CROHN’S DISEASE

Rivera,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
Treatment
Surgery 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.