Crohn Disease in Paediatric Patients Discussion Essay
The Disease Process for Crohn’s Disease
Crohn’s disease is among the common inflammatory bowel diseases characterized by chronic inflammation affecting the colon and the terminal ileum. The inflammation may also be present in other gastrointestinal parts. The prevalence of the disease among children and adolescents below the age of 20 has been on the rise, which affects their quality of life. An interplay between environmental and immunological factors in a genetically susceptible host has been associated with the disease’s development (Catto-Smith & Kansal, 2014). The disease pathogenesis involves tissue inflammation resulting from an unrestrainable immune response against luminal bacterial antigens. The immune cells involved in the inflammation include CD4 T-Cells, CD8 T-Cells, B-Cells, CD14 monocytes, and natural killers. Crohn Disease in Paediatric Patients Discussion Essay
Crohn’s disease process involves a dysregulated response by the mucosal immune system to the bacterial floral in the intestinal lumen. This results in an intestinal epithelial layer that is excessively permeable, which permits the entry of pathogens into the underlying mucosal layers. An autoimmune reaction is then triggered with subsequent persistent activation of immune cells. This results in the production of pro-inflammatory cytokines in the neutrophils, lymphocytes, and lymphoid tissues. The pro-inflammatory cytokines (TNF-α) and interleukins (ILs) carry on the inflammatory response. The inflammation is transmural, and granulomas may be seen on biopsies with discontinued disruption in the longitudinal axis (Catto-Smith & Kansal, 2014). In children, the disease is commonly present in the ileocolic region, with abdominal pain, diarrhea, and weight loss as the most common presenting symptoms. The implications of CD in pediatric patients are deleterious. Therefore, early diagnosis and treatment are critical in managing the disease. Crohn Disease in Paediatric Patients Discussion Essay
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Patient Teaching Plan Handout
What the Patient should know about the disease
What is Crohn’s disease
Crohn’s disease is a chronic inflammatory bowel disease. The disease is characterized by inflammation of the ileum with skipped lesions between the mouth and the anus. The situation is more common in the ileocolonic region than in the colon regions. However, the condition may also affect other gastrointestinal parts.
What are the signs and symptoms
Patients with other primary inflammatory bowel diseases, such as ulcerative colitis, may present several symptoms related to Crohn’s disease. Therefore, it is important to comprehensively understand the signs and symptoms related to Crohn’s disease. Patients experience abdominal pains, fatigue, persistent diarrhea, weight loss, delayed growth, and perianal disease, including abscesses near the anus (Petagna et al., 2020). Granulomas are also identified through biopsies in the inflammation areas. The condition also results in inadequate absorption of essential nutrients that may cause malnutrition, affecting growth and development. The condition can result in irreversible tissue damage with severe health outcomes if untreated. Crohn Disease in Paediatric Patients Discussion Essay
What causes the disease, and who is at risk
The disease affects both girls and boys below the age of 20. The main causes identified in the development of Crohn’s disease involve an interplay between genetic factors, environmental factors, and the immune system. Studies have shown that at least 20% of children with Crohn’s disease have a family history of the condition (Petagna et al., 2020). Another theory is that the disease may result from environmental antigens triggering inflammation as the immune system fights the identified antigen. Nonsteroidal anti-inflammatory diseases are also associated with bowel inflammation that worsens Crohn’s symptoms. Any child is at risk of developing Crohn’s disease. However, those with a family history of CD and those exposed to environmental factors contributing to the disease development are at an increased risk. Crohn Disease in Paediatric Patients Discussion Essay
How is the disease diagnosed?
The doctor will rule out based on the physical examination and family history to establish the correct diagnosis. In addition, a combination of tests and procedures can be conducted on the Patient to confirm the diagnosis. Some tests which may be conducted on the child include;
- A colonoscopy is where the colon interior is examined using a camera mounted at the end of a lighted tube.
- Upper endoscopy involves a tube insertion through the mouth to the first part of the stomach when the child is under anesthesia.
- Capsule endoscopy is where the child swallows a capsule containing a camera that moves through the small intestine and takes pictures transmitted through a receiver belt.
Treatment of Crohn’s Disease
The main objective in treating Crohn’s disease is to decrease inflammation, promote remission and improve overall well-being, consequently preventing its related complications. According to Tun et al. (2018), the treatment approach may include pharmacological, diet change, or surgery, depending on the severity and specific special needs. Of the condition. Crohn Disease in Paediatric Patients Discussion Essay
Medication
- Steroids and immunosuppressants can be prescribed to reduce the disease progression, thus allowing intestinal tissues to heal and decrease symptoms flare-ups.
- Immunomodulatory treatments can also be prescribed, which help in decreasing inflammation and weakening the immune system. The medications are more effective if combined with biologic and immunosuppressive medications.
- Biological medications, including infliximab, help in blocking the inflammation response, thus reducing the inflammation process (Tun et al., 2018).
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Nutrition and Surgery
Specific foods are not associated with the development of Crohn’s disease. Eating healthy may aid in reducing the symptoms. A bowel resection may be conducted to reduce the disease portion in the bowel. The surgeon may need to connect both ends of the healthy bowel. Crohn Disease in Paediatric Patients Discussion Essay
Patient Education
- The Patient should take the medication as prescribed. Seek medical attention in case the patient has problems with the medication.
- Patients must avoid anti-inflammatory medications that may worsen the symptoms. Such medications include; aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve). In the case of other medications, it’s essential to consult with the doctor (Tun et al., 2018).
- The patient should avoid foods that may worsen the symptoms, including milk, foods with high-fiber, and spicy foods. Patient should eat a healthy diet which includes adequate amounts of fruits and vegetables, iron-enriched cereals, and adequate water icy foods.
- Seek immediate medical attention in case of severe vomiting, diarrhea, weight loss, fever, and blood in the stool.
Evaluation and Follow-up
Follow-up should be conducted after three to six weeks to evaluate the efficacy of the treatment option. The symptoms will have to reduce if the treatment is effective. If the drug causes severe side effects for the pharmacological approach, then changing the drug can be recommended. Crohn Disease in Paediatric Patients Discussion Essay
References
Catto-Smith, A., & Kansal, S. (2014). Pediatric crohn’s disease: Epidemiology and emerging treatment options. Pediatric Health, Medicine and Therapeutics, 59. https://doi.org/10.2147/phmt.s45509
Petagna, L., Antonelli, A., Ganini, C., Bellato, V., Campanelli, M., Divizia, A., Efrati, C., Franceschilli, M., Guida, A. M., Ingallinella, S., Montagnese, F., Sensi, B., Siragusa, L., & Sica, G. S. (2020). Pathophysiology of crohn’s disease inflammation and recurrence. Biology Direct, 15(1). https://doi.org/10.1186/s13062-020-00280-5
Tun, G. S. Z., Cripps, S., & Lobo, A. J. (2018). Crohn’s disease: Management in adults, children and young people – concise guidance. Clinical Medicine, 18(3), 231–236. https://doi.org/10.7861/clinmedicine.18-3-231
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