Ulcerative Colitis (UC) and Crohn’s Disease are the two main types of Inflammatory Bowel Disease (IBD), both of which are autoimmune disorders where the immune system attacks the gastrointestinal tract. While they share some similarities, their patterns of inflammation, affected areas, and complications differ significantly — and knowing these differences is crucial for accurate diagnosis, treatment, and nursing care.
This article will break down pathophysiology, causes, risk factors, symptoms, complications, nursing care plans, pharmacology, surgery, and NCLEX tips for both conditions, based on medical and nursing exam standards.
Causes and Triggers of IBD
Both UC and Crohn’s are autoimmune diseases, meaning the body’s immune system mistakenly attacks its own tissues.
Common triggers include:
- Stress – Emotional and physical stress can trigger flare-ups (NCLEX TIP).
- Smoking – Worsens Crohn’s but sometimes paradoxically improves UC.
- Sepsis or infections – Can worsen inflammation.
The exact cause is unknown, but genetics, environmental factors, and abnormal immune responses play key roles.
Pathophysiology
Ulcerative Colitis (UC)
- Location: Affects only the colon (large intestine) and rectum.
- Pattern: Continuous areas of inflammation starting at the rectum and spreading proximally.
- Depth: Involves only the mucosal layer.
- Lesions: Long, open sores (ulcers) that bleed.
- Result: Decreased hemoglobin from chronic blood loss.
Crohn’s Disease
- Location: Can affect any part of the GI tract from mouth to anus, but most commonly the terminal ileum and small intestine.
- Pattern: "Skip lesions" — patches of healthy tissue between inflamed areas.
- Depth: Full-thickness (transmural) inflammation.
- Lesions: Granulomas (lumps and bumps) that do not bleed.
- Result: Risk of fistulas (abnormal connections between bowel and other organs) and malabsorption.
Signs and Symptoms
Ulcerative Colitis
- 15–20 bloody liquid stools per day
- Anemia from chronic blood loss
- Decreased hemoglobin and hematocrit (H/H)
- Rebound tenderness (may indicate peritonitis)
Crohn’s Disease
- 5 loose stools per day with mucus or pus
- Steatorrhea (fatty stools) due to malabsorption
- Weight loss and nutritional deficiencies
- Abdominal pain and cramping
Complications
Shared Complication – Peritonitis
- Cause: Bowel rupture (from toxic megacolon in UC or fistula perforation in Crohn’s)
- Signs: Fever >100.3°F, rebound tenderness, rigid “board-like” abdomen, tachycardia, tachypnea
UC-Specific Complication – Toxic Megacolon
- Severe inflammation dilates colon → risk of rupture and deadly infection in peritoneal cavity.
Crohn’s-Specific Complication – Fistulas
- Deep inflammation causes abnormal tunnels between bowel loops or between bowel and skin/bladder.
Nursing Care
Fluid and Electrolyte Management
- Strict I&O monitoring
- At least 2 liters of water daily, more with diarrhea
- Watch for hypokalemia (K⁺ ≤ 3.5 mEq/L)
- Daily multivitamins with calcium
Dietary Guidelines
- High protein, high calorie
- Low fiber during flare-ups (to reduce bowel irritation)
- Small, frequent meals
- Keep a food journal (NCLEX tip)
Pain & Lifestyle Management
- Administer analgesics as prescribed
- Avoid alcohol
- Reduce caffeine intake (coffee, tea)
- Stress management and psychosocial support
Pharmacology
Anti-inflammatory:
- Sulfasalazine – “Stops body attacking itself”
- Corticosteroids (Prednisone) – “Soothes the swelling”
- Loperamide – “Low bowel movements”
- Dicyclomine – “Dry cycle” (reduces bowel spasms)
Surgical Management
- UC: Colectomy can be curative.
- Crohn’s: Surgery may help complications but does not cure the disease (high recurrence rate).
- Procedures may include colostomy or ileostomy after bowel resection.
Table: Ulcerative Colitis vs Crohn’s Disease
| Feature | Ulcerative Colitis | Crohn’s Disease |
|---|---|---|
| Area Affected | Colon & rectum only | Anywhere from mouth to anus |
| Pattern | Continuous | Skip lesions |
| Depth | Mucosal layer only | Transmural |
| Bleeding | Common | Rare |
| Stool | Bloody diarrhea | Fatty, mucus-containing diarrhea |
| Curative Surgery | Yes | No |
NCLEX Exam Tips
- UC: Report >15 bloody stools/day or rebound tenderness.
- Crohn’s: Watch for signs of fistula or severe malabsorption.
- Both: Avoid high fiber during flares, encourage high protein/calorie diet when stable.
- Peritonitis signs require immediate notification of HCP.
Frequently Asked Questions
Q1: Can stress alone cause UC or Crohn’s?
No, but it can trigger flare-ups in those already diagnosed.
Q2: Is surgery a cure for both?
Surgery can cure UC but not Crohn’s, which can recur in other parts of the GI tract.
Q3: Can I eat fiber with UC or Crohn’s?
During flare-ups, fiber should be limited; during remission, moderate amounts may be tolerated.
Q4: How are UC and Crohn’s diagnosed?
Through colonoscopy, biopsy, imaging studies, and lab tests for anemia/inflammation.
Q5: Can UC turn into cancer?
Yes, chronic UC increases the risk of colorectal cancer, so regular screenings are important.
