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Similarities Between Crohn's and Ulcerative Colitis

Persistent Diarrhea

Abdominal pain/cramps

Fever

Weight LOSS - Malnutrition, more common with Crohns

Fluid imbalance (FVD)

Anemia

Blood from rectum

Joint, Skin, Eye irritation

Delayed Growth

Extraintestinal manifestations

Uveitis (eye inflammation)

Sclerosing cholangitis (inflammation of hepatic ducts)

Nephrolithiasis (renal stones)

Cholelithiasis (gallstones)

Joint, Skn, and Oral Ulcers

Unique to Crohns

Risk of cancer of small bowel

Mouth Ulcers

Stool (less severe diarrhea than UC)

5-6 soft, loose, NONBLOODY stool

Transmural - all layers affected

Non-uniform appearance

SKIP lesions

COBBLESTONE appearance

Fistulas more common

Strictures and adhesions are common

Nutritional deficiencies arise from an inability to absorb nutrients

Electrolyte Disturbances

Low Mg2+, K+, and Ca2+

Pain in RIGHT LOWER QUADRANT

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Malnourishment: if affects small intestine (site of nutrient absorption)

Fistula: abnormal tunnel forms between two body parts (worsening of abscess)

Obstruction: from severe swelling & formation of scar tissue

Perineal Abscess: pus around anus and rectum

Strictures: narrowing or constricting of the intestines

Electrolyte and Fluid Imbalance: diarrhea and malnourishment

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-> It is important for the patient to understand their condition in a way that is digestible for them. One way to say this is "Crohns disease is when your immune system starts attacking your intestines in random areas." Pictures and visuals might be helpful in teaching the patient about their condition.

-> Diet is an important patient teaching point. Certain foods might trigger flares, or make flares worse. Generally, high fat, grains, legumes, and caffeine should be avoided- especially during flare ups. Low fiber grains, fat free milk, lean meats, and soy milk should be encouraged. Intramuscular B12 and liquid vitamins might be indicated.

-> The patient should understand what types of medications they might be taking, side effects, and what they do. Common medications for those with Crohns include antidiarrheals, glucocorticoids, and amino salicylates.

-> Follow ups and annual colonoscopies are important to attend. It is vital that the patient attends their follow ups and colonoscopies to ensure there are no severe complications or worsening of the condition.

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A 55-year-old male patient is newly diagnosed with Crohn’s disease and is admitted to the Med-Surg unit for further management. The patient is experiencing abdominal pain, diarrhea, and fatigue. His medical history includes hypertension and hyperlipidemia. As the nurse, which of the following actions should be prioritized when caring for this patient during his hospitalization? (Select all that apply.)

A) Educating the patient about dietary restrictions and the potential need for nutritional supplements.
B) Assessing the patient for signs of dehydration, electrolyte imbalances, and fluid volume deficit.
C) Encouraging the patient to engage in physical activity to maintain muscle strength.
D) Administering prescribed antibiotics to prevent infections associated with Crohn’s disease.
E) Monitoring the patient for signs of complications such as bowel obstruction or perforation.
F) Providing emotional support to the patient and addressing concerns related to the chronic nature of the disease.

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Crohn's can affect any portion of the GI tract from the mouth to anus and affects all layers of the bowel

The exact cause of Crohn's is unknown but it has been linked to:

Genetic predisposition

Family history of IBD

Defects in immune regulation

Environmental conditions

Smoking, infections, meds: the body has an inappropriate response that leads to intestinal inflammation.

Crohn's is common among Jewish and Caucasian individuals

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String Sign = occurs when the small intestine becomes narrowed and inflamed, causing it to resemble a string (Stricture)

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Procedures

Colonoscopy

Differentiate between Crohn's and UC

In Crohn's

Mucosal Changes: Inflammation, stricture, fistula

Patchy Areas

Cobblestone appearance

Sigmoidoscopy

Looks at sigmoid colon

Barium Enema

Shows STRING SIGN (stricture)

Fissure, Fistulas, Narrowing

Imaging

Biopsy

Shows Granulomas

X-ray

Irregular mucosa

Uler & stiffening

CT

Thickened wall, strictures, dilation, abscess, fistulae

Endoscopic ultrasonography

Helps to differentiate between diesases

LABS

Fecal occult for blood

LOW Hbg & Hct (anemia)

Increased WBC (the body's immune system is actively fighting inflammation in the intestinal tract)

Increased Erythrocyte sedimentation & C-reactive protein (indicate an active inflammatory process)

Electrolytes

LOW

Magnesium

Potassium

Calcium

Albumin Low

Low B12 and Folic Acid

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NO CURE

Goal: symptom management

Medications

Sulfasalazine: decreases inflammation

Corticosteroids: decreases inflammation and immune response

Antibiotics: during flareups to prevent infection

Antimicrobials

Anti-diarrheals

Immunomodulators

Monthly B12 injections

Ileum can't absorb this nutrient

Liquid vitamins

Tablets are excreted intact due to frequent diarrhea

CAMs

Ex: turmeric, probiotics, acupuncture, exercise, etc

Psychosocial Management

Surgical Management

Daily weight, Is&Os, and fluid and electrolyte status

Encourage smaller frequent meals with family

Pain management, rest, and proper skin care