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 Crohn's disease

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مُساهمةموضوع: Crohn's disease    السبت ديسمبر 11, 2010 7:08 pm



Crohn's disease




.


Introduction


Crohn's disease is a chronic, ongoing disease of the gastrointestinal tract. It is one type of inflammatory bowel disease. The hallmarks of Crohn's disease are swelling of the gastrointestinal tract, abdominal pain and frequent diarrhea. Crohn's disease can seriously affect a person's ability to participate in normal activities of daily living and can lead to serious complications.





Crohn's disease can affect any area of the gastrointestinal tract, from the mouth to the anus. This includes the esophagus, stomach, small intestine, large intestine, and rectum. Crohn's disease most commonly affects the ileum, the lower portion of the small intestine.




The chronic gastrointestinal inflammation of Crohn's disease also results in a variety of other symptoms, including bloody stools (melena). Serious complications of Crohn's disease include anemia, bowel obstruction, gastrointestinal ulcers and fistulas.


The exact cause of Crohn's disease is unknown, but researchers believe it may be due to an abnormal response of the immune to an infection or to food and other substances in the GI tract. Crohn's disease may also have a genetic component, and it can run in families. Crohn's disease is not caused by eating certain foods, although some foods can irritate the bowel and intensify symptoms in people who already have the disease. Making a diagnosis of Crohn's disease begins with taking a thorough personal and family medical history, including symptoms, and completing a physical examination. It may also include doing blood tests and other tests that check for bacteria, viruses, and blood on stool. This includes a complete blood count, which can help reveal if a person has developed anemia. Making a diagnosis also includes performing special imaging tests to see a picture of the insides of the intestines and look for areas of inflammation. Tests may include an upper GI series. This test takes X-ray pictures of the small intestine after drinking barium, a solution that helps to illuminate abnormalities in the GI tract. CT scan and a variety of tests using video imaging technology may also be done. One such test is a colonoscopy. A colonoscopy involves passing a small flexible tube fitted with a camera through the anus into the colon to look for areas of inflammation. During this procedure, samples of inflamed tissue are taken to be examined under a microscope to confirm a diagnosis. A diagnosis of the Crohn's disease may be missed or delayed because symptoms can mimic the symptoms of other conditions. For more information on misdiagnosis, refer to misdiagnosis of Crohn's disease. Although there is no cure, Crohn's disease is treatable and can often be controlled to effectively reduce symptoms and bring on periods of symptom-free remission. This can be achieved by using a variety of medications, depending on the type and severity of the condition and the individual case. Dietary and lifestyle changes can also be helpful. Surgery may also be needed to control the disease in some cases. For more information on treatment, refer to treatment of Crohn's disease.

Types


Crohn's disease is one type of condition in a broader disease category, called inflammatory bowel disease. Other types of inflammatory bowel disease include ulcerative colitis and irritable bowel syndrome. These disease are similar in that they all cause symptoms of diarrhea and inflammation. However, the conditions also vary greatly as to seriousness and impact on the body. Only a thorough evaluation by a qualified health care professional, such as a gastroenterologist, can determine what is causing your particular symptoms and make a diagnosis of Crohn's disease.



Symptoms


Symptoms of Crohn's disease can run the gamut from mild to severe. Symptoms are due to the chronic inflammation of the gastrointestinal tract. They can include abdominal pain, cramps, and recurring bouts of diarrhea that may have blood or pus in it. Symptoms may also include bloody stool (melena), weight loss, poor appetite, malabsorption, malnutrition, fatigue, dehydration, and fever.




Chronic inflammation can lead to the formation of gastrointestinal ulcers. This can result in the formation of scar tissue that thickens and narrows the intestinal tract. Gastrointestinal ulcers can also become so deep that they result in the development of fistulas. Fistulas are abnormal holes between the gastrointestinal tract and other areas of the body such as the vagina, bladder and skin.


Fistulas can easily become seriously infected, resulting in critical complications, such as peritonitis and shock. Other serious complications include, rectal bleeding, anemia, deteriorating bowel function, bowel obstruction, malnutrition and problems with growth in children. Crohn's disease can also increase the risk of getting colorectal cancer.



Causes


Crohn's disease is an autoimmune disorder of unknown cause, although genetically susceptible individuals have a higher risk for developing Crohn's disease. Environmental agents are also thought to trigger the disease.



Diagnostic tests


A complete evaluation and history and physical by a qualified health care professional will determine the type and severity of Crohn's disease you have and the most appropriate and effective treatment plan for you.

Diagnostic testing can include a complete blood count, which can help reveal if you are losing blood in your bowel movement and if you have become anemic (an abnormally low number of red blood cells). Radiological testing may include an upper GI series. This test takes X-ray pictures of your small intestine after you drink barium, a solution that helps to illuminate abnormalities in the small intestine. A sigmoidoscopy or colonoscopy may also be ordered. These tests allow a physician to see the linings of the intestines using a probe that sends picture to a computer screen.


Treatments


There is no cure for Crohn's disease, but can it be effectively treated in many people, allowing them to live normal, active lives. Treatment is aimed at minimizing symptoms and complications by reducing inflammation of the bowel and ensuring good nutrition. To achieve this requires regular medical care and a multifaceted treatment plan that is individualized to the severity of the condition and other factors. A good treatment plan may produce long-term symptom-free periods of remission without symptoms. Prescribed medications may include anti-inflammation drugs that contain mesalamine, an active ingredient that helps control inflammation. The most commonly used drug of this type is sulfasalazine. Crohn's disease may also be treated with corticosteroids, including prednisone. Corticosteroids are very effective in controlling symptoms, but can have serious side effects, such as increased susceptibility to infection. Other medications include infliximab and immune system suppressors, which also decrease inflammation but can have serious side effects. Treatment may also include medications that have an anti-diarrheal effect, such as codeine. Intravenous rehydration and electrolyte replacement may be needed because frequent diarrhea can result in the loss of too much fluid and too many electrolytes, potentially causing severe dehydration and electrolyte imbalances. Complete intravenous nutrition may be needed to ensure complete nutrition if a person with Crohn's disease is unable to eat in order to let the GI tract rest. Vitamins and other nutritional supplements may also be needed. Dietary changes can also be helpful. This can include drinking extra fluids to prevent dehydration, eating a low-fat diet, and limiting dairy products and any other foods that seem to aggravate symptoms. These foods may be different for every individual. Reducing stress and getting regular exercise can also be of benefit. Surgery may also be needed to control Crohn's disease in some severe cases. These include cases in which dietary and lifestyle changes and medications do not reduce severe symptoms or when there are complications, such as fistula formation. Surgical procedures include a partial colectomy, in which a portion of the colon is removed, and total colectomy, in which the entire colon is removed.


Complications


The list of complications that have been mentioned in various sourcesfor Crohn's disease includes:

  • Intestinal blockage
  • Gastrointestinal bleeding
  • Intestinal ulcers (see Digestive symptoms) - and these may lead to various complications:

    • Performated intestinal ulcer
    • Peritonitis
    • Abdominal abscess
    • Abdominal fistula
    • Adhesions
    </li>
  • Protein deficiency
  • Calorie deficiency
  • Vitamin deficiency
  • Malabsorption
  • Bacterial infections of the digestive tract
  • Gastrointestinal abscess
  • Gastrointestinal fistula (type of Fistula) - affecting bladder, vagina, or skin
  • Intestinal cancer (see Digestive symptoms) - higher risk for cancer of the ileum.
  • Complications of the predisnone and steroid treatments rather than Crohn's itself include

    • Infections
    • Fractures
    • Bone loss (osteoporosis)
    • Fractures
    • Weight gain
    </li>
  • Eye complications (see Eye symptoms)
  • Uveitis
  • Arthritis
  • Skin problems
  • Eye inflammation
  • Mouth inflammation
  • Kidney stones
  • Gallstones
  • Liver diseases
  • Biliary system diseases
  • Abscess
  • Obstruction
  • Fistulae formation
  • Abscesses
  • Severe hemorrhage
  • Colon cancer
  • The most common complication is blockage of the intestine
  • Crohn's disease may also cause sores, or ulcers, that tunnel through the affected area into surrounding tissues, such as the bladder, vagina, or skin. The areas around the anus and rectum are often involved. The tunnels, called fistulas, are a common complication and often become infected.

Prognosis


Prognosis of Crohn's disease: the prognosis depends on treatment .




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مُساهمةموضوع: رد: Crohn's disease    السبت ديسمبر 11, 2010 7:44 pm

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مُساهمةموضوع: رد: Crohn's disease    السبت ديسمبر 11, 2010 9:04 pm

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Crohn's disease
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