Chrons Disease and Ulcerative Colitis

OBSTRUCTIVE
STRUCTURAL BOWEL
DISORDERS
Ulcerative Colitis & Crohn’s Disease
Presented by: GROUP 1

ULCERATIVE COLITIS
DEFINITION
Ulcerative Colitis is a condition that causes inflammation and ulceration of the
inner lining of the colon (the large bowel) and rectum. Inflammation is the
body’s reaction to irritation, injury or infection, and can cause redness,
swelling and pain. In Colitis, ulcers develop on the surface of the bowel lining
and these may bleed and produce mucus. The inflammation usually begins in
the rectum and lower colon, but it may affect the entire colon. If Colitis only
affects the rectum, it is called proctitis.
PREVALENCE
There were 6.8M cases with IBD globally.
For ulcerative colitis, the global ceiling incidence range is 23.1–57.9 per 100,000
population.
In the Philippines, the prevalence of Ulcerative colitis is 1.22 per 100,000 persons
TYPES
TYPES
• Proctitis
• In proctitis, only the rectum (the lowest part of the large bowel) is inflamed. This
means that the rest of the colon is unaffected and can still function normally. For many
people with proctitis, the main symptom is passing fresh blood, or bloodstained
mucus. The person who has this may get diarrhea, or may have normal stools or even
constipation. It may also feel an urgent need to rush to the toilet. Because the inflamed
rectum is more sensitive, some people with proctitis often feel that they have an urge
to pass a stool, but cannot pass anything as the bowel is actually empty. This is called
tenesmus.
TYPES
2. Proctosigmoiditis
In some people, the sigmoid colon (the short curving piece of colon nearest the rectum)
may also be inflamed. The symptoms are similar to those of proctitis, although
constipation is less likely.
3. Left- sided colitis

• In this type of Colitis, the inflammation involves the distal colon, which includes the
rectum and the left side of the colon (also known as the descending colon).
Symptoms include diarrhea with blood and mucus, pain on the left side of the
abdomen, urgency and tenesmus.
TYPES
4. Extensive colitis
• If not all parts of the colon are inflamed, it is known as extensive colitis. Extensive
and total colitis can cause very frequent diarrhea with blood, mucus, and sometimes
pus (a thicker, more yellow fluid than mucus). It may also have severe abdominal
cramps and pain, tenesmus, fever and weight loss. In milder flare-ups, the main
symptom may be diarrhea or loose stools without blood.
TYPES
5. Pancolitis
• A type of Colitis that affects the whole colon is known as total colitis or pancolitis. If
the inflammation affects most of the colon.
RISK FACTORS
NON-MODIFIABLE MODIFIABLE
1. GENETICS 1. DIET
2. AGE 2. SMOKING
3. ETHNICITY 3. NSAIDs
4. GENDER 4. Air Pollution
5. Stress
CLINICAL MANIFESTATIONS
ABDOMINAL PAIN
AND CRAMPING WEIGHT LOSS
DIARRHEA
FATIGUE FEVER BLOODY IN STOOL

DIAGNOSTIC TESTS
Stool Examination
A test done on a stool (feces) sample to check
for blood or organisms such as parasites,
viruses, bacteria in the feces.
Purpose: To help identify diseases of the

digestive tract, or to rule out infectious causes of
gastrointestinal symptoms.
DIAGNOSTIC TESTS
Nursing Responsibilities
Before
• Check the doctor’s order
• Explain the procedure to the patient.
• Encourage the patient to urinate.
DIAGNOSTIC TESTS
After
• Collect the specimen in an appropriate container.
• Label the container with the patient’s name, date, time, hospital
number, physician, and room number.
• Transport the specimen to the laboratory immediately.
• Note the stool consistency, color, and appearance
• Instruct the patient to do handwashing.
DIAGNOSTIC TESTS
Abdominal X-ray
A test that produces images of the organs in the
abdominal cavity including the stomach, liver,
intestines, and spleen.
Purpose: To help in determining the cause of

symptoms. These can include masses, holes in
the intestine, or blockages.
DIAGNOSTIC TESTS
Before
• Explain the procedure to the patient
• Provide the patient with a hospital gown before the test.
• Instruct the patient to remove all the jewelry, metal objects or anything.
• Instruct the patient to empty the bladder before the procedure.
• Instruct the patient to stay still in a few moments when the X-ray is taken.
DIAGNOSTIC TESTS
During
• Assist the patient to an appropriate
position.
DIAGNOSTIC TESTS
After
• Evaluate the client’s response.
• Document the findings.
DIAGNOSTIC TESTS
Colonoscopy
A diagnostic procedure that uses a flexible tube
with a camera on one end to look inside the
rectum and colon.
Purpose: To help identify the characteristic areas

of damage, swelling, inflammation, and sores in
the intestine. To reveal the colon wall
thickening.
DIAGNOSTIC TESTS
Before
• Obtain or confirm an informed consent
• Instruct the patient to take a laxative, suppository, or drug as ordered.
• Provide the patient with a hospital gown before the test.
• Instruct the patient to remove all the jewelry, metal objects or anything.
DIAGNOSTIC TESTS
During
• Assist the patient to lie on your left side with your
knees pulled up towards your chest.
• Monitor the vital signs
DIAGNOSTIC TESTS
After
• Monitor the vital signs of the patient
• Encourage to increase fluid intake
DIAGNOSTIC TESTS
Blood Test
A series of tests to measure the amount of
concentration of the cellular component of
blood in the body.
Purpose: To find a wide range of conditions,

including anemia, infection, inflammation, and
presence of autoantibodies in the blood.
DIAGNOSTIC TESTS
• Instruct the patient to apply manual pressure in the puncture site.
• Monitor for any oozing or hematoma formation on the puncture
site.
DIAGNOSTIC TESTS
Barium Enema
A radiographic examination of the lower
gastrointestinal tract by filling the colon with a liquid
suspension called barium sulfate. Barium highlights
certain areas in the body to create a clearer picture.
Purpose: To assess extent of disease and detect active

ulcerative disease, masses, polyps, carcinoma, and
strictures.
DIAGNOSTIC TESTS
Before
• Verify the doctor’s order
• Obtain or Confirm an informed consent.
• Instruct the patient to take a laxative, suppository, or
drug as ordered.
DIAGNOSTIC TESTS
Before
• Instruct the patient to have NPO for 8 to 10 hours prior to the
procedure
• Instruct the patient to change into a hospital gown before the test
• Instruct the patient to remove all the jewelry, metal objects or
anything
DIAGNOSTIC TESTS
During
• Instruct the patient to lie on the x-ray table
on your left side.
• Monitor vital signs.
DIAGNOSTIC TESTS
After
• Inspect the patient’s stool for the presence of barium (white stool)
• Administer enema or laxatives as per doctor’s orders, if the patient does
not have a bowel movement for more than two days after the exam or
are unable to pass gas rectally.
• Encourage the patient to increase the fluid intake
DIAGNOSTIC TESTS
Magnetic Resonance Imaging (MRI)
A non-invasive imaging technology that produces
three dimensional detailed anatomical images. It
is a large tube that contains powerful magnets
which the patient will lie inside during the scan.
Purpose: To identify abscesses and perirectal

involvement
DIAGNOSTIC TESTS
Before
• Check the doctor’s order.
• Explain to the patient the procedure
anything
• Instruct the patient to stay still during the procedure
DIAGNOSTIC TESTS
During
• Assist the patient to lie flat in the
examination table.
DIAGNOSTIC TESTS
After
• Encourage the patient to increase fluid intake
• Monitor the patient for an adverse reaction to the contrast
medium such as flushing, nausea, and sneezing)
DIAGNOSTIC TESTS
RECTAL
BIOPSY
It is a procedure used to extract a
tissue sample from the rectum
for laboratory analysis. This
procedure is usually performed
during Sigmoidoscopy or
Colonoscopy
DIAGNOSTIC TESTS
BEFORE
• Ensure the patient fully understands the rectal biopsy procedure, its
purpose, potential risks, and benefits, and obtain informed consent.
• Ensure the patient has completed any bowel preparation as prescribed,
such as laxatives or enemas.
• Ensure the patient is NPO (nothing by mouth) for the appropriate
amount of time before the procedure.
DIAGNOSTIC TESTS
DURING
• Assist the patient into the appropriate position for the rectal biopsy
procedure, typically the left lateral decubitus position.
• Monitor for any signs of bleeding during the procedure, such as excessive
bleeding.
• Assess the biopsy site for signs of infection, such as redness, swelling,
warmth, or discharge, and report any abnormalities.
DIAGNOSTIC TESTS
AFTER
• Provide post-procedure care instructions to the patient, including any
activity restrictions, wound care guidelines, and medication instructions.
• Document all post-procedure assessments, interventions, patient education
provided, and the patient's response to treatment in the medical record for
continuity of care and legal documentation.
DIAGNOSTIC TESTS
Sigmoidoscopy
It is an exam used to evaluate the
lower part of the large intestine
(colon). During a flexible
sigmoidoscopy exam, a thin,
flexible tube (sigmoidoscope) is
inserted into the rectum.
DIAGNOSTIC TESTS
BEFORE
• Educate the patient about the sigmoidoscopy procedure, including its
purpose, what to expect during the procedure, and any potential risks or
complications.
• Instruct the patient to fasts before the procedure.
DIAGNOSTIC TESTS
DURING
• Assist the patient into the appropriate position for the sigmoidoscopy
procedure, typically lying on their left side with knees bent.
• Observe the patient's response to the procedure, including any signs of
discomfort, and pain.
DIAGNOSTIC TESTS
AFTER
• Educate patient including information on wound care (if biopsy was
performed), activity restrictions, medication management, and when to
seek medical attention for worsening symptoms or complications.
• Document the patient's response to the sigmoidoscopy procedure, including
vital signs, pain assessment, interventions provided, patient education, and
any complications or concerns identified.
RISK FACTOR
• Genetics
• Ethnicity
• Age
• Smoking
• Diet
• Medication
COMPLICATIONS IN
ULCERATIVE COLITIS
TOXIC MEGACOLON
COMPLICATIONS
PERFORATION BLEEDING
COMPLICATIONS
HIGHLY GRANULAR VASCULAR

TISSUE ENGORGMENT
COMPLICATIONS
• JOINT PAIN OR
• NEPHROLITHIASIS • CHOLELITHIASIS
ARTHITIS
• ERYTHEMA NODOSUM
• RETINITIS IRITIS
PHARMACOLOGIC
MANAGEMENT
AMINOSALICYLATES CORTICOSTEROIDS
Z
IMMUNOSUPPRESSANTS
• First-line treatment for • Modulating the immune
• Induce remission in
system to reduce
mild to moderate moderate to severe UC or
inflammation in the
Ulcerative Colitis during flare-ups.
colon
Examples: Examples: Examples:
• Prednisone • 6-mercaptopurine
• Sulfasalazine
• Prednisolone
• Azathioprine
• Mesalamine
• Methotrexate
• Budesonide
PHARMACOLOGIC
MANAGEMENT
BIOLOGICS JANUS KINASE (JAK)
• Helps by targeting specific INHIBITORS
• Interfere with the
components of the
activation of pro-
immune system inflammatory cytokines
Example: and subsequent immune
• Infliximab cell responses
• Adalimumab Example:
• Vedolizumab • Tofacitinib
SURGICAL MANAGEMENT
ILEOSTOMY
SURGICAL MANAGEMENT
ILEOANAL POUCH ANASTOMOSIS

NURSING MANAGEMENT
ULCERATIVE COLITIS
• Maintaining normal elimination pattern

• Relieving pain
• Maintaining fluid Intake
• Maintaining optimal nutrition
• Promoting rest
• Reducing anxiety
• Preventing skin breakdown
• Monitoring complications
CROHN'S DISEASE
DEFINITION
Crohn’s Disease is a chronic inflammatory bowel disease affecting any part of the digestive tract.It causes symptoms like abdominal pain, diarrhea,and fatigue, with
Crohn’s Disease is a chronic inflammatory bowel disease affecting any part
periods of active inflammation.Its exact cause is unclear but it is believed to involve genetic, environmental and immune factors. Management is lifelong focusing on
symptom control and improving quality of life.
of the digestive tract. It causes symptoms like abdominal pain, diarrhea,

and fatigue, with periods of active inflammation.
NON-MODIFIABLE
• Genetics
• Age
• Ethnicity
MODIFIABLE
• Smoking
• Diet
• Medications
ABDOMINAL PAIN URGENCY AND

DIARRHEA AND CRAMPING INCOMPLETE BOWEL
MOVEMENT
WEIGHT LOSS FATIGUE FEVER

DIAGNOSTIC TESTS
Capsule Endoscopy
A non-invasive diagnostic procedure to visualize the inside of the
digestive tract. The patient swallows a capsule that contains a tiny camera,
a transmitter, and a light as it passes through the stomach, intestines,
colon, and rectum that pictures and transmits.
Purpose: To explore the unexplained bleeding in the small intestines and

may help diagnose Crohn’s disease and other forms of inflammatory
bowel disease.
DIAGNOSTIC TESTS
Before
• Obtain or confirm an informed consent
• Restrict the patient diet to NPO prior to the test
DIAGNOSTIC TESTS
Before
• Instruct the patient to take a laxative, suppository, or drug as
ordered.
• Instruct the patient to change into a hospital gown before the
test
• Instruct the patient to avoid strenuous exercise.
DIAGNOSTIC TESTS
During
• Avoid MRI machines, ham radios, strong magnetic fields
• Observe the patient for bleeding and changes in vital signs
DIAGNOSTIC TESTS
During
• Avoid MRI machines, ham radios, strong magnetic fields
• Observe the patient for bleeding and changes in vital signs
DIAGNOSTIC TESTS
After
• Document the client response to the
procedure
DIAGNOSTIC TESTS
Barium Enema
A radiographic examination of the lower gastrointestinal tract by filling the
colon with a liquid suspension called barium sulfate. Barium highlights
certain areas in the body to create a clearer picture.
Purpose: To diagnose structural or functional abnormalities of the large

intestine, including the rectum. To find the extent of ulcerations and
inflammation in GI tract.
DIAGNOSTIC TESTS
Before
• Obtain or Confirm an informed consent.
• Instruct the patient to take a laxative, suppository, or drug as
ordered.
DIAGNOSTIC TESTS
Before
• Instruct the patient to have NPO for 8 to 10 hours prior to the
procedure
anything
DIAGNOSTIC TESTS
During
• Instruct the patient to lie on the x-ray table
on your left side.
DIAGNOSTIC TESTS
After
• Inspect the patient’s stool for the presence of barium (white stool)
• Administer enema or laxatives as per doctor’s orders, if the patient does
not have a bowel movement for more than two days after the exam or
are unable to pass gas rectally.
• Encourage the patient to increase the fluid intake.
DIAGNOSTIC TESTS
COLONOSCOPY
It is a procedure used to examine the
inside of the colon and rectum using a
long flexible tube with a camera at the
end called a colonoscope. The
colonoscope is inserted through the
rectum and advanced through the
entire length of the colon.
DIAGNOSTIC TESTS
DIAGNOSTIC TESTS
BEFORE
• Educate the patient about the colonoscopy procedure, including its purpose,
risks, and preparation instructions.
• Ensure that the patient has signed a consent form after understanding the
risks, benefits, and alternatives of the colonoscopy procedure.
• Ensure the patient follows the prescribed bowel preparation regimen to
cleanse the colon adequately.
DIAGNOSTIC TESTS
BEFORE
• Encourage the patient to maintain adequate hydration during
bowel preparation.
• Provide dietary guidance to the patient before the colonoscopy,
emphasizing low-residue or clear liquid diet.
DIAGNOSTIC TESTS
DURING
• Assist the patient into the appropriate position for the colonoscopy
procedure, typically lying on the left side with knees flexed.
• Monitor the patient’s vital signs, including blood pressure, heart rate,
respiratory rate, and oxygen saturation, throughout the colonoscopy
procedure.
DIAGNOSTIC TESTS
AFTER
• Monitor the patient for signs and symptoms of post-colonoscopy bleeding.
• Assess the patient's fluid status and electrolyte balance post-procedure,
monitoring for signs of dehydration, electrolyte disturbances.
• Assess the patient's gastrointestinal function post-procedure, monitoring for
signs of bowel movement, or abdominal distension
DIAGNOSTIC TESTS
AFTER
• Document all post-procedure assessments
DIAGNOSTIC TESTS
COMPUTED TOMOGRAPHY
(CT SCAN)
It is a diagnostic imaging technique used to
visualize internal structures of the body in
detail. In Crohn’s disease, a CT scan is
commonly employed to assess the extent and
severity of inflammation, complications and
structural abnormalities within the
gastrointestinal tract, particularly the small
intestine and colon.
DIAGNOSTIC TESTS
BEFORE
• Explain the procedure of CT scan to the patient, including the necessity of
fasting and potential discomfort during the scan.
• Verify patient’s any allergies.
• Obtain patient’s informed consent.
• Ensure the patient is adequately hydrated.
DIAGNOSTIC TESTS
DURING
• Ensure patient comfort and safety during the scan.
• Monitor the patient for any signs of contrast reactions, such as flushing,
itching, or shortness of breath.
DIAGNOSTIC TESTS
AFTER
• Evaluate the patient for immediate post-procedure complications, such as
allergic reactions to contrast media.
• Encourage the patient to increase fluid intake post-procedure, particularly if
contrast media was administered.
• Continuously assess the injection site for signs of contrast extravasation
complications, such as swelling, and pain.
• Accurately document all aspects of post-procedure care, including vital
signs, interventions performed, and any complications or adverse events
observed.
DIAGNOSTIC TESTS
MAGNETIC RESONANCE
IMAGING (MRI)
It is a medical imaging technique that
uses a magnetic field and computer-
generated radio waves to create
detailed images of the organs and
tissues in your body.
DIAGNOSTIC TESTS
BEFORE
• Obtain informed consent from the patient, explaining the purpose of the
MRI, the procedure itself, potential risks, and what to expect during the
scan.
• Instruct patient to remove all metallic objects, including jewelry, piercings,
and clothing with metal components.
DIAGNOSTIC TESTS
DURING
• Assist the patient in comfortable positioning on the MRI table, ensuring
proper alignment for the desired imaging plane.
DIAGNOSTIC TESTS
AFTER
• Provide the patient with instructions on post-procedure care, including any
restrictions on activities, dietary guidelines, and to watch for signs of
complications.
• Document all assessments, interventions, and observations accurately and
promptly in the patient's medical record, providing a comprehensive record
of the patient's post-MRI care.
COMPLICATIONS
OF CROHNS DISEASE
• INTESTINAL OBSTRUCTION
AND STRICTURE FORMATION
COMPLICATIONS
OF CROHNS DISEASE
• FLUID AND ELECTROLYTE
• PERIANAL DISEASE
IMBALANCES
COMPLICATIONS
OF CROHNS DISEASE
MALNUTRITION FROM FISTULAS ABSCESS FORMATION
MALABSORPTION
COMPLICATIONS
OF CROHNS DISEASE
MALIGNANT NEOPLASMS PYELONEPHRITIS
COMPLICATIONS
OF CROHNS DISEASE
HEMORRHAGE ARTHRITIS RETINITIS, IRITIS
PHARMACOLOGIC MANAGEMENT
Corticosteroids
• Reducing inflammation in Immunomodulators Biologic
the digestive tract • Azathioprine • Infliximab
Examples: • Mercaptopurine • Adalimumab
• Prednisone • Methotrexate • Vedolizumab
• Budesonide
PHARMACOLOGIC MANAGEMENT
Antibiotics Anti-Diarrhea Pain Reliever

• Ciprofloxacin • Loperamide • Loperamide
• Metronidazole
SURGICAL MANAGEMENT
CHRON’S DISEASE
1. Resection
SURGICAL MANAGEMENT
CHRON’S DISEASE
2. Anastomotic Technique
SURGICAL MANAGEMENT
CHRON’S DISEASE
3. Laparoscopy
SURGICAL MANAGEMENT
CHRON’S DISEASE
4.Strictureplasty
NURSING MANAGEMENT
CHRON’S DISEASE
1. Assessment and Monitoring
● Regular Symptom Assessment and Documentation
● Monitoring Laboratory Values and Biomarkers
2. Medication Management
● Conducting medication reconciliation during clinic visits involves
reviewing the patient's current medications, including prescription
drugs, over-the-counter medications, and supplements,
● Providing Medication Adherence Counseling
NURSING MANAGEMENT
CHRON’S DISEASE
3. Nutritional Support
● Conducting Nutritional Assessments and Providing Dietary
Counseling
● Administering Enteral or Parenteral Nutrition Support
4. Managing Complications
● Wound Care and Ostomy Management
● Monitoring and Managing Medication Side Effects
NURSING MANAGEMENT
5. Promoting Self-Management
● Teaching Symptom Self-Management Techniques
● Facilitating Patient Engagement in Shared Decision-Making
6. Wound Care
● Assessment and Management of Surgical Wounds
● Prevention and Management of Peristomal Skin Complications
7. Continuity of Care
● Coordinating Interdisciplinary Care Team Meetings
● Facilitating Transition Planning and Care Coordination
NURSING MANAGEMENT
8. Educational support
• Providing written educational materials such as pamphlets or brochures.
• Connecting patients with peer support groups or online communities
allows them to interact with others who are living with Crohn’s Disease,
share experiences and provide mutual support

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OBSTRUCTIVE

Presented by: GROUP 1

There were 6.8M cases with IBD globally.

3. Left- sided colitis

FATIGUE FEVER BLOODY IN STOOL

Purpose: To help identify diseases of the

Purpose: To help in determining the cause of

Purpose: To help identify the characteristic areas

Purpose: To find a wide range of conditions,

Purpose: To assess extent of disease and detect active

Purpose: To identify abscesses and perirectal

HIGHLY GRANULAR VASCULAR

ILEOANAL POUCH ANASTOMOSIS

• Maintaining normal elimination pattern

of the digestive tract. It causes symptoms like abdominal pain, diarrhea,

ABDOMINAL PAIN URGENCY AND

WEIGHT LOSS FATIGUE FEVER

Purpose: To explore the unexplained bleeding in the small intestines and

Purpose: To diagnose structural or functional abnormalities of the large

Antibiotics Anti-Diarrhea Pain Reliever

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