CROHN'S DISEASE

CROHN'S DISEASE

DEFINITION

Crohn's disease is an inflammatory bowel disease (IBD) which causes inflammation of d digestive tract, which can lead to abdominal pain, severe diarrhoea, fatigue, weight loss and malnutrition.

 Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people.

The inflammation caused by Crohn's disease often spreads deep into the layers of affected bowel tissue.

Also called REGIONAL ENTERITIS, It can affect any area from d oropharynx to the anal area (transmural).

N.B: While there's no known cure

 Crohn's disease, therapies can greatly reduce its signs and symptoms and even bring about long-term remission. With treatment, many people with Crohn's disease are able to function well.

CAUSES

The exact cause is unknown (Idiopathic), usually auto immune.

Risk factors

·        Hereditary

·        Age (can occur at any age, but most common among 30years and above.

·        Ethnicity: whites and people of Jewish race are at risk.

·        Cigarette smoking

·        NSAIDs medications.

·        autoimmune.

 Diagnostic evaluation

·        Blood test to rule out anaemia

·        Colonoscopy

·        Sigmoidoscopy

·        Fecal occult blood test

·        CT scan

·        MRI

·        Barium enema

·        Inflammatory markers

 PATHOPHYSIOLOGY

Crohn’s disease begins as inflammation in the intestinal submucosa and crosses the intestinal wall to involve the mucosa and serosa. Type 1 helper T-cells begin the damaging inflammatory response and activate leukocytes and cytokines which cause further injury.

Prostaglandins, proteases, reactive oxygen species, leuokotrienes, and nitric oxide are released by leukocytes and continue the inflammatory response and subsequent injury.

Aphthoid lesions (shallow ulcers) result after neutrophils invade and destroy the intestinal crypts.

The inflammation and lesions can be interspersed with healthy mucosal tissue creating what are known as “skip” lesions.

One side of the intestinal wall may be affected while tissue on the other side remains healthy.

SIGNS AND SYMPTOMS

Signs and symptoms ranges from mild to severe..

·        Diarrhea

·        Fever

·        Fatigue

·        Abdominal pain and cramping

·        Melena

·        Loss of appetite

·        weight loss

·        Fistula

·        Anemia

 Medical management

There's no cure for Crohn's disease, only conservative management.

·        Anti-inflammatory drugs: Corticosteroids, Oral 5 aminosalicylates..

·        Immune system suppressors: Azathioprine, mecaptopurine, Methothrexate,

·        Antibiotics: can help heal fistulas and abscesses. Example of prescribed antibiotics re ciprofloxacin, metronidazole

·        Anti diarrheals: metamucil, loperamide.

·        Pain relievers: Acetaminophen is prescribed, NSAIDs is contraindicated.

·        Iron supplements

·        Vitamin B12 shots

·        Calcium and vitamin D supplements

·        Nutrition therapy: A special diet is usually recommended nd given via a feeding tube.

Surgical managements

·        Bowel resection

·        Colostomy

·        Ileostomy

 Nursing management

·        History taking: Take a careful history to obtain info about current symptoms and previous diseases

·        Observation: Look for signs of dehydration and monitor patient's vital signs and level of responsiveness.

·        Fluid and electrolyte monitoring: Maintain fluid and electrolyte by administering prescribed I.V fluids and monitoring electrolyte.

·        NG tube placement: insert NG tube for administration of special diets.

·        Nutrition: Special diets are recommended. Liaise with d kitchen department.

·        Administration of Prescribed drugs: Administer prescribed analgesic  antibiotics and other drugs

·        Physical care: Assist patient with routine cares nd encourage patient to ambulate to prevent decubitus ulcer.

·        Physiological care: maintain nil per oral as prescribed, nd prepare patient for surgery if indicated.

·        Psychological care: Reassure d patient and allay patient anxiety.

Health teachings on discharge:

·        Advice patient to avoid smoking

·        Increase dietary fiber

·        Decrease emotional stress

·        Demonstrate Ostomy care ,including cleaning if colostomy or ileostomy is done

NURSING DIAGNOSIS

•     Diarrhoea related to inflammation, irritation of the bowel evidenced by frequent and often passage of watery stools
•      Acute pain related to perirectal excoriation evidenced by patient's verbalisation.

·        Imbalanced nutrition: Less than body requirements related to altered absorption of nutrients evidenced by weight loss.

·        Anxiety related to the prognosis of the disease evidenced by patient asking too many questions.

Complications

·        Bowel obstruction

·        Ulcers

·        Fistulas

·        Anal fissure

·        Toxic mega colon

·         Colon cancer

·        Anemia

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