Facts on Regional Entiritis (Crohn's Disease)

I haven't come across inflammatory bowel diseases much and only know one, ulcerative colitis which I am going to post later. It commonly occurs among adults or young adults but may appear any time in the entire lifespan. Although women are more susceptible but the older population experiences the bouts more than any other age group (Between the ages 50 to 80). The site of affection is commonly located at the distal ileum and colon. Crohn's may be subacute or chronic inflammation which extends through all layers of the intestinal wall. Remissions and exacerbations happen. The pathogenesis begins with intestinal edema and of course, thickening of the mucosa then ulcers begin to appear on the inflammed areas. Lesions are not in continuous contact with each other for they are separated with normal tissue. As the disease progresses into the peritoneum fistulas, fissures and abscesses form. Bowel wall thickens and becomes fibrotic and the intestinal lumen narrows in the advance stage. Granulomas form in almost half of the patients. Diseased bowel loops sometimes adhere to other loops surrounding them.

Clinical Manifestations:

• Lower right quadrant pain
• Diarrhea unrelieved by defecation
• Crampy abdominal pains AFTER MEALS
• Abdominal tenderness and spasm
• Weight loss
• Secondary anemia due to poor nutrient absorption
• Nutritional deficiencies
• Fever
• Leukocytosis
• Anoreixa

Complications:

• Intestinal obstruction
• Perianal disease
• Fluid and electrolyte imbalances
• Malnutrition secondary to malabsorption
• Fistula and abscess formation
• Stricture formation

Lab Findings (click here for normal lab values)

• Decreased hematocrit and hemoglobin levels
• Elevated white blood cell count
• Elevated sedimentation rate
• Low albumin and protein levels
• Positive for occult blood and steatorrhea (excess fat in the feces) in fecalysis

Diagnostics (click here for diagnostic procedures)

• Proctosigmoidoscopy
• X-Ray barium study of upper gastrointestinal tract
• Endoscopy and intestinal biopsy (Confirming diagnosis)
• Barium enema
• CT Scan

Impression:
Barium enema shows ulcerations (cobblestone appearance)
Classic 'string sign' on X-Ray indicating constriction of a segment of a bowel (most conclusive diagnosis)

Medical Management:

• Nutritional therapy
• Antidiarrheal and antiperistaltic medications are given
• Sulfasalazine which is effective for mild or moderate inflammation, reduces recurrence
• Corticosteroids

Surgical Management:

• Total Colectomy with Ileostomy
• Total Colectomy with Continent Ileostomy
• Total Colectomy with Ileoanal Anastomosis

Nursing Management:
Assessment:

• Health history
• Dietart patterns (include intake of alcohol, nitcotine)
• Assess elimination patterns and stool consistency
• Nutrition status
• Assess abdomen for bowel sounds and characteristics
• Pain assessment

Nursing Diagnosis:

• Diarrhea R/T the inflammatory process
• Acute pain R/T increased peristalsis and GI inflammation
• Deficient fluid volume deficit R/T anorexia. nausea and diarrhea
• Imbalanced nutrition, less than body requirements
• Activity intolerance R/T fatigue
• Anxiety
• Ineffective coping
• Risk for impaired skin integrity

Nursing Intervention:

• Relieve pain by administering anticholinergic medications 30 mins. before meals
• Maintain fluid intake
• Maintain optimal nutrion through parenteral nutrition in severe cases
• Record intake and output
• Weigh daily
• High protein low fat and residue diet
• If food is tolerated give small frequent feedings
• Promote rest
• Establish rapport to reduce anxiety
• Provide perianal care and prevent skin breakdown for bed-ridden clients especially over bony prominences

Evaluate:

• Elimination status
• Pain
• Fluid Balance
• Nutrition status
• Skin integrity
• Knowledge of disease process and management
• Potential complications must be reported

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