Question

Ms. K, who is 32 years old, is admitted to the medical/surgical floor with abdominal pain, diarrhea and rectal bleeding. Her initial diagnosis is inflammatory bowel disease.

1. Test results indicate inflammation of the mucosa and submucosa of her rectum and colon. Which form of IBD does Ms. K most likely have?

2. You review the medication record and note that Ms. K is to receive sulfasalazine. What will your teaching for this medication include?

3. Ms. K wants to know more about her condition. What will you tell her regarding how the disease may progress and how it will be treated long term?

4. Ms. K asks, “Are ulcerative colitis and Crohn disease the same thing?” How will you respond?

Answer 1

1.Inflammatory bowel disease is used to describe disorders that involve chronic inflammation of your digestive tract.

Two types of IBD

a) ULCERATIVE COLITIS : This causes long lasting inflammation of rectal and colonic mucosa and submucosa.

b) CROHN'S DISEASE : It can cause inflammation in any part of digestive tract. However it mostly affects the tail end of the small intestine.

Here the patient is having inflammatory changes in mucosa and submucosa of colon and rectum. so the patient is having ulcerative colitis.

2.PATIENT EDUCATION ON SULFASALAZINE

a) About the drug

Sulfasazine is used to treat bowel inflammation,diarrhea,rectal bleeding and pain in patients with ulcerative colitis.It works by reducing inflammation inside the body.

b) How to take it

Sulfasalazine shuld be taken with food and full glass of water to avoid upset stomach.

Enteric coated preparation should not be chewed or crushed.

Adequate fluid intake is required to prevent kidney stones.

c) Side effects

In general ,most patients can take it with few side effects. Common side effects are nausea and abdominal discomfort.

Sunsensitivity of the skin can also be a side effect. Should use sunscreen when outdoors and avoid prolonged exposure to sun light.

Some may develop orange colored urine and even orange skin.It is harmless and goes away once medication is stopped.

d) Tell your doctor

It may interfere with warfarin ,cyclosporine or digoxin,so dose adjustment may be needed.

Increases the risk of liver injury if given with isoniazid - used for tuberculosis treatment.

Considered safe during pregnancy, but usage should be discussed with physician if planning to become pregnant.

Contraindicated during breastfeeding,causes jaundice and brain problems in infants younger than 2 years of age.

Tell if you are allergic to sulfa medicines.

3. DISEASE PROGRESS AND TREATMENT

In contrast with Chrons disease, where disease is fairly stable , UC is a dynamic disease with colorectal inflammation extend changing over time,which has important implications.The extent of colonic involvement is clinically relevant.

UC is a progressive disease that over time can lead to bowel damage and complications including abnormal colon contraction and absorption and colon cancer .

Treatment

Mild to moderate cases are treated with medications which include antiinflammatory drugs, corticosteroids etc.

Severe cases require admissin to hospital for aggressive treatment with intravenous steroids, antibiotics , in case of significant rectal bleeding - blood transfusion and treatment for anemia.

Surery : Colectomy may needed in severe cases which cannot be controlled with medications.

4 . ULCERATIVE COLITIS VS CROHN'S DISEASE

ULCERATIVE COLITIS

Inflammation is more likely to be uniform or continous.

Localised to rectum and colon

Blood and mucus in the stools are common

Nausea and vomiting not usually not seen

Pain is more likely to be intermittent and experienced with bowel movements

Treated with steroids

Surgery usually resolves the disease

Fistulaes,fissures and strictures less common

CROHN'S DISEASE

Inflammation tends to occur in patches

Can affect any part of GI tract

Blood and mucus in the stools not common

Abdominal pain more severe and continous

Inflammation in mucosa and muscle tissue

Treated with steroids,immunosuppressants

Surgery may not eliminate the disease

More likely to cause fistulae,fissures, strictures etc