Disorders of the Gastrointestinal System, 2nd Edition
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The exact cause of Crohn’s disease is unknown; however, a genetic link has been established. Recent research has shown that a mutation in the gene CARD15 (previously called NOD2 ) is cor- related with CD. This mutation has been identified in 27% of individuals with CD, significantly higher than in the general population (Ghazi, 2019). Another gene associated with the development of CD, especially in those with European Jewish genetic backgrounds, is IL23R . This gene is linked to the recognition of certain bac- teria and other microorganisms in the co- lon, and some mutations can cause the body to react inappropriately to stimuli (Ghazi, 2019). Smoking has been shown to increase the risk of Crohn’s disease (Rowe, 2020). Stress and particular foods may exacer- bate flares, but they do not cause CD to develop. Certain viral and bacterial in- fections have also been hypothesized to cause CD by causing the body to attack healthy tissue (Ghazi, 2019). Early symptoms of CD may be mistak- en for bowel obstruction or appendicitis, as symptoms often include a steady col- ic-like pain in the right lower abdomen, cramping, and tenderness. Other symp- toms may include weight loss, diarrhea, joint pain, weakness, bloody stools, fever, and a palpable mass in the right lower abdominal quadrant. Malnutrition may impede young patients’ physical devel- opment (Ghazi, 2019). Complications associated with Crohn’s disease include (Ghazi, 2019): ● Intestinal obstructions. ● Malnutrition. ● Fistulas, as the walls of the intestine, break down and leak fluids. ● Anal fissures, especially in patients with chronic constipation.
| NURSING CONSIDERATION
Malabsorption is common with Crohn’s disease, especially in those who have been chronically ill. Damage to the intestinal wall and constant inflamma - tion keeps the body from absorbing vital nutrients and can contribute to various nutrition-related symptoms and dehydration. This is especial- ly evident in patients whose Crohn’s disease affects their small intestines (Ghazi, 2019). A consultation with a nutritionist may help the patient to avoid weight loss and malnutrition. The number of cases of CD has steadily increased over the past 50 years, and it is estimated that about eight people out of every 100,000 develop the condition (Ghazi, 2019). It is most common among teens and adults between the ages of 15 and 35 and affects both men and women equally. It is less common in those with African American backgrounds; however, the disease is becoming more prevalent in individuals from many cultural, genetic, and ethnic backgrounds and nationalities (Ghazi, 2019). | NURSING CONSIDERATION The pattern of ulcerations in Crohn’s disease is not continuous throughout every part of the GI tract (skipping) compared to the continuous pattern of lesions found in ulcerative colitis. This characteristic helps to differenti- ate the two types of IBD (Peppercorn & Kane, 2022b).
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