Nursing alert Monitor for failure to thrive and aspiration during and after
feedings.Crohn Disease
What Went Wrong?
Crohn disease is the inflammation of any portion of the GI tract. The majority
of cases involve the small and large intestine, often in the right lower quad-
rant at the point where the terminal ileum and the ascending colon meet.
Patients typically have an insidious onset of intermittent symptoms. The disease
causes transmural inflammation, going deeper than the superficial mucosal layer of
the tissue to affect all layers. Over time the inflammatory changes within the GI
tract can lead to strictures or the formation of fistulas. The affected tissue develops
granulomas and takes on a mottled appearance interspersed with normal tissue.
There is a genetic predisposition and a bimodal peak of onset. Crohn dis-
ease is a chronic disorder with periods of exacerbation and remission. Many
patients ultimately need surgery to deal with bowel obstruction, development
of strictures, or fistula formation.Nursing alert Healed lesions can lead to strictures.Signs and Symptoms
Fever
Right lower quadrant pain
Diarrhea (nonbloody)
Abdominal mass
Weight loss (unintentional)
Fatigue
Bloating after meals
Abdominal cramping due to spasm
Borborygmi:Loud, frequent bowel sounds
Aphthous ulcers (oral ulcerations)Test Results
Erythrocyte sedimentation rate: Elevated during exacerbations.
Blood count: Decreased hemoglobin level (anemia) due to both vitamin
B 12 and folic acid deficiency.
Serum: Decreased albumin level.
Blood chemistry: Abnormal due to loss from diarrhea and malabsorption.
Barium studies: Show “apple core” in area of stricture formation, nar-
rowing due to inflammation, and fistula formation.CHAPTER 11/ Gastrointestinal Conditions^237