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inflammatory Bowel Disease (IBD) = chronic inflammation/ ulceration (or…
inflammatory Bowel Disease (IBD) = chronic inflammation/ ulceration (or both) of the bowel lining
Ulcerative colitis (UC)
Diffuse mucosal inflammation consistently involves rectum & to the proximal colon (mostly on left side)
high mortality & serious morbidity
disease extent
Proctitis -> distal colitis confined to the rectum
Proctosigmoiditis -> rectum & sigmoid colon
Left-sided colitis -> up to the splenic flexure
Extensive colitis -> up to the hepatic flexure
Pancolitis -> the whole colon
Clinical manifestations
Bloody diarrhoea
colicky abdominal pain, urgency
Crohn's disease (CD)
erosion, ulcers, patchy, transmural inflammation, involving the whole GI tract
Clinical course: peroid of exacerbarion and remission
location: upper GI, terminal ileal, colonic, ilecolic
Clinical manifestations
abdominal pain
diarrhoea
weight loss
intestinal obstruction, fever
pathophysiology
associated factor
diet, drug, vaccination history, environmental factor
increase risk of colonic carcinoma
Nursing assessment
history taking
family history, recent travel, smoking, medication, bowel history (stool frequency & consistency, urgency, rectal bleeding)
physical examination
general well being, anaemia, dehydration, weight loss, taking vital signs, abdominal pain (tenderness/ distension), palpable masses
Laboratory investigation
CBC, LFT, RFT
Erythrocyte sedimentation rate (ESR)
C reactive protein (CRP)
Stool for C&ST, clostridium difficile toxin, ova&cysts
*Abdominal X-ray -> initial assessment to exclude colonic dilation
assessing disease extent in ulcerative colitis
Small bowel barium studies -> defining extent and site of disease
Endoscopic exam.
sigmoidoscopy -> for all patients hv diarrhoea
Colonoscopy -> perferable to flexible sigmoidoscopy, visualize the terminal ileum
pathological exam -> biopsy
CT enterography
assess extraural manifestations & complication such as abscess/ fistulae
Medication
aminosalicylates -> for maintanance of remission in UC
Corticosteroids
Oral prednisolone, prednisone
intravenous hydrocortisone
Tropical suppositories
immunosuppressive drugs
Azathioprine (AZA) & Mercaptopurine (MP)
antidiarrhoeal medications
Diverticulosis
multiple diverticula, no inflammation. symptoms
diverticula -> blind-ended pouches/ herniations of the mucosal & submucosal layers of the colon developing at weak points
Diverticulitis
infection
impede drainage
rectal bleeding
abscess formation, peritonitis, perforation