Welcome to the IBD Nurse Fellowship Program!

Transcription

1 Welcme t the IBD Nurse Fellwship Prgram! The prgram cnsists f 13 mdules: Mdule 1 Ulcerative Clitis Mdule 2 Crhn's Disease Mdule 3 Ulcerative Clitis vs. Crhn's Disease Mdule 4 Management f Ulcerative Clitis Mdule 5 Management f Crhn's Disease Mdule 6 IBD and urgery Mdule 7 Medicatin Adherence in IBD Mdule 8 Health Prmtin and Maintenance in IBD Mdule 9 Nutritin and IBD Mdule 10 Extra-intestinal Manifestatins f IBD Mdule 11 Anemia in IBD Mdule 12 Fatigue in IBD Mdule 13 Anxiety and Depressin in IBD Each mdule is divided int sectins, all f which are listed in the Table f Cntents. The Table f Cntents allws yu t click n the page numbers t navigate t each sectin. Each page has a Hme Buttn n the bttm right-hand crner that will take yu back t the Table f Cntents. The learning bjectives are at the beginning and end f each mdule. Befre cmpleting the mdule, yu will have the pprtunity t take a self-directed quiz, which will test yur knwledge n several f the key cncepts and takeaways frm the mdule. It is recmmended that yu take the quiz and accmplish all f the learning bjectives befre mving n t the next mdule. 1

2 Mdule 3 Ulcerative clitis vs. Crhn s disease 2

3 Table f cntents Learning bjectives... ectin 1 What discerns ulcerative clitis and Crhn s disease?.. ectin 2 ymptmatlgy.. ectin 3 teps t diagnsis ectin 4 elf-assessment quiz References. Page 4 Page 5 Page 7 Page 9 Page 19 Page 28 3

4 Learning bjectives After cmpleting Mdule 3 yu will be able t: Describe the key differences between ulcerative clitis and Crhn s disease List the cmmn symptms f ulcerative clitis and Crhn s disease ummarize the prcedures invlved in diagnsing bth diseases 4

5 ectin 1 What discerns ulcerative clitis and Crhn s disease? 5

6 Ulcerative clitis vs. Crhn s disease 1 Ulcerative clitis: Large intestine (cln) nly Affects the mucsa f the large intestine Causes mucsal inflammatin Bldy diarrhea is a cmmn symptm Cntinuus inflammatin with n patches f healthy tissue in the diseased sectin Crhn s disease: Transmural invlvement and skipped lesins Can affect any part f the GI tract (aka gums t bum ), including the large intestine (cln) and the ileum (last part f small intestine) Cmmn features include fistulae, granulmas, deep abscesses, stenses, and segmental lesins Ulcerative clitis Crhn s disease GI, gastrintestinal Kirsner JB,

7 ectin 2 ymptmatlgy 7

8 Cmparisn f cmmn symptms 2 ymptm Ulcerative Clitis Crhn s Disease Abdminal pain metimes (lwer left quadrant) Yes (lwer right quadrant) Anemia Yes Yes Anrexia N Yes Bldy diarrhea Yes N Diarrhea Yes Yes EIMs (jints, eyes, skin) Yes Yes Fever N Yes Perianal disease N Yes Pubertal delay in pediatrics N Yes Tenesmus Yes N Weight lss metimes Yes EIMs, Extra-intestinal manifestatins. Bartn JR et al., 1990; Greenstein AJ, 1979; Kanf ME et al., 1988; afar, B et al.,

9 ectin 3 teps t diagnsis 9

10 Prcedures fr diagnsing ulcerative clitis and Crhn s disease 3 The fllwing prcedures can be applied t help identify and diagnse ulcerative clitis and Crhn s disease: Bld tests tl tests Clnscpy Barium swallw Ultrasund Cmputed Tmgraphic Entergraphy (CTE) Magnetic Resnance Imaging (MRI) MR Entergraphy These prcedures are described in mre detail n the fllwing pages 10

11 Bld tests 3 Cmplete bld cunt (CBC) Lw hemglbin and elevated platelets are cmmnly bserved C-reactive prtein (CRP) Bld cncentratins increase in respnse t inflammatin High levels usually indicates inflammatin f the bwels Erythrcyte sedimentatin rate (ER) Rate at which RBCs precipitate ver a perid f 1 hur erlgy ANCA and ACA antibdies May be dne if IBD is unclassified Many UC patients have ANCAs but n ACAs Many CD patients have ACAs but n ANCAs me patients have neither antibdies Other cmmn tests include: Albumin, ferritin/irn studies, TH, Vitamin B12, Vitamin D, ttal prtein, liver enzymes and liver functin tests, celiac serlgy Rises with increasing clnic disease activity (des nt reflect small bwel disease activity) RBCs, red bld cells; ANCA, anti-neutrphil cytplasmic antibdy; ACA, anti-accharmyces cerevisiae antibdy; IBD, inflammatry bwel disease; UC, ulcerative clitis; CD, Crhn s disease. Frbes A, 2003; chlmerich J et al. 2003; Travis et al., 2003; crhnsandclitis.rg.uk. 11

12 tl tests 3 1. Fecal calprtectin (FCP): Elevated FCP indicates the migratin f neutrphils t the intestinal mucsa which ccurs during intestinal inflammatin 2. Bacterial cultures: T identify infectin 3. tl va and parasite exam: Detects parasites and their eggs 4. Clstridium difficile test: Detects txin prduced by the pprtunistic C. difficile bacterium Frbes A, 2003; chlmerich J et al. 2003; Judd TA, et al. 2011; Travis et al.,

13 Clnscpy 3 Cnsidered the Gld tandard Visual examinatin frm rectum t terminal ileum Allws fr a bipsy t be cllected and micrscpically examined A clnscpy can help t identify: Clnscpy Ulcerative Clitis Chrnic inflammatry cells in the lamina prpria Fcal fragmentatin r cryptitis Marked architectural distrtin Cntinuus invlvement Inflammatry plyps and pseudplyps Crhn s Disease Mucsal pseudplyps Cbblestning features Granulmas may be present Transmural, discntinuus Abscesses/fistulae Kadell BM, 2003; alena BJ et al., 1994; ucy et al.,

14 Barium swallw 3 Als knwn as: Esphagus-tmach-mall Bwel (EB) Upper GI Radigraphy with mall Bwel Fllw-Thrugh (UGI + BFT) Allws fr images f the esphagus and entire small bwel t be viewed Useful when lesins, fistulas, r strictures f the small intestine are suspected Patient ingests a chalky substance X-Rays are then taken as patient mves thrughut different psitins Barium swallw f the esphagus Batres et al., Image surce: Cpyright 2012 Ryan L. Kau et al. 14

15 Ultrasund 3 High frequency sund waves are transmitted by mving a prbe ver the abdmen Helps with evaluating bwel wall thickness and surrunding structures including: Peri-intestinal inflammatry reactins Extent and lcalizatin f invlved bwel segments Detectin f extraluminal cmplicatins such as fistulae and abscesses Nn-invasive with n radiatin expsure Ultrasund f the bwel Dietrich CF, Image surce: 2&query=ultrasund%20cln&it=xg&req=4&nps=44. Cpyright 2011 Busseaden et al; licensee: BiMed Central Ltd. 15

16 Cmputed Tmgraphic Entergraphy (CTE) 3 Prvides detailed images f the small bwel by using an ral cntrast media CT scanner Cmbines advantages f CT and enterclysis Extensive extraluminal infrmatin and visualizatin Distensin f small bwel fr visualizatin Cnsidered by sme t be superir t ther barium studies in the evaluatin f symptmatic Crhn's disease Extremely useful fr the detectin f: Fistulae Abscesses kip lesins Lymphadenpathy Cnglmeratin f small bwel lps Vgel J et al.,

17 Magnetic Resnance Imaging (MRI) 3 Uses a magnetic field and radi waves t create detailed images f the rgans and tissues within the bdy N radiatin expsure but access t this technlgy can be an issue Capable f detecting disease lcatin, extent, and cmplicatins Particularly useful fr assessing rectal/anal area and surrunding tissue, especially fr Crhn s patients with pelvic and perianal fistulae and/r abscesses MRI f the bwel Lin MN, et al., Image surce: %20Imaging%20cln&it=xg&req=4&nps=25. Cpyright Arthurs OJ, et al. Pediatr Radil

18 MR Entergraphy 3 Magnetic resnance examinatin targeted at the small bwel Prvides high-image reslutin and excellent sft-tissue cntrast withut expsure t inizing radiatin Used t detect small bwel bstructins and small bwel fistulae and/r abscesses MR entergraphy setting Damian JM et al., 2010; Miller JC, 2009; iddiki et al.,

19 ectin 4 elf-assessment quiz 19

20 4 elf-assessment quiz Nw that yu have reviewed the mdule cntent, yu have the pprtunity t test yur knwledge and understanding f the material by cmpleting a self-assessment The assessment cnsists f 5 multiple chice questins Please attempt each questin befre lking at the answer key, which is lcated n page 26 The answer key prvides the ratinale fr each answer and indicates where the crrect answer can be fund in the mdule 20

21 Questin 1 4 Which f the fllwing features is characteristic f ulcerative clitis? a) Transmural invlvement and skipped lesins b) Cntinuus inflammatin with n patches f healthy tissue in the diseased sectin c) Fistulae and segmental lesins d) Granulmas and deep abscesses 21

22 Questin 2 4 Which f the fllwing features typically differs between Crhn's disease and ulcerative clitis? a) Area f the GI tract affected b) Mucsal inflammatin c) Bldy diarrhea d) All f the abve 22

23 Questin 3 4 Which f the fllwing symptms generally ccurs in Crhn s disease but nt in ulcerative clitis? a) Anrexia b) Diarrhea and abdminal pain c) Weight lss d) Tenesmus 23

24 Questin 4 4 Which prcedure fr diagnsing ulcerative clitis and Crhn s disease allws fr a bipsy t be cllected and micrscpically examined? a) MR Entergraphy b) Fecal calprtectin test c) Barium swallw d) Clnscpy 24

25 Questin 5 4 Which f the fllwing diagnstic tests helps with evaluating bwel wall thickness? a) Cmputed Tmgraphic Entergraphy b) Magnetic Resnance Imaging c) Ultrasund d) MR Entergraphy 25

26 Answer key 4 1. The crrect answer is b. Cntinuus inflammatin with n patches f healthy tissue in the diseased sectin is characteristic f ulcerative clitis. ee page 6 fr mre infrmatin n this tpic. 2. The crrect answer is a. Crhn s disease can affect any part f the gastrintestinal tract, including the large intestine and the ileum, while ulcerative clitis affects the large intestine nly. ee page 6 fr mre infrmatin n this tpic. 3. The crrect answer is a. Anrexia is a cmmn symptm f Crhn s disease but nt ulcerative clitis. ee page 8 fr mre infrmatin n this tpic. 4. The crrect answer is d. A clnscpy allws fr a bipsy t be cllected and micrscpically examined. It is cnsidered the Gld tandard f tests fr diagnsis f bth ulcerative clitis and Crhn s disease. ee page 13 fr mre infrmatin n this tpic. 5. The crrect answer is c. Ultrasunds help t evaluate bwel wall thickness. ee page 15 fr mre infrmatin n this tpic. 26

27 Cngratulatins! Yu have cmpleted the 3 rd mdule f the prgram. Based n what yu learned in Mdule 3, yu shuld be able t: Describe the key differences between ulcerative clitis and Crhn s disease List the cmmn symptms f ulcerative clitis and Crhn s disease ummarize the prcedures invlved in diagnsing bth diseases If yu have answered the quiz questins crrectly and achieved the learning bjectives, yu are ready t mve n t Mdule 4, which will fcus n the management f ulcerative clitis. 27

28 References Bartn JR, Fergusn A. Clinical Features, Mrbidity and Mrtality f cttish Children with Inflammatry Bwel Disease. Q J Med. 1990;277: Batres L, Maller E, Ruchelli E, et al. Terminal Ileum Intubatin in Pediatric Clnscpy and Diagnstic Value f Cnventinal mall Bwel Cntrast Radigraphy in Pediatric Inflammatry Bwel Disease. J Pediatr Gastrenterl Nutr. 2002;35: Crhn s & Clitis UK. Tests and investigatins fr IBD website. Nvember Accessed Octber 26, Damian JM, Greenhalgh R, Zealley IA, et al. MR Entergraphic Manifestatins f mall Bwel Crhn Disease. Radigraphics. 2010; 30(2): Dietrich CF. ignifigance f abdminal ultrasund in inflammatry bwel disease. Dig Dis. 2009;27: Frbes A. Chapter 14: Clinical presentatin f Crhn's; Diagnsis f Crhn's. In: atsangi J, utherland L, ed. Inflammatry Bwel Diseases 4 th ed. Trnt, Canada: Elsevier Canada; 2003: Greenstein AJ, Wertkin M, Dughlin G et al. Enterenteric intussusceptin in Crhn's disease. Mt inai J Med. 1979;46: Judd TA, Day A, Lemberg DA, Turner D, and Leach T. Update f fecal markers f inflammatin in inflammatry bwel disease. Jurnal f Gastrenterlgy and Hepatlgy. 2011;26: Kadell, BM. Ch. 25. Features f Ulcerative Clitis and Crhns Disease. In: Targan R, hanahan F, Karp LC eds. Inflammatry bwel disease: frm bench t bedside. Publishers: Wiliams and Wilkins, Baltimre, Maryland; 1994:395. Kanf ME, Lake AM, Bayless TM. Decreased height velcity in children and adlescents befre the diagnsis f Crhn's disease. Gastrenterlgy. 1988;95: Kirsner J. Inflammatry Bwel Disease (Ulcerative Clitis, Crhn s Disease). In: Chen R, ed. Inflammatry Bwel Disease: Humana Press; 2003:1-16. Lin MF, Narra V. Develping rle f magnetic resnance imaging in Crhn s disease. Curr Opin Gastrenterl. 2008;24: Miller, JC. MR Entergraphy fr Crhn's Disease. Radilgy Runds, MGH. 2009;7(9). afar B, ands D. Perianal Crhn s Disease. Clin Cln Rectal urg. 2007;20: alena BJ, Hunt RH. Ch. 24. Measuring quality f life in inflammatry bwel disease. In: Targan R, hanahan F, Karp LC eds. Inflammatry bwel disease: frm bench t bedside. Publishers: Wiliams and Wilkins, Baltimre, Maryland; 1994:356. chlmerich J, Warren BF. Chapter 15: Differential diagnsis and ther frms f IBD. In: atsangi J, utherland L, ed. Inflammatry Bwel Diseases 4 th ed. Trnt, Canada: Elsevier Canada; 2003: iddiki H, Fidler J. MR imaging f the small bwel in Crhn s disease. Eur J Radil. 2009;69: ucy G, Wang HW, Farraye FA et al. Clinical and pathlgical analysis f clnic Crhn s disease, including a subgrup with ulcerative clitis-like features. Md Path. 2012;25: Tlan, DJM, Greenhalgh R, Zealley IA, et al. MT Entergraphic Manifestatins f mall Bwel Crhn Disease. Radigraphics. 2010;30: Travis, Jewell DP. Chapter 13: Ulcerative Clitis: Clinical presentatin and diagnsis. In: atsangi J, utherland L, ed. Inflammatry Bwel Diseases 4 th ed. Trnt, Canada: Elsevier Canada; 2003: Vgel J, Mreira A, Baker M et al. CT Entergraphy fr Crhn s Disease: Accurate Preperative Diagnstic Imaging. Dis Cln Rectum. 2007;50: