ULCERATIVE COLITIS OUTLINE: A. ETIOLOGY & PATHOPHYSIOLOGY 1. 2. 3.

Autoimmune anti-inflammatory disorder of the colon and rectum Cause unknown, Females 15-25, white Jewish Diffuse inflammation leading to loss epitheliumulcer and abscess formation. Begins rectum and moves to cecum in orderly fashion B. SIGNS& SYMPTOMS 1. 2. 3. 4. 5. 6. 7. 1. 2. 3. 4. 1. Abdominal pain & distention Bloody diarrhea Low grade fever (99-100F) Tachycardia Dehydration Anemia Weight loss Sigmoidoscopy for definitive diagnosis Guaiac stool & fecal analysis- blood, parasites, ova Barium enema- distinguish between Crohns & colitis Labs: HgB, HCT, WBC DIARHHEA MANAGEMENT i. Note vol, colour, constancy stool ii. Assess perineal area & skin care iii. Daily weights 11. 8. 9. 10. Anorexia Psychological stress Abnormal lab values: decreased HgB, HCT, Na+, K+, Cl- & albumin, increased WBC & ESR anemia

C. LABS & DIAGNOSTIC TESTS:

D. COLLABORATIVE INTERVENTIONS

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DRUG THERAPY i. Aminosalicylates to block intestinal prostaglandin synthesis and prevent re-occurrence 1. Sulfasalazine (Azulfidine), Mesalamine (Asacol) ii. Corticosteroids: Hydrocortisone iii. Antimicrobials: Neomycin- bowel antiseptic iv. Anti-diarrheal: Diphenoxylate (Lomotil)

3.

DIET THERAPY i. NPO if severe 1. NG tube; TPN- elemental TPN if less severe ii. Low fibre, high protein, high cal diet iii. Teach avoid whole wheat grains, nuts, fresh fruits and veggies, dairy smoking, alcohol, caffeine & pepper iv. Ensure bedside commode v. Complementary & alternative therapies ex. Yoga, acupuncture, herbs like flaxseed etc

4. 5.

REST SURGERY i. Total proctocolectomy w/ permanent Ileostomy (colon, rectum & anus removedanus closed) 1. Needs Ostomy at all times 2. Initial output dark green and loosevol. Decreases turns yellow-green then yellow brown 3. Foul odour suggests blockage or infection ii. Total Colectomy w/ continent Ileostomy (kock Ileostomy or Ileostomy reservoir) 1. Internal system 2. Cather placed in pouch immediately for sxn & irrigation iii. Ileoanal reservoir (J-pouch)

1. Colon removed & ileum sutured into rectal stump to form reservoir 6. NURSING INTERVENTIONS: i. Manage Pain 1. Administer Antidiarrheals 2. Administer anti-Cholinergics before meals for pain relief 3. Skin care for irritated perianal areas a. Clean area after bowel movements b. Sitz baths ii. Monitor s/s internal bleeding iii. Check stools for blood iv. Monitor HCT, HgB, e-lytes v. Observe for fever, tachycardia, fluid volume depletions, severe abdominal pain, or change mental status E. COMPLICATIONS 1. Internal complications i. Intestinal perforation w/ peritonitis ii. Fistulas iii. TOXIC MEGA COLONcolon dilation >10cm 2. Extra Intestinal complications i. Arthritis ii. Ankylosing spondylitis iii. Eye inflammation iv. Skin lesion v. Mouth sores iv. Hemorrhage v. Abscess vi. Malabsorption, bowel obstruction