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Definition

Crohn’s disease is a chronic immune-mediated inflammatory bowel disease that can affect anywhere from mouth to anus, most often the terminal ileum.

Features

• Patchy skip lesions involving the full thickness of the bowel wall
• Can cause strictures, fistulas and abscesses
• Versus ulcerative colitis: UC is continuous, starts at the rectum and affects only the inner lining

Symptoms

• Chronic diarrhoea and right lower abdominal pain
• Weight loss and fatigue
• Perianal disease and mouth ulcers
• B12 deficiency from ileal involvement

Diagnosis

Colonoscopy with biopsy, CT or MR enterography, and faecal calprotectin.

Treatment

• Steroids for flares
• Immunomodulators such as azathioprine and methotrexate
• Biologics such as anti-TNF agents
• Surgery for complications

Nursing care

• Nutritional support and fluid replacement
• Watch for infection on immune drugs
• Stop smoking, which worsens Crohn’s

Exam point

Smoking worsens Crohn’s, whereas ulcerative colitis is noted to be commoner in non-smokers.