Inflammatory Bowel Disease
Features Ulcerative Colitis – curable Crohn’s Disease – not curable only managed
Location/Patho Inflammation of rectum & sigmoid colon Inflammation often in terminal ileum &
(common), spreads in continuous pattern further ascending colon (but can happen anywhere in GI
Both peak @ into large intestine tract), spreads in patchy/sporadic manner,
age 15-30 cobblestone appearance (skip lesions)
Main concerns for UC is control diarrhea, pain
and monitor for GI bleeding. Promote comfort.
Etiology Idiopathic, genetic, immunologic, environmental Idiopathic, genetic, immunologic, environmental
Risk Factors Poor hygiene, stress, smoking, NSAIDS & Poor hygiene, stress, smoking, NSAIDS &
antibiotic use, Jewish & Caucasian population antibiotic use
# of stools 5-30 bloody/mucus loose stools/day Mild – moderate loose stools/day, no blood or
mucus
Mild < 4/day
Moderate 4-6/day
Severe > 6/day
Fulminant >10/day
Complications Toxic megacolon, perforation, hemorrhage Obstruction, fistulas, abscess formation,
Long term—colorectal cancer malabsorption
Long term-colon cancer
S/S (local) Tenesmus RLQ cramps/pain/tenderness (think Crohn’s –
LLQ cramps/pain (think Ulcerative colitis – has has r in word so it’s right lower quadrant pain)
2 l in words so it’s left lower quadrant pain) RLQ palpable mass (common)
Frequency/urgency Periumbilical pain
S/S (systemic) • Malaise • Malaise
• Anemia • Fever
• Dehydration (d/t loose stools) • Fatigue
• Wt loss • Anemia
• Wt loss
• Significant vit & mineral loss
Pt w/Crohns are @ high risk for malnutrition d/t
malabsorption (since small intestine is where
nutrients are absorbed)
Labs • CBC (low Hct, Hgbàblood loss, Same as UC
anemia)
• WBC – elevated (+) for infx (norm:
4500 – 10,000)
• ESR – elevated (norm: M < 15, F<20)
• CRP - elevated (norm: > 20)
• Serum albumin (hypoalbuminemia – d/t
malabsorption, malnutrition, protein
loss & chronic inflammation)
Stool cultures/Fecal Occult Blood Test
• Infx and presence of blood/mucus
Imaging Barium Enema (lower GI view) Abdominal CT
• Indicated for visualization of structures; • Noninvasive, cross-sectional (multiple views)
-procedures polyps, strictures/obstructions & ulcerations imaging of soft tissues & organs
same for both • PREàAssess barium allergy, clear liquids • PREàassess iodine allergy (if contrast used)
diet 2 days prior (no foods w/red dye) Colonoscopy
• POSTàmonitor for constipation, increase • Inspection of large intestine (colon) using
fluids to excrete barium (laxatives ok prn) colonoscope, screen for polyps & pathologies
Barium Swallow (upper GI view) • Not for pregnant pt, recent abdominal sx,
• Indicated for view of esophagus, stomach and confused/uncooperative pt, caution of colon
duodenum perforationàbleeding
Features Ulcerative Colitis – curable Crohn’s Disease – not curable only managed
Location/Patho Inflammation of rectum & sigmoid colon Inflammation often in terminal ileum &
(common), spreads in continuous pattern further ascending colon (but can happen anywhere in GI
Both peak @ into large intestine tract), spreads in patchy/sporadic manner,
age 15-30 cobblestone appearance (skip lesions)
Main concerns for UC is control diarrhea, pain
and monitor for GI bleeding. Promote comfort.
Etiology Idiopathic, genetic, immunologic, environmental Idiopathic, genetic, immunologic, environmental
Risk Factors Poor hygiene, stress, smoking, NSAIDS & Poor hygiene, stress, smoking, NSAIDS &
antibiotic use, Jewish & Caucasian population antibiotic use
# of stools 5-30 bloody/mucus loose stools/day Mild – moderate loose stools/day, no blood or
mucus
Mild < 4/day
Moderate 4-6/day
Severe > 6/day
Fulminant >10/day
Complications Toxic megacolon, perforation, hemorrhage Obstruction, fistulas, abscess formation,
Long term—colorectal cancer malabsorption
Long term-colon cancer
S/S (local) Tenesmus RLQ cramps/pain/tenderness (think Crohn’s –
LLQ cramps/pain (think Ulcerative colitis – has has r in word so it’s right lower quadrant pain)
2 l in words so it’s left lower quadrant pain) RLQ palpable mass (common)
Frequency/urgency Periumbilical pain
S/S (systemic) • Malaise • Malaise
• Anemia • Fever
• Dehydration (d/t loose stools) • Fatigue
• Wt loss • Anemia
• Wt loss
• Significant vit & mineral loss
Pt w/Crohns are @ high risk for malnutrition d/t
malabsorption (since small intestine is where
nutrients are absorbed)
Labs • CBC (low Hct, Hgbàblood loss, Same as UC
anemia)
• WBC – elevated (+) for infx (norm:
4500 – 10,000)
• ESR – elevated (norm: M < 15, F<20)
• CRP - elevated (norm: > 20)
• Serum albumin (hypoalbuminemia – d/t
malabsorption, malnutrition, protein
loss & chronic inflammation)
Stool cultures/Fecal Occult Blood Test
• Infx and presence of blood/mucus
Imaging Barium Enema (lower GI view) Abdominal CT
• Indicated for visualization of structures; • Noninvasive, cross-sectional (multiple views)
-procedures polyps, strictures/obstructions & ulcerations imaging of soft tissues & organs
same for both • PREàAssess barium allergy, clear liquids • PREàassess iodine allergy (if contrast used)
diet 2 days prior (no foods w/red dye) Colonoscopy
• POSTàmonitor for constipation, increase • Inspection of large intestine (colon) using
fluids to excrete barium (laxatives ok prn) colonoscope, screen for polyps & pathologies
Barium Swallow (upper GI view) • Not for pregnant pt, recent abdominal sx,
• Indicated for view of esophagus, stomach and confused/uncooperative pt, caution of colon
duodenum perforationàbleeding
