Crohn's Disease - Causes, Symptoms and Treatment .MF .
Crohn's disease - a chronic inflammatory disease that affects the entire gastrointestinal tract, from the mouth to the anus.Unlike ulcerative colitis, Crohn's disease at all layers of the bowel wall involved in the inflammatory process.Inflammation in most cases the first occur in the ileum, and then proceeds to other sections of the intestine.At the same time the symptoms of acute ileitis (inflammation of the ileum) are indistinguishable from symptoms of acute appendicitis, so patients often operate during the operation put the true diagnosis.
Crohn's disease - it is a rare pathology.Usually the disease begins between the ages of 20 - 40 years, but can also occur in childhood.Men more often than women suffer Statistics.
failed to identify the causative agent of Crohn's disease to date.However, the infectious theory - the basic version of the origin of the disease.This is due to the positive effect of the treatment with antibacterial drugs.In addition, the development of the disease pla
predisposing factors for the disease are:
• a viral infection (measles);
• food allergy;
• Stress and mental strain;
• genetic predisposition.
Symptoms of Crohn's disease
Given that Crohn's disease can affect any part of the gastrointestinal tract, the picture of the disease is very multifaceted and depends on the localization of the main focus of inflammation.The clinical picture can distinguish local, general and extra-intestinal manifestations of the disease.
Common symptoms arise due to disorders of the immune system and the presence of intoxication.These include fever with chills, weight loss, weakness and malaise.When
fever which may be caused by purulent complications Crohn's temperature reaches 39 - 40 ° C.
malabsorption of nutrients, trace elements, vitamins, bile acids because of extended intestinal wall inflammation leads to metabolic disorders, weight loss, osteoporosis (loss of bone strength), the formation of cholesterol gallstones.
main local manifestations of the disease are abdominal pain, diarrhea with blood in the stool.
Abdominal pain may be of low intensity, cramping in nature with a feeling of heaviness and swelling.Often the pain localized in the right lower quadrant of the abdomen, sometimes they can not be distinguished from those of appendicitis.
Loose stools mixed with blood - a permanent symptom, its frequency varies from 3 to 10 times a day.After the stool stomach pain decreases.
extraintestinal manifestations of the disease are associated with immunological disorders and include:
• arthropathy - asymmetrical lesion of large joints accompanied by pain and limited mobility;
• sacroiliac disease - inflammation of the sacroiliac joint with intense pain in the sacral region;
• decreased vision;
• skin rash (erythema nodosum, pyoderma gangrenosum);
• sores in the oral cavity.
Given the presence of pain in the abdomen and frustration of a chair, Crohn's disease is difficult to distinguish from an attack of acute appendicitis, Meckel diverticulum inflammation, ulcerative colitis, infectious enterocolitis, malignant lymphoma (a tumor of the blood cells) and intestinal tuberculosis.Therefore, if you have abdominal pain that does not go in for 6 hours, it is necessary to consult a surgeon.
If you have pain, you can take antispasmodic drugs such as no-spa, Buscopan, once no more than 2 tablets.With the development of diarrhea without signs of bleeding can take Imodium loperamide or at an initial dose of 4 mg, followed by 2 mg after each defecation, a maximum of 16 mg per day, no more than 24 hours.With the ineffectiveness of the treatment it is necessary to consult a surgeon. Do not use warm compresses and field abdomen - this may enhance inflammation. Analgesics for pain in the stomach can not take - they distort the picture of the disease and prevent a correct diagnosis.Self-medication and delay in diagnosis can lead to complications of the disease.
survey in Crohn's disease
Specific laboratory diagnosis of Crohn's disease does not exist.When applying for medical assistance is necessary to pass a standard examination, which includes a general analysis of blood and urine tests, blood sugar, blood chemistry.
The general analysis of blood marked increase in white blood cells and increased erythrocyte sedimentation rate, decreased hemoglobin level (anemia), decrease in the number of lymphocytes (lymphopenia), elevated levels of eosinophils (eosinophilia).In the biochemical analysis of blood to the fore decrease in the total protein content (hypoproteinemia).
most characteristic changes can be seen by X-ray and endoscopic intestinal study.
Given that the inflammation of the intestinal wall in Crohn's disease leads to the formation of many restrictions (stricture) in the course of the intestinal tube, inspect the colon all over using colonoscopy (endoscopic examination method allows us to see the inner lumen of the intestine to evaluate mucosal changes)It is not always possible.But in this case, the constriction can be detected ulcerated mucosa defects and biopsied (mucous portion for histology).
The figure shows the endoscopic picture of Crohn's disease with severe inflammation and narrowing of the lumen of the colon, hampering research.
To detect lesions of the stomach and duodenum using fibrogastroduodenoscopy (EGD).
safest and most informative method of examination in the presence of stricture - radiography with barium passage .A distinctive feature of the X-ray picture of Crohn's disease is the presence of cracks, ulcers on the inner relief of the mucosa and multiple contraction of the intestinal tube, alternating with the normal, unaffected areas of the intestine.
Ultrasound examination of the abdominal cavity allows us to estimate the diameter of the bowel loops, the presence of free fluid in the abdominal cavity, which helps in the diagnosis of complications (perforation of the wall of the intestine with peritonitis).
Computer tomography to evaluate the presence of complications - infiltration or abscess formation in the abdominal cavity.
Treatment of Crohn's disease
Because Crohn's disease affects the entire gastrointestinal tract, treatment of Crohn's disease is mainly medical.Surgery is used only in the presence of complications for their correction.
diet in this disease should include a high-calorie foods containing large amounts of protein and vitamins with restriction of fat and coarse fiber plant foods that cause intestinal irritation.It is necessary to eliminate the use of alcohol.You can eat soups low fat-free meat and fish broth, cooked and pureed meat (chicken, beef, rabbit), oat, buckwheat porridge on the water, eggs (2 per day), boiled or in the form of a steam omelette, jelly, jellyblueberries, ripe pears, fresh cheese, cottage cheese soufflé.All other dairy dishes should be deleted, as they can contribute to the development of diarrhea.From drinks can be tea, cocoa, water, broth hips, cherry, blueberry.It is necessary to eliminate all the fresh vegetables, sauces, spices.
During an exacerbation of the disease is carried out antibiotic therapy.Ciprofloxacin and metronidazole in doses up to 1 g per day.It is possible combination or sequential assignment.Taking drugs for a long time up to 6 weeks.The most effective use of antibiotics in lesions of the colon.
as anti-treatment mesalazine used in a daily dose of 3 - 4 g for up to 6 months, then carry out a check-up, when the positive dynamics of drug overturned, in the absence of positive developments, continue treatment.
Complications of Crohn's disease
Late diagnosis or long-term course of the disease may develop these complications.
• Intestinal obstruction - a specific trait, especially in lesions of the small intestine, is the narrowing of the lumen of the intestine and the disruption of normal passage of food.Usually, complete obstruction of the lumen is not developed, so perhaps expectant conservative management with the appointment of antibacterial drugs, hormones (prednisone), antispasmodic drugs (no-spa, papaverine).However, the failure of conservative treatment performed operation - resection of part of the colon (intestine removed a neck).
The figure shows the X-ray pattern of intestinal obstruction swollen with loops of small intestine, overflowing with gas and liquid levels.
• Perforations in the free abdominal cavity - a violation of integrity bowel wall because of the deep ulcers with the outpouring of the contents into the abdominal cavity, accompanied by the development of peritonitis (inflammation of the peritoneum).In this case shows emergency surgery.
• infiltrate and abscess in the abdomen - are due to previous complications.Due to the activation of the protective properties of the peritoneum occurs delimitation of the inflamed area to form a conglomerate of inflamed tissues (infiltration) with purulent contents (abscess).If you have any of these complications conduct medical therapy, the above operation is performed when it is ineffective.
• Intestinal bleeding are less common than, for example, in ulcerative colitis, but there may be.In such cases, appoint hemostatic drug therapy, which usually turns out to be successful.
• Toxic dilation (pronounced widening of part of the colon), the affected intestine is extremely rare, unlike ulcerative colitis.Its development can be triggered by taking antidiarrheal agents, barium enema and colonoscopy.In this case, the anti-inflammatory drug (prednisolone) and antimicrobials together with the termination of a meal help to eliminate the above complication.
• Anal fissures, fistulae and abscess (purulent inflammation of fatty tissue around the rectum), a common complication from which the disease can begin.Lies in the formation of ulcers anal mucosa with the transition to the surrounding skin, fistulous passages are formed in a good effort ulcers okolopryamokishechnoy fat.To correct these complications excising operation is performed on the background of medicinal therapy.
Currently, effective prevention of Crohn's disease has not been developed.So the only way to some extent to protect themselves from developing the disease - it is a healthy way of life, with the exception of predisposing factors.
To prevent the development of complications requires early diagnosis of Crohn's disease and promptly started drug therapy.Therefore, when a self these symptoms is unacceptable.
As Seneca said: "One of the conditions for recovery - the desire to get well."So take care of your health.It is better to overestimate the severity of your symptoms, rather than later, seek medical attention.
Surgeon Thews DS