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Class notes PNP Study Guide for Gould's Pathophysiology for the Health Professions
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Notes for nursing students about Lower Gastrointestinal Pathophysiology and Healing
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Disease Pathophysiology Etiology/Risk Factors Clinical Manifestation Diagnostic TestsCrohn’s Disease -Inflammation of the bowel wall -higher morbidity and *Varies according to location -Endoscopy and biopsy
-is a chronic, -begins with inflammation and mortality in older adults -diarrhea (usually nonbloody d/t (can use upper b/c
progressive crosses the intestinal wall to d/t to their other chronic inflammatory process or Crohn’s is from gum to
disorder with involve mucosa and serosa problems malabsorption) bum)
Unpredictable mucosal ulceration - transmural -mostly Jewish -abdo cramping + pain -CBC for anemia
periods of spread of inflammation leading -Fever intermittent -Barium studies to deter
recurrence and to lymphedema and thickening -severe weight loss the location and extent of
remission of bowel wall -malabsorption the disease
-affects any part of -‘skip lesions’ affected areas are -fatigue -Fecal occult: Testing stool
GI (from gum to separated by areas of normal As the disease progress for occult blood
bum) tissue -dehydration -CT and MRI, Xray
-commonly affect the terminal -electrolyte imbalance -colonoscopy
of ileum -anemia d/t lack of B12 absorption
-damage wall impair processing -def in folic acid and Vit D
and absorption of food -pain around the umbilicus and RLQ
-inflammation stimulates -possible perianal disease
intestinal motility
Complications
• Scar tissue from inflammation and ulcer = narrowing of lumen = strictures and obstruction
• Cutaneous fistulas: common in perianal area and recto-vaginal
o Loops of bowel, bladder or psoas muscle
• Systemic complications: Arthritis, liver disease, cholelithiasis
• Interreference with digestion and absorption leading to hypoproteinemia, malnutrition
• Delayed growth and sexual maturation
Drug Therapy
• Sulphasalazine (Salazopyrin): effective if the inflammation is only in LI
• Corticosteroid therapy: to reduce inflammation and suppressing disease
• Metronidazole (Flagyl): useful in treating in Crohn’s of perianal area
Nutritional Therapy
• Parenteral nutrient is given before and after surgery to promote wound healing, reduce complication and hasten recovery
o Is given to pt with severe fistula, or short bowel syndrome
• Milk and diary products are excluded because may not be adequately digested d/t inability if the damage intestinal mucosa to produce
sufficient lactase
• High-fat diets are poorly tolerated d/t loss of absorbing mucosa and altered bile salt metabolism and absorption
, • Cobalamin injection every month may be needed b/c of inability of terminal ileum to absorb vitamins
Surgical Therapy
• Only to severe and unresponsive pt with life-threatening complications
• Is not cured by surgery, the recurrence rate is high after surgery
• Conservative intestinal resection with anastomosis of healthy bowel is the go to
• Indications for surgery:
o Drainage of abdo abscess, fistulas, inability to decrease corticosteroids, intestinal obstruction, massive hemorrhage, perforation,
carcinoma
Nursing Management
• Pt with perianal fistulas or abscess may need special skin care
• Teaching include:
o importance of rest and diet management
o perianal care
o action and a/e of drugs
o symptoms of recurrence of disease
o when to seek medical care
o use stress management technique
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