CHRONIC

INFLAMMATOR
Y BOWEL
DISORDERS

A. REGIONAL
ENTERITIS
(CROHNS DISEASE)
Transmural
Ileum

/ Ascending Colon

CAUSES:
Unknown
Jewish
Environmental

AGE:
20-30 years
40-60 years

BLEEDING:
decreased; stool with pus &
mucus
PERIANAL INVOLVEMENT:
severe

FISTULAS:
Common

RECTAL INVOLVEMENT:
20%
DIARRHEA:
5-6 soft stools/day
ABDOMINAL PAIN:

WEIGHT LOSS:

INTERVENTIONS:
TPN
Steroids
Azulfidine (Sulfasalazine)
Ileostomy
Colectomy

B. ULCERATIVE COLITIS
Mucous

Ulceration
Rectum / Lower colon

CAUSES:
Unknown
Familial
Jewish
Emotional Stress

AGE:
15-40 years

BLEEDING:
Severe; stool with blood, pus
& mucus

PERIANAL INVOLVEMENT:

Mild

FISTULAS:

Rare

RECTAL INVOLVEMENT:
100%
DIARRHEA:
20-30 watery stools/day
ABDOMINAL PAIN:

WEIGHT LOSS:

INTERVENTIONS:
Diet
TPN
Steroids
Azulfidine
Ileostomy
Proctocolectomy

NOTES:
Azulfidine has antiinfective
and anti-inflammatory effects.

Ileostomy continuously drain

watery fecal wastes. It does
not require irrigation.

APPENDICITIS

APPENDICITIS:
Inflammation of the vermiform

appendix.
More common in males, 10 to 30 years
of age.

Causes:
Obstruction by fecalith or foreign
bodies, bacteria and toxins.
Low fiber diet.
High intake of refined carbohydrates.

PATHOPHYSIOLOGY

Inflammation
Intraluminal Pressure

Lymphoid Swelling
Decreased Venous Drainage
Thrombosis
Bacterial Invasion

Abscess

ASSESSMENT
Acute abdominal pain that
usually starts in the epigastric or
umbilical region.
- Pain gradually becomes
localized in RLQ / Mc Burneys
point (halfway between the
umilicus and the anterior spine of
the ilium).

- Pain is initially intermittent then

becomes steady and severe over a
short period.
Anorexia, nausea and vomiting
o Rigid abdomen, guarding
o Rebound tenderness (Blumberg
sign)
o Fever (temp. = 38-38.5C)
o

Elevated wbc (above

10,000/cu.mm)

Psoas

sign (lateral position with

right hip flexion)
Decreased or absent bowel
sounds.

COLLABORATIVE MANAGEMENT:

Bed rest
NPO
Relieve pain (cold application over the
abdomen)
Avoid factors that increase peristalsis,
thereby rupture:
- Heat application over abdomen
- Laxative
- Enema

IVF therapy to maintain fluid

electrolyte balance.

Antibiotic therapy

Surgery: Appendectomy

APPENDECTOMY

Spinal anesthesia.

Flat on bed for 6-8 hours.

Monitor for return of sensation in

the lower extremities.

NPO until peristalsis returns.

Ambulation after 24 hours.

If appendicitis ruptured
(peritonitis): with penrose drains;
Semi-Fowlers position to localize
inflammation within the pelvic
area.

Resume all normal activities

within 2 to 4 weeks.