215 Nursing Assessment, Management and Treatment of Autoimmune Diseases
otics have been implicated in the devel- opment of inflammatory bowel disease (IBD). However, none of these types of as- sociations have been substantiated with large epidemiological studies (Feuerstein & Cheifetz, 2017). Cigarette smoking, the best-studied environmental risk factor, doubles the risk of developing Crohn’s disease. It is im- portant to note that the risk is increased in both current and former smokers (Feuer- stein & Cheifetz, 2017). | NURSING CONSIDERATION Family history may be linked to an in- creased risk for the development of Crohn’s disease. However, only 10% to 25% of patients with IBD have a first-degree relative with the disease. More than 200 genes have been asso - ciated with IBD development, making genetic specificity difficult (Feuerstein & Cheigetz, 2017). Diagnosis and treatment Diagnosis Various conditions can mimic Crohn’s disease. Examples of conditions that present with similar signs and symptoms include appendicitis, Behcet disease, and ulcerative colitis (Feuerstein & Cheifetz, 2017). The diagnosis of Crohn’s disease is made based on signs and symptoms and some diagnostic tests. It is important to know which part of the gastrointestinal tract is affected by the disease. Signs and symptoms may vary depending on what type of Crohn’s disease a patient has (Crohn’s & Colitis Foundation, 2021a) Types of Crohn’s disease based on affect- ed part of the gastrointestinal tract are
as follows (Crohn’s & Colitis Foundation, 2021a): ● Ileocolitis : Ileocolitis is the most common type of Crohn’s disease. It affects the terminal ileum and the colon. Symptoms associated with ileocolitis include cramps, diarrhea, and pain in the lower right abdominal quadrant. ● Ileitis : Ileitis affects only the ileum. Symptoms are the same as ileocolitis. If the disease is severe, complications may develop including fistulas or inflammatory abscesses in the right lower abdominal quadrant. ● Gastroduodenal Crohn’s disease : Gastroduodenal Crohn’s disease affects the stomach and the duodenum. Symptoms may include nausea, vomiting, loss of appetite, and weight loss. ● Jejunoileitis : Characterized by patchy areas of inflammation of the jejunum, jejunoileitis may cause mild to intense abdominal pain and cramps after meals, diarrhea, and fistulas that may form in severe cases or after lengthy periods of inflammation. ● Crohn’s (Granulomatous) colitis : Crohn’s colitis affects only the colon. Its symptoms may include diarrhea, rectal bleeding, and disease around the anus (e.g., abscess, fistulas, and ulcers). Skin lesions and joint pain are more common in this type of Crohn’s disease than others. Both types of IBD (Crohn’s disease and ul- cerative colitis) have similar symptoms but are not the same disease and affect dif- ferent areas of the gastrointestinal tract. Differences include the following (Crohn’s & Colitis Foundation, 2021a): ● Crohn’s disease : May affect any part of the gastrointestinal tract from
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