CARE OF CLIENTS WITH IMMUNOLOGIC RESPONSENCM-104

Crohn's disease(Regional Enteritis)

Regional enteritis is a subacute and chronic inflammation of the gastrointestinal (GI) tract wall that extends through all layers. Crohn’s disease is usually first diagnosed in adolescents or young adults but can appear at any time of life. Although the most common areas in which it is found are the distal ileum and colon, it can occur anywhere along the GI tract. Fistulas, fissures, and abscesses form as the inflammation extends into the peritoneum. In advanced cases, the intestinal mucosa has a cobblestone like appearance. As the disease advances, the bowel wall thickens and becomes fibrotic and the intestinal lumen narrows. The clinical course and symptoms vary. In some patients, periods of remission and exacerbation occur, but in others, the disease follows a fulminating course.

Clinical Manifestations •Onset of symptoms is usually insidious, with prominent right lower quadrant abdominal pain and diarrhea unrelieved by defecation.•Abdominal tenderness and spasm.•Crampy pains occur after meals; the patient tends to limit intake, causing weight loss, malnutrition, and secondary anemia.•Chronic diarrhea may occur, resulting in a patient who is uncomfortable and is thin and emaciated from inadequate food intake and constant fluid loss. The inflamed intestine may perforate and form intra-abdominal and anal abscesses.•Fever and leukocytosis occur.•Abscesses, fistulas, and fissures are common.•Symptoms extend beyond the GI tract to include joint disorders (eg, arthritis), skin lesions (eg, erythema nodosum), ocular disorders (eg, conjunctivitis), and oral ulcers.

ASSESSMENT AND DIAGNOSTIC METHODS

Barium study of the upper GI tract is the most conclusive diagnostic aid; shows the classic “string sign” of the terminal ileum (constriction of a segment of intestine) as well as cobblestone appearance, fistulas, and fissures.

Endoscopy, colonoscopy, and intestinal biopsies may be used to confirm the diagnosis. R

Proctosigmoidoscopic examination, computed tomography (CT) scan. Stool examination for occult blood and steatorrhea. Complete blood cell count (decreased Hgb and Hct), sedimentation rate

(elevated), albumin, and protein levels (usually decreased due to malnutrition).

Medical Management See “Medical Management” under “Ulcerative Colitis” for additional information.

Nursing Management See “Nursing Process: The Patient with Inflammatory Bowel Disease” under “Ulcerative Colitis” for additional information.

JEZALYN T. BRUSOLABSN-3A