Anatomy and Physiology & Pathophysiology CROHN’S DISEASE Anatomy and Physiology & Pathophysiology

Definition Crohn’s disease, also known as crohn syndrome and regional entiritis, is a type of inflammation bowel disease that may affect an part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms, It primarily causes abdominal pain, diarrhea, vomiting or weight loss, but may also cause complication outside the gastrointestinal tract such as anemia, skin rashes, arthritis, inflammation of the eye ,tiredness and lack of concentration

Anatomy and Physiology of GI Tract

Mucosal Lining of the GI Tract

Pathophysiology Precipitating Factors Microbes Immune/Inflammatory Response NSAIDS Appendectomy Predisposing Factors Age Race/Ethnicity Genetic Environmental (Smoking, Diet, Lifestyle Pathophysiology Abnormal epithelial/mucosal barriers Increased ANTIGENS Uncontrolled Mucosal Inflammation Activation of Inflammatory Helper T Cells Release of Cytokinens TNF (Tumor Necrosis Factor) alpha Ulceration and Tissue/Bowel Injury Crohn”s (granulomatous) colitis Diarrhea Rectal bleeding Skin lesions Joint pains Ileocolitis Diarrhea & cramping/pain of abdomen Weight loss Ileitis Diarrhea & cramping/pain of abdomen Weight loss Gastroduodenal crohn’s disease Loss of appetite Weight loss Nausea & vomiting Jejunoileitis Mild to intense abdominal pain & cramps Diarrhea COMPLICATIONS Malabsorption of nutrients, Intestinal bleeding, Disease of Anus (Abscess ,fistula, ulcers), Bowel Obstruction, Perforation of Colon, massive distention/dilatation of colon, erythema, ulcerating skin, visual difficulties, uveitis, Increased risk of cancer

Inflamed Mucosal Lining of Intestine Cobblestones

Assessment Patient’s history and presenting sign and symptoms: 26 yrs old woman Abdominal pain Nausea Constipation alternating with periods of diarrhea. Pain in her joints skin lessions Tiredness Depression

Dietary history Eating fried foods and some fruits and vegetables worsen her condition. Nursing Diagnosis: 1. Imbalance Nutrition less than body requirement related to restricted nutrient intake

2. Acute pain related to increase peristalsis. 3 2. Acute pain related to increase peristalsis. 3. Anxiety to crisis situation and changes in health status. 4.Diarrhea related to effect of inflammatory changes of the bowel.

Planning Nutrition imbalance Acute pain In I week of nursing care patient able to demonstrate lifestyle changes to regain and maintain appropriate weight. In 1 week of nursing care patient able to demonstrate effective coping and able to participate the diet therapy.

Anxiety to crisis situation and changes in health status. Diarrhea In 1 week of nursing care patient able to determine the benefits of the diet therapy In 1 week of nursing care patient able to tell the changes of her health status based on restricted food intake. In 1 week of nursing care patient will report of reduction of frequency of stool.

Nursing intervention Weight daily Encourage bedrest Recommended rest before meal Provide oral hygiene Serve food in well-ventilated, pleasant surrounding, with unhurried atmosphere, congenital company.

Avoid limit foods that can cause abdominal pain. e Avoid limit foods that can cause abdominal pain.e.g milk product, high in fiber or fat and etc. Record intake and changes in symptomatology Promote patient participation in dietary planning as possible Resume/advance diet as indicated, e.g., clear liquids progressing to bland diet.

Acute pain Encourage patient to report pain Assess report of abdominal cramping or pain