Nursing Case Study on Crohn's Disease and Diverticulitis

This nursing case study discusses the symptoms, diagnosis, and treatment of Crohn's disease and diverticulitis. It explains the aetiology and pathophysiology of Crohn's disease and how it affects the digestive tract. The study also highlights the risk factors and diagnosis methods for both diseases. The patient's medical history and symptoms are evaluated to determine the most likely diagnosis. The study concludes with expert insights on the management of these chronic diseases.

Running head: NURSING CASE STUDY
Nursing Case Study
Name of the student
Name of the university
Author note

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Answer to question 1.
The patient Mr Bob Jackson is a 55 year old married man who have
two children. He lives in Patersons Plains of Melbourne and is a sheep
farmer. He has been admitted to the ED due to experiencing nausea,
malaise, diarrhoea and increasing Left Lower Quadrant (LLQ) abdominal
pain since one week. His surgical history and medical records points out
that the most likely chronic disease that fits Mr Jackson’s symptoms is
Crohn’s disease.
Aetiology:
Crohn’s disease is a chronic digestive tract inflammation that
spreads into the deeper layers of the gut tissues and affects the normal
digestion and bowel of the individuals. There are three major causes of
Crohn’s disease, which are as follows:
 Infection: Several environmental agents can cause this disease,
although it is not transmissible.
 Immuno-response: There are also chances of occurrence of the
disease due to an immune responses generated against any
antigens present in the gut. These are usually hypersensitive
response to the gut microflora (Cleynen et al., 2016). Changes in
these gut microbiome may result in Crohn’s disease.
 Vasculitis: There are also evidences of the gut mucosal ulceration
which results from the ischaemic condition generated due to
vasculitis of the submucosal vessels of the gut (Ishida, Iwai,
Yoshida, Kagotani & Okabe, 2013).
Several other theories are also hypothesized but the exact
pathogenesis of Crohn’s disease is yet to be known.
In Australia, the prevalence of Crohn’s disease or other inflammatory
bowel diseases are the highest among the world. More than five million
people suffer from the disease worldwide, out of which 75,000 are from
Australia (De Cruz et al., 2015). The number of people affected is

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increasing at such an alarming rate, it is assumed that within ten years
the number of reported cases of Crohn’s disease will be 100,000 in
Australia. This is not a contagious disease. Although medication improves
the inflammation, often surgery is required to eliminate the affected
portions of the intestine.
The symptoms of the disease include diarrhoea, abdominal pain,
nausea, vomiting: all of which are similar to the symptoms of Mr Jackson.
Even though the reason behind this inflammatory bowel disease is still
not known, it is thought that generation of an immune response due to
invasion of a virus or bacteria can lead to the inflammation. Mr Jackson is
a sheep farmer. Parasites that infect sheep, could have infected Mr
Jackson and resulted in all the symptoms of Crohn’s disease (Laass,
Roggenbuck & Conrad, 2014). Also, He has medical history of suffering
from depression. But he is currently not on any anti-depressant
medication. That is probably one of the reason behind his current
malaise.
Pathophysiology:
This is considered as an autoimmune disease and is known to
mostly affect individuals with genetic susceptibility. The inflammation
mostly occurs in the small intestine and the colon of the GI tract. The
disease may affect any part of the gastro-intestinal (GI) tract, but is
mostly reported to appear in the terminal portion of the ileum and colon.
The disease starts with inflammation of the crypts and formation of
abscesses which are developed into small mucosal lesions or ulcers
(Gecse et al., 2014). The spread of this inflammation thickens the walls of
the bowel and develops lymphedema. Excessive inflammation results in
fibrosis, and stricture formation, leading to obstructions in bowel.
According to the phenotypic characteristics, CD can be divided into
three subtypes:
 Inflammatory: Inflammation of the GI tract (Neurath, 2014)

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 Stricturing: Fibrosis and luminal narrowing resulting from the
inflammation
 Fistulizing: Developed between the bowel and adjacent organs
The patient has medical history of piles. About three months per year,
he suffers from loose stool and has frequent bloody stool too. He also
often suffers from watery diarrhoea from time to time and takes Gastro-
stop medicine to treat it. On examining his GI tract it was found that his
abdomen was soft and tender in the LLQ and his lower abdomen was
found to be distended. All his symptoms are simultaneous with the
symptoms of Crohn’s disease. The risk factors for the disease include
infection in the GI tract, excessive alcohol consumption, smoking,
increased stress and poor bowel habits (Gevers et al., 2014). The patient
Mr Jackson consumes 6 stubbies of heavy beer every week. For the last
35 years he has been smoking 1 pack of cigarrette each day. Also he has
history of hypertension along with quite poor bowel habits. All these
factors strengthens the hypothesis of Crohn’s disease. Inappropriate
diagnosis of CD, led to appendectomy surgery can cause CD later in life
of the affected person. Mr Jackson had appendectomy surgery when he
was a child.
Diarrhoea causes severe water loss and thereby dehydration in the
body. It is known that properly functioning kidneys show SG levels
between 1.002 and 1.030. If the person is dehydrated, the SG level goes
above 1.010. The higher the value, the more dehydrated the person is.
Mr. Jackson’s urinalysis shows specific gravity of 1.05. Therefore it can
be concluded that Mr. Jackson is quite dehydrated, due to constant loss
of water through diarrhea and vomiting. Dehydration results in mild to
severe headache, muscle cramps and dizziness. Although Mr Jackson did
not experience any dizziness or muscle cramps yet, but he is having mild
headache from the last few days. Therefore, special care must be taken
to ensure that he stays hydrated.

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Answer to question 2.
The other chronic disease that supports Mr Jackson’s symptoms is
diverticulitis which is an inflammatory disease of the intestine and forms
diverticula or small pouch-like structures that are present on the walls of
the intestine (Feingold et al., 2014). The symptoms of diverticulosis
include bloody stool and pain in the left side of the lower abdomen, both
of which are relevant to the symptoms of Mr Jackson.
The major symptoms of diverticulitis include constant and
persistent pain in the left lower quadrant of the abdomen, nausea,
vomiting, distension and tenderness of the abdomen, and diarrhoea.
Diverticulitis develops due to pressure in the weak places of the colon,
which then result in formation of the pouches. If these diverticula tear up
and result in inflammation and infection, it turns into diverticulitis
(Morris et al., 2014).
The factors that increase the risk of developing the disease are
cigarette smoking and consumption of NSAIDs, both of these are
consistent with the patient situation.
Diagnosis:
Several other diseased conditions mimic the symptoms of Crohn’s
disease. Therefore, suspected patients should be assessed for infection
and IBD.
For diagnosis of Crohn’s disease, the following tests are performed:
 Colonoscopy: to do a biopsy of the epithelial lining of the colon. If
clusters of inflammatory cells or granulomas are found, then the
diagnosis can confirm for Crohn’s disease (Gomollón et al., 2016).
 CT scan: to check for any presence of blockage, infection,
abscesses or fistulas
 Endoscopy: this procedure is done to check for any internal
abnormalities in the GI tract.

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 MRI: to check up on the conditions of the internal organs that
helps the doctors to identify the areas of inflammation and
narrowing which are common symptoms of Crohn’s disease (Gecse
et al., 2014).
 Blood tests: to check for signs of anaemia, which may result from
excessive bleeding from the GI tract
For diagnosing diverticulitis, the tests performed are as follows:
 CT scan and abdominal ultrasound: to assess the condition of
the GI tract by evaluating the images
 Blood and urine tests: to check for signs of infection,
inflammation, kidney or liver issues (Andeweg et al., 2013).
 Liver enzyme tests: for ruling out liver related causes of
abdominal pain.
The symptoms of inflammatory bowel diseases such as Crohn’s
disease, and the symptoms of gastroenteritis are quite similar, therefore
the doctors may ask for a sigmoidoscopy which is an invasive
examination of the sigmoid colon, to evaluate the symptoms properly
(Shahedi et al., 2013).

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References
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