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CROHNS DISEASE OUTLINE:

A.CROHNS DISEASE- A.k.a REGIONAL ENTERITIS, is the inflammationof the GI tract.

B.ETIOLOGY & PATHOPHYSIOLOGY:1. Autoimmune disease, genetic pre-disposition2. Effects all layers of mucosa and entire GI tract, but common in terminal

ileum

3. Key features: skip lesions, cobblestone appearance, thick walls4. Strictures & obstructions, after 15-40yrs cancer

C.SIGNS & SYMPTOMS1. Fever2. Increased WBC w/

decreased e-lytes

3. Diarrhea4. Steatorrhea5. loose stools6. Pre-umbilical pain before

and after BM

7. Colicy abdominal pain aftereating

8. Visible peristalsis

9. Palpable mass10. Decreased/absent bowels

sound w/ severe

inflammation

11. Weight loss12. Anorexia13. High pitched bowel sounds

over areas of narrowed

bowel loops

14. Anemia

D.DIAGNOSTICS & LABS:1. Barium enema2. Upper GI series Endoscopy3. WBC & elytes

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E.COLLABORATIVE INTERVENTIONS1. DIARRHEA MANAGEMENT:

i. Note vol, colour, consistence & # stoolsii. Assess perineal area & skiniii. Daily weight

2. DRUG THERAPYi. Anti-diarrheal- decrease intestinal motility

a.Diphenoxylate HCL (Lomotil)ii. Prostaglandin Inhibitors- inhibit synthesis prostaglandins in

intestinea.Sulfalazine (Azulfidine), Mesalamine (Azacol)

iii. Corticosteroids- to suppress inflammationa.Hydrocortisone

iv. Anti-infective- bowel antiseptic- inhibit bacterial proteinsynthesis

a.Neomycin (mycifradin)b.Metronidazole (Flagyl)

v. Infliximab (Remicide)- antitumor necrosis factor for thosewith active fistulas

3. MALNUTRITION MANAGEMENTi. High carb, protein, low fat, fibre dietii. Oral suppliments- ensure and vivonexiii. Record food intake w/ calorie countiv. TPN for those NPO

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4. FLUID & ELYTE REPLACEMENTi. Oral and/or IV fluidsii. Strict I/O

5. ASSESS SKINi. Apply pouch to fistula to prevent irretationii. Cover area around fistula w/ barrier ex. Duoderm, apply

wound drainage system

iii. Clean & keep dryiv. Observe for infection/sepsis: fever, abdominal pain, change

mental status6. SURGERY

i. Bowel resection & anastomosis w/or without colon resectionii. Strictoplasty for bowel strictures

a.Pre-op:1)Explain & reinforce surgeons teaching2)Instruct consume liquid diet +1 days3)Bowel prep: laxatives, enemas4)IV antibiotics

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b.Post-op1)Patency & placement tube2)Relief pain3)Colostomy management

i. Cover stoma & keep moist if no pouch inplace

ii. Monitor for:- necrotic tissue, stoma colour,bleeding

iii. Check & fit pouch & check leaksiv.

Assess fxn colostomy 2-4dys post-op

v. Empty pouch when full of gas or 1/3-1/2full stool

vi. Irrigate wound if indicatedvii. Change dressing as indicatedviii. Assess perineal woundix. Comfort measures for perineal itching-

antipyretics

x. Check s/s infectionF.COMPLICATIONS

1. Malabsorption2. Fistula3. Hemorrhage4. Abscess5. Bowel obstruction6. cancer