CROHNS DISEASE

Anatomy and Physiology

&
Pathophysiology
Definition

Crohns disease, also known as crohn syndrome
and regional entiritis, is a type of inflammation
bowel disease that may affect an part of the
gastrointestinal tract from mouth to anus,
causing a wide variety of symptoms, It primarily
causes abdominal pain, diarrhea, vomiting or
weight loss, but may also cause complication
outside the gastrointestinal tract such as
anemia, skin rashes, arthritis, inflammation of
the eye ,tiredness and lack of concentration

Anatomy and Physiology of GI Tract
Mucosal Lining of the GI Tract
Pathophysiology
Predisposing Factors
Age
Race/Ethnicity
Genetic
Environmental (Smoking, Diet, Lifestyle

Precipitating Factors
Microbes
Immune/Inflammatory Response
NSAIDS
Appendectomy

Abnormal epithelial/mucosal barriers
Increased ANTIGENS

Uncontrolled Mucosal Inflammation

Activation of Inflammatory Helper T Cells

Release of Cytokinens

TNF (Tumor Necrosis Factor) alpha

Ulceration and Tissue/Bowel Injury

Ileocolitis
Diarrhea & cramping/pain
of abdomen
Weight loss
Ileitis
Diarrhea & cramping/pain
of abdomen
Weight loss
Gastroduodenal
crohns disease
Loss of appetite
Weight loss
Nausea & vomiting
Jejunoileitis
Mild to intense
abdominal pain & cramps
Diarrhea
Crohns
(granulomatous) colitis
Diarrhea
Rectal bleeding
Skin lesions
Joint pains
COMPLICATIONS
Malabsorption of nutrients, Intestinal bleeding, Disease of Anus (Abscess ,fistula, ulcers), Bowel Obstruction,
Perforation of Colon, massive distention/dilatation of colon, erythema, ulcerating skin, visual difficulties, uveitis,
Increased risk of cancer
Inflamed Mucosal Lining of
Intestine
Cobblestones











Assessment
Patients history and presenting sign
and symptoms:
26 yrs old woman
Abdominal pain Nausea
Constipation alternating with periods of
diarrhea.
Pain in her joints
skin lessions
Tiredness
Depression

















Dietary history

Eating fried foods and some fruits
and vegetables worsen her
condition.

Nursing Diagnosis:
1. Imbalance Nutrition less than
body requirement related to
restricted nutrient intake








2. Acute pain related to increase
peristalsis.
3. Anxiety to crisis situation and
changes in health status.
4.Diarrhea related to effect of
inflammatory changes of the bowel.
Planning
Nutrition imbalance





Acute pain







In I week of nursing care
patient able to
demonstrate lifestyle
changes to regain and
maintain appropriate
weight.
In 1 week of nursing care
patient able to
demonstrate effective
coping and able to
participate the diet
therapy.




Anxiety to crisis situation
and changes in health
status.


Diarrhea
In 1 week of nursing care
patient able to determine
the benefits of the diet
therapy

In 1 week of nursing care
patient able to tell the
changes of her health
status based on restricted
food intake.
In 1 week of nursing care
patient will report of
reduction of frequency of
stool.
Nursing intervention
Weight daily
Encourage bedrest
Recommended rest before meal
Provide oral hygiene
Serve food in well-ventilated,
pleasant surrounding, with
unhurried atmosphere, congenital
company.




Avoid limit foods that can cause abdominal
pain.e.g milk product, high in fiber or fat and
etc.
Record intake and changes in symptomatology

Promote patient participation in dietary
planning as possible
Resume/advance diet as indicated, e.g., clear
liquids progressing to bland diet.

Acute pain
Encourage patient to report pain
Assess report of abdominal cramping or pain