1. Inflammatory Bowel Diseases CD, UC, and ostomies… oh my!

2. Statistically Speaking…. 1.6 million Americans live with IBD today (1 in 200) Between 67% and 75% of those living with IBD will require surgery for their IBD Only 10% of individuals find the right treatment option on the first attempt Fastest growing age group to be diagnosed with IBD…? In 2011, 80,000 kids in US had been diagnosed with IBD Increased risk for colorectal cancer

3. UC vs. CD CharacteristicsUlcerative ColitisCrohn’s Disease Rectal bleedingCommonUncommon DiarrheaOften severeModerate to severe PainLess frequentCommon AnorexiaMild or moderateMay be severe Weight lossModerateMay be severe Growth retardationUsually mildMay be severe Anal and perianal lesionsRareCommon Fistulas and stricturesRareCommon RashesMild Joint painMild to moderate Continuous?NoYes Table 26-6 (1085)

4. Non-continuous vs. Continuous

5. Presentation Normal, healthy colon

6. Presentation Ulcerative ColitisCrohn’s Disease

7. Causes?

8. Diagnostic Procedures Blood/serum tests CRP and ESR Stool examinations Imaging CT/ultrasound, with and without contrast Scope procedures Endoscopy, Sigmoidoscopy, Colonoscopy Biopsies

9. Development with IBD 7-12yo Loss of control, autonomy, and competence Perception of differences may cause isolation and feelings of anger, sadness, frustration, and resentment Learn about interest/skills, and incorporate into care if possible Give opportunities to help with safe procedures, make decisions, and feel in control Encourage activities that allow for expression and mastery

10. Development with IBD 13-18yo Majorly impacted: self-esteem, independence, and body image Loss of control and privacy May withdraw, experience anger, aggression, and isolation Intimacy…. RESPECT! Accept that they have the ultimate control over themselves: “you can’t make me” Have a sense of humor Allow them to contribute in a meaningful way and express your belief in them

11. Nutrition Important in care and can influence remission Malnutrition Stunted growth, weight loss, and delayed onset of puberty Avoidance of inflammatory and/or trigger foods SCD (eliminates most sugars, starches, and grains) Pediasure/liquid diet NG feeds (enteral formulas) TPN A word about fiber…

12. Pharmacological Options Bottom-to-TopTop-to-Bottom

13. Pharmacological RED FLAG Do NOT mix biologics with immunomodulators Biologics: infliximab [Remicade], adalimumab [Humira], vedolizumab [Entyvio] Immunomodulators: 6-MP [Purinethol or Purixan], azathioprine [Imuran or Azasan] Combination causes fatal liver lesions in those under 42yo!

14. Surgical Options Resection of the large intestine Colectomy/Colostomy Ostomy is named for placement along the GI tract (i.e. ileostomy, jejunostomy, colostomy) Creation of a J- or S-pouch Repair of emergent complications

15. Ostomies

16. “I know what you’re going through” We can never “know” anyone else is living through Instead: “I know someone who lives with an IBD, so I’m somewhat familiar with it. Can you tell me about your disease so I know how to best help you?” “Sometimes people with an IBD may experience [X, Y, and Z]; do you find this is true for you?” If not, ask! “Live with”

17. Resources for all involved GI Tract Guide IBD Fact Book CCFA Camp Oasis Campus Connection Professional Resources