Regional Enteritis (Crohn's Disease, Granulomatous Ileitis or Ileocolitis)
- Regional enteritis is a subacute and chronic inflammation that extends through all layers of the bowel wall from the intestinal mucosa. It is characterized by periods of remissions and exacerbations.
- Regional enteritis commonly occurs in adolescents or young adults but can appear at any time of life.
- It is more common in women, and it occurs frequently in the older population (between the ages of 50 and 80).
- The most common areas are the distal ileum and colon.
- Crohn’s disease is seen two times more often in patients who smoke than in nonsmokers.
Clinical Manifestations
- Prominent lower right quadrant abdominal pain and diarrhea unrelieved by defecation.
- There is abdominal tenderness and spasm.
- Weight loss, malnutrition, and secondary anemia.
- Disrupted absorption causes chronic diarrhea and nutritional deficits. The result is a person who is thin and emaciated from inadequate food intake and constant fluid loss.
- In some patients, the inflamed intestine may perforate,leading to intra-abdominal and anal abscesses. Fever and leukocytosis occur.
- Chronic symptoms include diarrhea, abdominal pain, steatorrhea, anorexia, weight loss, and nutritional deficiencies.
- The clinical course and symptoms can vary; in some patients, periods of remission and exacerbation occur, but in others, the disease follows a fulminating course.
Complications
- Complications of regional enteritis include intestinal obstruction or stricture formation, perianal disease, fluid and electrolyte imbalances, malnutrition from malabsorption, and fistula and abscess formation.
- The most common type of small bowel fistula that results from regional enteritis is the enterocutaneous fistula.
- Abscesses can be the result of an internal fistula tract into an area that results in fluid accumulation and infection.
- Patients with regional enteritis are also at increased risk for colon cancer.
Nursing Diagnosis for Crohn's Disease / Regional Enteritis
- Chronic pain related to Irritable bowel, abdominal cramps and surgical response.
- Risk for fluid and electrolyte imbalance related to discharge of excessive vomiting.
- Risk for Imbalanced nutrition: less than body requirements related to the inadequate nutritional intake secondary to pain, stomach and intestinal discomfort.
- Risk for infection related to the post-surgical wounds.
- Anxiety related to the prognosis of the disease and surgical plans.
