Lecture on Gastrointestinal System and Inflammatory Bowel Disease

Introduction

• Focus on Inflammatory Bowel Disease (IBD), including Crohn's Disease and Ulcerative Colitis.
• Emphasis on being prepared to learn and connect content to professional nursing practice.
• Importance of active learning and reflection on existing knowledge and experiences.

Learning Objectives

• Understand the causes, symptoms, management, and nursing considerations for both Crohn's Disease and Ulcerative Colitis.

Crohn's Disease

Overview

• An autoimmune disease with unknown causes; suspected factors include genetics, immune response, and gut microorganisms.
• Characterized by periods of exacerbation and remission.
• Can affect any part of the GI tract, commonly the distal ileum and ascending colon.
• Lesions are transmural and can be random, leading to abscesses, ulcers, fissures, fistulas, scarring, fibrosis, and stenosis.

Symptoms

• Abdominal pain, particularly in the right lower quadrant.
• Malnutrition, weight loss, and anemia (often due to poor intake rather than bleeding).
• Dehydration and possible electrolyte imbalances.
• Vary depending on lesion location (absorption issues in small bowel vs. water/electrolyte issues in large bowel).

Medical and Nursing Management

• Diagnostics: x-rays, MRIs, CT scans, colonoscopy, CBC, BMP, inflammation markers (ESR, C-reactive protein), albumin, and protein levels.
• Treatment: corticosteroids, amino salicylates, immunomodulators, monoclonal antibodies, antibiotics, parenteral feeding.
• Surgical options: ileostomy (does not cure the disease).
• Nursing care: manage anemia, monitor vital signs, provide oral care, administer medications, and provide education.

Complications

• Anorexia, weight loss, malnutrition, osteoporosis.
• Life-threatening: strictures, obstructions, fistulas, abscesses, colon cancer, perforation, hemorrhage, peritonitis.

Ulcerative Colitis

Overview

• Chronic inflammatory disease of the mucosal and submucosal layers of the colon and rectum.
• Similar risk factors to Crohn's (genetics, immune response, microorganisms).
• Inflammation progresses from rectum upwards; affects only the inner lining, causing potential extensive scarring.

Symptoms

• Severe bleeding and frequent bloody diarrhea.
• Abdominal pain, especially in the lower left quadrant.
• Electrolyte imbalances, dehydration, anemia, and fatigue.

Medical and Nursing Management

• Diagnostics similar to Crohn's.
• Possible colectomy (can cure the disease).
• Medications: similar to Crohn's with the addition of addressing severe anemia and potential blood transfusions.
• Nursing care: similar to Crohn's, with additional focus on managing bleeding and acute blood loss.

Complications

• Anorexia, weight loss, malnutrition, osteoporosis.
• Life-threatening: toxic megacolon, which requires immediate management to prevent fatal outcomes.

Nursing Considerations

• Address anemia, monitor vital signs, administer IV fluids, manage obstructions and NG tube care.
• Provide patient education tailored to their understanding and readiness to learn.
• Practice therapeutic communication to support psychosocial and holistic care.
• Be aware of the potential exacerbations of IBD due to stress or hospitalization for other conditions.

Conclusion

• Encourage reflection on how IBD affects patients' lives and the importance of compassionate care.
• Review learning objectives and ensure comprehensive understanding of IBD management.