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Crohn’s Disease
NURS 418
Ms. Evangelin Sally Singh

Section 5
Atheer Basali
Farah Alwehaibi
Shahad Alzaid Alshareif
Mona Alsubaie
Maha Alshetwi

Sep 26, 2021

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At the end of this presentation, the student will be able to:

- Define crohn’s disease, its causes, and clinical manifestations

- Identify nursing management of Crohn’s disease

- Identify the assessment and diagnostic tests of Chron’s disease

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Outline
 Introduction
 Definition
 Incidence
 Causes/Risk factors
 Pathophysiology
 Clinical manifestations
 Diagnostic procedures
 Management
 Nursing care plan
 Recent researches
 Conclusion
 References
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Introduction
What is inflammatory bowel disease?

Inflammatory bowel disease (IBD) refers to two diseases (Crohn's

disease and ulcerative colitis) characterized by chronic inflammation
of the gastrointestinal (GI) tract. Prolonged inflammation damages the
GI tract.(1).
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Definition
What is Crohn’s disease ?

Crohn's disease is a digestive tract inflammation and

irritation that mostly affects the small intestine and the
beginning of the large intestine (U.S. Department of Health
and Human Services. (n.d.). Definition & facts for crohn's
disease. National Institute of Diabetes and Digestive and
Kidney Diseases).
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Regional variation of pediatric inflammatory bowel disease

in Saudi Arabia: Results from a multicenter study
Background Aim
Inflammatory bowel disease (IBD) The goal of this study was to
has been observed to vary in investigate  the regional
incidence and severity between variations in the IBD
regions and areas within the same characteristics of pediatric
country in Western populations.
patients in Saudi Arabia.
However, no data from other
countries was provided.

Methods
The researchers utilized data from a nationwide multicenter IBD study. Crohn's
disease (CD) and ulcerative colitis (UC) incidence, time trends, and clinical
presentation were studied and compared in the Central region (CR), Western
region (WR), and Eastern region (ER). Poisson regression analysis for
incidence variation and the Chi-square test for demographic and clinical
characteristics were used in the statistical study.

El Mouzan, Mohammad I, et al. “Regional Variation of Pediatric Inflammatory Bowel Disease in Saudi ARABIA: Results from a Multicenter Study.” World
Journal of Gastroenterology, Baishideng Publishing Group Inc, 28 Jan. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7002901/.
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Regional variation of pediatric inflammatory bowel disease

in Saudi Arabia: Results from a multicenter study (4)
Results
Children with CD from the ER had a lower prevalence of positive family
history than children with CD from the CR or the WR. Children with CD
and UC from the CR and ER, respectively, had a greater consanguinity rate.
The incidences of CD and UC, as well as their time trends, were not
substantially different between regions.

Conclusion
The most significant finding is the discovery of a considerably more severe
presentation of CD in the Kingdom of Saudi Arabia's eastern region. To
understand such differences, prospective research are required.

El Mouzan, Mohammad I, et al. “Regional Variation of Pediatric Inflammatory Bowel Disease in Saudi ARABIA: Results from a Multicenter Study.” World Journal of
Gastroenterology, Baishideng Publishing Group Inc, 28 Jan. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7002901/.
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Causes

There are no exact understood cause of Crohn’s disease, but it progressed with
multifactorial disorder (2)

Genetic Immunologic Environmental factors

 
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Risk Factors
Age
Most often affects age 15-35

Children are more at risk if they :

Have family history ( close relative)

Live in a develop countries

Smoke
.

.
(3)
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Pathophysiology

Immune system is a cause of Crohn’s disease.

How does the immune system can cause this disease?

Crohn’s disease pathogenesis is based on tissue

inflammation, caused by an unrestrainable immune
response against luminal bacterial antigens. Immune
cells like CD4 T-Cells, CD8 T-Cells, B-Cells, CD14
monocytes and natural killers, are involved in this
process as they infiltrate the gut of CD patients (11)
11 Clinical Manifestations (5)
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Diagnostic tests Physical examination

Diagnostic procedures for Crohn’s Disease

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Diagnostic Tests (7)

Blood test
Look for sign of inflammation and anemia

Stool test
To check for the presence of blood and infection-causing bacteria.

Digital rectal exam

To look for sign of Crohn's disease by insert fingers into the rectum to check
blood and tenderness
 (7)
14 Diagnostic Tests
Upper endoscopy
To check for any inflammation, bleeding, ulcers, or obstructions

Colonoscopy
To detect the inflammation in the intestine

Magnetic Resonance Enterography

Type of MRI to image the intestine

Bone density testing


Medical management
Aminosalicylates  Corticosteroids  Immunomodulators
The aminosalicylates drugs have
(5-ASA) 5-aminosalicylic acid,
that helps to reduce the
inflammation. It used to treat
mild symptoms with people who
are recently detected to have
Crohn’s disease.
For exmaple: Mesalamine and
Balsalazide
(13)
It called steroids, the main action
is to lower the activity of the
immune and reduce the
inflammation. It used with
moderate – severe symptoms
For example: budesonide and
Hydrocortisone.
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This type of drugs depresses the
immune system result in lower
the inflammation in the digestive
system. It used for some weeks
to three months
For example: azathioprine and
cyclosporine.
16 Surgical management (12)

 Bypass surgery
- Internal bypass
- External bypass

 Resection

 Resection margins

 Anastomotic technique

 Laparscopy

 Strictureplasty
 (14)
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Nursing management
Promote patient and family comfort. Enhance nutritional status.

• Referee the client to psychotherapy find
out the factors that caused the distress for
the patient and how to deal with it to avoid
exacerbations of the situation
• Assess the fluid intake and out take
• Assess for electrolyte & fluid balance, provide IV if
imbalance is indicated
• Encourage diet rich with protein and calories in
addition to iron and vitamin supplement

Provide client teaching covering Minimize pain.

• Disease process • Assess the pain with the proper scale to

• About the adequate nutrition and fluid track the improvement
• Perianal skin care due to excessive diarrhea • Provide rest period during the acute
• Managing the pain with exacerbations
nonpharmacological method
• The importance of following up the
appointments
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Assessment Diagnosis Outcomes Intervention Rationale Evaluation

 - Assess abdominal  Diarrhea related  - stool consistency  - Decrease intake of  -Avoiding irritants  - Less
pain, discomfort, to excess bile acid of the patient will irritant that cause keep the intestines relax abdominal
cramping, and evidenced be with the normal diarrhea. and reduces the discomfort 
frequency by hyperactive levels within 48 workload 
bowel sounds by hours - Normal stools
- Evaluate defecation statoscope - Promote the bedrest -Rest decreases the level rate
pattern. and frequent -The patient's metabolism and reduces
stools abdominal pain will -Administer intestinal motility.
report less within 12 medications as -To decrease frequancy
hours  prescribed of stool and abdominal
pain 
-The child’s mother -Educate the patient on
will be educated what causes diarrhea - Education makes the
about factors patient more
causing diarrhea to aware which enhances
avoid it. health care
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Nursing Care Plan (8)

Assessment Diagnosis Outcomes  Intervention  Rationale  Evaluation 

Assess for Imbalanced 1- The patient will Promote a semi or Elevating the head to at
nutritional status and nourishing less improve nutrition high Fowler’s position  45 degrees, help Nutritional daily
absorptions, lose of than body absorbtion within 3 while feeding.  patient in swallowing needs are met
appetite , nausea , requirements Days and reduces the risk and the wight
diarrhea and weight related to of aspiration raised to
malabsorption 2- The patient Encourage bedrest and normal. 
according to will gain wight to limit the activity during Decreasing metabolic 
Crohn’s disease the normal within a acute phase. conserves energy.
evidenced by loss week
of appetite, Clean mouth enhance
nausea vomiting 3- The patient the taste of food and
and wight loss will start to take Provied oral hygiene tolerance 
proper calories for
his wight within
24h
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Nursing Care Plan (8)

Assessment Diagnosis Outcomes  Intervention  Rationale  Evaluation

 
Assess oral Impaired oral - patient’s mucous  -Assist the patient with -Mouth care helps  -Moist
hygiene and mucus membrane membranes will be moist right techniques of oral to reduce infection, by Intact and
mucus related to and normal color without hygiene maintaining circulation to hydrated
membrane inflammation sore with 48 hours the mucous membrane oral
of gastrointestina mucous. All
l track evidenced -Patient will be able to -Use water or a normal - hydrogen peroxide in are met
by mouth swallows without any pain saline for oral hygiene mouthwasher injures oral
stomatitis and discomfort within the mucosa
12h -Educate the mother - alcohol contant can cause
about oral care drying of oral mucous
-The mother will be techniques membranes
educated about
appropreate mouthwashes -To maintain mouth
without high alcohol  moistening and mucous
content,or prolonged use intact  free from germs.
of hydrogen peroxide after
discharge . 
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Diagnostic delay of pediatric inflammatory bowel disease in Saudi Arabia (9)

Background Aim Results

to describe the pattern and risk CD and UC were found in 240 and 183 Saudi
Complications are linked to
factors linked to IBD children, respectively. The median diagnosis
delayed diagnosis of inflammatory
diagnostic delays in Saudi delays in CD and UC were 8 and 5 months,
bowel disease (IBD).
children. respectively, with CD children experiencing
considerably longer delays than UC children
Methods
(P 0.001). For CD and UC, long diagnostic
This was a retrospective/prospective design with a multicenter study. From delays (>75th percentile) were 24 and 8.8
months, respectively. In CD, ileal location was
physician's notes, data on diagnostic delay in children with Crohn's disease
a significant risk factor, but in UC, beginning
(CD) and ulcerative colitis (UC) was gathered. The risk factors linked with a
age of more than 10 years was protective.
long delay in diagnosis were assessed using multivariate regression analysis

Conclusion
The longer diagnosis delay in IBD was mainly due to the prolonged consultation delay with a gastroenterologist. A
review of the referral system is required in order to concentrate on strategies to reduce long diagnostic delays. The
use of the ileal location as a risk factor in CD and age greater than 10 years as a protective factor in UC should aid
in early detection and referral.
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Impact of Pediatric Inflammatory Bowel Disease on Linear Growth:

Data from a National Cohort Study in Saudi Arabia (10)
Results
Background Aim
There were 374 children aged 0.33 to 16, with
One of the most notable to determine the effect of IBD
119 (32%) having ulcerative colitis and 255
characteristics of children with on children's linear growth in
(68%) having Crohn's disease. In IBD, CD,
inflammatory bowel illness (IBD) the Kingdom of Saudi Arabia
and UC, respectively, the prevalence of LGI
is linear growth impairment (LGI). (KSA).
was 26%, 28%, and 21%. LGI was
Methods considerably more common in CD children
From 2003 to 2012, data from a cohort of newly diagnosed children with IBD under the age of 10 (P = 0.010), while it was
was analysed retrospectively. The diagnosis of inflammatory bowel disease more common in UC children over the age of
(IBD) was confirmed using published criteria. At the time of diagnosis, the 10 (P = 0.011).
length/height for age was measured. The World Health Organization (WHO)
reference was used and LGI was defined by length/height for age <-2 standard
deviation.
Conclusion
The prevalence of LGI in this study is similar to that described in the literature, although it is higher in CD children
with early onset (under 10 years) and older children with UC, highlighting the necessity of monitoring growth in
children with IBD in the Saudi community. To determine the impact of IBD on growing velocity, puberty, and final
adult stature, prospective studies are required.
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Conclusion
This seminar has discussed :-
I. Crohn’s disease definition which is inflammation in the bowl.
 
II. Crohn’s disease symptoms are abdominal pain, fever, vomiting and other symptoms were mentioned.
III. The causes of this disease was classified: genetic, immunologic, environmental factors.
IV. Crohn’s disease has many risk factors, but children are at more risk if they have family history, smoke, and live in
develop countries.
V. The main pathophysiological cause of Crohn’s disease is the immune system immune process.
VI. The identification of significantly more severe presentation of CD in the eastern region of the Kingdom of Saudi
Arabia.The incidences and time trends of CD and UC were not significantly different between regions.
VII. Medical, surgical, and nursing management were discussed.
VIII. Nursing care plan.
IX. Diagnostic delay of pediatric inflammatory bowel disease in Saudi Arabia.
X. Impact of Pediatric Inflammatory Bowel Disease on Linear Growth.
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References
1) “Definition & Facts for Crohn's Disease.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and
Human Services, www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease/definition-facts.
 
2) “Pediatric Crohn's Disease.” NORD (National Organization for Rare Disorders), 6 May 2019, rarediseases.org/rare-diseases/pediatric-crohns-
disease/.
3) Crohn's Disease in Children | Cedars-Sinai. (2021). Retrieved 10 September 2021, from https://www.cedars-sinai.org/health-library/diseases-and-
conditions---pediatrics/c/crohns-disease-in-children.html
4) El Mouzan, Mohammad I, et al. “Regional Variation of Pediatric Inflammatory Bowel Disease in Saudi ARABIA: Results from a Multicenter
Study.” World Journal of Gastroenterology, Baishideng Publishing Group Inc, 28 Jan. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7002901/.
5) “Signs and Symptoms of Crohn's Disease.” Crohn's & Colitis Foundation, www.crohnscolitisfoundation.org/what-is-crohns-disease/symptoms.
6) “Diagnosis of Crohn's Disease.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human
Services, www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease/diagnosis.
7) “Diagnosing Crohn's Disease in Children.” Patient Care at NYU Langone Health, nyulangone.org/conditions/crohns-disease-in-children/diagnosis.
8) Herdman, T. Heather, and Shigemi Kamitsuru. NANDA International, Inc. Nursing DIAGNOSES: Definitions & CLASSIFICATION 2015-2017.
Wiley Blackwell, 2014.
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References
9) El Mouzan, Mohammad I, et al. “Diagnostic Delay of Pediatric Inflammatory Bowel Disease in Saudi Arabia.” Saudi Journal of Gastroenterology
: Official Journal of the Saudi Gastroenterology Association, Wolters Kluwer - Medknow, 2019,
 
www.ncbi.nlm.nih.gov/pmc/articles/PMC6714469/.
10) El Mouzan, Mohammad I, et al. “Impact of Pediatric Inflammatory Bowel Disease on Linear Growth: Data from a National Cohort Study in Saudi
Arabia.” Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association, Medknow Publications & Media Pvt
Ltd, 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4817292/.
11) Zhang, Yi-Zhen, and Yong-Yu Li. “Inflammatory Bowel Disease: Pathogenesis.” World Journal of Gastroenterology, Baishideng Publishing
Group Co., Limited, 7 Jan. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC3886036/.
12) Strong, Scott A. “Surgical Management of Crohn's Disease.” Surgical Treatment: Evidence-Based and Problem-Oriented., U.S. National Library
of Medicine, 1 Jan. 1970, www.ncbi.nlm.nih.gov/books/NBK6934/.
13) “Treatment for Crohn's Disease.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human
Services, www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease/treatment.
14) Golik, Magdalena, et al. “Working Group Guidelines on the Nursing Roles in Caring for Patients with Crohn's Disease and Ulcerative Colitis in
Poland.” Przeglad Gastroenterologiczny, Termedia Publishing House, 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4178043/.
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Questions &
feedback
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THANK YOU