Inflammatory Bowel Disease
• Immunologically-related disorder
• Characterized by chronic recurrent inflammation of the GI tract
• Cause unknown but theories exist: infection (bacteria or virus), food allergies, autoimmune reaction,
heredity
Ulcerative Colitis
Pathologic • Inflammation of colon and
Characteristics rectum
• Involves mucosa and
submucosal layers
Age/Sex
Clinical Bloody diarrhea
Manifestations (Metabolic acidosis = loss
bicarbonate in stools)
Complications INTESTINAL
• Hemorrhage
• Increase risk of colon cancer
if ulcerative colitis >10
years
• Strictures/perforation (less
common than with Crohn’s)
• Toxic Megacolon
Perforation d/t colon losses
its mobility. Dilation and
paralysis of colon ends with
perforation and peritonitis.
Eventually colon becomes
necrotic and gangrenous
Diagnostics CBC
Common to Both Crohn’s Disease
• Inflammation of the • Inflammation of segments of
GI tract the GI tract- can occur
anywhere in the GI tract
• Skip Lesions
• Cobblestone appearance
• Entire thickness of GI tract
Upper middle class urban:
Jewish
15-30 years old
• Abdominal pain Non bloody diarrhea
• Cramping, constant or
intermittent
• Elevated temperature
• Weight loss
• Dehydration
• Elevated heart rate
• Fatigue
• Abdominal distention
EXTRAINTESTINAL INTESTINAL
• Associated with active • Strictures and obstruction =
inflammation scar tissue from inflammation
• Joint = arthritis and narrow lumen
• Fingers = clubbing • Fistulas develop between
• Skin= erythema sections of GI tract and
• Malabsorption organs (bowel –vaginal and
• Eyes = conjunctivitis bowel – bladder). Patient at
• Gallstones risk for UTI and urinary
• Kidney stones stools in Foley
• Perforation d/t inflammation
in ALL layers = peritonitis
and abscess
• Decreased absorption, esp. fat
= decrease in fat soluble
ADEK
• Electrolytes WBC
• Stool C&S
• Endoscopy – best
diagnostic to visualize
scar tissues
• Barium xray (lower GI
= enema, upper GI =
 barium swallow)

Treatment: Azulfidine (Sulfa-salazine) Corticosteriods Azulfidine (Sulfa-salazine)

Medication • Anti-inflammatory (Prednisone) • Effective if Crohn’s located
• 5 amino salicyclic acid • Induced remission in large intestine, but not as
Goals: • People allergic to • Anti-inflammatory effective if Crohn’s located in
• Rest bowel sulfonamides or salicylates effect small intestine
• Control (e.g., ASA) should not take • Not used as long term
inflammation this drug.
• Prevent • Adequate fluid intake must Flagyl useful when Crohn’s is in
infection be maintained in order to Immunosuppressives perianal area
• Correct prevent crystal and stone 1. 6MP
malnutrition formation. (Mercaptopurine)
• Decrease 2. Cyclosporine Adalimumab (Humira)
stress 3. Imuran • Crohn’s disease
• Symptomatic • Monoclonal antibody (type of
relief Me-salamine (Rowasa, • Risk for infections d/t biologic response modifier)
Pentasa, Asacol) bone marrow • Usually prescribed after other
suppression pharmacologic treatments
• Taken 3-6 months fail.
• Anti-inflammatory • Goal: induce and maintain
• 5 amino salicyclic acid remissions
• May produce an orange- Infliximab (Remicade) • SubQ (self injection) 1 q
yellow color of the urine • Indication: Patient other week.
with IBD with • Side effects: TB, lymphoma,
inadequate responses injection site reactions,
to other therapies. A nausea, URI
monoclonal antibody
that interferes with the
inflammatory
process/immune
system. 2 hr IV
infusion: initial, then
wks 2 & 6; then q 8
weeks. Side effects:
Infection (high
incidence of TB: pre-
treatment screening
and ongoing
monitoring)

Surgery • Total Proctocolectomy • NO surgical can treat Crohn’s

with Permanent disease
Ileostomy: removal of • Balloon dilatation
colon, rectum, cecum, anus
• Liquid stools

• Total Proctocolectomy
with continent Ileostomy
(Kock Pouch): removal of
colon, rectum and anus.
Anus is closed. Internal
pouch created with one way
valve to prevent continuous
leakage of fluid. No external
pouch. Self-catheterize.
Complication: Valve failure
 and Pouchitis. Can be
treated with Flagyl.

• Total Colectomy and Ileal

Reservoir: Two surgeries.
• 1) Colectomy, reservoir
construction, temporary
ileostomy
• 2) Ileostomy closure – as
this functions as internal
pouch; must have competent
anal sphincter; over 3-6
months, patients learn to
control BMs; Post op Kegel
exercise to increase strength
of pelvic floor muscles.

Treatment: • Vitamin and iron • TPN with severe • Low fat

Nutrition Goals supplements disease • No milk products – lactose
• Long term Azulfidine – can • Elemental diets: high not adequately absorbed
cause Folic acid deficiency calorie and nutrient, because of damage mucosa
• Malabsorption lactose-free, absorbed • Malabsorption – decreased
in the proximal small absorption of B12 by terminal
intestine which allows ileum (if affected)
the more distal bowel
to rest Probiotics
• Initially NPO • Good bacteria
• Hi calorie – Hi • Restores balance to gut flora
protein-Lo • Decrease in flares
residue/fiber • Lactobacillus (Culturelle)
• Avoid smoking • Pourable yogurt and yogurt
(increase GI motility) with “live cultures’
• Zinc deficiency may
result from chronic
diarrhea
• Provide rest
• Assist with coping
strategies
• Frequent BMs – rectal
discomfort, anxiety
and depression
• Monitor for
hypovolemia
• Monitor nutritional
status