Introduction, anatomy of GI tract, definition, cause & risk factors, pathophysiology, types, clinical manifestations, diagnostic tests, medical management, surgical management and nursing management, complications of Regional Enteritis/Crohn's Disease.

1. SWATILEKHA DAS
(RN,MSN)

2. It can affect any area of the GI tract, from the
mouth to the anus, but it most commonly
affects the lower part of the small intestine.

4. Crohn’s disease is granulomatous
inflammation of terminal ileum and adjoining
colon, resulting in ulceration, stricturing,
fistula & abscess formation.

5. Exact cause is unknown.
 Familial
 Genetic disorders
 Environmental factors(Intestinal helminth
infection)
 Immunological disorders(due to
production of inflammatory cytokines,
interleukins, chemokines & TNF- α)
 Smoking –strong association
 Non-steroidal anti-inflammatory
drugs(NSAIDs)

7.  Colonic disease
 Perianal disease
 Small bowel disease
 Gastro duodenal Crohn’s disease

8. The symptoms may vary depending on the
severity & location of the disease.
 Crampy abdominal pain
 Fatigue
 Pain with passing stool(Tenesmus)
 Persistent watery diarrhea
 Fever
 Loss of appetite
 Unintentional weight loss
 General malaise

9. Other symptoms are –
 Consipation
 Eye inflammation
 Fistulas
 Fissures
 Abscess
 Mouth ulcer
 Rectal bleeding

11.  Thorough physical examination
 Blood tests to check for anemia, WBC count
 Stool test
 Barium x-ray
 Sigmoidoscopy/Colonoscopy
 Biopsy from the lesion

12. Depends on the severity & extent of the
disease.
A. PHARMACOLOGIC INTERVENTIONS-
1. Anti-inflammatory drugs-
• Mesalamine
• Sulfasalazine
• 5-ASA agents, such as Asacol, Dipentum, or
Pentase
2. Cortisone or steroids

13. 3. Immune system suppressors-
6- mercaptopurine/ Azathioprine
4. Infliximab(Remicade)
5. Antibiotics
6. Anti-Diarrheals- Diphenoxylate,
Loperamide, Codeine
7. Fluid replacement- treat dehydrated patients
with fluids & electrolytes.

14.  High protein, high calorie diet is given by oral or
parenteral route.
 Plasma & blood transfusions are given for anemia &
hypoproteinaemia.
 Low fat diet or milk free diet improves lactose
deficiency or malabsorption.
 Low residue or high fibre diet is also supplemented to
reduce colics.
 Supplementation of iron, folic acid, calcium, vitamin
D, electrolytes whenever deficiency occurs.
 Total parenteral nutrition (TPN) has been
demonstrated to be effective in controlling the disease
actively & complications of crohn’s disease.

15.  Surgery to remove a damaged portion of GI
tract or to close fistulas or remove scar
tissue.

16.  Surgical procedures include resection of the
affected area with anastomosis, colectomy
with ileostomy, or colectomy with ileorectal
anastomosis, depending on the area of bowel
involved.

17. COLECTOMY WITH ILEOSTOMY

18. COLECTOMY WITH ILEORECTAL ANASTOMOSIS

19.  Diarrhea related to inflammatory bowel disease
 Impaired nutrition less than body requirements related
to anorexia & malabsorption
 Fluid volume deficit related to anorexia, nausea, diarrhea
 Acute pain related to increased peristalsis & cramping
 Impaired skin integrity related to frequent loose stools
 Ineffective coping related to repeated episodes of
diarrhea

20.  Intestinal obstruction
 Peritonitis
 Fistula formation( Enterovesical fistula,
enterovaginal fistula)
 Extraintestinal manifestations(Arthritis,uveitis)
 Slight increased risk of development of
carcinoma of the colon