rectum.
 The peak incidence is between 30-50years of the age .
 10-15 % of the patients develop carcinomas of the colon .
Etiology:
 Genetic predisposition
 Environmental factors may trigger disease (viral or bacterial pathogens,
dietary).
 Immunological imbalance or disturbances
 Defect in intestinal barrier causing hypersensitive mucosa and increased
permeability.
 Defect in repair of mucosal injury which may develop into a chronic
condition.
Clinical Manifestations:

 Diarrhea
 Painful straining
 Increased bowel sounds
 Weight lose
 Fever
 Dehydration
 Hypokalemia
 Anorexia
 Nausea/vomiting
Conti………………….
 Crampy abdominal pain
 Anal area may be irritating and reddened
 There is tendency for the patient experience remissions and exacerbations
 Increase risk of colorectal cancer
 May inhibit extracolonic manifestation of eye , joint (polyarthritis), and skin
complains(erythema nodosum)
Diagnostic evaluations :
 Stool examination
 CBC(complete blood count)
 ESR (elevated erythrocytes sedimentation rate)
 Decrease serum level of magnesium , potassium, and albumin
 Colonoscopy
 CT-scan
 Rectal biopsy
 Barium enema
Medical Management:

General measures:
 (IV fluid replacement , bed rest, diet, iron supplements for chronic bleeding ,
blood replacement in massive bleeding )

Drug therapy:
 Anti-inflammatory (mesalamine)
 Steroids
 Immunosuppressants drugs( mercaptopurine)
 Anti-diarrheal
Conti………….
Surgical measures:
Temporary lope colostomy
Subtotal-colectomy
Ileostomy
Hartmann’s pouch
Total proctocolectomy with permanent end ileostomy
The ultimate surgical goal is to remove the entire colon and rectum to cure the
patient.
Complication:
 Perforation
 Hemorrhage
 Toxic megacolon ( fever, tachycardia , abdominal distention, peritonitis,
leukocytosis, dilated colon on abdominal x-ray).
 Abscess formation, stricture and anal fistula .
 Malnutrition , anemia , electrolyte imbalance, skin lesions
 Arthritis
 Colon malignancy
 Liver disease
 Conjuctivitis
Nursing Diagnosis:
 Chronic pain relate to disease process
 Imbalance nutrition less than body requirements
 Fluid volume deficit related to diarrhea and lose of fluid
 Risk for infection related to surgical procedure if the disease
 Ineffective coping related to fatigue , feeling of helplessness and lack of
support system
NCP for acute pain
Nursing Management :
 Measure vital signs to obtain a baseline date and have record of the health.
 Provide emotional support to the patient and his family to build a trusty
environment.
 If the patient is receiving parenteral nutrition , provide meticulous site care.
 Give iron supplements and blood transfusion as per prescription to prevent
from anemia .
 Administer medication as ordered.
 Record fluid intake and out daily, weigh the patient daily.
 Evaluate the effectiveness of the medication administration and care plan.
 Give the patient a list of food to avoid ,including lactose containing milk
products and spicy foods.
Patient Education:
 Teach patient about the chronic aspect of the disease
 Encourage self care in monitoring symptoms , seeking annual check up and
monitoring health
 Alert the patient to possible post operative problems with skin care
 Guide the patient about healthy diet plan.