Introduction
In recent years, the incidences of ulcerative colitis and Chron’s disease have increased substantially in the developed and the developing world as more and more people continue to be diagnosed with the chronic, disabling conditions (da Silva et al., 2015; Reid, Chivers, Plummer, & Gibron, 2010). These conditions, which are collectively classified under the umbrella term of inflammatory bowel disease (IBD), are known to result from pathological immune responses to endogenous antigens and can affect individuals of all any age though most people are diagnosed at the age of 20-30 years (Sephton, 2009). Both disorders are characterized by inflammation of the intestinal mucosa for no apparent reason, leading to high morbidity and a substantial reduction in health related quality of life (Reid et al., 2010). The present paper looks into the clinical manifestations and medical/nursing management of ulcerative colitis and Chron’s disease.
Clinical Manifestations
Available literature demonstrates that ulcerative colitis and Chron’s disease are similar in terms of clinical manifestations and treatments, though a significant number of differences have been noted between the two. The most shared clinical manifestations of inflammation in ulcerative colitis and Crohn’s disease include “increased bowel frequency, diarrhea, fecal urgency resulting in incontinence, passage of blood per rectum, loss of appetite, anemia, fatigue, abdominal pain, and tenderness” (Reid et al., 2010, p. 19). A substantial number of patients with ulcerative colitis or Chron’s disease have reported experiencing extra intestinal complications involving inflammation in the biliary tract, skin, mouth, eyes and joints, with existing nursing scholarship demonstrating that the chronic remission and relapse associated with these disorders affect the quality of life variables and are a significant cause of patient morbidity (Amplo & Nelson, 2009).
In terms of differences, Kefalides and Hanaver (2003) note that ulcerative colitis is characterized by bloody diarrhea (though not always) and often begins in the patient’s rectum towards other areas through proximal and continuous spread. On the other hand, Crohn’s disease normally presents as nonbloody diarrhea and is known to skip some areas of the bowel during its manifestation as the disease has been found to spare the rectum in as many as 50% of cases. Additionally, perianal lesions are common in Chron’s disease but are often absent in ulcerative colitis (Wang, Zhang & Ouyang, 2007). Available literature demonstrates that “it is often difficult to distinguish between ulcerative colitis and Crohn’s disease in patients with pancolitis [as] roughly 10% of affected patients will have only an indeterminate diagnosis of colitis until further work-up determines the specific type” (Kefalides & Hanaver, 2003, p. 53). The similarities in clinical manifestations make it increasingly difficult for health practitioners to make a correct diagnosis without undertaking comprehensive laboratory and histological examinations.
Nursing/Medical Management
Ulcerative colitis and Chron’s disease demand comprehensive nursing management as “people with IBD report a greater disease burden than other common digestive disorders and have fewer employment prospects when the disease is active” (Reid et al., 2010, p. 20). Indeed, these authors note that long term nursing management and other multi-disciplinary input are required due to morbidity and chronicity associated with ulcerative colitis and Chron’s disease. The interventions involved in effective nursing management for the disorders entail providing ongoing education with the view to improving self-management of the conditions, advising patients on where to seek for specialist services during disease relapse, providing additional support and services targeting quality of life issues including how to cope with fecal urgency and incontinence which characterize acute episodes of IBD, coordinating IBD treatment, and ensuring that patients take medications as prescribed (Carter, Lobo, & Travis, 2004).
Owing to the fact that both disorders are characterized by chronic relapse and remission, nursing professionals are required to provide timely interventions and expert monitoring to avoid hospital readmissions and prevent other complications that are associated with these disorders. Patients with ulcerative colitis and Chron’s disease can be exposed to oral or intravenous corticosteroids (e.g., oral prednisolone, hydrocortisone or methylprednisolone), 5-aminosalicylic acid (5-ASA) therapy, antibiotics (e.g., metronidazole and ciprofloxacin), immunosuppressive drugs (e.g., azathioprine) and colectomy; however, the administration of these therapies and procedures should be dependent on level of involvement and disease severity (da Silva et al., 2015; Sephton, 2009). Other nursing interventions required in the management of these disorders include observing and monitoring patients for improvement or deterioration in their condition (e.g., temperature, pulse, respiratory rate, and blood pressure), providing emotional support, referring patients to a dietician for nutritional therapy and support, providing continuity of care through direct telephone access and other communication channels, recording stool charts intended to show the number of bowel movements including the presence or absence of blood and liquid versus solid stool, and monitoring patients for drug-related side effects (Amplo & Nelson, 2009; Carter et al., 2004).
Conclusion
This paper has provided useful insights into the clinical manifestations and medical/nursing management of ulcerative colitis and Chron’s disease. Although the disorders have no known cure, the medical therapies and nursing management interventions discussed in this paper are adequate in reducing inflammation, minimizing morbidity and disease burden, as well as improving patients’ quality of life and other health variables.
References
Amplo, K., & Nelson, D. (2009). Care of patients with inflammatory bowel disease. AORN Journal, 90(6), 909-918.
Carter, N.J., Lobo, A.J., & Travis, S.P.L. (2004). Guidelines for the management of inflammatory bowel disease in adults. Gut, 53(5), 1-16.
da Silva, B.C., Lyra, A.C., Mendes, C.M.C., Ribeiro, C.P.O., Lisboa, S.R.O., de Souza, T.L.,…Santana, G.O. (2015). The demographic and clinical characteristics of ulcerative colitis in a Northeast Brazilian population. Biomed Research International, 17(1), 1-8.
Kefalides, P.T., & Hanaver, S.B. (2003). Ulcerative colitis: Diagnosis and management. Hospital Physician, 36(4), 53-63.
Reid, L.W., Chivers, S., Plummer, V., & Gibron, P. (2010). Inflammatory bowel disease management: A review of nurses’ roles in Australia and the United Kingdom. Australian Journal of Advanced Nursing, 27(2), 19-26.
Sephton, M. (2009). Nursing management of patients with severe ulcerative colitis. Nursing Standard, 24(15-17), 48-57.
Wang, Y.F., Zhang, H., & Ouyang, Q. (2007). Clinical manifestations of inflammatory bowel disease: East and west differences. Journal of Digestive Diseases, 8(3), 121-127.