LIceo de Cagayan University

R.N. Pelaez Blvd. Kauswagan, Carmen Cagayan de Oro City

College of Nursing

Medical Surgical Nursing Report

Crohn’s Disease

Submitted to:

Submitted on: August, 9 2008

CROHN’S DISEASE

CONTENTS

I. Overview of the report

II. Assessment

A. Anatomy and Physiology of the Digestive tract

B. Pathophysiology

C. Signs and Symptoms

D. Diagnostic Tests

III. Nursing Management

A. Nursing Diagnosis

B. Independent Nursing Actions

C. Dependent Nursing Actions

Medical Management

Surgical Management

Pharmacologic Management

IV. Expected Outcome

A. Prognosis

B. Complication

I. Overview of the report

Crohn's disease, a type of inflammatory bowel disease (IBD), is a condition in

which the lining of your digestive tract becomes inflamed, causing severe diarrhea and

abdominal pain.  The inflammation often spreads deep into the layers of affected tissue.

Like ulcerative colitis, another common IBD, Crohn's disease can be both painful and

debilitating and sometimes may lead to life-threatening complication.

While there's no known medical cure for Crohn's disease, therapies can greatly

reduce the signs and symptoms of Crohn's disease and even bring about a long-term

remission. With these therapies, many people afflicted with Crohn's disease are able to

function normally in their everyday lives.

Crohn’s disease is an ongoing disorder that causes inflammation of the digestive

tract, also referred to as the gastrointestinal (GI) tract. Crohn’s disease can affect any

area of the GI tract, from the mouth to the anus, but it most commonly affects the lower

part of the small intestine, called the ileum. The swelling extends deep into the lining of

the affected organ. The swelling can cause pain and can make the intestines empty

frequently, resulting in diarrhea.

Crohn’s disease is an inflammatory bowel disease, the general name for

diseases that cause swelling in the intestines. Because the symptoms of Crohn’s

disease are similar to other intestinal disorders, such as irritable bowel syndrome and

ulcerative colitis, it can be difficult to diagnose. Ulcerative colitis causes inflammation

and ulcers in the top layer of the lining of the large intestine. In Crohn’s disease, all

layers of the intestine may be involved, and normal healthy bowel can be found

between sections of diseased bowel.

Crohn’s disease affects men and women equally and seems to run in some

families. About 20 percent of people with Crohn’s disease have a blood relative with

some form of inflammatory bowel disease, most often a brother or sister and sometimes

a parent or child. Crohn’s disease can occur in people of all age groups, but it is more

often diagnosed in people between the ages of 20 and 30. People of Jewish heritage

have an increased risk of developing Crohn’s disease, and African Americans are at

decreased risk for developing Crohn’s disease.

Crohn’s disease

Inflammatory Bowel Disease (IBD) - refers to two chronic inflammatory GI disorders:

Regional Enteritis (Crohn’s disease) and Ulcerative

Colitis

Regional Enteritis - first diagnosed in adolescents or young adults but

can appear at any time of life

- Histopathologic changes consistent with regional

entiritis most commonly occur in distal ileum

and colon but can occur anywhere along the GI

tract.

- is seen more often in smokers than non-smokers.

- Sub acute and chronic inflammation of the GI tract

wall that extends through all layers. Although it

can occur anywhere in the GI tract, it most

commonly occurs in the distal ileum and to a

lesser degree the ascending colon.

II. Assessment

A. Anatomy and Physiology of the Gastrointestinal tract

Each cell of the body requires a constant supply of nutrients to use as the basic

building blocks of the body and for the hundreds of biochemical process that are

continuously going on within the body. The digestive system is the way in which the

body transforms food into the energy it needs to build, repair and fuel itself.

To be absorbed and used by the body, however, food substances must first be broken

down into pieces small enough to cross the cellular membrane. The first step in this

process is digestion. Digestion begins in the mouth. Food, once chewed, travels through

the throat or pharynx to the esophagus and then on to the stomach. From the stomach,

it passes into the small, then large intestines where it is further digested with the aid of

bile and enzymes from the pancreas and liver, and finally absorbed. Any waste

materials of this process exit the body through the colon and rectum.

Mouth

The mouth is the oral cavity where foods are received and prepared for digestion.

The mouth is responsible for the secretion of salivary amylase, which begins the

digestion process by converting starches into sugars.

Pharynx

The pharynx ,or throat, is a muscular tube that serves as a vehicle for both

respiration and digestion. When we swallow, reflex movements of muscles in the

pharynx propel food into the esophagus.

Esophagus

The esophagus is a tube that carries swallowed foods to the stomach.

Stomach

The stomach is a muscular organ that is located in the central/upper left hand

region of the abdominal cavity. The function of the stomach is to break down food items.

The stomach secretes digestive juices, such as hydrochloric acid and pepsin, to aid in

this process. It's muscular walls churn the food until it is in a semi-liquid form.

Small Intestines

The small intestines digest and absorb many of the foods we eat. In addition to

secreting a strong mucus membrane to protect it's walls from the strong acid food

mixture that passes into it from the stomach, the small intestines (along with the liver

and pancreas) secrete enzymes that help to digest proteins and carbohydrates and

break them down into their simplest form. Once digested, nutrients are extracted and

are absorbed by the body.

Large Intestines

The large intestine is responsible for the elimination of food materials that cannot

be digested and assimilated by the body. It is also responsible for the re-absorption of

water used during the digestive process. As food materials pass through the large

intestine, friendly bacteria that live in the colon act upon this waste, producing vitamin K

and some of the B-vitamins.

Liver

The liver is the largest gland in our bodies. It is located in the upper right portion

of the abdominal cavity, with the lower edge of the liver extending just below the rib

cage. The liver is responsible for a multitude of different functions, including:

The synthesis of lipoproteins such as cholesterol.

Synthesis of bile, which is necessary for fat digestion and absorption.

Manufactures carnitine for use in cell mediated fat transport.

Regulation of the amount of cholesterol circulating in the blood.

The storage and releasing of glucose.

Converts lactic acid into glycogen.

Converts B vitamins into their active co-enzyme form.

Coverts ammonia into urea, which is excreted by the kidneys.

The production or synthesis of specific proteins such as albumin and blood

clotting factors.

The storage of substances such as glucose, fat soluble vitamins, including A,

B12, D, E & K, folate, and minerals such as copper and iron.

Modification and inactivation of hormones; i.e., the breakdown of hormones that

have served their function.

Detoxification of chemical elements whether ingested or inhaled.

Removal of harmful substances from the blood and converts them into less

harmful substances that can be eliminated.

Pancreas

The pancreas is a gland that is located in the upper left hand quadrant of the

abdominal cavity. The pancreas houses the Isles of Landerhorn, which are responsible

for regulating blood sugar levels. It also produces enzymes that digest fats, proteins and

carbohydrates. In addition, the pancreas also produces an alkaline fluid, which

neutralizes the acidity of foods as they exit the stomach and proceed into the small

intestines.

B. Pathophysiology

Edema and thickening of the mucosa

Inflamed mucosa ulceration

(these lesions are not in continous contact with one another and are separated by

normal tissue. These cluster of ulcers tend to take on a classic “ cobble stone”

appearance.)

Fistula, fissures, and abscesses forms as the inflammation extend into the peritoneum

Bowel walls becomes thickened comes fibrotic

Intestinal lumen narrows

disease bowel loops sometimes adhere to other loops surrounding them

C. Signs and Symptoms

Clinical Manifestation:

-prominent lower right quadrant abdominal pain

-diarrhea unrelieved by medication

-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

-crampy abdominal pain occurs after meals because eating stimulates

intestinal peristalsis

-abdominal tenderness and spasm

* to avoid this bouts of crampy pain the patient tends to limit food

intake, reducing the amount and types of food to such a degree that

normal nutritional requirement are often not met, results in

- weight loss

-malnutrition

-secondary anemia

*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

Chronic Symptoms:

-diarrhea

-abdominal pain

-steatorrhea ( excessive fat in the feces )

-anorexia

-nutritional deficiency

-weight loss

Symptoms that may extend beyond GI tract:

-Joint disorder ( arthritis)

-skin lesions ( erythema nodosum)

-occular disorder ( conjunctivitis)

-oral ulcers

D. Diagnostic Tests

-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 the

terminal ileum, indicating the constriction of a segment

of intestine

-cobblestone appearance, fistulas, and fissures

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

-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 involved is part of the intestinal, the procedure is called a intestinal biopsy.

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

and fistula

-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 of

RBCs:elevation is indicative of inflammation also called

the “SED rate”

-Albumin and Protein level may be decreased, indicating malnutrition

III. Nursing Management

A. Nursing Diagnosis

-Diarrhea elated to the inflammatory process

-Acute pain related to increased peristalsis and GI inflammation

-Deficient fluid volume related to anorexia, nausea, and diarrhea

-Imbalanced nutrition, less than body requirements, related to dietary

restrictions, nausea and malabsorption

-Activity intolerance related to fatigue

-Anxiety related to impending surgery

-Ineffective coping related to repeated episodes of diarrhea

-Risk for impaired skin integrity related to malnutrition and diarrhea

-Risk for ineffective therapeutic regimen management related to insufficient

knowledge concerning the process and management of the disease

B. Independent Nursing Actions

-Maintaining Normal Elimination Patterns

-Determine if there is a relationship between diarrhea and certain foods,

activities, or emotional stress

-Identify any precipitating factors as well as stool frequency, consistency

and amount

-Provide ready access to bathroom or bedpan; keep environment clean

and odor-free

-Administer anti-diarrheal agents as prescribed and record frequency

and consistency of stools after therapy has started

-Encourage bed rest to decrease peristalsis

-Relieving Pain

-Describe character of pain (dull, burning or cramp-like) and its onset,

pattern and medication relief

-Administer anticholinergic medications 30 minutes before a meal to

decrease intestinal motility.

-Give analgesic agents as prescribe; reduce pain by position changes,

local application of heat (as prescribed) diversional acivities, and

prevention of fatigue.

-Maintaining Fluid Balance

-Record intake and output, including wound or fistula drainage.

-Monitor weight daily.

-Assess for signs of fluid volume deficit: dry skin and mucous

membranes, decreased skin turgor, oliguria, exhaustion, decreased

temperature, increased hematocrit.

-Evaluate urine specific gravity, and note hypotension.

-Encourage oral intake: monitor intravenous flow rate.

-Initiate measures to decrease diarrhea; dietary restrictions, stress

reduction, and antidiarrheal agents.

Promoting Nutritional Measures

-Use PN when symptoms are severe.

-Record fluid intake and output daily weights during PN therapy; test for

glucose daily.

-Give feedings high in in protein and low in fat and residue after PN

therapy; note intolerance ( eg, vomiting, diarrhea, distention ).

-Provide small, frequent, low residue feedings if oral foods are tolerated.

-Restrict activities to conserve energy, reduce peristalsis, and reduce

calorie requirements.

Promoting Rest

-Recommend intermittent rest periods during the day; schedule or

restrict activities to conserve energy and reduce metabolic rate.

-Encourage activity within limits; advise bed rest with active or passive

exercises for a patient who is febrile, has frequent stools, or is bleeding.

Reducing Anxiety

-Establish rapport by being attentive and displaying a calm, confident

manner.

-Provide time for patient to ask questions and express feelings.

-Note nonverbal indicators of anxiety (restlessness, tense facial

expressions).

-Tailor information about impending surgery to patient’s level of

understanding and desire for detail.

Promoting Coping Skills

-Provide understanding and emotional support to patients who feels

isolated, helpless and out of control.

-Recognize that behavior may be affected by a number of factors

unrelated to inherent emotional characteristics.

- Support patient’s attempts to deal with stresses

-Communicate that patients feeling are understood; encouraged patient

to discuss any disturbing matters.

-Used stress-reduction measures: relaxation techniques, breathing

exercises, and biofeedback.

-Refer for professional counseling as needed.

Preventing Skin Breakdown

-Examine skin, especially perianal skin.

-Provide perianal care after each bowel movement.

-Give immediate care to reddened or irritated areas over bony

prominences.

-Use pressure-relieving devices to avoid skin breakdown.

-Consult with a wound care specialist or enterostomal therapist as

indicated.

Monitoring and Managing Potential Complications

- Monitor serum electrolyte levels; administer replacements.

- Report dysrhythmias or change level of consciousness.

- Monitor rectal bleeding, and give blood and volume expanders.

- Monitor blood pressure; obtain laboratory blood studies.

- Monitor for indications of perforation: acute increase in abdominal

pain, rigid abdomen, vomiting or hypotension.

- Monitor for signs of obstruction and toxic megacolon: abdominal

distention, decreased or absent bowel sounds, changes in mental

status, fever, tachycardia, hypotension, dehydrations and electrolyte

imbalances.

Promoting home and community- base care

Teaching patient’s self-care

- Assess need for additional information about medical management

(medications, diet) and surgical interventions.

- Provide information about nutritional management (blond, low-

residue, high-protein, high-calorie, and high-vitamin diet).

- Give rationale for using steroids and anti inflammatory, anti bacterial,

anti diarrheal, and anti spasmodic agents.

- Emphasized importance of taking medications as prescribed and not

abruptly discontinuing regimen ( especially steroids, because serious

medical problems my result.

- Explain procedure and preoperative and postoperative care if surgery

is required. Review ileostomy care as necessary. Obtain information

from the national foundation for ileitis and colitis.

Continuing care

- Refer for homecare nurse if nutritional status is compromise and

patient is receiving PN.

- Explain that disease can be controlled and patient can lead a healthy

life between exacerbations.

- Encouraged patient to rest as needed and modified activities

according to energy levels during a flare-up. Advice patient to limit

task that impose strain on the lower abdominal muscles and to sleep

close to bathroom because of frequent diarrhea. Suggest room

deodorizers for odor control.

- Instruct about medications and the need to take them on schedule

while at home. Recommend used of medication reminders

(containers that separate pills according to day and time).

- Recommend low-residue, high-protein, and high- calorie diet during

an acute phase. Encourage patient to keep a record of foods that

irritate bowel and to eliminate them from diet. Recommend intake of

8 glasses of water per day.

- Provide support for prolonged nature of disease because it is a strain

on family life and financial resources. Arranged for individual and

family counseling as indicated.

- Provide time for patient to express fears and frustrations.

E. Dependent Nursing Actions

Medical Management

Surgical Management

Pharmacologic Management

Treatment may include drugs, nutrition supplements, surgery, or a combination of

these options. The goals of treatment are to control inflammation, correct nutritional

deficiencies, and relieve symptoms like abdominal pain, diarrhea, and rectal bleeding.

At this time, treatment can help control the disease by lowering the number of times a

person experiences a recurrence, but there is no cure. Treatment for Crohn’s disease

depends on the location and severity of disease, complications, and the person’s

response to previous medical treatments when treated for reoccurring symptoms.

Some people have long periods of remission, sometimes years, when they are

free of symptoms. However, the disease usually recurs at various times over a person’s

lifetime. This changing pattern of the disease means one cannot always tell when a

treatment has helped. Predicting when a remission may occur or when symptoms will

return is not possible.

Someone with Crohn’s disease may need medical care for a long time, with

regular doctor visits to monitor the condition.

(Pharmacologic Management)

Drug Therapy

Anti-Inflammation Drugs. Most people are first treated with drugs containing

mesalamine, a substance that helps control inflammation. Sulfasalazine is the most

commonly used of these drugs. Patients who do not benefit from it or who cannot

tolerate it may be put on other mesalamine-containing drugs, generally known as 5-

ASA (5-aminosalycylic acid) agents, such as Asacol, Dipentum, or Pentasa. Possible

side effects of mesalamine-containing drugs include nausea, vomiting, heartburn,

diarrhea, and headache. Olsalazine (Dipentum).

Antispasmodics. Such as Hyoscyamine, Dicyclomine may be useful to patients who

do not respond to standard interventions; Psyllium Absorbs water to increase bulk in

stools, thereby decreasing diarrhea.

Antibiotics. Antibiotics are used to treat bacterial overgrowth in the small intestine

caused by stricture, fistulas, or prior surgery. For this common problem, the doctor may

prescribe one or more of the following antibiotics: ampicillin, sulfonamide,

cephalosporin, tetracycline, or metronidazole, ciprofloxacin Anti-infectives.

Metrinidazole, Ciprofloxacin treats local suppurative infections, or maybe part of a

long term treatment regimen.

Antiulcer agent. Antacids, Ranitidine decreases gastric irritation, preventing

inflammation and reducing risk of infection in colitis.

Anti-Diarrheal and Fluid Replacements. Diarrhea and crampy abdominal pain are

often relieved when the inflammation subsides, but additional medication may also be

necessary. Several antidiarrheal agents could be used, including diphenoxylate,

loperamide, and codeine. Patients who are dehydrated because of diarrhea will be

treated with fluids and electrolytes.

Bile Acid Sequestrant. Cholestyramine binds bile salts, reducing diarrhea that results

from excess bile acid.

Cortisone or Steroids. AdrenoCorticoTropic Hormone (ACTH), Hydrocortisone

Cortisone drugs and steroids—called corticosteriods—provide very effective results.

Prednisone is a common generic name of one of the drugs in this group of

medications. In the beginning, when the disease it at its worst, prednisone is usually

prescribed in a large dose. The dosage is then lowered once symptoms have been

controlled. These drugs can cause serious side effects, including greater susceptibility

to infection.

Immune System Suppressors/Immune-modulating Agents . Drugs that suppress

the immune system are also used to treat Crohn’s disease. Most commonly prescribed

are 6-mercaptopurine or a related drug, azathioprine. Immunosuppressive agents

work by blocking the immune reaction that contributes to inflammation. These drugs

may cause side effects like nausea, vomiting, and diarrhea and may lower a person’s

resistance to infection. When patients are treated with a combination of corticosteroids

and immunosuppressive drugs, the dose of corticosteroids may eventually be lowered.

Some studies suggest that immunosuppressive drugs may enhance the effectiveness of

corticosteroids.

Monoclonal Antibodies. IV infliximab binds to tumor necrosis factor alpha (TNF

alpha) an inflammatory agent found in high amounts in crohn’s disease. Drug blocks the

inflammatory agents activity, leading to decrease inflammation and promoting intestinal

healing. Infliximab (Remicade). This drug is the first of a group of medications that

blocks the body’s inflammation response. The U.S. Food and Drug Administration

approved the drug for the treatment of moderate to severe Crohn’s disease that does

not respond to standard therapies (mesalamine substances, corticosteroids,

immunosuppressive agents) and for the treatment of open, draining fistulas. Infliximab,

the first treatment approved specifically for Crohn’s disease is a TNF substance.

Additional research will need to be done in order to fully understand the range of

treatments Remicade may offer to help people with Crohn’s disease.

Nutrition Supplementation

The doctor may recommend nutritional supplements, especially for children

whose growth has been slowed. Special high-calorie liquid formulas are sometimes

used for this purpose. A small number of patients may need to be fed intravenously for

a brief time through a small tube inserted into the vein of the arm. This procedure can

help patients who need extra nutrition temporarily, those whose intestines need to rest,

or those whose intestines cannot absorb enough nutrition from food. There are no

known foods that cause Crohn’s disease. However, when people are suffering a flare in

disease, foods such as bulky grains, hot spices, alcohol, and milk products may

increase diarrhea and cramping.

Surgery

Two-thirds to three-quarters of patients with Crohn’s disease will require surgery

at some point in their lives. Surgery becomes necessary when medications can no

longer control symptoms. Surgery is used either to relieve symptoms that do not

respond to medical therapy or to correct complications such as blockage, perforation,

abscess, or bleeding in the intestine. Surgery to remove part of the intestine can help

people with Crohn’s disease, but it is not a cure. Surgery does not eliminate the

disease, and it is not uncommon for people with Crohn’s Disease to have more than

one operation, as inflammation tends to return to the area next to where the diseased

intestine was removed.

Some people who have Crohn’s disease in the large intestine need to have their

entire colon removed in an operation called a colectomy. A small opening is made in

the front of the abdominal wall, and the tip of the ileum, which is located at the end of

the small intestine, is brought to the skin’s surface. This opening, called a stoma, is

where waste exits the body. The stoma is about the size of a quarter and is usually

located in the right lower part of the abdomen near the beltline. A pouch is worn over

the opening to collect waste, and the patient empties the pouch as needed. The majority

of colectomy patients go on to live normal, active lives.

Sometimes only the diseased section of intestine is removed and no stoma is

needed. In this operation, the intestine is cut above and below the diseased area and

reconnected.

Because Crohn’s disease often recurs after surgery, people considering it should

carefully weigh its benefits and risks compared with other treatments. Surgery may not

be appropriate for everyone. People faced with this decision should get as much

information as possible from doctors, nurses who work with colon surgery patients

(enterostomal therapists), and other patients. Patient advocacy organizations can

suggest support groups and other information resources. (See For More Information for

the names of such organizations.)

People with Crohn’s disease may feel well and be free of symptoms for

substantial spans of time when their disease is not active. Despite the need to take

medication for long periods of time and occasional hospitalizations, most people with

Crohn’s disease are able to hold jobs, raise families, and function successfully at home

and in society.

(Surgical Management)

When nonsurgical measures fail to relieve the sever symptoms of inflammatory

bowel disease, surgery may be recommended (Segmental, Subtotal, or Total

Colectomy).A fecal diversion maybe needed, such as ileostomy, Continent Ileal

Reservoir (Koch Pouch), or Ileoanal anastomosis. Strictureplasty or fecal

diversions 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.

IV.Expected Outcome

A.Prognosis

-Report decrease in frequency of diarrheal stools

- complies with dietary restrictions; maintains bedrest

- takes medication as prescribed

-Experiences less pain

-Maintains fluid volume balance

-drinks 1-2 L of oral fluids daily

-has normal body temperature

-displays adequate skin turgor and moist mucus membranes

-Attains optimal nutrition; tolerates small, frequent feedings without

diarrhea.

-Prevents fatigue

-rests periodically during the day

-adheres to activity restrictions

-Experiences less anxiety

-Copes successfully with diagnosis

-verbalizes feelings freely

-uses appropriate stress reduction behaviors

-Maintains skin integrity

-cleans perianal skin after defecation

-uses lotion or ointment a skin barrier

-Acquires an understanding of the disease process

-modifies diet appropriately to decrease diarrhea

-adheres to medication regimen as prescribed

-Recovers without complications

-electrolytes within normal ranges

-normal sinus or base line cardiac rhythm

-maintains fluid balance

-experiences no perforation or rectal bleeding

B. Complications

-Intestinal Obstruction or stricture formation

-Perianal disease

-Fluid and Electrolyte imbalances

-Malnutrition from malabsorption

-fistula and abscess formation

* the most common type of small bowel fistula caused by regional enteritis

is the “ enterocutaneous fistula” ( an abnormal opening between the small bowel

and the skin)

*abscesses can be the result of an internal fistula that results in fluid

accumulation and infection.

*patients with regional enteritis are also at increased risk of colon cancer.

Comparison of Regional Enteritis and Ulcerative Colitis

Factor Regional enteritis Ulcerative Colitis

Course Prolonged, Variable Exacerbation, remission

Pathology

Early Transmural thickening Mucosal ulceration

late Deep, penetrating

granulomas

Minute, mucosal ulceration

Clinical manifestation

Location Ileum, ascending colon

( usually )

Rectum, descending colon

Bleeding Usually not, but if it occurs

tends to be mild

Common - severe

Perianal involvement Common Rare - mild

Fistulas Common Rare

Rectal involvement About 20% Almost 100%

Diarrhea Less severe Severe

Diagnostic Study

Findings

Barium Series Regional, discontinuous

lesions

Diffuse involvement

Narrowing of colon No narrowing of colon

Thickening of bowel wall No mucosal edema

Mucosal edema Stenosis rare

Stenosis fistulas Shortening of colon

Sigmoidoscopy May be unremarkable

unless accompanied by

perianal fistulas

Abnormal inflamed mucosa

Colonoscopy Distinct ulcerations

separated by relatively

normal mucosa in

Friable mucosa with

pseudopolyps or ulcers in

ascending colon descending colon

Therapeutic management Corticosteroids,

sulfonamides (sulfasaline

[ Azulfidine ] )

Corticosteroids,

sulfonamides; sulfasalazine

useful in preventing

recurrence

Antibiotics Bulk hydrophilic agents

Parenteral nutrition Antibiotics

Partial or complete

colectomy, with ileostomy

or anastomosis

Proctocolectomy, with

ileostomy

Rectum can be reserved in

some patients

Rectum can be preserved

in only a few patients

”Cured” bicolectomy

Recurrence common

Systemic Complications Small Bowel Obstruction Toxic Megecolon

Right-sided hydronephrosis Perforation

Nephrolithiasis Hemorrhage

Cholelithiasis Malignant Neoplasms

Arthritis Pyelonephritis

Retinitis, Iritis Nephrolithiasis

Erythema Nodosum Cholangiocarcinoma

Arthritis

Retinitis, Iritis

Erythema Nodosum