Re: chrones disease
Asked by pooh

Question:
 

Is there antone out there that has any idea about chrones disease in children?

My Advice:

 

Crohns disease is an inflammatory disease of the gastro-intestinal tract

and may involve any part of the GI tract from the mouth to the anus, but most commonly affects the bowel.  This inflammation can cause ulcers, fibrosis, adhesions, stiffening of the bowel wall, strictures and fistulas.  The disease is characterized by flare ups and remission- there will be well times and sick times- fluctuating between relatively normal function and hospitalization (1,2).

Symptoms include (1,2):

Changes to bowel movements: pus, mucus or blood in stools, diarrhea, frequency of bowel movements, incontinence and urgency issues (rush to get to the toilet)

Nutritional deficiencies: anaemia (resulting in pale skin, fatigue, low energy and needing to sleep more) and low protein levels (hypoalbuminemia), dehydration, electrolyte imbalance, Malnutrition, weight loss, poor growth and delayed development- caused by a decreased appetite and the bowel does not absorb nutrients as well as healthy bowel

Abdominal symptoms: abdominal pain, cramping, nausea and vomiting, going off food (anorexia),

There may be skin tags, fistulas, abscesses and/or fissures on the perianal area (around the anus on the outside of the body).

Other complications:

Skin lesions, joint arthritis, mouth ulcers, liver disease, kidney stones

Diagnosis (1,2):

Includes blood and stool samples, endoscopy/colonoscopy (a diagnostic camera is inserted either end of the GI tract under general anaesthetic), bowel biopsy (taken during the colonoscopy), sometimes a CT scan is performed.

Treatment:

Treatment goals include- remission of active disease (there is no cure, but we aim to stop the symptoms), prevent growth and nutrition issues, promote quality of life (through normalizing function and avoiding hospital admissions, preventing embarrassing accidents), prevent surgical intervention.

Drug treatments:

Can be either oral- tablet or syrup form; or IV-intravenous through a drip.  Most drug therapies are chemotherapy/cytotoxic drugs (the kind used to treat cancer) and do have side effects.  Hence more medication may be required to control the side effects of the crohns treating drugs.  The same precautions need to be taken- pregnant and breastfeeding women are not allowed to touch them and body wastes may be considered cytotoxic (1).

Chemo drugs: Azathioprine, 6-mercaptopurine (6-MP), Methotrexate, Infliximab, Sulfasalazine (1,2,3)

Steroid treatment-prednisolone and methylprenisolone (1,2,3)

Pain relief:buscopan for bowel cramps, paracetamol, morphine etc. (1)

Nutritional support

Vitamin and mineral supplements- iron, vitamin B, folic acid (1,2)

High calorie, high protein diet (1,2)

Fish oil can increase the absorption of nutrients (2)

The child may require nasogastic feeding of formula or intravenous nutrition if this is not tolerated (1,2).

Surgery

Surgery is used as a last resort if other treatments have not been successful- unhealthy parts of the bowel can be removed and healthy tissue re-sected (1,2).

Affects about 3 in 100000 children (2)

Exact cause is unknown but there is research focusing on theories that it may be due to a disorder of the immune system and inflammatory response to bacteria or viruses in the bowel (2).

About a ¼ of cases have a family history so there are some genetic/hereditary tendencies (2).

It’s a horrible disease and is complicated to treat.  Hospital admission will be required until remission is achieved and weight gain will need to be monitored carefully.  Dietician input is important.

 This information is based on my own previous experience and education as a paediatric nurse (1), as well as facts, statistics and information from (2)"Wong's Nursing Care of Infants and Children" eighth edition, 2007, Hockenberry and Wilson; (3)"Australasia Nursing Drug Handbook" 1999, Springhouse Corporation; and "Mosby's Medical, Nursing and Allied Health Dictionary" fifth edition, 1998, K.Anderson, L.Anderson and W. Glanze.