Caring for Crohn's & UC

The ABC’s of Crohn’s & UC: “O” & “P”

January 3, 2013 at 9:27 pm Rebecca K. 2 comments

We are over halfway done with the ABC’s of Crohn’s and Colitis series! I hope it’s been informative thus far for those who have been following along.

Next up in the ABC’s of Crohn’s and Colitis series: O and P.

Obstruction: A nightmare for IBDers. A bowel obstruction occurs when a part of the small or large intestines becomes partially or totally blocked, preventing stool from passing through. In IBD patients, this can occur if the patient has a stricture that is too narrow and stool cannot pass through it. Symptoms of a bowel obstruction include bloating, abdominal pain, vomiting, constipation, inability to pass stool, and a feeling of fullness in the abdomen, among others. In some cases, obstructions are treated a nasogastric (NG) tube. The NG tube, as I mentioned in another blog entry, goes through the nose and down into the stomach, decompressing the intestines. If the NG tube doesn’t work, surgery may be needed. Surgery also may be needed, in some cases, if tissue in the intestines has died as a result of the blockage.

Dr. Gordon D. Oppenheimer: One of the doctors who discovered Crohn’s Disease along with Drs. Crohn and Ginzburg.

Osteoporosis: According to the NIH Osteoporosis and Related Bone Diseases National Resource Center, “osteoporosis is a condition in which the bones become less dense and more likely to fracture.” People with IBD are at a higher risk to develop osteoporosis for several reasons. People with IBD are often treated with glucocorticoids like prednisone and cortisone which interfere with the development and maintenance of health bones.  Additionally, patients who have severe inflammation in the small bowel or have parts of it removed may have difficulty absorbing calcium and vitamin D, which is a concern for bone health. Patients with IBD can protect their bone health by eating a diet rich in calcium vitamin D, exercising, not smoking or drinking excessively, and, in some cases, taking medication to prevent further bone loss.

Ostomy: An ostomy is a surgically created opening in the body for the discharge of body wastes. Ostomies are commonly created in IBD patients who have all or part of their small intestine, colon or rectum removed due to disease and inflammation. There are many kinds of ostomies, including colostomy (rectum is removed and colon is attached to the stoma), ileostomy (colon and rectum are removed and the ileum is attached to the stoma), and urostomy (the ureters are attached to either the small intestine or abdominal wall).

p-ANCA: Stands for perinulclear anti-neutrophil cytoplasmic antibodies, p-ANCA is a test that aids in diagnosing ulcerative colitis. The test distinguishes it from Crohn’s Disease.

Pain Relievers: OTC pain relievers, like Tylenol and Advil, may be effective in treating acute pain caused by IBD symptoms. However, patients should consult with their doctors before taking Advil and other ibuprofen products because they can cause adverse effects in IBD patients.

Pancolitis: One type of Ulcerative Colitis. Pancolitis extends for the entire length of the colon, including the cecum. Pancolitis poses the highest risk of developing sudden and severe inflammation that requires urgent surgery. Additionally, a high risk for colon cancer is associated with pancolitis. Pancolitis affects around 20 percent of Ulcerative colitis patients.

Perforation: One possible IBD complication that is potentially fatal and requires immediate medical attention. A perforation due to IBD is rare. It is more common during a first flare-up of Ulcerative colitis, especially if it’s severe. It can occur in Crohn’s Disease but it’s rare, only between one and three percent over the course of the disease. A perforation can also occur if the disease causes the walls of the intestine to become weak and develop a tear. Symptoms of a perforation include fever, chills, nausea, vomiting, severe abdominal pain, and rectal bleeding. Perforations are diagnosed using radiology (MRIs and CT Scans) and treated with antibiotics, an NG tube, or surgery, depending on the severity.

Pouchitis: A common complication that occurs in UC patients who have an ileoanal anastomosis. Pouchitis is the inflammation of the lining of this pouch. According to the Mayo Clinic, it occurs in up to half of the people who undergo this procedure. Symptoms of pouchitis include abdominal pain, cramps, increased number of bowel movements and strong urgency to have a bowel movement. Pouchitis is treated with a course of antibiotics.

PPD: Stands for purified protein derivative. It’s a tuberculosis (TB) skin test. Gastroenterologists advise all patients taking biologic therapies have PPD tests done to asses the presence of TB disease.

Probiotics: Some probiotics can help with IBD symptoms. According to a recent Northwestern study, the friendly bacteria in probiotics act as a calming agent to the diseased bacteria in the gut. The probiotic mobilized immune cells that enhanced the production of  T-cells that rebalanced intestinal and systematic inflammation. Probiotics for IBD patients are still being studied and you should consult with your doctor before taking any. After a colonoscopy, Dan’s doctor recommended he take Align for a bit to help his stomach go back on track because it was having trouble realigning after the procedure. They did help him readjust then but he isn’t taking them at the moment.

Proctocolectomy: This is the surgery to remove the colon and rectum. According to UCSF, a proctecolectomy is the standard procedure for patients with Ulcerative colitis who are not responding to medication or have a serious life-threatening complication. Proctocolectomies are followed by either an Ileal Pouch Anal Anastomosis or an ileostomy.

Proctosigmoiditis: One form of Ulcerative colitis, it involves the rectum and lower end of the colon (sigmoid colon). Symptoms of proctosigmoiditis include bloody diarrhea, abdominal cramps and pain, and an inability to move the bowels despite the urge to do so.

Purinethol (6-MP): A common immunosuppressant  used to treat Crohn’s Disease and Ulcerative Colitis. It is used to help keep patients feeling well and off steroids. 6-MP decreases the activity of the immune system, resulting in decreased inflammation in the intestine. 6-MP can also help close fistulas in patients with Crohn’s Disease. It is a slow acting medication and can take three to six months to begin working. It’s important to note that 6-MP is also a chemotherapy drug and comes with lots of possible side effects including headache, nausea, vomiting, diarrhea, and malaise. Dan was on 6-MP for several years and it made him feel awful- he was constantly fatigued to the point where he could barely work.

Entry filed under: ABC Series. Tags: 6-MP, abcs, Bowel Obstruction, crohn's, crohn's disease, Crohn's Sucks, ibd, inflammatory bowel disease, O, Obstruction, Osteoporosis, ostomy, P, Pancolitis, Perforation, Pouchitis, Probiotics, Proctocolectomy, Proctosigmoiditis, TB, Tuberculosis, uc, ulcerative colitis.