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Crohn's Disease Inflammatory disorder affecting the gastrointestinal…
Crohn's Disease
Inflammatory disorder affecting the gastrointestinal tract from mouth to anus
(McCane & Huether, 2014)
Pathophysiology
(Atlas of Patho, 2002)
Lymphatic obstruction leads to Edema, Skipping Lesions, fissures and granulomas
Peyer's patches develop in lining of small intestine
Fibrosis thickens bowel walls, causing stenosis of lumen
Serous membrane become inflamed
Inflamed bowel loops adhere to other diseased or normal loops and become interspersed with healthy ones
Diseased parts of bowel become thicker, narrower and shorter
Enlarged lymph nodes block lymph flow in submucosa
Location
(Atlas of Patho, 2002)
Ascending colon
Course of Disease
Chronic
Slow and progressive
Terminal Ileum
Nursing Care**
Control diarrhea/promote optimal bowel function.
(Sparks & Taylor, 2005)
Help patient understand diet//preventing flare-ups
High Calorie/high protein diet
Avoid trigger foods (foods that cause a flare-up)
Low-residue diet
Vitamin/mineral supplements
Monitor fluid closely;input and output
Relief or diminish symptoms
Administer steroids, analgesics, anticholinergics, antibiotics
Clinical Manifestations
NHS, 2015
Small intestine malabsorption
Unintended weight loss
Abdominal pain
Recurring diarrhea
Extreme tiredness
Blood and mucus in your feces
Fever
Pharmacology
A combination of treatment options can help you stay in control of your disease and lead a full and rewarding life (Crohn's Disease, 2017)
Corticosteroids
: non-specifically suppress the immune system and are used to treat moderate to severely active crohn's disease - these drugs have significant short & long term side effect, should not be used for maintenance (Crohn's Disease, 2017)
Immunomodulators:
modulates or suppresses the body's immune system response so it cannot cause ongoing inflammation - may take several months to begin working (Crohn's Disease, 2017)
Antibiotics:
may be used when infections such as abscesses occur in crohn's disease, can be helpful with fistulas around the anal canal and vagina (Crohn's Disease, 2017)
Biologic Therapies:
these medications represent the latest class of therapy used for people with crohn's disease who have not responded well to conventional therapy - these medications are antibodies grown in the laboratory that stop certain proteins in the body from causing inflammation (Crohn's Disease, 2017)
Aminosalicylates (5-ASA):
these include medications that contain 5-aminosalicylate acid. They can work at the level of the lining of the GI tract to decrease inflammation - not particularly effective if the disease is limited to the small intestine.
Sulfasalazine, Mesalamine
- may cause nausea, diarrhea, vomiting, heartburn and headache (Mayo Clinic, 2014)
Prednisone, Methylprednisolone
- may cause puffy face, excessive facial hair, night sweats, insomnia, hyperactivity, high blood pressure, diabetes, osteoporosis, glaucomo, etc. (Mayo Clinic, 2014)
Azathioprine, Mercaptopurine
- may cause lowered resistance to infection, can be associated with inflammation of the liver and pancreas, and bone marrow suppression (Mayo Clinic 2014)
Metronidazole
- may cause numbness, tingling in hands and feet, muscle pain and weekness.
Ciprofloxacin
- may cause tendon rupture, increased risk with corticosteroid (Mayo Clinic, 2014)
Infliximab, Adalimumab, Certolizumab, Cyclosporine, Tacrolimus
- cyclosporine may cause kidney and liver damage, seizures, and fatal infections. These medications aren't for long term use, may be associated with certain cancers, including lymphoma and skin cancers (Mayo Clinic, 2014)
