ULCERATIVE COLITIS, CROHN’S DISEASE
I. Pathophysiolgy—Abnormal response of the immune system,
leading to chronic inflammation of various portions of the
a. Ulcerative colitis (UC)
i. Usually starts in rectum and distal portions of the colon,
possibly spreading upward to involve the sigmoid and
descending colon or the entire colon
ii. Intermittent, with acute exacerbation and long remissions;
however, 30% to 40% of individuals have
iii. Cure is effected only by total removal of colon and
rectum and rectal mucosa.
b. Crohn’s disease
i. Found in any portion of the alimentary tract from the
mouth to the anus, most commonly in the small intestine
or terminal ileum
ii. Slowly progressive chronic disease with intermittent
iii. Five types of Crohn’s disease (A.D.A.M. Encyclopedia,
1. Ileocolitis, the most common form, affects the lowest
part of the small intestine and the large intestine.
2. Ileitis affects the ileum.
3. Gastroduodenal Crohn’s disease causes inflammation
in the stomach and first part of the small intestine
4. Jejunoileitis causes spotty patches of inflammation in
the top half of the small intestine or jejunum.
5. Crohn’s granulomatous colitis only affects the large
iv. No known cure
III. Etiology (National Digestive Diseases Information
Clearinghouse [NDDIC], 2007)
a. Unknown, but may result from a complex interplay
between genetic and environmental factors
b. Inability to downregulate immune responses, and consequently,
the mucosal immune system remains chronically activated and
the intestine chronically inflamed (Hanauer, 2006)
c. Additional risk factors include smoking (in Crohn’s disease)
and use of nonsteroidal anti-inflammatory drugs
(NSAIDs) or isotretinion (Acutane).
d. Periods of remission are interspersed with episodes of acute
inflammation, characterized by frequent episodes of diarrhea,
abdominal pain, fever, and weight loss.
e. Extraintestinal manifestations (EMs) include systemic
inflammation affecting most of the body’s organ systems—
internal organs, eyes, blood, skin, and musculoskeletal
IV. Statistics (National Women’s Health Information Center,
a. Morbidity: More than 1 million people in the United States
are affected, with 30,000 new cases annually; higher
incidence in late adolescence, with onset often between
ages 15 and 35; men and women equally affected.
b. Mortality: Rare, although life expectancy may be reduced
in certain populations, such as older age at onset and
development of pancolitis (Loftus, 2003).
c. Cost: Estimated at $100 billion for nonadherence to
long-term medical therapy for UC (Kane, 2006).
Care is usually handled at the community level; however,
severe exacerbations requiring advanced pain control, nutrition,
and rehydration may necessitate short stay in acute care
Fluid and electrolyte imbalances
Psychosocial aspects of care
Total nutritional support: parenteral/enteral feeding
1. Control diarrhea and promote optimal bowel function.
2. Minimize or prevent complications.
3. Promote optimal nutrition.
4. Minimize mental and emotional stress.
5. Provide information about disease process, treatment needs,
and long-term aspects and potential complications of recurrent
1. Bowel function stabilized.
2. Complications prevented or controlled.
3. Dealing positively with condition.
4. Disease process, prognosis, therapeutic regimen, and potential
5. Plan in place to meet needs after discharge.