AMS1

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Author:
alyn217
ID:
164565
Filename:
AMS1
Updated:
2012-07-31 12:38:27
Tags:
AMS1T3 IBD
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Description:
Inflammatory Bowel Disease
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  1. General info about Inflammatory Bowel Disease
    • What?  Chronic Inflammation of the GI tract 
    • --Chron’s or Ulcerative Colitis
    • --Autoimmune disease
    • Who? Teenager, Young Adult, Peak 6th decade
    • Whites (Jewish), susceptibility gene
  2. Chrone's vs. Ulcerative colitis
    • \
  3. Clinical manifestations of inflammatory bowel disease
    • Diarrhea, bloody stools, weight loss, abdominal pain, fever, fatigue
    • Chronic with mild to severe exacerbations
    • Chron’s: colicky abdominal pain
    • Ulcerative Colitis: abdominal cramping w/ diarrhea
    • Mild: 1-2 semiformed stools daily, small amt blood
    • Moderate: 4-5 stools daily, increased bleeding, systemic symptoms (fever, malaise, anorexia)
    • Severe: 10-20 bloody stools/day, fever, weight loss greater than 10%=anemia, tachycardia, dehydration
  4. Complications assocaited with infammatory bowel disease
    • Hemorrhage
    • Strictures
    • Perforation (peritonitis)
    • Fistulas
    • Colonic dilation 
    • --Toxic Megacolon
    • --Ulcerative Colitis
    • Nutritional deficiencies
    • Colorectal Cancer 
    • Systemic Complications
  5. Diagnostics involved with IBD
    • CBC
    • Lytes
    • Erythrocyte Sedimentation Rate (ESR)
    • Sigmoidoscopy
    • Colonoscopy
    • Double contrast barium enema
    • Capsule endoscopy
  6. Collaborative care of pt w/IBD
    • Goals of treatment
    • Rest bowel, no eating for a bit. 
    • Control inflammation
    • Combat infection, ie flagel
    • Correct Malnutrition. v fat. 
    • Alleviate Stress
    • Symptomatic relief
    • Improve quality of life
  7. Rx Therapy for pt w/IBD
    • Aminosalicylates (decrease inflammation
    • --Sulfasalazine (Azulfidine), mesalamine (Pentasa)
    • Antimicrobials
    • --Metronidazole (Flagyl), Ciprofloxacin (Cipro)
    • Corticosteroids (decrease inflammation)
    • --Methylprednisolone, prednisone, budesonide (Entocort)
    • Immunosuppressants
    • --Aziathioprine (Imuran), Methotrexate, Cyclosporine
    • Biologic and targeted therapy
    • --Infliximab (Remicade), Adalimumab (Humira)
  8. Surgical therapy for pt w/IBD
    • Total Colectomy 
    •      w/ Ileoanal Reservoir
    • Total Proctocolectomy 
    •     w/ permanent Ileostomy
    • Total Proctocolectomy 
    •     w/ continent Ileostomy
    •      (Koch Pouch)
  9. Post surgical care for pt w/IBD
    • Postsurgical Care
    • Peristomal skin care
    • Wound/Ostomy 
    •    (enterostomal) nurse
    • Monitor output
    • Assess for: 
    • Obstruction
    • Abscess
    • Hemorrhage
    • Dehydration
  10. Nutritional tx for pt w/IBD
    Nutritional Therapy





    • Consult Dietician
    • Cobalamin replacement
    • Fat malabsorption=Cholestyramine
    • Folic Acid
    • Calcium (if corticosteroids)






    Avoid high fat, cold, high fiber foods






    • No smoking
    • Parenteral/Enteral Nutrition
    • Iron supplements
    • Potassium Supplement (corticosteroids)

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