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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 Minute, mucosal ulceration
granulomas
Clinical manifestation
Location Ileum, ascending colon Rectum, descending colon
( usually )
Bleeding Usually not, but if it occurs Common - severe
tends to be mild
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 Diffuse involvement
lesions
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 Abnormal inflamed mucosa
unless accompanied by
perianal fistulas
Colonoscopy Distinct ulcerations Friable mucosa with
separated by relatively pseudopolyps or ulcers in
normal mucosa in descending colon
ascending colon
Therapeutic management Corticosteroids, Corticosteroids,
sulfonamides (sulfasaline sulfonamides; sulfasalazine
[ Azulfidine ] ) useful in preventing
recurrence
Antibiotics Bulk hydrophilic agents
Parenteral nutrition Antibiotics
Partial or complete Proctocolectomy, with
colectomy, with ileostomy ileostomy
or anastomosis

Rectum can be reserved in Rectum can be preserved
some patients 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