Nursing Continuing Education FYI
Focus: Ulcertative Colitis and Crohn's Disease
Chronic inflammatory disease of the large bowel is divided into two major entities-nonspecific ulcerative colitis & Crohn's disease of the large bowel (regional enteritis, granulomatous colitis). Both involve abdominal pain, diarrhea, and rectal bleeding. Crohn’s disease is one-fifth as common as ulcerative colitis in the US.
Crohn's disease is a nonspecific chronic transmural inflammatory dz that most commonly affects the distal ileum and colon but may also occur in any part of the GI tract from the mouth to the anus and perianal area. Chemicals and low-fiber diets of industrialized nations facilitate this onset of this disease. It occurs more commonly in Jewish people of Eastern European descdent and has familial tendencies. Most cases begin before age 40 and have peak incidence in the 20's.
The earliest macroscopic lesions of Crohn’s disease appear to be tiny focal "aphthoid" ulcerations of the mucosa, usually with underlying nodules of lymphoid tissue. The inflammation may regress or progress to involve all layers of the intestinal wall.
The transmural inflammation, deep ulcerations, edema, and fibrosis are responsible for obstruction, deep sinus tracts and fistulas and mesenteric abscesses. Chronic diarrhea associated with abdominal pain, fever, anorexia, weight loss, and a right lower quadrant mass or fullness are the most common presenting features. However, many patients are first seen with an "acute abdomen" simulating acute appendicitis or intestinal obstruction.
Ulcerative colitis, however, is usually a series of attacks of bloody diarrhea varying in intensity and duration interspersed with asymptomatic intervals. Onset of an attack may be acute and fulminant with sudden violent diarrhea, high fever, signs of peritonitis and profound toxemia.
Psychological aspects of ulcerative colitis play a secondary role in attack onset. The initial pathologic lesion is confined to the mucosal layer and consists of abscess formation in the crypts, as opposed to Crohn’s disease, which involves the entire thickness of the bowel wall. Ulcerative colitis reveals a friable and intensely inflamed mucosa with exudate. Usually, the rectosigmoid area of the colon is involved. The disease may extend from this area but always in a continuous fashion, in contrast with Crohn’s disease, which tends to skip. Ulcerative colitis patients may have narrowing of the bowel lumen as a result of fibrosis, which is generally mild compared to Crohn’s disase. Age onset differs. Ulcerative colitis peaks at 15-30 years and also 50-70 years of age.