1. Crohn's disease is a chronic inflammatory bowel disease that causes inflammation of the digestive tract and can affect any area from mouth to anus. It is characterized by abdominal pain, diarrhea, and weight loss. 2. The causes of Crohn's disease are unclear but involve genetic susceptibility and an abnormal immune response to environmental triggers like bacteria or viruses. There is no cure for Crohn's disease but treatment aims to induce and maintain remission. 3. A qualitative study interviewed 30 Crohn's disease patients and identified 13 themes of how the disease impacts their quality of life such as nutrition, hygiene, relationships, and autonomy. The study provides insights beyond just symptoms to understand the full effects of living with

1. CLASS PRESENTATION
ON
INFLAMMATORY BOWEL DISEASE
(CROHN’S DISEASE)
PRESENTED BY:
BHAVYA SHARMA
M.Sc NURSING FIRST YEAR.

2. ANATOMY AND PHYSILOGY OVERVIEW

3. INTESTINE
• The intestine which is the longest part of the digestive tube, is divides into
small intestine and large intestine.
• Food has to be digested, metabolized and stores for expulsion in the intestines.

4. SMALL INTESTINE
The small intestine or lower
gastrointestinal tract or small bowel
is an organ in the gastrointestinal
tract where most of the end
absorption of nutrients and minerals
from food take place. It lies between
the stomach and large intestine. It
may be divided into the duodenum,
jejunum, and ileum.

5. LARGE INTESTINE
The large intestine, also known as the
large bowel, is the last part of the
gastrointestinal tract and of the
digestive system. The large intestine
consists of the colon, rectum, and anal
canal. Water is absorbed here and the
remaining waste material is stored as
feces before being removed by
defecation.

6. INFLAMMATORYBOWEL DISEASE
INTRODUCTION:
• Inflammatory bowel disease is a group of
idiopathic chronic relapsing remitting
inflammatory intestinal conditions which disrupt
body’s ability to digest food absorb nutrition and
eliminate waste.
• Inflammatory bowel disease IBD represent a group
of intestinal disorders that cause prolonged
inflammation of the digestive tract.
• It is a spectrum of chronic idiopathic inflammatory
condition.

7. DEFINITION
 Conditions characterized by presence of IDIOPATHIC intestinal
Inflammation- Biley and love
 Chronic Conditions resulting from Inappropriate Mucosal Immune
Activation. – Robbins and Cotran

8. CLASSIFICATION
• In 85% cases IBD can be differentiated into Ulcerative
Colitis or Crohn’s disease based on – Distribution of
affected Sites and Morphological expression of Disease.
• In 15% cases differentiation is impossible these patients
are classified as having Indeterminate Colitis.

9. ULCERATIVE COLITIS:
• Ulcerative colitis is a disease that causes
mucosal inflammation and sore (ulcers) in
the lining of the large intestine (colon).
• It is a chronic disease of unknown
aetiology characterized by inflammation
of the mucosa and submucosa of the
large intestine. It affect the mucosa and
superficial submucosa of the Rectum and
colon

10. CROHN’S DISEASE
• Crohn’s disease is a chronic idiopathic
Transmural Inflammatory disease with
Skin lesions that may affect any part of
the alimentary tract. Although there is
propensity to affect the distal small
bowel

13. INDETERMINATE COLITIS
• Indeterminate colitis (IC) originally referred to those 10–
15% of cases of inflammatory bowel disease (IBD) in
which there was difficulty distinguishing between
ulcerative colitis (UC) and Crohn's disease (CD) in the
colectomy specimen.

14. CROHN’SDISEASE

15. • Its is also know as Regional Enteritis
1. It is a chronic inflammatory bowel disease that affects the lining
of the digestive tract. It causes inflammation of digestive tract,
which lead to abdominal pain, severe diarrhoea, fatigue, weight
loss and malnourishment
2. It is a chronic inflammatory disease of the intestines, especially
the colon and ileum, associated with ulcers and fistulae.
• Most case involve the small bowel, particularly the terminal
ileum.

16. HISTORY
• 1806: first reported case of Crohn’s by Combe and Sanders to the
Royal college of Physicians in London England.
• 1913: Surgical evidence of the disease reported in the paper
‘Chronic intestinal enteritis’ written by Dr. Kennedy.
• Described in 1932 by Crohn, Ginsburg and oppenheimer of Mount
Sinai Hospital in New York

17. CLASSIFICATION OF CROHNS DISEASE
• On the bases of area of the gastrointestinal tract which it affects:

18. ON THE BASES OF BEHAVIOUR OF DISEASE AS IT PROGRESS
• Stricturing disease causes narrowing of the bowel which may lead
to bowel obstruction or changes in the caliber of the feces.

20. MONTREAL CLASS CLASSIFICATION

21. CAUSES OF CROHN’S DISEASE

22. GENETICS
• The disease runs in families then 30 times more likely to develop
CD, particularly if a first degree relative has the disease.
• Mutations in the NOD2 /CARD15 gene are associated with
Crohn's disease.
• Anomalies in the XBP1 gene have recently been identified as a
factor, pointing towards a role for the unfolded protein response
pathway of the endoplasmic reticulum in inflammatory bowel
diseases

23. IMMUNE SYSTEM
• Crohn's disease is thought to be an autoimmune disease, with
inflammation stimulated by an over-active Th1 cytokine response.
• Recent gene to be implicated in Crohn's disease is ATG16L1, which may
induce autophagy and hinder the body's ability to attack invasive
bacteria

24. ENVIROMENTAL FACTORS
• Smoking has been shown to increase the risk of the return of
active disease, or "flares".
• Hormonal contraception is also linked with a dramatic increase in
the incidence rate of Crohn's disease.

25. MICROBES
• Mycobacterium avium subspecies paratuberculosis (MAP),
• Yersinia spp and Listeria spp contribute to Crohn’s disease.

26. PSYCHOLOGICAL CONDITIONS
• ANXIETY
• DEPRESSION

27. 1.AGE: People with 15 to 30 year of the age followed by
those between 50 to 70 years of age.
2.Gender: Women and men tend to be equally affected,
 Others : Pesticides, Tobacco, Radiations, Steroidal
Therapy.

28. PATHOPHYSIOLOGY

29. Impaired handling of microbial antigen by the immune system
Mucosal breakdown and continuous exposure to bacterial antigens
Release of inflammatory mediators
Amplification of immune response
Dysregulated inflammatory and immune response in genetically susceptible persons
Etiological factors/ triggering factors

30. Complete GI obstruction
As the disease advances the bowel wall thickens and becomes fibrotic and the intestinal lumen narrows.
As the inflammation extends the muscle trophy also occur which cause fistulas, fissures and abscesses
Hence these clusters of ulcers tends to take on a classic ‘cobblestone’ appearance.
As the Ulcer lesions are not in contact with one another and are separated by normal tissue
Ulcer formation begins with edema and thickening of the mucosa
The disease process begins with edema and thickening of the mucosa

31. CLINICAL MANIFESTATIONS
• GASTROINTESTINAL SYMPTOMS
 Right and left lower quadrant
abdominal pain
 Diarrhoea unrelieved by
defecation.
 Intermittent tenesmus
 Rectal bleeding ( bleed may be
mild to sever)
Anorexia
 Vomiting
 Inability to empty bowels.
 Dehydration as well as
cramping.
 Leakage of stool
 Nutritional deficiency
 Steatorrhea
 The mouth may be affected
by non-healing sores
(aphthous ulcers).

32. SYSTEMIC SYSMPTOMS
 Weight loss
 Anaemia
 Growth retardation.
 Vitamins and mineral deficiency
 Abscesses, fistula and fissures are common so
manifestation may extend beyond GI
Arthrities,
 Skin lesions ( erythema nodulesum), ocular
disorders ( conjunctivitis) and oral ulcers too

33. DIAGNOSTICFINDINGS

34.  HEALTH HISTORY: History regarding age, family history, and
previous autoimmune disorders we can assess.
 Physical examination
 Abdominal X rays

35.  Ultrasounds
 MRI
 CT scans

36. PROCTOSIGMOIDOSCOPY

37. Barium Studies
Video capsular endoscopy
Endoscopy
Colonoscopy.

38. INTESTINAL BIOPSY :
(COBBLESTONE APPEARANCE)

39.  Testing for anti-Saccharomyces cerevisiae antibodies (ASCA) and
anti-neutrophil cytoplasmic antibodies (ANCA) has been
evaluated to identify inflammation of the intestine.
 Complete blood count
 ESR
 Albumin level.
 Gene test

40. MANAGEMENT
• Treatment for Crohn's disease is
only when symptoms are active and
involve first treating the acute
problem, then maintaining
remission
MEDICAL
MANAGEMENT
SURGICAL
MANAGEMENT
NUTRITION
MANAGEMENT
NURSING
MANAGEMENT

41. GOALS:
 To relieve symptoms
 To reduce the underlying cause
 To improve the health status of the individual.
 To achieve the Crohn’s free status of the client.
 To improve the patients functional status and quality of the life

42. MEDICAL MANAGEMENT:
• ANTI- INFLAMATORY DRUGS:
• anti-inflammatory drugs are the first step in the treatment of Cronh’s
disease and are appropriate for the majority of people with this
condition. These drugs include:
• 5-aminosalicylates [sulfazine which help to control moderate
symptoms]
• Corticosteroids [prednisone, hydrocortisone, methylprednisolone and
budesonide]

43. • >Immunomodulators such as azathioprine, mercaptopurine,
methotrexate, infliximab, adalimumab
• >Antibiotics: Metaclopramide
• >Antiemetic: Ondesterone
• >Antispasmodic: Buscopane
• >Anti diarrhoeal: Loperamide
• >Anti metabolite drug: Methotrexate

44. • >Non steroidal anti inflammatory drugs: Decrease pain, reduce
inflammation and reduce fever
• >Antibiotics: Broad spectrum antibiotics can be given
• >Omega 3 fatty acids
• >Multivitamins and folic acids
• >Iron supplements

45. SURGICAL MANAGEMENT
Proctocolectomy/Ileoanal anastomosis
Colostomy
Ileostomy
Strictureplasty and resection
•

46. STRICTUREPLASTY AND RESECTION

47. PROCTOCOLECTOMY/ILEOANAL ANASTOMOSIS

48. COLOSTOMY

49. ILEOSTOMY

50. NUTRITIONAL MANAGEMENT
• >Take pre-digested nutritional drinks to give bowel a rest and
replenish lost nutrients.
• >Limit caffeine, alcohol and sorbitol .
• >Limit gas-producing foods such as broccoli, cabbage,
cauliflower, brussels sprouts, dried peas ,lentils, onions, and
carbonated drinks.
• >Reduce fat intake if part of the intestines has been surgically
removed.
• >Studies found that fish oil and flax seed oil may be helpful in
managing .

51. • >Drink lots of fluid to keep body hydrated and prevent
constipation.
• >Take multivitamin-mineral supplement to replace lost nutrients
• >Eat a high fiber diet when CD is under control.
• >During a flare up, limit high fiber foods and follow a low fiber
diet.
• >Avoid lactose-containing foods if one has lactose intolerance or
use lactase enzymes and lactase pretreated foods.
• >Try small frequent meals.
• >Eating a high protein diet with lean meats, fish and eggs, may
help relieve symptoms of Crohn’s

52. NURSING MANAGEMENT

53. NURSING ASSESSMENT
 Health History
 Physical Examination
• NURSING DIAGNOSIS:
 Diarrhoea related to inflammation, irritation, or malabsorption of the bowel
 Risk for deficient fluid volume related to severe frequent diarrhoea, vomiting
 Anxiety related to change in health status
 Acute pain related to prolonged diarrhoea, hyperperistalsis
 Ineffective coping related to multiple stressors, situational crisis
 Imbalance nutrition less than body requirements related to altered absorption
of nutrition

54. NURSING INTERVENTION
 Limit dairy products: problems such as diarrhoea, abdominal
pain and gas improve by limiting or eliminating dairy products.
 Not drink carbonated drink
 Not eating high-fibre foods such as popcorn, nuts while you have
symptoms
 Eat small meals
 Drink plenty of liquids
 Talk to a dietitian; if begin to lose weight or diet has become
very limited.
 Use low fibre diet, lean protein, residue and calorie diet.
 Regular relaxation and breathing exercises.

55. COMPLICATIONS OF CROHN’S DISEASE
 Eye complications occur in about 5 percent of people with Crohn's
disease.
 These include: • Iritis (inflammation of the colored part of the eyes) •
Uveitis (inflammation of the middle layer of the eye) • Episcleritis
(inflammation of the white part of the eyes)

56.  Pyoderma gangrenosum is a painful ulcerating nodule.
 Clubbing, a deformity of the ends of the fingers, also be a result of
Crohn's disease

57. • Osteoporosis is a threat to people with Crohn's disease because of:
 Low calcium and vitamin D intake  Poor absorption of
nutrients in the body  The use of corticosteroids
 Toxic Megacolon
 Complete Bowel obstruction
•

58. RESEARCHOVERVIEW
A qualitative study of the impact of Crohn's disease from a patient's
perspective
• Jeanette Wilburn, James Twiss, Karen Kemp, and Stephen P
McKenna
• Published on May 2016
• Frontline Gastrentrology
• Objective
• To understand how the lives of people with Crohn's disease (CD) are
affected. Most research in CD has focused on symptoms and
functioning rather than on how these outcomes influence quality of
life (QoL).

59. • Design
• As part of a study to develop a CD-specific patient-reported outcome measure, qualitative interviews were
conducted with patients from Manchester Royal Infirmary to determine how CD affects QoL. The needs-
based model was adopted for the study. The interviews, which took the form of focused conversations
covering all aspects of the impact of CD and its treatment, were audio-recorded. Theoretical thematic
analysis of the transcripts identified needs affected by CD.
• Results
• Thirty patients (60% female) aged 25–68 years were interviewed. Participants had experienced CD for
between 2 and 40 years. Nearly 1300 statements relating to the impact of CD were identified. Thirteen main
need themes were identified: nutrition, hygiene, continence, freedom from infection, security, self-esteem,
role, attractiveness, relationships, intimacy, clear-mindedness, pleasure and autonomy.
• Conclusions
• The findings from the interviews indicate that CD has a major impact on need-fulfilment. Such issues should
be addressed in CD audit, clinical trials and when evaluating clinical practice