crohns.pptx MED SURGICAL NURSING BY JEPHTERS

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2. REGIONAL ENTERITIS (CROHN’S DISEASE) It is more common in women , and it occurs frequently in the older population ( between the ages of 50 and 80). It can occur anywhere along the GI tract , but the most common areas are the distal ileum and colon.

3. Crohn’s disease is seen two times more often in patients who smoke than in nonsmokers (Rose, 1998 ).

4. Pathophysiology Regional enteritis is a subacute and chronic inflammation that extends through all layers ( ie , transmural lesion) of the bowel wall from the intestinal mucosa . It is characterized by periods of remissions and exacerbations . The disease process begins with edema and thickening of the mucosa . Ulcers begin to appear on the inflamed mucosa. These lesions are not in continuous contact with one another and are separated by normal tissue.

5. Fistulas, fissures , and abscesses form as the inflammation extends into the peritoneum. Granulomas occur in one half of patients. In advanced cases , the intestinal mucosa has a cobblestone appearance. As the disease advances, the bowel wall thickens and becomes fibrotic, and the intestinal lumen narrows. Diseased bowel loops sometimes adhere to other loops surrounding them.

6. Clinical Manifestations onset of symptoms is usually insidious, with prominent lower right quadrant abdominal pain and diarrhea unrelieved by defecation . There is abdominal tenderness and spasm. Because eating stimulates intestinal peristalsis, the crampy pains occur after meals . weight loss, malnutrition, and secondary anemia. Ulcers in the membranous lining of the intestine and other inflammatory changes result in a weeping, swollen intestine that continually empties an irritating discharge into the colon.

7. Disrupted absorption causes chronic diarrhea and nutritional deficits. The result is a person who is thin and emaciated from inadequate food intake and constant fluid loss. Abscesses, fistulas, and fissures are common. Symptoms extend beyond the GI tract and commonly include joint involvement ( eg , arthritis ), skin lesions (eg, erythema nodosum), ocular disorders ( eg, conjunctivitis ), and oral ulcers.

8. Assessment and Diagnostic Findings proctosigmoidoscopic examination is usually performed initially to determine whether the rectosigmoid area is inflamed. Stool examination is also performed; the result may be positive for occult blood and steatorrhea ( ie , excessive fat in the feces ). Barium study of the upper GI tract that shows the classic “string sign” on an x-ray film of the terminal ileum, indicating the constriction of a segment of intestine.

9. NUTRITIONAL THERAPY Oral fluids and a low-residue, high-protein, high-calorie diet with supplemental vitamin therapy and iron replacement are prescribed to meet nutritional needs, reduce inflammation, and control pain and diarrhea. Milk may contribute to diarrhea in those with lactose intolerance. Cold foods and smoking are avoided.

10. PHARMACOLOGIC THERAPY Sedatives and antidiarrheal and antiperistaltic medications are used to minimize peristalsis to rest the inflamed bowel. Aminosalicylate formulations such as sulfasalazine ( Azulfidine ) are often effective for mild or moderate inflammation and are used to prevent or reduce recurrences in long-term maintenance regimens.

11. Corticosteroids are used to treat severe and fulminant disease. These corticosteroids ( eg , prednisone) can be administered orally in outpatient treatment or parenterally in hospitalized patients . Immunomodulators (eg, azathioprene [Imuran], 6-mercaptopurine, methotrexate , cyclosporin ) have been used to alter the immune response (Wolfe, 2000). The exact mechanism of action of these medications in treating IBD is unknown.

12. SURGICAL MANAGEMENT A newer surgical procedure developed for patients with severe regional enteritis is intestinal transplant Total Colectomy With Ileostomy Total Colectomy With Continent Ileostomy

13. Endoscopy and intestinal biopsy may be used for confirmation of the diagnosis. A barium enema may show ulcerations (the cobblestone appearance described earlier), fissures, and fistulas.A CT scan may show bowel wall thickening and fistula tracts . complete blood cell count is performed to assess hematocrit and hemoglobin levels (usually decreased) and the white blood cell count (may be elevated).

14. Complications Complications of regional enteritis include intestinal obstruction or stricture formation, perianal disease, fluid and electrolyte imbalances, malnutrition from malabsorption , and fistula and abscess formation .

15. Medical Management of Chronic Inflammatory Bowel Disease Medical treatment for regional enteritis and ulcerative colitis is aimed at reducing inflammation, suppressing inappropriate immune responses, providing rest for a diseased bowel so that healing may take place, improving quality of life, and preventing or minimizing complications.