Disorders of the Gastrointestinal System, 2nd Edition
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be given when first-line medications do not work or in cases of more severe dis- ease (Cohen & Stein, 2022). Surgery may be necessary for patients who do not respond to medications or supportive measures. Surgery is often indicated when complications related to UC are present, such as toxic megaco- lon, fulminant UC that is not responsive to medications, and hemorrhage (Basson, 2022; Fleshner, 2021). Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) This procedure eliminates the need for an external ostomy pouch and is the preferred surgical treatment method. The procedure is often performed in one to three stages. The anus and anal sphinc- ter muscles are left intact. The ileum is made into a pouch and connected to the anus. A temporary ileostomy may be per- formed to allow the new pouch to heal. However, studies have not supported this as reducing leaks from the anastomosis site, so this approach is not as common as it once was. After the pouch has healed, the temporary ileostomy is reversed, and stool passes through the anus (Fleshner, 2021). Several possible complications can occur after an IPAA is performed. These include pouchitis (inflammation of the pouch), risk of infertility, bowel obstruc- tion, and pouch failure. Pouch failure ne- cessitates the removal of the pouch and the performance of a permanent ileosto- my (Fleshner, 2021; Rabbenou & Chang, 2021). Proctocolectomy with end ileostomy In this procedure, the colon, rectum, and anus are removed, and the end of the small intestine (ileum) is brought through the abdominal wall and skin to form a stoma, which allows the drainage of in- testinal waste products from the body. An
| NURSING CONSIDERATION
In the event of severe GI bleeding, emergency measures must be initi- ated. These include administering blood products and surgery if perfo- ration is suspected (Stanley & Laine, 2019). Patients with severe GI symp- toms should be held NPO, and vital signs and hydration status should be monitored closely until a treatment plan is determined. Primary ulcerative colitis treatment goals are to cause remission and con- trol and prevent future flares. This can be done by administering medications and treatments that control inflammation; re - placing lost blood; and replacing lost flu - ids, electrolytes, and other nutrients (Co- hen & Stein, 2022). Supportive measures are initiated to control the disease and avoid surgery. Mesalazine is the drug of choice admin - istered for its anti- inflammatory and an - timicrobial actions. It is generally tolerat- ed orally better than similar medications (Basson, 2022). As mesalazine may affect the immune system, it should be avoid- ed in immunosuppressed patients. Oth- er drugs that have anti-inflammatory and antimicrobial actions include Budoneside, which was recently FDA-approved as a rectal foam and has been successful in promoting remission in cases of mild UC. Steroids such as prednisone and hydro- cortisone are given to control inflamma - tion during flares. Steroids can be used long-term in severe cases that have not responded to other treatments; however, there may be severe side effects, and a taper is recommended (Basson, 2022). Bi- ologics, tumor necrosis factor inhibitors, and immunosuppressant drugs may also
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