Crohns Disease

Crohn’s Disease By: Michael Gray 10 May 2004 Mrs. Bodner Honors Anatomy and Physiology Crohn’s Disease- General Crohn's disease is a chronic inflammatory disease of the intestines. It primarily causes ulcerations in the small and large intestines, but can affect the digestive system anywhere between the mouth and the anus. Crohn’s Disease- General (cont.) It is named after the physician who described the disease in a landmark paper written in 1932. It is also called Morbus Crohn's, Granulomatous enteritis, Regional enteritis, or Terminal ileitis. Crohn’s Disease- General (cont.) The disease is found in equal frequency in men and women, and usually affects young patients in their teens or 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 Crohn's disease. Crohn's disease can be difficult to diagnose because its symptoms are similar to other intestinal disorders such as irritable bowel syndrome and to another type of IBD called ulcerative colitis. What causes Crohn's disease? The cause of Crohn's disease is unknown. Some scientists suspect that infection by certain bacteria, such as strains of mycobacterium, may be the cause of Crohn's disease. To date, there has been no convincing evidence that the disease is caused by infection. What causes Crohn's disease? (cont.) Crohn's disease is believed to be related to abnormalities in the response of the body's immune system to the bowel contents. The body's immune system is composed of cells and proteins 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 Crohn's 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. What causes Crohn's disease? (cont.) This abnormally active immune system is believed to be genetically inherited. First degree relatives of patients with Crohn's disease (brothers, sisters, sons and daughters) are more likely to develop the disease. Furthermore, certain chromosome markers have been found in patients with Crohn's disease. What are the symptoms? The most common symptoms of Crohn's disease are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be serious and persistent, leading to anemia. Children with Crohn's disease may suffer delayed development and stunted growth. What are the symptoms? (cont.) Diseases affecting the anus are common. Up to one third of patients with Crohn's 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. How is Crohn's disease diagnosed? A thorough physical exam and a series of tests may be required to diagnose Crohn's disease. Blood tests may be done to check for anemia, which could indicate bleeding in the intestines. Blood tests may also uncover a high white blood cell count, which is a sign of inflammation somewhere in the body. By testing a stool sample, the doctor can tell if there is bleeding or infection in the intestines. The doctor may do an upper gastrointestinal (GI) series to look at the small intestine. The doctor may also do a colonoscopy. What are the complications of Crohn's Disease ? Complications of Crohn's disease may be related to the intestinal disease or occur in areas unrelated to the intestines (extra-intestinal). Intestinal complications of Crohn's 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 (sclerosing cholangitis) that drain the liver. Complications (cont.) 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 crampy abdominal pain, abdominal distention (enlargement), nausea and vomiting. Complications (cont.) Massive dilatation (opening) of the colon (megacolon) and rupture of the intestine (perforation) are potentially life-threatening complications. Both situations generally require surgery. Fortunately, these two complications are rare. Complications (cont.) Areas of extra-intestinal complications include the skin, joints, spine, eyes, liver and bile ducts. Painful red eye conditions (uveitis, episcleritis) 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 sclerosing 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. – leads to kidney transplants What are the treatment options for Crohn's Disease ? Treatment for Crohn's disease depends on the location and severity of disease, complications, and response to previous treatment. The goals of treatment are to control inflammation, correct nutritional deficiencies, and relieve symptoms like abdominal pain, diarrhea, and rectal bleeding. Treatment may include drugs, nutrition supplements, surgery, or a combination of these options. At this time, treatment can help control the disease, but there is no cure. Treatment (cont.) Some people have long periods of remission, sometimes years, when they are free of symptoms. However, the disease usually recurs at various times over a person's lifetime. This changing pattern of the disease means one cannot always tell when a treatment has helped. Predicting when a remission may occur or when symptoms will return is not possible. Someone with Crohn's disease may need medical care for a long time, with regular doctor visits to monitor the condition. Sources http://zap.intergate.ca/crohn.html http://www.angelfire.com/ga/crohns/faq.html http://digestive.niddk.nih.gov/ddiseases/pubs/cro hns/ http://www.johnes.org/gif/Zoonosis_DK.jpg www.conciouschoice.com/holisficmd/hmd085.ht ml Gottschalk, Elaine Gloria. Breaking the Vicious Cycle: Intestinal Health Through Diet. Kirkton Pr. 1994