Crohn’s Disease
An idiopathic inflammatory disease of the small intestine (~60%), large intestine (~20%) or both (~50%). The most commonly affected site is the terminal ileum (~33%).
- It may also be caused by Mycobacterium avium subspecies paratuberculosis (M. paratuberculosis)
- Related to genetic disposition from 1st degree relatives.
Pathology
- Deep fissures (enterocutaneous, enteroenteric) and ulceration develops from inflammation. This results in bowel fistulas, which cause diarrhea and malabsorption.
- Chronic pathologic changes include thickening of the bowel wall, which narrows the bowel lumen and causes strictures. This results in obstruction.
Assessment Findings
- Abdominal distention, masses, and visible peristalsis from obstruction.
- Diarrhea, commonly containing fat (steatorrhea) and sometimes containing blood (hematochezia, melena).
- Constant abdominal pain
- Low-grade fever
- Weight Loss seen in 80% of clients
Diagnostic Examination
- Autoimmune blood tests: positive Anti-DNA and ANA
Nursing Interventions
- Monitor for peritonitis, bowel obstruction, and nutritional and fluid imbalances
Ulcerative Colitis
Ulceration and inflammation of the colon or rectum. Its cause is unknown.
Assessment Findings
- Anorexia, weight loss
- Fever
- Severe diarrhea with rectal bleeding, dehydration, anemia
- Abdominal pain and cramping
Inflammatory Bowel Disease
| Differences | Crohn’s Disease | Ulcerative Colitis |
|---|---|---|
| Depth and Manifestation | Transmural, Patchy | Mucous Ulceration, Continuous |
| Region | Any part; Ileum | Rectum/Cecum |
| Causes | Unknown, Familial, Environmental | Unknown, Familial, Emotions |
| Age, Peak Incidence | 15 - 40 y.o. | 15 - 25 y.o., 55 - 65 y.o. |
| Bleeding | Minimal; stool contains pus and mucus | Severe; stool contains blood, pus, and mucus. |
| Fistulas | Common (d/t Transmural affectation) | Rare |
| Rectal Involvement | 20% | 100% |
| Diarrhea | 5 - 6 soft loose stools a day | 20-30 watery stools a day |
| Abdominal Pain | Present | Present |
| Weight Loss | Present | Present |
| Intervention | Total Parenteral Nutrition | Diet, Total Parenteral Nutrition |
| Medication | Steroids, Azulfidine (Sulfasalazine): antiinflammatory | Steroids, Azulfidine (Sulfasalazine) |
| Surgery | (Temporary) Ileostomy | Ileostomy, Proctocolectomy |
Nursing Interventions
- Maintain NPO during the active phase.
- Monitor for complications e.g. severe bleeding, dehydration, and electrolyte imbalances.
- Monitor bowel sounds
- Assist in stool and blood studies
- Restrict activities
- Administer IVF, Electrolytes, and TPN as ordered.
- Ileostomy: continuous watery drainage, with digestive enzymes (causes skin irritation)
- Irrigation (INC)
Diet Therapy
- Avoid gas-forming foods: whole grains, nuts, raw fruits and vegetables (spinach), pepper, alcohol, and caffeine.
- Avoid milk products
- Once off NPO, Clear Liquid Diet weaned into a low residue, high protein diet.
Medical Interventions
- Anti-inflammatory Drugs: Azulfidine (Sulfasalazine)
- Antibiotics
- Steroids (as anti-inflammatory)
- Bulk-Forming Agents (for diarrhea)
- Vitamin and Iron Supplementation (to compensate for malabsorption)