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

• 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

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.

-> 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.

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

  
  

• 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