Digestive & Gastrointestinal System Disorders | NCLEX Quiz 67

Toxic megacolon is extreme dilation of a segment of the diseased colon caused by paralysis of the colon. resulting in complete obstruction. This disorder is associated with both Crohn’s disease and ulcerative colitis. The other disorders are more commonly associated with Crohn’s disease.

Crohn’s disease can involve any segment of the small intestine. the colon. or both. affecting the entire thickness of the bowel. Answers 1 and 3 describe ulcerative colitis. answer 2 is too specific and therefore. not likely.

Although the definite cause of Crohn’s disease is unknown. it’s thought to be associated with infectious. immune. or psychological factors. Because it has a higher incidence in siblings. it may have a genetic cause.

Antibiotics are used to reduce the inflammation. The client isn’t typically isn’t allowed anything orally until the acute episode subsides. Parenteral fluids are given until the client feels better; then it’s recommended that the client drink eight 8-ounce glasses of water per day and gradually increase fiber in the diet to improve intestinal motility. During the acute phase. activities that increase intra-abdominal pressure should be avoided to decrease pain and the chance of intestinal obstruction.

Studies have shown that the terminal ileum is the most common site for recurrence in clients with Crohn’s disease. The other areas may be involved but aren’t as common.

Because of the transmural nature of Crohn’s disease lesions. malabsorption may occur with Crohn’s disease. Ankylosing spondylitis and colon cancer are more commonly associated with ulcerative colitis. Lactase deficiency is caused by a congenital defect in which an enzyme isn’t present.

The lesions of Crohn’s disease are transmural; that is. they involve all thickness of the bowel. These lesions may perforate the bowel wall. forming fistulas with adjacent structures. Fistulas don’t develop in diverticulitis or diverticulosis. The ulcers that occur in the submucosal and mucosal layers of the intestine in ulcerative colitis usually don’t progress to fistula formation as in Crohn’s disease.

Several theories exist regarding the cause of ulcerative colitis. One suggests altered immunity as the cause based on the extraintestinal characteristics of the disease. such as peripheral arthritis and cholangitis. Diet and constipation have no effect on the development of ulcerative colitis. Emotional stress can exacerbate the attacks but isn’t believed to be the primary cause.

Steatorrhea from malabsorption can occur with Crohn’s disease. N/V. and bloody diarrhea are symptoms of ulcerative colitis. Narrow stools are associated with diverticular disease.

Fistulas occur in all these areas. but the anorectal area is most common because of the relative thinness of the intestinal wall in this area.