 Also called as Regional Enteritis, Granulomatous Colitis, Ileitis.

 Is a chronic transmural inflammation of the G.I tract that usually affects the
small and large intestines but it can occur in any part of the alimentary
canal.
 Cause is unknown, but is multifactorial with factors including viral or
bacterial infection, immune disorder, defect in the intestinal barrier,
dysfunctional repair of mucosal injury, genetic predisposition, dietary and
environmental factors (chemical additives, milk products, heavy metals,
low fiber) and cigarette smoking.
 Complications include stricture and fistulae formation, dehydration,
nutritional deficiencies, hemorrhage, bowel perforation, and intestinal
obstruction.
 Incidence of colorectal cancer is higher in patients with Crohn’s Disease.
Assessment:
1. Signs and symptoms are characterized by exacerbations and remissions;
onset may be abrupt or insidious.
2. Crampy intermittent pain.
 Inflammatory pattern result in milder abdominal pain, but with
malnutrition due to malabsorption and weight loss, and possible
anemia (hypochromic or macrocytic).
 Fibrostenotic pattern may present with partial small bowel
obstructions: Diffuse abdominal pain, nausea, vomiting, and bloating.
 Perforating pattern is characterized by sudden profuse diarrhea, fever,
localized tenderness due to abscess, and symptoms of fistulae, such
as pneumaturia and recurrent urinary tract infection.
3. Abdominal tenderness occurs, especially in right lower quadrant; right
lower quadrant fullness or mass is palpable.
4. Chronic diarrhea caused by irritating discharge; usual consistency is soft
or semi-liquid. Bloody stools or steatorrhea (fatty stools) may occur.
5. Low-grade fever occurs if abscesses are present.
6. Arthralgias may also occur.
Diagnostic Evaluation:
1. Increased white blood cell count and sedimentation rate; decreased
hemoglobin; decreased albumin; and possibly decreased potassium,
magnesium, and calcium due to diarrhea.
2. Stool analysis shows leukocytes but no pathogens.
3. Barium enema permits visualization of lesion of large intestine and terminal
ileum; needs to be scheduled before upper G.I. to prevent interference by
barium passing through colon.
 4. Upper G.I. barium studies show classic
“string sign” at terminal ileum that suggests
constriction of a segment of intestine.
5. Colonoscopy to note cobblestone
appearance of ulcerations and fissures, skip
lesions, and rectal sparing; biopsy can be
taken for definitive diagnosis.
Surgical Interventions:
1. Surgery is indicated only for complications.
Roughly 70% of Crohn’s disease patients
eventually require one or more operations for obstructions, fistulae,
fissures, abscesses, toxic megacolon, or perforation.
2. Surgical options include:
 Segmental bowel resection with anastomosis.
 Subtotal colectomy with ileorectal anastomosis (spares rectum).
 Total proctocolectomy with end ileostomy for severe disease in colon and
rectum.
Nursing Interventions:
1. Monitor frequency and consistency of stools to evaluate volume losses
and effectiveness of therapy.
2. Monitor dietary therapy; weigh the patient daily.
3. Monitor electrolytes, especially potassium. Monitor intake and output.
Monitor acid-base balance because diarrhea can lead to metabolic
acidosis.
4. Monitor for distention, increased temperature, hypotension, and rectal
bleeding; all signs of obstruction caused by inflammation.
5. Observe and record changes in pain, especially frequency, location,
characteristics, precipitating events, and duration.
6. Offer understanding, concern, and encouragement because patient is
often embarrassed about frequent and malodorous stools, and often
fearful of eating.
7. Have patient participate in meal planning to encourage compliance and
increase knowledge.
8. Encourage patient’s usual support persons to be involved in management
of the disease.
9. 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.
10. Provide fluids as directed to maintain hydration (1,000 mL/24 hours
minimum intake to meet body fluid needs).
11. Clean rectal area and apply ointments as necessary to decrease
discomfort from skin breakdown.
12. Facilitate supportive counseling, if appropriate.