Disorders of the Gastrointestinal System, 2nd Edition
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● Lab studies : C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can be helpful tools to measure the degree of inflammation present. Although not diagnostic, they are useful in monitoring the disease process. An elevated WBC is often observed in IBD patients during a flare, but this does not necessarily indicate that an infection is present. If severe bleeding has occurred, hematocrit and hemoglobin may be low. Serologic markers have also recently been identified to help providers differentiate between or rule out other conditions. One such marker is perinuclear anti- Saccaromyces cerevisiae antibodies (pASCA), which, if positive, indicate UC. ● Stool specimen: The specimen should be evaluated for the presence of bacteria, parasites, and parasite ova. A fecal occult blood test is often conducted if bleeding is not profuse. Another fairly new test that can aid in diagnosis is fecal calprotectin level. An increased level of fecal calprotectin can indicate IBD, but it is not specifically sensitive to it. Several other conditions can also increase fecal calprotectin (Ricciuto & Griffiths, 2019). ● Imaging : X-rays may be used for suspected, more sensitive imaging will also be used to determine the severity of the disease and assess for any complications. One helpful imaging study is a barium enema, which shows the colonic mucosa in better detail. MRI, CT, and ultrasound may also assess the bowel wall for defects or changes. patients with a sudden onset of symptoms. Generally, if UC is
● Toxic megacolon. ● Increased risk of colorectal cancer.
Another complication of ulcerative coli- tis is fulminant colitis. This problem occurs when the lesions associated with ulcer- ative colitis penetrate the bowel muscles. The patient experiences abrupt, violent diarrhea characterized by ten or more stools per day accompanied by abdomi- nal pain and distention, fever, and anorex- ia (Peppercorn & Kane, 2022a). Fulminant colitis may also progress to toxic mega- colon, which results in a significantly dilat - ed colon due to inflammation within the muscle layer of the colon. This can lead to sepsis, ischemic bowel, or perforation of the bowel (Sheth & Lamont, 2022). | NURSING CONSIDERATION The nurse should be aware that toxic megacolon presents with increasing abdominal pain, fever, chills, abdom- inal distention, and signs of sepsis or shock (tachycardia, hypotension, and increased respiratory rate). It is a med- ical emergency and may require sur- gical intervention (Sheth & Lamont, 2022). Diagnostic tests used in ulcerative coli- tis include (Basson, 2022): ● Endoscopy : Ulcerative colitis generally develops in the rectum first and moves up the colon, so colonoscopy or flexible sigmoidoscopy may be the first diagnostic procedure performed. This method can also help rule out infectious colitis, diverticulitis, or ischemia as causes of symptoms. A biopsy and additional imaging are generally used in conjunction with a colonoscopy to confirm the diagnosis if ulcerative colitis is suspected.
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