Treating Ulcerative Colitis

Treating Ulcerative Colitis
By:Robert Theobald III, D.O.
Vein Associates, P.A.

Introduction
* Ulcerative colitis is a chronic inflammatory disease of unknown etiology
* Primarily affects the colon and rectum
* Lesions are characterized by superficial infiltration of the bowel wall by inflammatory white cells
* Results in mucosal ulcerations and crypt abscesses
History
Epidemiology
Clinical Presentation
Clinical Presentation Symptoms
Colitis Activity Assessment
Diagnosis
* The diagnosis of UC is based on the clinical picture, stool examination, colonoscopic appearance, and histologic assessment of biopsied specimens
* The differential diagnosis includes infectious, chemical, IBS, ischemia, and miscellaneous
Disease Distribution at Presentation
Current Pharmacotherapy
Fallingborg Study
Steroids
Immunomodulators
New Therapy for Treatment of UC
Natural Remedies

Treating Ulcerative Colitis.ppt

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Stoma Care Basics

Stoma Care Basics

Two basic types of diversions
* Urinary
* Fecal

Urinary Diversions
Reasons for diversions
* Removal of bladder from cancer
* Neurogenic bladder, congenital anomalies, strictures, trauma to the bladder, and chronic infections with deterioration of renal function

Types of diversions
* Incontinent
Ileal Conduit
Cutaneous ureterostomy
Nephrostomy
Continent Diversions
Kock Pouch
Indiana Pouch
Continent urinary diversions
Complications
* Breakdown of the anastomoses in the GI tract.
* Leakage from the ureteroileal or ureterosigmoid anastomosis
* Paralytic ileus
* Obstruction of ureters
* Wound infection
* Mucocutaneous separation
* Stomal necrosis
Wound infection
Mucocutaneous separation
Stomal necrosis
Nursing Management
* Pre-op Care
Postoperative Care
Stomal prolapse
Bowel Diversions
Colostomies
Ileostomy
Surgical interventions
Loop stoma
End Stoma
End stoma with Hartmann’s pouch
Double-barrel stoma
Continent fecal diversions
Ileoanal reservoir
Kock Pouch
Special considerations for patients who have ileoanal reservoirs
Nursing Management- preoperative
More to consider pre-op
More post op considerations:
Good stoma Bad stoma
More about stomas
What about pouching?
What do we need to observe and document?
What about eating?
What to avoid
Other food issues you need to know about
Management options for permanent descending colostomy
One and two piece units
Ileostomy care
Protect the skin!
Important to know
More to know
Patient Teaching
Managing odor
When you teach ostomy care
Routine Skin Care
Cleansing
Shaving
More considerations
Adaptation to a stoma

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Non-Inflammatory Bowel Disorders

Non-Inflammatory Bowel Disorders
Hernia
Colon Cancer
Intestinal Obstruction

Objectives
* Describe defining characteristics for the lower GI tract disorders discussed
* Develop intervention and teaching plans for the client with a lower GI tract disorder
* Appreciate the psychosocial impact of these disorders for the client and family

Hernia
Hernia—a protrusion of a portion of the bowel through an abnormal opening or weakness in the muscle wall.
Common locations:
inguinal (men)
umbilical
incisional
femoral
suprapubic

Types of Herniation
o Reducible
o Irreducible
o Strangulated: a surgical emergency
* Herniorraphy: puts bowel back in place
* Hernioplasty: repairs muscle weakness

Post op Care
Colon Cancer
Most prevalent in population
Colon Cancer
S/S may vary with tumor location
L sided tumor
R sided tumor
* Fatigue
* Vague crampy/colicky type pain
* Occult blood in stool
* Anemia
Colon Cancer
Diagnostics
* Decreased H&H
* CEA elevated
* Stool for occult blood (+)
* Liver tests may be high
* Sigmoidoscopy or Colonoscopy for biopsy
* Barium Enema or CT

Colon Cancer: Collaborative Care
Treatment and prognosis depend on staging results.
Colon Cancer: Collaborative Care
Client education includes dietary impact on ostomy:
Psychosocial issues for the ostomy client:
Other post-op needs:
Intestinal Obstruction
Causes of Intestinal Obstruction
Signs/Symptoms of Obstruction
Mechanical
Non-mechanical
Treatment of Obstruction
Enema
Inflammatory Bowel Syndromes
Acute: Appendicitis
Gastroenteritis
Chronic: Ulcerative colitis
Crohn’s disease
Diverticular disease
Appendicitis
Gastroenteritis
Nursing care is supportive
Inflammatory Bowel Disease
RLQ abdominal pain
Ulcerative Colitis
Signs/symptoms common to both:
* weight loss
* fatigue
* perineal skin breakdown
* low grade fever
* psychosocial distress
Inflammatory Bowel Disease: Complications
Diagnostics
Treatment: Medications
Nutrition less than Body Requirements
Important points of care for the client on TPN/PPN
Diverticular disease
Diverticular disease: Nursing care

Non-Inflammatory Bowel Disorders.ppt

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