Ulcerative colitis and Crohn’s disease are bacterial conditions that normally occur in the gastrointestinal tract in the human body, causing irritation and abdominal pain. Normally, the inflammation of the bowel occurs as a result of the destruction of harmless digestive bacteria during the clean up of the immune system. This paper looks at the pathophysiology, clinical manifestation, nursing management, and prognosis of the two diseases.
Pathophysiology of Ulcerative Colitis and Crohn’s Disease
Colonoscopy is normally used to assess the presence of both Crohn’s disease and Ulcerative Colitis. However, their pathology differs, such that inflammation in Crohn’s disease tends to span through the whole length of the gastrointestinal tract, mainly with skip lesions of infected and unaffected tissues (Warner & Barto, 2010) Biopsies of affected parts tend to exhibit mucosal damage by neutrophils cells, which in some cases may extend to the crypts and thus causing abscess.
Crohn’s disease is caused when T helper cells are interrupted in their protective role of the immune system, thus responding aggressively and in the process causing inflammation of the mucosal wall in the intestines (Engel & Neurath, 2010).
On the other hand, ulcerative colitis tends to be caused by colonic sulfate-reducing bacteria, which interfere with oxidation pathway thus increasing the amount of toxic hydrogen sulfide gas that causes inflammation of the intestinal wall (Engel & Neurath, 2010). People who consume a lot of red meat and alcohol are at risk of contracting ulcerative colitis due to the possibility of sulfur in those products reacting in the body to produce toxic hydrogen sulfide gas.
Clinical Manifestation
Generally, the two diseases share almost similar symptoms, which include loose and urgent bowel movements, rectal bleeding, abdominal cramps and pain, the sensation of incomplete evacuation, constipation that can lead to bowel obstruction, fever and loss of normal menstrual cycle, loss of appetite, weight loss and fatigue.
However, they differ in relation to how they manifest in the gastrointestinal tract. For instance, Crohn’s disease invades any part or the whole of the gastrointestinal tract, unlike ulcerative colitis, which is dedicated to the colon.
Crohn’s disease normally invades in various forms, as discussed in the following section. According to Tersigni & Prantera (2010), types of Crohn’s disease include Ileocolitis, which affects the ileum and the large intestine, Ileitis, which affects only the ileum, and gastroduodenal Crohn’s disease that normally affects the stomach and the upper part of small intestines (the duodenum). Others are jejunoileitis, which affects the jejunum and granulomatous, which normally infects the colon.
On the other hand, ulcerative colitis manifestation may be of different types. According to Bayless & Hanauer (2011), one type of ulcerative colitis is ulcerative proctitis, which causes inflammation of the rectum. Other common types are the proctosigmoiditis, which normally affects the rectum and the lower part of colon, left-sided colitis, that causes irritation along with the rectum and splenic flexure, and pan-ulcerative colitis, which is the most fatal because it can destroy the whole colon if not diagnosed and treated in time.
Nursing Management
Various diagnosis and treatment methods for both diseases are discussed below.
Diagnosis
In both diseases, a physical examination of the body may be required accompanied by an interview of the patient in order to establish medical history, lifestyle, dietary habits, and the environment in which the patient lives. In addition, the physician may require conducting laboratory tests of blood and stool in order to establish whether there are any links to either of the two diseases.
Crohn’s disease may require X-rays of the upper and lower gastrointestinal tract, including the use of Barium, a chemical that helps doctors to see more details of GI tract by increasing contrast of the X-Ray image (Bayless & Hanauer, 2011). However, ulcerative colitis may require a thorough examination of the colon using either a sigmoidoscopy or total colonoscopy (Bayless & Hanauer, 2011).
Treatment Options
Treatment of both diseases would focus on improving the immune system through a combination of treatment options, although treatment differs from patient to patient and the extent of spread of the disease (Warner & Barto, 2010).
Medication. Medication should be one that is designed to suppress the immune system’s abnormal inflammatory response. Drugs to treat Crohn’s disease include Aminosalicylates (5-ASA), corticosteroids, immunomodulators, antibiotics, and biologic therapies. On the other hand, ulcerative colitis is treated using drugs such as Azulfidine and immunosuppressive agents such as Imuran, 6-MP or cyclosporine, and prednisone (Langan et al., 2007).
Diet & Nutrition. Paying special attention to one’s diet may help reduce symptoms and replace nutrients that were lost through diarrhea resulting in reduced ability of body to absorb protein, fat, carbohydrates, as well as water, vitamins, and minerals; however, in the case of ulcerative colitis, soft foods with no added spices are preferred.
Surgery. Both diseases may require surgery when medical intervention fails to be effective or has resulted in complications. For Crohn’s disease, surgery is done on the affected areas, which are severed off and the remaining healthy parts of the GI joined to complete the system; this is unlike ulcerative colitis surgery, which may involve colectomy. The major difference is that while ulcerative colitis can be completely cured by removal of the colon, Crohn’s disease tends to reoccur even after removing the affected parts (Farraye, 2013).
Prognosis
Crohn’s disease may occur in start-stop kind of process but is mainly not curable due to its tendency of reoccurring even after treatment. Ulcerative colitis tends to follow an intermittent path, whereby there are times when symptoms are conspicuous and times when the disease is docile or dormant.
In most cases, the disease does not subside without therapy, and where the condition reaches a critical stage, it may lead to colorectal cancer. In some cases, people with ulcerative colitis are at risk of contracting inflammation of the bile duct. Moreover, one important aspect of the disease is that it is not fatal because it can be completely cured through colectomy, although it affects a person’s quality of life (Farraye, 2013).
Both diseases are likely to cause primary sclerosing cholangitis; however, Crohn’s disease has a higher causative rate, which is skewed more towards men than women. Another prognosis difference is that nutritional deficiency is more likely to cause Crohn’s disease than ulcerative colitis.
Moreover, chances of the colon cancer occurring are higher in ulcerative colitis than in Crohn’s disease. All in all, both diseases cause discomfort in the health conditions of patients; however, Crohn’s disease may lead to complications that degenerate to cancer or fistula, which are fatal.
Conclusion
The two diseases manifest in the gastrointestinal tract of the human body and are associated with inflammation of the intestinal wall. Generally, they exhibit similarities, especially in symptoms, but they differ in terms of pathophysiology, diagnosis, and prognosis. All in all, they may not be fatal, although Crohn’s disease may become dangerous when it exhibits incidences of reoccurrence and complications.
References
Bayless, T., & Hanauer, S. (2011). Advanced Therapy of Inflammatory Bowel Disease: Ulcerative Colitis. Shelton, England: Peoples Medical Publishing House.
Engel, M. A., & Neurath, M. F. (2010). New pathophysiological insights and modern treatment of IBD. Journal of Gastroenterology, 45(6), 571-583. Retrived from EBSCOHOST.
Farraye, F. A. (2013). 100 Questions and Answers About Crohn’s Disease. Burlington, England: Jones and Bartlet Learning Publications.
Langan, R., Gotsch, P., Krafczyk, M., & Skillinge, D. (2007). Ulcerative colitis: diagnosis and treatment. American family physician, 76 (9), 1323–1330.
Tersigni, R., & Prantera, C. (2010). Crohn’s Disease: A Multidisciplinary Approach. Rome, Italy: Springer.
Warner, A., & Barto, E. (2010). 100 Questions & Answers About Crohns Disease and Ulcerative Colitis; a lahey clinic guide. London, England: Jones and Bartlet Publishers.