CROHNS DISEASE OUTLINE:

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

B. ETIOLOGY & PATHOPHYSIOLOGY:

1. 2. 3. Autoimmune disease, genetic pre-disposition Effects all layers of mucosa and entire GI tract, but common in terminal ileum Key features: skip lesions, cobblestone appearance, thick walls Strictures & obstructions, after 15-40yrs cancer Fever Increased WBC w/ decreased e-lytes Diarrhea Steatorrhea loose stools Pre-umbilical pain before and after BM Colicy abdominal pain after eating Visible peristalsis

4. 1. 2. 3. 4. 5. 6. 7. 8.

C. SIGNS & SYMPTOMS 9. 10.

Palpable mass Decreased/absent bowels sound w/ severe inflammation

11. 12. 13.

Weight loss Anorexia High pitched bowel sounds over areas of narrowed bowel loops

14.

Anemia

D. DIAGNOSTICS & LABS: 1. 2. 3. Barium enema Upper GI series Endoscopy WBC & elytes

E. COLLABORATIVE INTERVENTIONS 1. DIARRHEA MANAGEMENT: i. Note vol, colour, consistence & # stools ii. Assess perineal area & skin iii. Daily weight 2. DRUG THERAPY i. Anti-diarrheal- decrease intestinal motility a. Diphenoxylate HCL (Lomotil) ii. Prostaglandin Inhibitors- inhibit synthesis prostaglandins in intestine a. Sulfalazine (Azulfidine), Mesalamine (Azacol) iii. Corticosteroids- to suppress inflammation a. Hydrocortisone iv. Anti-infective- bowel antiseptic- inhibit bacterial protein synthesis a. Neomycin (mycifradin) b. Metronidazole (Flagyl) v. Infliximab (Remicide)- antitumor necrosis factor for those with active fistulas 3. MALNUTRITION MANAGEMENT i. High carb, protein, low fat, fibre diet ii. Oral suppliments- ensure and vivonex iii. Record food intake w/ calorie count iv. TPN for those NPO

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FLUID & ELYTE REPLACEMENT i. Oral and/or IV fluids ii. Strict I/O

5.

ASSESS SKIN i. Apply pouch to fistula to prevent irretation ii. Cover area around fistula w/ barrier ex. Duoderm, apply wound drainage system iii. Clean & keep dry iv. Observe for infection/sepsis: fever, abdominal pain, change mental status

6.

SURGERY i. Bowel resection & anastomosis w/or without colon resection ii. Strictoplasty for bowel strictures a. Pre-op: 1) Explain & reinforce surgeons teaching 2) Instruct consume liquid diet +1 days 3) Bowel prep: laxatives, enemas 4) IV antibiotics

b. Post-op 1) Patency & placement tube 2) Relief pain 3) Colostomy management i. Cover stoma & keep moist if no pouch in place ii. Monitor for:- necrotic tissue, stoma colour, bleeding iii. Check & fit pouch & check leaks iv. Assess fxn colostomy 2-4dys post-op v. Empty pouch when full of gas or 1/3-1/2 full stool vi. Irrigate wound if indicated vii. Change dressing as indicated viii. Assess perineal wound ix. Comfort measures for perineal itchingantipyretics x. Check s/s infection F. COMPLICATIONS 1. 2. 3. 4. 5. 6. Malabsorption Fistula Hemorrhage Abscess Bowel obstruction cancer