CROHN’S DISEASERivera,Roel P.

CROHN’S DISEASE:definition A type of inflammatory bowel disease

(IBD) condition in which the lining of your digestive tract becomes inflamed, causing severe diarrhea and abdominal pain.

Also called as Regional Enteritis, Granulomatous Colitis, Ileitis.

The inflammation often spreads deep into the layers of affected tissue

CROHN’S DISEASE: cause

Chron’s disease has unknown cause. But one microorganism that may be involved in the development of Crohn's is Mycobacterium avium subspecies paratuberculosis (MAP), a bacterium that causes intestinal disease in cattle.

Risk Factor Age. Crohn's disease can strike at any age, but you're

likely to develop the condition when you're young.(ages of 20 to 30)

Ethnicity. Although whites have the highest risk of the disease, Jewish and of European descent are four to five times at risk.

Family history(hereditary and contact with family member)

Lifestyle(smoking) Environment Diet Immune disorder Defect in the intestinal barrier Dysfunctional repair of mucosal injury

Signs and Symptoms

Diarrhea. The inflammation that occurs in Crohn's disease causes cells in the affected areas of your intestine to secrete large amounts of water and salt. Because the colon can't completely absorb this excess fluid, you develop diarrhea. intestinal discomfort (mild crohn’s disease) Blood in your stool prominent lower right quadrant abdominal pain Scar tissue and formation of granuloma which

interferes with the ability of the intestine to transport products of the upper intestinal digestion through the constricted lumen, results in

Signs and Symptoms

Crampy abdominal pain occurs after meals because eating stimulates

Intestinal peristalsis abdominal tenderness and spasm Weight loss Malnutrition secondary anemia delayed growth or sexual

development(in children)

Signs and Symptoms

Ulcers in the membranous lining of the intestine and other inflammatory changes, results in

Weeping Edematous intestine which continually

empties an irritating discharge into the colon . Inflamed intestine may perforate leading to

Intraabdominal and anal abscesses Fever and Leukocytosis

Diagnostic Test Proctosigmoidoscopy is usually performed initially

to determine whether the recto sigmoid are is inflamed

Stool examination is the result may be positive for occult blood and steatorrhea.

Barrium study of the upper GI tract that shows the Classic“String Sign” on an X-ray film of theterminal ileum, indicating the constriction of a segmentof intestine

Endoscopy- An instrument for examining visually the interior of a bodily canal or a hollow organ such as the colon,bladder, or stomach.

Diagnostic Test Colonoscopy -is a medical procedure where a

long, flexible, tubular instrument called the colonoscope is used to view

the entire inner lining of the colon (large intestine) and the rectum

Intestinal Biopsy-A biopsy is a diagnostic procedure in which tissue or cells are removed from a part of the body and specially prepared for examination under a microscope. When the tissue involvedis part of the intestinal, the procedure is called a intestinal biopsy.

Barium enema may show ulceration ( the cobble stone appearance), fissure, and fistula

Diagnostic Test

CT scan which may show bowel wall thickening and fistula formation

Complete Blood Count (CBC) is performed to assess hematocrit and hemoglobin levels ( usually decreased ) as well as the white Blood Cell Count ( may be elevated )

Erythrocyte Sedimentation Rate (ESR) is usually elevated laboratory test that measures the rate of settling ofRBCs:elevation is indicative of inflammation also calledthe “SED rate”

Albumin and Protein level may be decreased, indicating malnutrition

Treatment Anti inflammatory drugs- Sulfasalazine

(Azulfidine),Mesalamine (Asacol, Rowasa). Corticosteroids Immunosuppressant drugs- Methotrexate

(Rheumatrex), Cyclosporine (Neoral,Sandimmune) Antibiotics -Metronidazole (Flagyl) ,Ciprofloxacin

(Cipro) Anti-diarrheals.-Metamucil or methylcellulose

(Citrucel), loperamide (Imodium) Laxatives Pain relievers Immune System Suppressors - mercaptopurine  Antacids, Ranitidine

TreatmentSurgery is used either to relieve symptoms that do notrespond to medical therapy or to correct complications such as blockage, perforation,abscess, or bleeding in the intestine. Surgery -to remove a damaged portion of your

digestive tract or to close fistulas or remove scar tissue

Strictureplasty, a procedure that widens a segment of the intestine that has become too narrow.

Laparoscopic surgery using small incisions can lead to improved outcomes and shorter hospital stays for some people with Crohn's disease.

Treatment

A fecal diversion maybe needed, such as ileostomy, Continent IlealReservoir (Koch Pouch), or Ileoanal anastomosis. 

Strictureplasty or fecaldiversions may be needed (e.g., Ileal reservoir, Ileoanal Anastomosis).

Proctocolectomy with Ileostomy (Excision of colon, rectum, and anus) may be performed if rectum is severely involved.

Complications Intestinal blockage Gastrointestinal bleeding Intestinal ulcers - these may lead to various

complications:Performated intestinal ulcer Peritonitis Abdominal abscess Abdominal fistula Adhesions Protein deficiency Calorie deficiency Vitamin deficiency Malabsorption

Complications Malnutrition Bacterial infections of the digestive tract Gastrointestinal abscess Gastrointestinal fistula- affecting bladder, vagina,

or skinIntestinal cancer- higher risk for cancer of the ileum.

Uveitis Arthritis Skin problems Eye inflammation Mouth inflammation Kidney stones

Complications Gallstones Liver diseases Biliary system diseases Obstruction Fistulae formation-are a common complication and often

become infected. Abscesses Severe hemorrhage Colon cancer The most common complication is blockage of the

intestine Crohn's disease may also cause sores, or ulcers, that tunnel through the affected area into surrounding tissues.

Prevention Crohn's disease cannot be prevented because the

cause is unknown. But you can take steps to reduce the severity of the disease.

Medicines taken regularly may reduce sudden (acute) attacks and keep the disease in remission(a period without symptoms).

Do not smoke. Smoking makes Crohn's disease worse.

Eat a healthy diet. Never use antibiotics unless they have been

prescribed for you by a doctor. Get regular exercise.

Nursing Intervention

Monitor frequency and consistency of stools to evaluate volume losses and effectiveness of therapy.

Monitor dietary therapy; weigh the patient daily. Monitor electrolytes, especially potassium. Monitor

intake and output. Monitor acid-base balance because diarrhea can lead to metabolic acidosis.

Monitor for distention, increased temperature, hypotension, and rectal bleeding; all signs of obstruction caused by inflammation.

Observe and record changes in pain, especially frequency, location, characteristics, precipitating events, and duration.

Nursing Intervention Offer understanding, concern, and encouragement because

patient is often embarrassed about frequent and malodorous stools, and often fearful of eating.

Have patient participate in meal planning to encourage compliance and increase knowledge.

Encourage patient’s usual support persons to be involved in management of the disease.

Provide small, frequent feedings to prevent distention of the gastric pouch. Diet is low in residue, fiber, and fat; high in calories, protein, vitamins, and minerals.

Provide fluids as directed to maintain hydration (1,000 mL/24 hours minimum intake to meet body fluid needs).

Clean rectal area and apply ointments as necessary to decrease discomfort from skin breakdown.

Facilitate supportive counseling, if appropriate.