Crohn’s Disease (Regional Enteritis)
1. What is the pathophysiology and etiology of the disease?
(Hinkle, p.1330 & Porth, p.706)
Crohn’s Disease is one of the Inflammatory bowel diseases (IBD). It is identified by
Chronic transmural inflammation (extending through all layers) of the gastrointestinal
(GI) tract through periods of exacerbation and remission. It usually affects the ileum
(35% of patients) and beginning of the colon (45% of patients have both affected), but
may affect any part of GI (from mouth to anus).
Crohn’s begins with crypt inflammation and abscesses that develop into ulcers that
grow becoming deeper and longer, often separated by patches of edema which give the
cobblestone appearance. Diseased bowel sections can be defined from surrounding
normal bowel tissue (called skip lesions, aka regional enteritis). Advancement of
Crohn’s causes the bowel to thicken, becoming fibrotic, and the lumen to narrow.
Causes of Crohn’s is uncertain but there is evidence that it may result from “a
combination of intestinal microorganisms, intestinal epithelial dysfunction, and aberrant
immune responses in a genetically predisposed host.” There is a greater risk for
development if there is a family history and/or smoking tobacco.
2. What are the clinical manifestations?
Onset symptoms are usually Right lower quad abdominal pain and persistent diarrhea.
The development of scar tissue and constriction of the lumen results in crampy
abdominal pain which worsens after eating. This usually leads to reduced intake and
results in weight loss, malnutrition, and possible anemia. Abdominal tenderness and
spasm are present. Ulcers and inflammation result in a “weeping, edematous intestine
that continually empties an irritating discharge” which presents as persistent diarrhea.
Manifestations may extend past the GI causing joint disorders (e.g., arthritis), skin
lesions (e.g., erythema nodosum), ocular disorders (e.g., uveitis), and oral ulcers.
, 3. What kind of diagnostic tests are used to evaluate the disease? (ex labs,
procedures, etc) Barium studies, Sigmoidoscopy, Colonoscopy.
4. How is the disease managed? Corticosteroids, Immunomodulators (if refractory
to corticosteroids) Rx’s: Imuran, Remicade, Humira. Antibiotics, Parenteral
nutrition, Partial/Complete colectomy with ileostomy or anastomosis. -rectum can
be preserved in few patients.
5. What are the complications that can occur with this disease?
Complications
Complications of Crohn’s disease include intestinal obstruction or stricture formation,
perianal disease, fluid and electrolyte imbalances, malnutrition from malabsorption, and
fistula and abscess formation. The most common type of small bowel fistula caused by
Crohn’s disease is the enterocutaneous fistula (i.e., an abnormal opening between the
small bowel and the skin). Abscesses can be the result of an internal fistula that results
in fluid accumulation and infection. Patients with colonic Crohn’s disease are also at
increased risk of colon cancer (NIDDK, 2016b; Walfish, 2016).
● Intestinal obstruction
● Stricture formation
● Perianal disease
● Fluid/electrolyte imbalances
● Malnutrition from malabsorption
● Fistula and abscess formation (most common type of small bowel fistula
associated w Crohn’s = enterocutaneous fistula which is an abnormal
opening between the small bowel and the skin
● Patients w colonic Crohn’s are at increased risk of colon cancer
6. What would you assess as a nurse?
● Assess nutritional status: weight loss, malnutrition, and secondary
anemia occur
● Assess for fluid volume deficit: patients will often be thin and emaciated
from inadequate food intake and constant fluid loss
● Assess skin integrity: anal abscesses, skin lesions (e.g., erythema
nodosum), and oral ulcers.
● Assess vital signs: fever, swollen and tender lymph nodes, and vital
signs associated with fluid volume deficit.
● Assess for pain: abdominal pain, tenderness, and painful cramping are
common with this disease. Additionally, patients may suffer from joint pain.
1. What is the pathophysiology and etiology of the disease?
(Hinkle, p.1330 & Porth, p.706)
Crohn’s Disease is one of the Inflammatory bowel diseases (IBD). It is identified by
Chronic transmural inflammation (extending through all layers) of the gastrointestinal
(GI) tract through periods of exacerbation and remission. It usually affects the ileum
(35% of patients) and beginning of the colon (45% of patients have both affected), but
may affect any part of GI (from mouth to anus).
Crohn’s begins with crypt inflammation and abscesses that develop into ulcers that
grow becoming deeper and longer, often separated by patches of edema which give the
cobblestone appearance. Diseased bowel sections can be defined from surrounding
normal bowel tissue (called skip lesions, aka regional enteritis). Advancement of
Crohn’s causes the bowel to thicken, becoming fibrotic, and the lumen to narrow.
Causes of Crohn’s is uncertain but there is evidence that it may result from “a
combination of intestinal microorganisms, intestinal epithelial dysfunction, and aberrant
immune responses in a genetically predisposed host.” There is a greater risk for
development if there is a family history and/or smoking tobacco.
2. What are the clinical manifestations?
Onset symptoms are usually Right lower quad abdominal pain and persistent diarrhea.
The development of scar tissue and constriction of the lumen results in crampy
abdominal pain which worsens after eating. This usually leads to reduced intake and
results in weight loss, malnutrition, and possible anemia. Abdominal tenderness and
spasm are present. Ulcers and inflammation result in a “weeping, edematous intestine
that continually empties an irritating discharge” which presents as persistent diarrhea.
Manifestations may extend past the GI causing joint disorders (e.g., arthritis), skin
lesions (e.g., erythema nodosum), ocular disorders (e.g., uveitis), and oral ulcers.
, 3. What kind of diagnostic tests are used to evaluate the disease? (ex labs,
procedures, etc) Barium studies, Sigmoidoscopy, Colonoscopy.
4. How is the disease managed? Corticosteroids, Immunomodulators (if refractory
to corticosteroids) Rx’s: Imuran, Remicade, Humira. Antibiotics, Parenteral
nutrition, Partial/Complete colectomy with ileostomy or anastomosis. -rectum can
be preserved in few patients.
5. What are the complications that can occur with this disease?
Complications
Complications of Crohn’s disease include intestinal obstruction or stricture formation,
perianal disease, fluid and electrolyte imbalances, malnutrition from malabsorption, and
fistula and abscess formation. The most common type of small bowel fistula caused by
Crohn’s disease is the enterocutaneous fistula (i.e., an abnormal opening between the
small bowel and the skin). Abscesses can be the result of an internal fistula that results
in fluid accumulation and infection. Patients with colonic Crohn’s disease are also at
increased risk of colon cancer (NIDDK, 2016b; Walfish, 2016).
● Intestinal obstruction
● Stricture formation
● Perianal disease
● Fluid/electrolyte imbalances
● Malnutrition from malabsorption
● Fistula and abscess formation (most common type of small bowel fistula
associated w Crohn’s = enterocutaneous fistula which is an abnormal
opening between the small bowel and the skin
● Patients w colonic Crohn’s are at increased risk of colon cancer
6. What would you assess as a nurse?
● Assess nutritional status: weight loss, malnutrition, and secondary
anemia occur
● Assess for fluid volume deficit: patients will often be thin and emaciated
from inadequate food intake and constant fluid loss
● Assess skin integrity: anal abscesses, skin lesions (e.g., erythema
nodosum), and oral ulcers.
● Assess vital signs: fever, swollen and tender lymph nodes, and vital
signs associated with fluid volume deficit.
● Assess for pain: abdominal pain, tenderness, and painful cramping are
common with this disease. Additionally, patients may suffer from joint pain.
