Crohn's Disease
Chronic transmural inflammation — can affect any part of GI tract (mouth to anus), most commonly terminal ileum. "Skip lesions" — diseased segments alternate with healthy tissue. Symptoms: chronic diarrhea, abdominal pain, weight loss, fistulas, perianal disease. Treatment: corticosteroids, immunosuppressants, biologics (infliximab), surgery (not curative).
Ulcerative Colitis
Continuous inflammation from rectum proximally — limited to colon and rectum. Mucosal and submucosal only. Symptoms: bloody diarrhea, abdominal cramping, tenesmus. Increased colon cancer risk after 8–10 years. Curative: total proctocolectomy with ileostomy or J-pouch.
Diverticulitis
Inflammation of diverticula (outpouchings of colon wall). Risk factors: low-fiber diet, age >40, obesity. Left lower quadrant pain, fever, nausea. Treatment: clear liquid diet, antibiotics (outpatient); NPO, IV antibiotics, fluids (inpatient). Complications: abscess, perforation, peritonitis.
Bowel Obstruction
Mechanical (adhesions, hernia, tumor, volvulus) vs. functional (paralytic ileus). Symptoms: cramping abdominal pain, distension, vomiting (early — proximal; late — feculent — distal), constipation, no flatus. Treatment: NPO, NG tube decompression, IV fluids, surgical correction if mechanical.
Nursing Management
Assessment: abdominal assessment (inspect, auscultate, palpate), bowel pattern, pain, hydration. IBD: monitor for flare signs, nutrition support (TPN if needed), stoma care if surgery. Obstruction: NG tube care (patency, output measurement), fluid/electrolyte monitoring, surgical preparation if needed.
Important Notes
- Toxic megacolon: life-threatening complication of UC — colon dilates massively, risk of perforation — emergency colectomy.
- Bowel obstruction with fever, severe pain, and peritoneal signs = possible strangulation — surgical emergency.
Clinical Tips
- Crohn's vs UC: Crohn's = "skip lesions," transmural, anywhere in GI; UC = continuous, mucosal only, colon/rectum only.
Summary
Bowel disorders require accurate differentiation, nutritional support, pain management, and monitoring for life-threatening complications like toxic megacolon and bowel perforation.
