Gastrointestinal Nursing.pdf

The Large Intestine 93FistulaeThe transmural inflammatory nature of Crohn’s disease predisposes to theformation of a fistula. The presence of fistulae is usually indicative of activedisease and this complication may respond to the medical treatment thatis aimed at the Crohn’s disease. Enterocutaneous fistulae commonly occurafter the incision and drainage of a local abscess and may follow surgery.Spontaneous enterocutaneous fistulae are rare, but can arise in associationwith recurrent disease.Entero-enteric fistulae usually occur between adjacent loops of small bowel.They do not usually cause specific symptoms and therefore do not affectclinical management, which is determined by the nature and severity of theunderlying disease. Entero-enteric fistulae may occasionally give rise to blindloop syndrome and malabsorption.HaemorrhageMassive haemorrhage is a rare but important complication of Crohn’s disease.It may occur from ulcers proximal to a tight stricture, owing to erosion of amajor artery.Management of Crohn’s diseaseThe treatment of Crohn’s disease encompasses a multi-disciplinary approachincluding drug therapy, dietary manipulation, replacement of nutritional deficitsand surgery. An holistic approach involving psychosocial aspects is importantin improving quality of life and this is addressed in detail in this study.Drug therapyDrugs used in the treatment of Crohn’s disease can be broadly grouped intoanti-inflammatory compounds, drugs that may act by affecting immuneresponses, anti-bacterial drugs and symptomatic treatments.Anti-inflammatory drugsSulphasalazineSulphasalazine has been widely used in the medical therapy of Crohn’s disease.Unfortunately, sulphasalazine is less than ideal as many patients sufferside-effects (abdominal discomfort, nausea, vomiting and headache). Todaythere are newer aminosalicylates, particularly Pentasa ® , which are released inthe ileum as well as the colon and that may have some value in preventingrelapse of small bowel disease.CorticosteroidsThe main role of corticosteroids in the medical mangement of Crohn’sdisease is to suppress acute inflammation of the gut. Currently hydrocortisone,