Med-Surg - Gastrointestinal System, part 9: Ulcerative Colitis, Crohn's Disease, Diverticulitis
by Cathy Parkes November 28, 2021 Updated: April 14, 2022 6 min read
Hi. I'm Cathy with Level Up RN. In this video, I am going to talk about inflammatory bowel disorders, including ulcerative colitis, Crohn's disease, and diverticulitis. If you have our medical-surgical flashcards available from leveluprn.com, definitely pull those out so you can follow along with me. At the end of the video, I'm going to give you guys a little quiz to test your understanding of some of the key facts I'll be covering in this video. So definitely stay tuned for that.
Let's first talk about ulcerative colitis, which is a chronic inflammatory disorder of the colon, and it is caused by immune system dysfunction that results in inflammation of the mucosa of the colon and the formation of continuous ulcerations. So this is differentiated from Crohn's disease, where you have patchy or sporadic ulcerations. With ulcerative colitis, those ulcerations are going to be continuous throughout the colon. And just like other autoimmune disorders, patients with ulcerative colitis will have periods of exacerbations as well as remissions. In terms of signs and symptoms of this disorder, these include diarrhea with blood or pus. So the patient will have 10 to 20 liquid stools per day. In addition, they will have fever, abdominal pain, fecal urgency, weight loss, weakness, as well as possible anemia and dehydration, which makes sense, right? If we are having diarrhea 10 to 20 times a day, then we are losing a lot of fluid, which is what's causing the dehydration. In addition, we are losing electrolytes, in all likelihood, so we can end up with electrolyte abnormalities such as hypokalemia. And then if we've got blood in the stool, in the diarrhea, then we are losing red blood cells as well, which is why we may have anemia with ulcerative colitis.
So in terms of other labs that will be abnormal, we will see an increase in white blood cells, and we will also see an increase in ESR and CRP. So ESR is erythrocyte sedimentation rate and CRP is C-reactive protein, and those two labs are elevated when we have chronic inflammation like we have with ulcerative colitis. Diagnosis of ulcerative colitis can be done through a colonoscopy, where we collect biopsies. In terms of medications that are helpful in the treatment of ulcerative colitis, we can use sulfasalazine, which is a GI anti-inflammatory medication. We can also use corticosteroids such as prednisone, which has an anti-inflammatory and immunosuppressant-type action. Other immunosuppressants are helpful, such as cyclosporine, and then anti-diarrheals can be used as well.
In terms of surgical interventions, if the patient's ulcerative colitis is very severe, they may require a proctocolectomy with an ileostomy. So a proctocolectomy means that we are removing the entire colon and rectum. And then in terms of nursing care, we're going to want to closely monitor our patient's Is and Os and their electrolyte levels because of the risk for electrolyte imbalances, such as hypokalemia. We're also going to want to monitor their CBC levels because of the risk of blood loss with this disorder. And then for patient teaching, they should be NPO during exacerbations. Ongoing, we want the patient to consume a high-calorie diet and a low fiber diet. So low fiber because we want the GI contents to slow down as they go through the GI tract. In addition, we should advise our patient to avoid caffeine, alcohol, and lactose because those things can make the diarrhea worse. And then we should encourage the patient to eat smaller, more frequent meals as opposed to bigger meals three times a day. So scattering the meals and making them smaller can help.
Now let's talk about Crohn's disease, which is another chronic inflammatory disorder of the GI tract. Like ulcerative colitis, it is an autoimmune disorder that is characterized by periods of exacerbations and remission. However, there are some key differences between these disorders. First of all, with Crohn's disease, the entire GI tract can be involved. This is different than with ulcerative colitis, which just affects the colon. In addition, with Crohn's disease, we have the formation of patchy ulcerations or skip lesions. So these ulcerations will be sporadic in the GI tract, as opposed to ulcerative colitis, which had continuous lesions throughout the colon. In addition, these ulcerations with Crohn's disease can affect all layers of the bowel wall, and then in turn, this can cause the formation of fistulas. So a fistula is an abnormal tunnel between two organs that should not be there. So examples of tunnels that can or fistulas that can form with Crohn's disease include a fistula between one part of the intestine and the other, or between the intestine and the bladder, or the intestine and the vagina. And you can only imagine what complications we would have if we have stool going from the intestine into the vagina or bladder. So fistulas are a key risk when we're talking about Crohn's disease.
Signs and symptoms of Crohn's disease include diarrhea. So five to six loose stools per day. Patients with Crohn's disease often have steatorrhea, which means we have a high fat content in the stool. They may have right lower quadrant pain, as well as weight loss, anemia, fever, and fatigue. Abnormal labs that may be present with Crohn's disease include an elevation in white blood cells as well as elevated ESR and CRP, which indicate the presence of inflammation. Diagnosis includes the use of endoscopy. So this can include a colonoscopy and an EGD. In terms of medications that are helpful, the same medications we used with ulcerative colitis are also helpful here with Crohn's disease. So that includes sulfasalazine, which is a GI anti-inflammatory medication, immunosuppressants, as well as anti-diarrheal agents.
And then surgical interventions that may be required include a small bowel resection or a colectomy and an ileostomy. In terms of nursing care, we're going to want to monitor our patient's Is and Os, their electrolyte levels and CBC levels, and we're going to want to monitor for complications, which include fistulas, malnutrition, as well as an intestinal obstruction. And then a lot of the same patient teaching applies here with Crohn's disease that we had with ulcerative colitis. So during acute exacerbations, we want our patient to be NPO. If they have a very severe exacerbation, they may require TPN. Ongoing, we want them to consume a high-calorie, low-fiber diet, and we want them to eat smaller, more frequent meals ongoing as well.
Now let's talk about diverticulitis. So with diverticulosis, we have the formation of these pouches off of the intestine, and these pouches form due to high intraluminal pressure, which can be caused by obesity, low-fiber diet, as well as genetic factors. If we have the accumulation of undigested food and bacteria in these pouches, it can cause those diverticula to get inflamed, which leads to diverticulitis. So signs and symptoms of diverticulitis include left lower quadrant abdominal pain. And the reason why we have this pain in the left lower quadrant is that diverticulitis primarily affects the descending or sigmoid colon, and that's where that is located. In addition, the patient may have bloating, fever, or nausea and vomiting. In terms of abnormal labs, we may see an elevation in white blood cells as well as ESR because of the inflammation. In addition, if there is bleeding associated with the diverticulitis, we may have a decrease in blood levels.
In terms of diagnosis, we can use a barium enema, colonoscopy, CT, as well as a lower GI series to help diagnose this condition. Treatment includes antibiotics as well as analgesics. And then in terms of nursing care, we're going to want to monitor for complications, which can include perforation of the diverticula. So that is something I see a lot at my hospital as a wound care nurse. So I help with the wound vac treatment for patients who have GI conditions such as perforated diverticulitis. Other complications include peritonitis, bleeding, as well as the possible formation of fistulas. In terms of patient teaching, we want them to be NPO or consume a clear liquid diet during exacerbations and then progress to a low-fiber diet, but ongoing, we want them to have a high-fiber diet.
All right. Time for a quiz. I have three questions for you. First question. What GI disorder is characterized by continuous ulcerations in the colon and 10 to 20 liquid stools per day? The answer is ulcerative colitis. Question number two. Which GI disorder is characterized by patchy ulcerations in the GI tract and increased risk for fistulas? The answer is Crohn's disease. Question number three. During acute exacerbations of diverticulitis, what diet should the patient consume? The answer is they should be NPO or consume a clear liquid diet. Okay. I hope this video has been helpful for you. If you haven't already subscribed to our channel, be sure to do that. And if you enjoyed this video and learned something, then definitely like it and leave me a comment. Take care and good luck with studying.
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