Inflammatory Bowel Disease: Ulcerative Colitis and Crohn’s Disease
Crohn’s disease and ulcerative colitis are idiopathic chronic inflammatory bowel diseases, which are often jointly referred to as inflammatory bowel disease (IBD). These disorders have similarities but can usually be differentiated by clinical, radiological, and pathologic findings. The classic clinical manifestations of inflammatory bowel disease include diarrhea, abdominal pain and cramping, and fever. The severity and pattern of signs and symptoms depend on the portion(s) of the bowel affected and depth of bowel wall involvement. Ulcerative colitis primarily involves the mucosa of the bowel wall, extending to the submucosa only in severe cases. It typically starts in the rectum and sigmoid colon and progresses in a continuous pattern through the colon. It rarely involves the small intestine. Crohn’s disease can occur anywhere in the gastrointestinal tract. The most frequent sites of involvement are the terminal ileum and right colon. The entire thickness of the bowel wall is involved and it has a segmental, discontinuous pattern of progression.
Clients with either condition may experience a number of the same complications; however, those with ulcerative colitis have a higher incidence of toxic megacolon and bowel perforation, whereas clients with Crohn’s disease have a higher incidence of perianal involvement and fistula formation. Some clients also experience extraintestinal manifestations such as liver and biliary involvement; kidney stones; arthritis; and skin, eye, and oral lesions. Clients with inflammatory bowel disease may require hospitalization during periods of exacerbation or if complications are suspected.
Cornerstones of medical treatment have traditionally included corticosteroids, sulfasalazine, nonsulfa-aminosalicylates, and immunomodulator agents such as azathioprine and mercaptopurine. Research indicates that there may be a defect in immunoregulation of inflammation in Crohn’s disease. This has lead to the use of monoclonal antibodies that neutralize a cytokine (specifically tumor necrosis factor-alpha) to treat persons with Crohn’s disease who have not been responsive to conventional therapy or who have draining enterocutaneous fistulas.
Risk for imbalanced fluid and electrolytes
deficient fluid volume, hypokalemia, hypomagnesemia, and hypocalcemia
Imbalanced nutrition: less than body requirements
abdominal pain and cramping
Risk for impaired tissue integrity
Risk for infection
perirectal, rectovaginal, enterovesical, and enteroenteric abscesses and fistulas
Deficient knowledge, Ineffective therapeutic regimen management, or Ineffective health maintenance
Disturbed sleep pattern