Pathophysiology:

Predisposing Factor:
Age – 15 and 30 years Precipitating Factor:
of age; 50 to 70 years of Pesticides, food
age additives, tobacco,
Women and men tend to radiation, and NSAIDs
be affected equally
Family history

Etiology:
Idiopathi
c

The disease process begins

Edema and
thickening of the
mucosa

These lesions are not

in continuous contact Ulcers begin to
with one another and appear on the
are separated by inflamed mucosa
normal tissue
Fistulas, fissures Granulomas
and abscesses occur in 50% of
These clusters of form as the patients
ulcers tend to take on inflammation
a classic “cobblestone” extends into the
appearance
As the disease
advances
The bowel wall
thickens and
becomes fibrotic

Intestinal lumen
narrows

Diseased bowel loops

sometimes adhere to other loops
surrounding them
Assessment:

Cramplike and colicky pain after meals

Diarrhea (semisolid); may contain mucus and pus

Dehydration

Electrolyte imbalances

Fever

A proctosigmoidoscopic examination is usually performed initially to determine

whether the rectosigmoid area is inflamed.

A stool examination is also performed; the result may be positive for occult
blood and steatorrhea (ie, excessive fat in the feces).

The most conclusive diagnostic aid for regional enteritis is a barium study of the
upper GI tract that shows the classic “string sign” on an x-ray film of the
terminal ileum, indicating the constriction of a segment of intestine.

Endoscopy and intestinal biopsy may be used for confirmation of the diagnosis.
A barium enema may show ulcerations (the cobblestone appearance
described earlier), fissures, and fistulas.

A CT scan may show bowel wall thickening and fistula tracts.

A complete blood cell count is performed to assess hematocrit and hemoglobin

levels (usually decreased) and the white blood cell count (may be elevated).
The sedimentation rate is usually elevated. Albumin and protein levels may
be decreased, indicating malnutrition.

Nsg Interventions:

Acute phase: maintain NPO status, administer IV’s and electrolytes, or total
parenteral nutrition (TPN), as prescribed.

Restrict the client’s activity, to reduce intestinal activity.

Monitor bowel sounds and for abdominal tenderness and cramping.

Monitor stools, noting color, consistency , and the presence or absence of

blood.
Monitor for perforation, peritonitis, and hemorrhage.

Following the acute phase, the fiet progresses from clear liquids to low
residue as tolerated.