GROUP 1B:

CROHN’S DISEASE
VS
HIRSCHSPRUNG
DISEASE

Igpit, Ken Jomar

Jazul, Angelica
Reyes, Jean Brienne
Sorima, Camille
Sumarca, Kris Dimple
Tavares, Jelsey Kaye

BSN 4A
 INFLAMMATORY BOWEL DISEASE: CROHN'S DISEASE

Definition
● Two conditions are categorized as inflammatory bowel disease: ulcerative colitis and
Crohn's disease. Both involve the development of ulcers of the mucosa or
submucosa layers of the colon and rectum.

Crohn's Disease
● A type of IBD that causes inflammation and ulcer formation in the GI tract
● The disease can be found in both large and small intestine most likely found terminal
of ileum and start of the colon

Clinical Manifestations
● Prominent lower right quadrant abdominal pain and diarrhea unrelieved by
defecation.
● Crampy abdominal pains
● Abdominal tenderness and spasm
● Weight loss, malnutrition, and secondary anemia
● Chronic diarrhea and steatorrhea
● Intra-abdominal and anal abscesses
● Fever and leukocytosis
● Fistula and fissures
Diagnostic and Laboratory Findings

COMPLETE BLOOD COUNT

TEST RESULT SI UNIT NORMAL ANALYSIS

REFERENCE
RANGE

Hemoglobin  10 g/dl 12.0-16.0 It indicates anemia, Iron

deficiency anemia (IDA) is
increasingly recognized as a
common complication in
patients with Crohn’s disease.

Sindhu 2015

Hematocrit  0.33 L 0.37-0.47 L Hematocrit is a blood test that

measures the number and size
of red blood cells.
Because IBD can often cause
an increased loss of blood,
many people with IBD have a
low hemoglobin and
hematocrit.

Brigham and Women’s

Hospital 2012

White Blood  19 x10^9/L 5-10 High white blood cell count

Count indicates sign of inflammation
somewhere in the body.

Brigham and Women’s

Hospital 2012

ESR  45 mm/h 1-20 ESR will be elevated when

there is a flare occurring.

UCSF Health 2016

Albumin  3.0 g/dL 3.4 to 5.4 Inflammation and malnutrition
both reduce albumin
concentration by decreasing
its rate of synthesis, while
inflammation alone is
associated with a greater
fractional catabolic rate (FCR)
and, when extreme, increased
transfer of albumin out of the
vascular compartment.

George Kaysen 2015

CRP  5.0 g/dL 8.0 C reactive protein (CRP) is a

marker of inflammation and
increases with active disease.
It is a produced by the liver
during episodes of acute
inflammation or infection.

Brigham and Women’s

Hospital 2012

BARIUM SERIES

RESULT INTERPRETATION

A: Barium enema showing tubercular

strictures (arrows) of the colon; B: Barium
enema demonstrating skip lesions affecting
descending and transverse colon as ulcers with
areas of narrowing in a patient with Crohn's
disease (CD); C: Deep ulcers with double
tracking of sigmoid colon in a patient with CD
(arrows).

COLONOSCOPY
 Erythematous and friable mucosa with
numerous pseudo polyps

COMPUTED TOMOGRAPHY SCAN

Inflamed ileum (arrows)

Pathophysiology

PRECIPITATING
PREDISPOSING FACTORS FACTORS
• Age
• Environment
• Gender
• Smoking
• Race
• Abnormal activation of
• Family History
the immune system
• Infections

Inflammation

Appearance of small, scattered,

shallow, crater-like ulcerations
(erosions) on the inner surface of the
bowel (ileum & ascending colon)

Tiny focal aphthous ulcers

Develop into deep longitudinal Creates a

& transverse ulcers with characteristic of:
intervening mucosal edema Cobblestoned
appearance bowel

S/s: Persistent
Transmural spread of
watery diarrhea &
inflammation
bleeding

Thickening of the wall &

Lymph edema mesentery

Mesenteric fat extends to the serosal

surface of the bowel
Mesenteric lymph nodes enlarge

Extensive inflammation

• Prominent lower right

quadrant abdominal pain and
diarrhea unrelieved by
defecation
• Crampy abdominal pain
• Abdominal tenderness and
spasm
• Weight loss, malnutrition, and
secondary anemia
• Intra-abdominal and anal
abscesses
• Fever and leukocytosis
• Fistula and fissures
 Nursing Care Plan
Assessment Diagnosis Planning Implementation Rationale Evaluation

Subjective cues: Acute Pain Short Term Goal: Independent: Short Term Goal:
“Grabe ang sakit related to Gl After 30 minutes of ● Provide some ● This is to provide comfort After 30 minutes span
ng tiyan ko inflammation as nursing interventions, comfort (e.g.. and alleviate the pain felt of nursing
pagkatapos ko manifested by the patient will be able change of position interventions, the
kumain at dumumi” the pain scale of to: & use of heating patient was able to:
as verbalized by the 7 out of 10 pad applied into
patient. ● Report decreased the abdomen) ● Breathing exercises relates ● Report pain is
pain as evidenced by the body, alleviating pain relieved as
Objective cues: having a pain scale ● Teach patient a and promoting relief evidenced by
● Increased RR, of 4 out of 10 specific relaxation having a pain scale
PR, and BP ● Have a decreased strategy (eg, slow, of 5 out of 10.
value in VS rhythmic breathing ● To prevent fatigue ● Have a decreased
RR: 22cpm RR: 18cpm or deep breath) value in VS
PR: 110bpm PR: 95bpm RR: 20cpm
BP: 140/90 BP: 120/90mmHg ● Encourage ● To monitor effectiveness PR: 100bpm
mmHg ● Follow prescribed adequate rest of medical treatment for BP: 130/90mmHg
pharmacologic periods the relief of heartburn and ● Follow prescribed
● Restlessness regimen stomach pain. The time of pharmacologic
● Pacing ● Demonstrate use of ● Assess the monitoring of vital signs regimen
● Guarding relaxation skills & patient’s vital may depend on the peak ● Demonstrate use of
behavior on the diversional signs and time of the drug relaxation skills &
abdominal area activities characteristics of administered. diversional
● Diaphoresis pain at least 30 activities.
● A pain scale of Long Term Goal: minutes after To rest the bowel to prevent
7 out of 10 After 3 days of nursing administration of further feeling of pain GOAL PARTIALLY
interventions the medication MET
patient will report pain
is relieved or controlled Long Term Goal:
and appear to be ● Anti-inflammatory drugs, After 3 days of nursing
relaxed and able to such as interventions the patient
sleep and rest methylprednisolone IV, able to report the pain is
appropriately reduce the inflammation of controlled and appear to
● Instruct the patient the bowel, relieving pain be relaxed and able to
to follow liquid sleep and rest
diet follow with appropriately
solid diet as ● To decrease intestinal
tolerated motility GOAL PARTIALLY
MET
Dependent:
● Administer anti-
inflammatory
drugs with doctor's
order.

● Complete bowel rest can

reduce pain, cramping

● Administer anti-
cholinergic or
antispasmodic
medications such
as propantheline
bromide 30
minutes before
meal as prescribed

Collaborative:
● Implement
prescribed dietary
modifications by
the dietician
 AGANGLIONIC MEGACOLON (HIRSCHSPRUNG DISEASE)

Definition
● Hirschsprung disease is a birth defect in which some nerve cells are missing in the
large intestine, so a child's intestine can't move stool and becomes blocked.
● Characterized by persistent constipation resulting from partial or complete intestinal
obstruction of mechanical origin.

Clinical Manifestations
● Abdominal distention
● Chronic constipation/ribbonlike stools
● Palpable intestinal loops
● Absence/delayed passage of meconium.
● Vomiting
● Malnourishment

Diagnostic and Laboratory Findings

COMPLETE BLOOD COUNT

TEST RESULT SI UNIT NORMAL ANALYSIS

REFERENCE
RANGE

WBC (12.0 × 10^9/L) L (4.5 to 10.0 × A high white

10^9/L) blood cell count
may indicate that
the immune
system is working
to destroy an
infection. It may
also be a sign of
physical or
emotional stress

PLAIN ABDOMINAL RADIOGRAPHY

RESULT INTERPRETATION

Anteroposterior projection of water-soluble

contrast enema

UNPREPARED SINGLE-CONTRAST BARIUM ENEMA

 Transitional zone, regarded as the site of
obvious caliber change from non-dilated to
dilated bowel (arrows)

RECTAL BIOPSY

The specimen obtained was 1.9 cm above the

dentate line that aganglionosis may be present

Pathophysiology
Nursing Care Plan

Assessment Diagnosis Planning Implementation Rationale Evaluation

Subjective cues: Constipation Short Term Independent: Short Term

“Hindi makadumi related to reduced Goal: • Auscultate for bowel • Bowel sounds are generally Goal:
ang anak ko ilang bowel function as After 30 minutes sounds decreased/absent in After 30 minutes
araw na.” as manifested by the of nursing constipation of nursing
verbalized by the objective cues interventions, the intervention the
mother. patient will be • Maintain adequate • To promote easy passage of patient was able
able to: fluid intake stool to:
Objectives cues:
• (+) Facial ● Promote bowel ● Promote
grimace elimination • Provide comfort bowel
• Irritability ● Maintain fluid (e.g.. changing the child’s • To alleviate feeling of elimination
• Absent bowel balance position, holding the child discomfort ● Maintain fluid
sounds ● Promote when possible, stroking, balance
• Abdominal comfort cuddling, and engaging in ● Promote
distention age-appropriate activities comfort
• Swollen belly Long Term Goal:
• Ribbon-like After 1 week of GOAL MET
stools nursing Dependent:
interventions, the • Administer enema as Long Term
patient will be prescribed Goal:
able to: After 1 week of
nursing
● Have daily interventions, the
bowel patient was able
movement to:
 with the use of • Administer 0.9% • Promotes bowel
enema NaCl. movement. Before surgery, ● Have daily
● Have (-) the child may be prescribed bowel
swollen belly, Collaborative: daily enemas to achieve movement
(-) irritability, • Educate parents about bowel movements. with the use of
(-) facial preparation and enema
grimace administration of • Promotes defecation ● Have (-)
● Have present enemas swollen belly,
bowel sounds (-) irritability,
● Have soft stool (-) facial
• To use for enemas, parents grimace
can buy ready-made saline ● Have present
preparation at a pharmacy, bowel sounds
• Refer to dietician or they can prepare their Have soft stool
own by mixing 2 teaspoons
of non iodized to 1qt of GOAL MET
water.

• To develop a proper meal

plan that will meet the
patient’s needs
 Factor Crohn’s Disease Hirschsprung Disease

Course Recurrence is common even with Can be treated with surgery

surgery

Pathology Chronic inflammation from T-cell Absence of enteric neurons

activation leading to tissue injury within the myenteric and
submucosal plexus of the rectum
and/or colon

• Mostly in the ileum, ascending • Most commonly involves the

Clinical colon rectosigmoid region of the
Manifestations • Prominent lower right colon
quadrant abdominal pain and • Vomiting
diarrhea unrelieved by • Malnourishment
defecation. • Abdominal distention
• Crampy abdominal pains • Palpable intestinal loops
• Abdominal tenderness and • Absence/delayed passage of
spasm meconium
• Weight loss, malnutrition, and
secondary anemia
• Intra-abdominal and anal
abscesses
• Fever and leukocytosis
• Fistula and fissures
 Chronic Diarrhea and Steatorrhea
Stool
Intestinal Endoscopies
Gold Standard Test
Therapeutic • Corticosteroids, sulfonamides
Management (sulfasalazine [Azulfidine])
• Antibiotics
• Parenteral nutrition
• Partial or complete colectomy,
with ileostomy or anastomosis
• high-calorie, high-protein diet •
Diet
• Small bowel obstruction
Systemic • Right-sided hydronephrosis
Complications • Nephrolithiasis
• Cholelithiasis
• Arthritis
• Retinitis, iritis
• Erythema nodosum
Chronic Constipation and
Ribbon-like stools
Rectal Biopsy
• Administration of enemas
using isotonic solution
(normal saline or 0.9% NaCl)
• Colostomy
• Dissection and removal of
affected section with
anastomosis of the intestine
high-fiber
• Enterocolitis
• Chronic obstruction
• Incontinence
• Late mortality may occur late
after surgery.
REFERENCES:

https://www.scribd.com/document/106331664/CROHN-S-DISEASE
https://nurseslabs.com/7-inflammatory-bowel-disease-nursing-care-plans/
https://www.aafp.org/afp/2011/1215/p1365.html
https://www.researchgate.net/figure/Findings-on-barium-study-of-the-colon-in-tuberculosis-
and-Crohns-disease-A-Barium_fig2_49792030
https://nurseslabs.com/hirschsprung-disease-aganglionic-megacolon/
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2009). Brunner and Suddarth’s
Textbook of Medical Surgical Nursing, 12th Edition (12th ed.). Lippincott Williams &
Wilkins.