Crohn's Colin — Inflammatory Bowel Disease (Crohn's vs Ulcerative Colitis)
Skip lesions and fistulas mean Crohn's; continuous rectal bleeding means ulcerative colitis
Colin has battled cramping right lower quadrant pain and unpredictable diarrhea for years, along with mouth ulcers and weight loss he can't explain. Lately a strange, foul-smelling drainage near his anus turns out to be a new fistula tract.
Colin's inflammatory bowel disease can affect any part of the GI tract from mouth to anus in patchy 'skip lesions' with transmural inflammation, distinguishing Crohn's disease from the continuous, mucosal-only inflammation of ulcerative colitis that starts in the rectum. Crohn's causes cramping abdominal pain, weight loss, malabsorption and fistula formation, while UC causes bloody diarrhea and urgency. Both carry a risk of toxic megacolon and colorectal cancer, but their surgical and pharmacologic management differ.
Read Crohn's Colin's full story →The story arc
The setup
Colin, in his twenties, develops intermittent RLQ cramping, non-bloody diarrhea, and unintentional weight loss over several months.
The turn
Colin develops perianal pain and notices a small opening draining stool-tinged fluid near his rectum, along with mouth sores and joint aches.
The crisis
Colin is admitted dehydrated, with a hemoglobin of 9.8 g/dL, albumin of 2.4 g/dL, and worsening abdominal distention with high fever, raising concern for a bowel obstruction or abscess.
The save
The nurse keeps Colin NPO during the acute flare, initiates IV fluids and nutritional support, administers prescribed corticosteroids and biologics, and monitors closely for signs of perforation or toxic megacolon.
NCLEX study section — Inflammatory Bowel Disease (Crohn's vs Ulcerative Colitis)
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Gastrointestinal & Renal
Take this chapter into practice questions on the same topic.