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

2. 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

3. Anatomy and Physiology of GI Tract

4. Mucosal Lining of the GI Tract

5. 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

6. Inflamed Mucosal Lining of Intestine
Cobblestones

7. 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

8. 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

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

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