 Welcome to Nursing School Explained and this video on Crohn's disease. Now Crohn's disease is one of the two inflammatory bowel disorders and is similar but very different from all sorts of colitis. So this video will only focus on Crohn's disease. While both inflammatory bowel disorders are outer immune disorders, the Crohn's disease involves any part of the GI tract but most commonly is located in the distal ileum and it usually involves inflammation that is trans-mural meaning that it goes through the entire wall of the GI tract so it's not very not just superficial and there are usually episodes of exacerbation and remission in patients and there are certain risk factors so environmental risk factors are for example diet, pollution as well as smoking and then genetics play a role in these inflammatory bowel disorders as well as in any other immune diseases and then other immune diseases put patients at higher risk for developing Crohn's disease as well as diets that is high in meat and high in fat is also not good for patients with Crohn's disease. Now signs and symptoms many times include inflammation of the GI tract. Many times patients will have diarrhea, abdominal pain and cramps but they might also because of this widespread inflammation develop fever and then because there is malabsorption that might need to malnutrition they might also have some weight loss and then there might be recto bleeding however it's typically not as significant as in ulcerative colitis and then patients will be fatigued from this widespread inflammation. For diagnostic criteria on a CBC the patient many times will show iron deficiency anemia as well as on a CMP usually there can be electrolyte imbalances and because of the malabsorption of malnutrition that we see many times of human levels will be low in patients with Crohn's disease. Inflammatory markers ESR and CRP are going to be elevated sometimes we need stool cultures just to make sure there's no underlying infectious disease or process going on that's causing the patient symptoms. There might be a barium enema bowel series that basically allows us to highlight areas of the digestive tract and then see where this inflammation is located. Patients might also receive ultrasounds, CAT scans as well as MRIs and then a colonoscopy to visualize the inside of the digestive tract and a very simple test a hemo-cult can determine if there's active recto bleeding in patients with Crohn's disease. Now this complications from Crohn's disease are many and really it depends on how long the patient has had Crohn's disease and also how severe their symptoms are and how many exacerbations they've had. So there can be a perianal abscess and fistula and fistulas are an abnormal opening between two different body systems or organs. So over here I've drawn out the colon and then the bladder right here so a fistula would be an abnormal opening between the bladder and the bowel because typically they are contained in either the bladder or the colon. But because we have this transmural inflammation and the effect of the Crohn's disease through the entire layer of the colon wall basically the inflammation will kind of eat through the colon wall and then could eat into the bladder and so now we have this abnormal opening. So then what happens we could have urine excreted through the rectum and stool excreted through the urethra. So that can be a very telltale sign that there's a fistula and a urinary colon fistula is not unfortunately is not uncommon in patients with Crohn's disease and this can involve any other organ so in women it can be a fistula between the uterus and the colon or any other organs that you can think of in that general digestive area. Now because of the widespread inflammation it can also lead to strictures which now there's a lot of inflammation causing narrowing of the digestive tract and then the stool can't pass through and it could lead to a bowel obstruction. It can also because there's all this inflammation this transmural inflammation it can not only can cause the fistula to form but it can also cause perforation. So basically just the wall of the colon of the digestive tract just bursts and then digestive products could escape into the peritoneal cavity leading to peritoneitis which is a very significant complication. Crohn's disease also increases the risk of cancer of the digestive tract that can be hemorrhaged because we have now there's some bleeding that can lead to anemia. It can lead to a toxic mega colon which is basically this abnormal dilation. So if we have the stricture here stool would be backing up and then this proximal end of the colon here could be very dilated and then really lead to a perforation as well and then certainly as with if you imagine the digestive tract is very inflamed it's the digestive tract is not going to be able to be work to work appropriately and do its job of absorbing all the nutrients so now we have nutritional deficiencies and those are many times fat and fat soluble vitamins as well as B12 deficiencies. For treatment it is an autoimmune disorder so unfortunately there's typically no cure but the goal is to manage and decrease exacerbations. So first and foremost always we have to educate our patients to consume an adequate diet that is or maybe even eliminates meat and is low in fat and we also have to make sure that they get adequate nutrition because of the smell absorption that happens because of the involvement of the different parts of the GI tract they are at risk for not being able to absorb all the important nutrients vitamins and minerals and then we can also decrease environmental factors and those that I mentioned are smoking or pollution and those kind of things and then there are five different types of medications that are used in the treatment of Crohn's disease and really everything but number two here has to do with suppressing the immune system to manage the autoimmune disorder. So immunosuppressants, corticosteroids, five amino salicates and biologics and most likely you won't have to know the details because this is usually managed by a specialist the rheumatologist who manages patients on these different medications and they might even require a combination of several classes of medications. Now rest is going to be very important because of the risk for anemia and this widespread inflammation but when there are repeated episodes or now there are some major exacerbations that happen and we have to trans-mural involvement sometimes the patient will need a colactomy so partial removal of the colon which then will end up in short bowel syndrome because now the bowel has been shortened because of the removal and then again we're dealing with nutritional deficiencies because we just don't have the ability to absorb the nutrients. Many times patients will need total parenteral nutrition if there's total bowel risk needed or if they've had part of the colon removed or if they're having severe exacerbations because there are many times kept in PO because we want to just let the digestive tract rest so the inflammation can subside and the least thing that they want to do is send food through the digestive tract that might cause more inflammation just by the sheer force or friction that the food processing might cause on the colon. So thanks for watching this video on Crohn's disease. I also watched my other video on orthodive colitis which again is similar but different from Crohn's disease but those two make up the two inflammatory bowel disorders that are both autoimmune in cause. Please subscribe, give me a thumbs up if you've liked this video and I'll see you soon here on Nursing School Explained. Thanks for watching.