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What is Crohns Disease? Crohns disease is a chronic inflammatory disease of the intestines. It primarily causes ulcerations in the small and large intestines, but can effect the digestive system anywhere between the mouth and the anus. It is named after the physician who examined the disease in a landmark paper written in 1932. It is also called Morbus Crohns, Granulomatous enteritis, Regional enteritis, or Terminal ileitis. The disease is found in equal frequency in men and women, and usually effects young patients in their teen s of early twenties.
Once the disease begins, it tends to be a chronic, recurrent condition with periods of remission and disease exacerbation. The disease tends to be more common in relatives of patients with Crohns disease. What are the symptoms of Crohns Disease? The terminal ileum is commonly involved in Crohns disease. Since the terminal ileum is located adjacent the appendix, right-sided abdominal pain and tenderness mimicking appendicitis is common. The pain of Crohns disease can also be camp in nature, and may reflect bowel obstruction.
Diarrhea is also common. Diarrhea may be a result of a partial bowel obstruction, excessive growth of bacteria in the small bowel, poor absorption of nutrients and bile acids and inflammation of the large intestine. The diarrhea may be bloody and associated with abdominal pain and cramps. Rectal bleeding and bloody diarrhea are common.
While massive bleeding (hemorrhage) from Crohns ulcer is rare, it can occur. Diseases affecting the anus are common. Up to one third of patients with Crohns disease may have diseases involving the anal area. Anal diseases include tears of the anal tissue (fissures), infections (abscesses) adjacent to the anus and draining abnormal passages or tubes (fistulae) between the inside of the anus and the surrounding skin. What causes Crohns Disease?
The cause of Crohns disease is unknown. Some scientists suspect that infection by certain bacteria, such as strains of mycobacterium, may be the cause of Crohns disease. To date, there has been no convincing evidence that the disease is caused by infection. Crohns disease is not contagious. Although diet may affect the symptoms in patients with Crohns disease, it appears unlikely that diet is responsible for the onset of the disease. Currently, Crohns disease is believed to be related to abnormalities in the response of the bodys immune system is composed of cells and protein that normally protect the body from infections or other foreign invaders.
In normal individuals, no immune response will be directed against food, bacteria, and other substances in the intestines. In patients with Crohns disease, the immune system seems to react actively to a variety of substances and / or bacteria in the intestines, causing inflammation, bowel injury, and ulcerations. This abnormally active immune system is believed to be genetically inherited. First degree relatives of patients with Crohns disease (brothers, sons, and daughters) are more likely to develop the disease. Furthermore, certain chromosome markers have been found inpatients with Crohns disease. Chromosomes are components in the cells where all the genetic information of the body is stored.
What are the complications of Crohns disease? Complications of Crohns disease may be related to the intestinal disease or occur in areas unrelated to the intestines (extra-intestinal). Intestinal complications of Crohns disease include bowel obstruction, bowel perforation, formation of pus collections (abscesses), fistulae, cancer of the bowel and intestinal hemorrhage. Extra-intestinal complications include tender, raised, reddish skin nodules (erythema nodosum) and inflammation of the following areas; the joints (arthritis) and spine (spondylitis), the eyes (uveitis and episceritis), the liver (hepatitis), and the bile ducts (sclerosis cholangits) that drain the liver. Progressive scarring and inflammation of the bowel causes narrowing. Sometimes, obstruction can be acutely caused by the ingestion of poorly digestible fruit or vegetables that plug the already narrowed segment of the intestine.
Symptoms of obstruction include camp abdominal pain, abdominal distention (enlargement), nausea and vomiting. As the inflammatory ulcer burrows through the bowel wall, it may tunnel into adjacent structures. If the ulcer tract reaches an adjacent empty space inside the abdomen, a collection of infected material (abscess) is formed. Patients with abdominal abscesses may develop piking fevers and tender abdominal masses. When the ulcer burrows into an adjacent organ, a fistula, or tube, is formed. When a fistula, or tube, develops between the bowel and the bladder, the patient can develop recurrent urinary infections, and passage of air and feces in the urine.
A fistula can also occur between the intestine and the skin, leading to the discharge of pus or mucus through a small painful opening on the skin of the abdomen. Massive dilatation (opening) of the colon (mega colon) and return of the intestine (perforation) are potentially life-threatening complications. Both situations generally require surgery. Fortunately, these two complications are rare. Recent data suggest that there is an increased risk of cancer of the small and the large intestines (colon) in patients with long-standing Crohns disease. Cancer of the small intestine is very rare.
However, cancer of the colon occurs more frequently than previously thought. Areas of extra-intestinal complications include the skin, joints, spine, eyes, liver and bile ducts. Skin lesions include the presence of painful red raised spots on the legs (erythema nodosum) and an ulcerating skin condition generally found around the ankles (pyoderma gangrenous). Painful red eye conditions (uveitis, epi scleritis) can cause visual difficulties.
Active arthritis can cause pain, swelling, and stiffness of the joints of the extremities. Inflammation of the low back (sacroiliac joint arthritis) and of the spine (ankylosing spondylitis) can cause pain and stiffness of the spine. Inflammation of the liver (hepatitis) or bile ducts (primary sclerosis cholangitis) can also occur. Sclerosing cholangitis causes narrowing and obstruction of the ducts draining the liver, and can lead to yellow skin, recurrent bacterial infections, and liver cirrhosis and failure. Sclerosing cholangitis with liver failure is one of the reasons a liver transplant is performed. There is no know cure for Crohns disease.
Treatments are aimed at alleviating symptoms, inducing remission from acute flares of the disease, and minimizing complications. Several types of medications are used to reduce inflammation and treat some of the symptoms of Crohns disease. In some cases of bowel obstruction, patients may be placed on total parental attrition. Nutritional solutions are administered through an indwelling catheter placed in one of the main veins in the chest. Nutrients bypass the intestines and are taken directly into the bloodstream. This gives the bowels a temporary rest that will hopefully interrupt the inflammatory process.
The prognosis of severe cases of Crohns Disease, doctors may choose surgery. Researchers estimate that up to 70 % of patients with Crohns disease will need surgical treatment for the disease. In the typical surgery, the diseased portion of the intestine is cut out and the healthy ends are sewn together. Generally, surgery is reserved for patients who have obstruction, hemorrhage, perforation, or symptoms that cannot be controlled with medication. The surgery provides a temporary cure for the condition. However, the disease recurs in about 60 % of patients.
Although Crohns disease is considered a disease of young adults, a second peak of this inflammatory condition occurs around the age of 70 (Lewis, Collier, Heitkemper, 1983). The pathogenesis, natural history, and clinical course of Crohns disease in older patients are similar to those observe in younger patients. However, the distribution of the inflammation appears to be somewhat different. In the older patient, the colon rather than the small intestine, as in ulcerative colitis, tends to be involved. There tends to be less recurrence in older patients treated with surgical resection. The degree of inflammation associated in this condition tends to be less in the older adult than in the younger patient.
Medical management of the older patient with Crohns disease is similar to younger patients. However, because of increased risk of cardiovascular and pulmonary complications, older adults tend to have increased morbidity associated with younger patients. In addition, older adults are also vulnerable to inflammation of the colon (colitis) from medication use and systemic vascular disease. Some drugs have been associated with colitis in elderly patients. To perform diagnostic studies, a thorough history and physical examination should be performed. Abdominal x-rays are the most useful diagnostic aids.
Upright and lateral abdominal x-rays show the presence of gas and fluid in the intestines. The presence of intraperitoneal air indicates perforation. Barium enemas are helpful in locating large intestinal obstruction in the colon. Laboratory tests are important and provide essential information. Elevated hematocrit values may reflect hemoconcentration. Decreased hemoglobin and hematocrit values may indicate bleeding from a neoplasm or strangulation with necrosis.
Serum electrolytes should be monitored frequently. They provide essential information on the patients fluid and electrolyte balance. The blood urea nitrogen value may be increased because of dehydration. The stool should be checked for occult blood.
Although this subject may be boring and / or hard to understand, It is very important to myself because a family member very close and dear to me has this disease. Having myself pick this topic has helped me to understand this disease for my family member and for myself, since it is hereditary.
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