Regional enteritis treatment (Crohns disease)

Regional enteritis (Crohns disease treatment)

CROHNS DISEASE TREATMENT (REGIONAL ENTERITIS)

Regional enteritis (Crohns disease treatment)

Regional enteritis(Crohns disease) is a Chronic idiopathic inflammatory disease that can affect any part of the GIT, usually the small and large intestines. The disease is more prevalent in adults (age:20-40).

Cause

The exact cause is unknown, but its multifactorial with the following factors:

  1. Genetic predisposition (familiar)
  2. viral or bacterial infection.
  3. Immunologic inbalance
  4. Defect in the intestinal barrier
  5. Defect in the intestinal barrier.
  6. Dysfunctional repair of mucosal injury.
  7. Cigarette smoking
  8. Dietary and environment factors (chemical additives, milk products, heavy, metal, low fiber).

"Regional enteritis (Crohns disease treatment)"

Pathophysiolgy

In Crohn's disease lymph nodes enlarge and lymph flow in the sub - mucosa of the GIT is blocked, lymphatic obstruction cause oedema, mucosal ulceration, fissures, abscesses and granulomas. the mucosal ulceratous are called skipping lesion because they are not continues. Elevated patches of closely packed lymph follicles called peyer's patches develop on the living of the small intestine. Fibrosis occurs, thickening of the bowl wall and causing stenosis or narrowing of the lumen. Inflammation of the serous membrane develops and the disease parts of the bowl become thicker, narrower and shorter.

Clinical Manifestation

- Crampy pain at the right lower quadrant

- Chronic Diarrhea

- Fever/chills

- Faecal urgency

- Malaise

- Weight loss

- Nausea and vomiting

- Bloody Stools

- Steatorrhea

 

"Regional enteritis (Crohns disease treatment)"

 

Diagnosis Evaluation

  1. Faecal occult test shows minute amounts of blood in stools
  2. Abdominal X-ray shows irregular mucosa, ulceration and suffering.
  3. Sigmoidoscopy and colonoscopy show patchy area of inflammation which helps rule out ulceration colitis.
  4. Increased WBC count ESR.
  5. Biopsy reveals granulomas, infiltrated lymphocytes and monocytes.
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Management

The treatment requires drug therapy, Lifestyle change and sometimes surgery. During acute attacks, maintain fluid and electrocytes balance is the key. Debilitated patients need total parental nutrition to provide adequate calories and nutrition while resting the bowl.

Drugs

- Corticosteroid such as. Prednisone to reduce diarrhea, pain bleeding by decreasing inflammation.

- Immuno-suppressants, such as azathioprine, suppress the body's response to antigens.

- Sulfasalazin reduces inflammation.

- Metronidazole to manage perianal complications.

- Antibiotics to combat infection.

- Narcotics to control pain.

- Anti-spasmodic for treatment of abdominal pain.

Surgery includes colostomy with lleostomy in patients with extensive disease of the large intestine and rectum.

 

"Regional enteritis (Crohns disease treatment)"

 

Nursing Management

- Admission: patient is admitted in a calm environment while adequate rest is encouraged to reduce pain and to conserve energy.

- Check vital signs routinely, and weight patient daily.

- Diet and fluid encourage diet low in residue, fibre and fat and high in calories, protein and carbohydrates with vitamin and mineral supplements. Provide small, frequent feeding to prevent distention and Place patient on TPN if debilitated, Provide fluid as prescribed to maintain hydration and monitor weight daily.

- Psychological care, offer understanding, concern and encouragement and facilitate

supportive Psychological counseling.

- Administer medication as prescribed.

- Physical care: caring out bed bath on patient who are debilitated, Assist in ADLs to promote cleanliness.

- Patient Education: Encourage regular follow up, instruct on all prescribed medication patient to participate in stress reducing activities of exercise, relaxation technique and music therapy.

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"Regional enteritis (Crohns disease treatment)"

Nursing Diagnosis

  1. Impaired nutrition less than body requirements related to nausea and malabsorption evidence by weight loss.
  2. Fluid volume deficit related to diarrhea.

iii. Pain related to inflammation process evidence by patient complain.

  1. Ineffective coping related to feeding of rejection and embarrassment.

Complication

- Abscess
- Fistula

- Stricture

- Bowl perforation

- Hemorrhage

- intestinal obstruction

- Peritonitis

- Colorectal cancer

- Malabsorption.

"Regional enteritis (Crohns disease treatment)"

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