Crohn’s Disease: Pathology, Treatment, and Nursing Implications

Abstract

Crohn’s disease is an inflammatory bowel disease that is characterized by inflammation in the intestinal walls. Though the causes of the disease are unknown, clinicians increasingly support the perspective that Crohn’s disease is an autoimmune disorder. This assessment has been made because of the observed connection between deficiencies in the immune system and the inflammation of intestinal tissues, which results in the onset of the disease. Because Crohn’s disease is genetic, its prevalence is concentrated among certain ethnic groups. Specifically, the disease occurs at higher rates within the Jewish American community. Further, while individuals of either gender or any age can obtain the disease, Crohn’s is slightly more likely to develop in men and youth.

Because the cause of Crohn’s is unknown, there is no cure for the disease. However, patients who are diagnosed with the disease can be treated through pharmaceutical treatments that reduce intestinal inflammation. This paper will be used to describe Crohn’s disease, discuss the treatment options for this disease, and explain the role of nurse practitioners in recognizing symptoms of the disease and treating patients with the disease.

Physiologic Problems

Crohn’s disease is a form of inflammatory bowel disease that consists of a noncontiguous, periodic inflammation of the intestinal wall. According to Nursing Central, a professional online resource for nurse practitioners, Crohn’s disease is an acute form of inflammatory bowel disease, with deep ulcers and fissures developing primarily along the terminal ileum; yet, formations can be found along the whole intestine (Nursing Central, 2013). In the United States, it is estimated that there are 7 cases of Crohn’s disease for every 100,000 people; further, this rate has increased over the past decade (2013).

There are ethnic associations with this disease. According to an overview of Crohn’s disease by the U.S. National Library of Medicine, genetics plays a determining role in one’s likelihood of obtaining the disease (Crohn’s Disease, 2012). Thus, individuals of Jewish descent are at a higher risk of having the disease passed on to them through their parents (2012). As Nursing Central elaborates, the Jewish population possesses two to four times the prevalence of Crohn’s disease than the general population, and African Americans and Asian Americans are least susceptible to the disease (Nursing Central, 2013).

Further, there are gender and age associations with the disease. While Crohn’s disease can affect both men and women, men possess slightly higher rates of the disease (2013). Also, while it is important to keep in mind that the disease can impact patients of any age, the age of diagnosis for the disease is between the ages of 15 and 30 (2013). Yet, while Crohn’s disease is often associated with younger individuals, it is necessary to screen older patients for the disease as well. As Nursing Central asserts, aspects of the aging process, such as vulnerability to infections and reduced blood supply to the bowel, are potential contributors to a trend of increased Crohn’s disease diagnoses in patients above the age of 55 (2013).

What distinguishes Crohn’s from many other diseases is that its cause has not been identified by research (2013). Factors including bacteria, an autoimmune response, and environmental aggravators have been attributed as causes of the disease (2013). During the pathology, these factors will be discussed further.

Pathophysiology

Though the effects of Crohn’s disease are evident, clinicians dispute the cause of Crohn’s disease. As Vinh and Behr (2013) assert, observations of Crohn’s disease revealed that there were no microorganisms in the proximity of inflamed sites that caused the disease. Because of the growing body of evidence that points to immune system responses, rather than viral or bacterial infections, as the cause of inflammation there is wider support for viewing Crohn’s primarily as an autoimmune condition.

Yet, despite a dispute over the causes, the physiological effects of Crohn’s disease are well documented by researchers. Crohn’s disease occurs when the immune system attacks and degrades tissues, resulting in inflammation of the gastrointestinal tract (Crohn’s Disease, 2012). The extent of the inflammation suffered by the patient can be far-reaching and can affect the small intestine, the large intestine, the rectum, or the mouth (2012). The pathology of this disease can further be understood by examining its effects on the gastrointestinal tract.

Speaking to the scope and importance of the gastrointestinal tract, the inflammation caused by Crohn’s disease can cause a variety of intestinal problems, including obstruction, fistulae, and abscesses (Mazal, 2014). Because a large percentage of the body’s mucosal lymphoid tissue is located within the gastrointestinal tract, the adverse effects of an autoimmune response on the intestinal tissues especially heighten the risk of Crohn’s disease (2014). Resulting from inflammation in the intestines, the lumen in a patient with Crohn’s can be narrowed by adhesions, which in turn blocks the passage of antigens and other chemicals that are necessary for the healthy functioning of the intestines (2014). The onset of Crohn’s disease occurs when the mucosal functions become impaired and hinder the response of the lymphoid cells in the intestine (2014).

There are secondary conditions that can emerge in patients with this disease. In addition to obstructions in the intestines, fistulae can appear in several areas, including two loops of bowel, between the bowel and the bladder, between the bowel and the vagina, and between the bowel and the skin (Mazal, 2014; Crohn’s Disease, 2012). The abdomen is a secondary site where abscessing can occur in a patient who possesses Crohn’s disease (Mazal, 2014). Additionally’ the manifestation of the disease in the small intestine can increase the risk for developing colon cancer (2014).

There are several symptoms that manifest from the inflammation suffered by a Crohn’s disease patient. Based on the malfunctioning of the intestines, nutrients are improperly absorbed, which causes the following symptoms: diarrhea, malnutrition, fatigue, abdominal pain, cramping, blood in the stool, ulcers, appetite, and weight loss - although there is a high incidence of obese individuals diagnosed with Crohn's Disease (Crohn’s Disease, 2012). Additional indicators of Crohn’s disease are skip lesions, mucosal inflammation, abscess, giant cells, mucosal damage, atypical branching of the crypts and metaplasia (2012). In severe cases, Crohn’s sufferers may also experience fatigue, fever, arthritis, inflammation of the eyes and skin disorders (2012).

A physical examination enables clinicians to investigate symptoms in a patient who is expected to have the disease. Yet, to understand what clinicians must look for in their physical examination, it is necessary to consider the symptoms that manifest from the disease. First, the inflammation causes parts of the intestine to secrete large amounts of water and salt (Mazal, 2014). Thus, as the intestinal contents pass through the inflamed areas, the intestinal linings become irritated, which then causes bleeding resulting in high levels of pain for the Crohn’s disease sufferer (2014). Through examination, a practitioner can determine whether the discomfort caused by these symptoms are caused by Crohn’s disease. A colonoscopy is an effective method of detecting these symptoms and, thus, is necessary to confirm a Crohn’s disease (Nursing Central, 2013). Further, through a colonoscopy, clinicians can obtain an accurate diagnosis by identifying inflammation, which spans the entire depth of the intestinal wall (2013).

Treatment

Since the cause of Crohn’s disease is unknown, prevention options are limited. Because of the genetic basis of the disease, increased screening among at-risk populations can enable early detection of the disease when symptoms are present (Crohn’s Disease, 2012). Yet, the best course of action is to reduce the severity of the disease once it has been diagnosed (Baran & Karaca, 2013). Smokers are cautioned to quit smoking since smoking exacerbates the disease. Eating small meals, a healthy diet, regular exercise and plenty of sleep help to reduce the symptoms (2013).

Nurse practitioners should especially there is no cure for Crohn’s disease, rather the symptoms of the disease can be treated and controlled. Thus, the goal of treatment is to assess the severity of the disease, minimize the impact of the disease, and attain remission (2013). Pharmacological treatments that reduce mucosal inflammation are the primary method of treating Crohn’s disease (2013). Further, increasing evidence supports immunosuppressive strategies that are applicable to autoimmune disease (2013).

In addition to treatments that aim at reducing inflammation, patients can also pursue treatment for secondary symptoms of the disease. For example, surgical procedures can be utilized to remove intestinal obstructions and abdominal abscesses (2013). Specific surgeries that can be performed to treat Crohn’s disease or its secondary symptoms include ileostomy, large or small bowel resection, total adnominal colectomy, and total proctocolectomy (Crohn’s Disease, 2012). Overall, treatment for the disease serves the goals of directly treating the disease, reducing symptoms of the disease, and reducing discomfort for the patient.

Nursing considerations

All of this is important for nurses to keep in mind because they have a direct role in managing and monitoring the symptoms of patients. A nurse practitioner has daily contact with patients and possesses the ability to evaluate patients who possess the discussed symptoms of Crohn’s disease and refer them for additional evaluation. Symptoms that seem unrelated, such as anorexia, diarrhea, or improper intestinal functioning can all be indicative of Crohn’s disease. Further, by possessing an understanding of which populations are at-risk and the secondary symptoms that are present in patients with this disease, nurses can make apt observations that enable them to make a diagnosis.

This survey also provides critical information for treating patients who are diagnosed with Crohn’s disease. The nurse practitioner has the ability to perform routine functions that manage the symptoms of the disease. First, nurse practitioners can oversee the nutritional intake of patients, advise patients on the dangers of smoking, and oversee the management of medications that are administered to the patient. Additionally, understanding the physical effects of the disease enables a nurse practitioner to remain sensitive to pain management. Through these considerations, a nurse practitioner can play a critical role in minimizing the symptoms of the disease while aiding the patient in attaining remission.

Conclusion

While Crohn’s disease can affect people of any age, gender, and ethnicity, the prevalence of this disease is currently concentrated in a select population. As this assessment revealed, Jewish Americans, men, and youth between the ages of 15 and 30 are especially at risk for the disease. Yet because increased incidents are occurring in individuals outside of these groups, health care professionals must be vigilant in monitoring patients for this disease. Crohn’s disease is caused when an autoimmune deficiency enables excessive inflammation to take place in the intestines. As a result, several other painful conditions, such as ulceration, stomach discomfort, fatigue, and abdominal pains can ensue.

Because the exact cause of Crohn’s is unknown, there are no cures for this disease. However, through pharmacological treatments that reduce inflammation in the intestines, patients can attain remission and alleviate the symptoms of the disease. Further, surgery can correct unpleasant symptoms and secondary ailments that result from this disease. A nurse practitioner plays a critical role in assessing the symptoms of Crohn’s disease and aiding patients in their treatment. By recognizing the symptoms of the disease, understanding the discomfort that the patient experiences, and understanding the patient’s treatment options, a nurse practitioner can assist patients in recovering from the symptoms of this disease.

References

Baran, B., & Karaca, C. (2013). Practical medical management of Crohn’s disease. ISRN Gastroenterology. doi: 10.1155/2013/208073

Crohn’s disease. (2012). PubMed Health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001295

Mazal, J. (2014). Crohn’s disease: Pathophysiology, diagnosis, and treatment. Radiologic Technology, 85(3), 297-316. PubMed. Retrieved March 2, 2014 from http://www.ncbi.nlm.nih.gov

Nursing Central. (2013). Crohn’s disease. Unbound Medicine. Retrieved March 2, 2014, from unboundmedicine.com: http://nursing.unboundmedicine.com/nursingcentral/ub/view/Diseases-and-Disorders/73564/all/crohn%27s_disease

Vinh, D.C., Behr. M.A. (2013). Crohn’s as an immune deficiency: From apparent paradox to evolving paradigm. Expert Review of Clinical Immunology, 9(1), 17-30. doi: 10.1586/eci.12.87