ulcerative colitis ase Study Ulcerative Colitis: Ms. Beauchamps., a 37-year-old

Question

ulcerative colitis ase Study Ulcerative Colitis: Ms. Beauchamps., a 37-year-old mother to two school-aged children, is admited for the fifth time in 11 months with acute ulcerative colitis. Subjective Data: Complains of severe diarrhea (10 to15 stools a day with blood and mucous) and intestinal cramping States she has lost 8 lb in the past 11 months . Complains of fatigue, anorexia, nausea, and vomiting States she takes sulfasalazine (Azulfidine) and prednisone - Has not taken any medication in past 72 hours because of nausea and vomiting Tearfully states she is "tired of this disease interfering with her life* Objective Data: Physical Examination Temperature of 100.4 F . Pulse 110; BP 115/70 . Weight 109 lb Palpation over the colon reveals abdominal tenderness Laboratory Tests ·Hct 26% Hb 9 g/dl Serum albumin 2.3 g/d Critical Thinking Questions: What are the complications of ulcerative colitis and the role of the nurse in preventing

Explanation / Answer

Difference between the pathophysiology of ulcerative colitis and Crohn's disease.

Ulcerative colitis is the disease in which the inflammatory response and morphologic changes remain limited to the colon (from the cecum to rectum). In around 95% of patients, rectal involvement is seen. Initially, the inflammation is confined to the mucosal lining and variable severity of disease with ulceration, edema, and hemorrhage along the length of the colon is seen. The main histologic findings are acute and chronic inflammation of the mucosa by polymorphonuclear leukocytes and mononuclear cells, crypt abscesses, distortion of the mucosal glands, and goblet cell depletion. The distinguishing features of UC are hematorrhoea with mucus, frequent diarrhea, loss of appetite, abdominal pain, and tenesmus.

Crohn's disease is the idiopathic, chronic inflammation which can occur anywhere in the GI tract, from the oropharynx to the perianal area (mouth to the anus). Usually affects all the layers of the bowel walls, not just the mucosa. Skip areas (affected segments separated by intervening normal bowel area) are common. The inflammation can often extend through the serosa ( transmural) results in the formation of sinus tracts or fistula. The most commonly affected area is the ileocecal region, followed by the terminal ileum then, diffuse small bowel (decreasing order of frequency). Histologic studies exhibit small superficial ulcerations over a Peyer’s patch (aphthoid ulcer) and focal chronic inflammation extending to the submucosa, many tiemes followed by noncaseating granuloma formation.

The characteristic features are abdominal pain and diarrhea can be complicated by intestinal fistula or obstruction. Other symptoms may include nausea, weight loss, and vomiting, occasional rectal bleeding and diarrhea. Remissions are common in the long-term course.

Tachycardia

Patients with ulcerative colitis may develop ventricular tachycardia in association with hypomagnesemia. The replacement of magnesium by infusions are capable of suppressing the arrhythmia but hypomagnesemia and ventricular tachycardia reoccurred after the infusion stop due to continuous bowel emptying and diarrhea. Anemia and UC medications, especially prednisone, also contribute tachycardia.

Low albumin and anemia

Anemia and low albumin are the most frequent complications of UC. Iron deficiency is the main reason for anemia. Iron deficiency may affect the quality of life of patients. Iron deficiency and hypoalbuminaemia coexist due to the deficiency of Hepcidin, a central regulator of iron absorption from the intestine and of iron plasma levels. Reason for anemia and low plasma albumin can be malabsorption and continuous blood loss in active colitis.

Complications

§ Hypertrophy of the intestinal wall

§ Severe dehydration

§ inflammation of other organs like skin, joints, and eyes

§ toxic megacolon

§ liver involvement

§ Renal calculi

§ GI bleeding

§ Perforation of bowel

§ Sepsis

Nursing management:

Maintain NPO status

Total parenteral nutrition

Limit activity

Assess bowel sounds

Low fibre, high protein diet (when beginning oral feed)

Assess for signs and symptoms of infection

Avoid the bowel irritants like nuts, alcohol, caffeine

Advice on smoking cessation

Monitor for warning signs

Check vitals frequently

Provide emotional support

Educate about the disease process and dietary modifications

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