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LCERATIVE COLITIS OUTLINE:

A.ETIOLOGY & PATHOPHYSIOLOGY1. Autoimmune anti-inflammatory disorder of the colon and rectum2. Cause unknown, Females 15-25, white Jewish3. Diffuse inflammation leading to loss epitheliumulcer and abscess

formation. Begins rectum and moves to cecum in orderly fashion

B.SIGNS& SYMPTOMS1. Abdominal pain & distention2. Bloody diarrhea3. Low grade fever (99-100F)4. Tachycardia5. Dehydration6. Anemia7. Weight loss

8. Anorexia9. Psychological stress

10. Abnormal lab values:decreased HgB, HCT, Na+,

K+, Cl- & albumin,

increased WBC & ESR

11. anemiaC.LABS & DIAGNOSTIC TESTS:

1. Sigmoidoscopy for definitive diagnosis2. Guaiac stool & fecal analysis- blood, parasites, ova3. Barium enema- distinguish between Crohns & colitis4. Labs: HgB, HCT, WBC

D.COLLABORATIVE INTERVENTIONS1. DIARHHEA MANAGEMENT

i. Note vol, colour, constancy stoolii. Assess perineal area & skin careiii. Daily weights

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2. DRUG THERAPYi. Aminosalicylates to block intestinal prostaglandin synthesis and

prevent re-occurrence

1. Sulfasalazine (Azulfidine), Mesalamine (Asacol)ii. Corticosteroids: Hydrocortisoneiii. Antimicrobials: Neomycin- bowel antisepticiv. Anti-diarrheal: Diphenoxylate (Lomotil)

3. DIET THERAPYi. NPO if severe

1. NG tube; TPN- elemental TPN if less severeii. Low fibre, high protein, high cal dietiii. Teach avoid whole wheat grains, nuts, fresh fruits and veggies, dairy

smoking, alcohol, caffeine & pepper

iv. Ensure bedside commodev. Complementary & alternative therapies ex. Yoga, acupuncture, herbs

like flaxseed etc

4. REST5. SURGERY

i. Total proctocolectomy w/ permanent Ileostomy (colon, rectum &anus removedanus closed)

1. Needs Ostomy at all times2. Initial output dark green and loosevol. Decreases turns

yellow-green then yellow brown

3.Foul odour suggests blockage or infectionii. Total Colectomy w/ continent Ileostomy (kock Ileostomy or Ileostomy

reservoir)

1. Internal system2.Cather placed in pouch immediately for sxn & irrigation

iii. Ileoanal reservoir (J-pouch)

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1. Colon removed & ileum sutured into rectal stump to formreservoir

6. NURSING INTERVENTIONS:i. Manage Pain

1. Administer Antidiarrheals2.Administer anti-Cholinergics before meals for pain relief3.Skin care for irritated perianal areas

a. Clean area after bowel movementsb. Sitz baths

ii. Monitor s/s internal bleedingiii. Check stools for bloodiv. Monitor HCT, HgB, e-lytesv. Observe for fever, tachycardia, fluid volume depletions, severe

abdominal pain, or change mental status

E.COMPLICATIONS1. Internal complications

i. Intestinal perforationw/ peritonitis

ii. Fistulasiii. TOXIC MEGA

COLONcolon dilation

>10cm

iv. Hemorrhagev. Abscessvi. Malabsorption, bowel

obstruction

2. Extra Intestinal complicationsi. Arthritisii. Ankylosing spondylitisiii. Eye inflammationiv. Skin lesionv. Mouth sores