Chrohn's Disease Flashcards
What is Chron’s Disease?
Also called granulomatous colitis is a nonspecific granulomatous inflammatory process affecting different regions of the GIT
It is characterised by segmentary lesions, recurrent clinical course with formation of deep transmural longitudinal ulcers external and internal Fistulas, strictures, perianal rectal lesions
Etiology and Pathogenesis of C.D
Due to infection by viruses,chlamydia, disturbances of micro bio enosis of the bowels, genetic factors, drug and food allergies, environmental pollution
In pathogenesis autoimmune mechanisms take part with production of antibodies to the GIT
Inflammatory process with ulcers in the bowels as well as extraenteric manifestations occur. A great part in pathogenesis is due to deficiency of immunoglobulin A.
First microscopic signs of C.D are nidal line mucosal ulcerations
When the process progresses the ulcerations become multiple, transmural and curve.
Their presence and mucosal Edema between them looks like a typical picture of “cobbled roadway”
Clinical picture of C.D
Most often chronic forms of the disease are found
The disease manifests by a group of general and local symptoms
Main symptoms are;
- occasional colicky abdominal pains in the direction of the bowels. Persistent pains are also possible
- evident diarrhea up to 12times a day and often with blood and mucus
- fever
- body weight loss
Palpatory tenderness of the abdomen in the direction of the bowels is found, infiltrated intestine cam be palpated
80% of the patients have painless anal fissures without sphincter spasm. There can be external and internal Fistulas, communicating with large intestine, static infiltrates of the abdominal cavity
Complications of C.D
- small and large bowel obstruction
- perforation of the intestinal wall
- intraperitoneal abscesses
- perianal external and internal Fistulas communicating with the rectum and colon
- toxic dilatation
- hemorrhages
- development of malignant tumor
- extra intestinal complications (lesions of skin, bones, joints, eyes, liver)
Diagnosis of C.D
- CBC and urine-anemia, ESR acceleration, left shift, dysproteinemia, deficiency of vitamins,micro elements
- biochemical blood analysis
- Abdominal US
- Fiberesopgagogastroduodenoscopy(FEGDS)-allows to determine localisation of the process, size of lesions
- Digital rectal examination,to take biopsy, to deliver drug, mucosa looks like “cobbled roadway “, ulcers are not extensive and fused
- Proctosigmoidoscopy
- Fibre optic colonoscopy combined with biopsy and histological study with biopsy material
- Irrigoradioscopy-segmentary lesion, presence of unchanged areas in the colon between affected segments, there can be pseudo polyps, symptom of “cord” is observed incase of colonic stenosis
- Blood immunodetection
- Feces analysis combined with macroscopic estimation
- Histologic study of the biopsy-incase of inflammatory cellular infiltrate usually there are carcoid like cells
Treatment of C.D
-Corticosteroids are used incase of severe forms of the disease
-aminosalicyclates can also be used or in combination with hormonal therapy
-incase of infection metronidazole, fluoroquinolones
-Azithroprinum is recommended if there is no remission of the disease
-use of interleukins , spirulina
- mechanically and chemically sparing diet is done
In severe cases parenteral nutrition
Blood preparations are used incase of anemia and hemorrhages
Desensitizing and sedative therapy
Indications for surgery
Absolute-complete intestinal obstruction caused by strictures, incase of complications perforation,abscesses,internal Fistulas,acute toxic dilatation (which is non responsive to conservative therapy), repeated profuse bleeding, malignant tumors within the fundamental illness
Relative indications are absence of effective conservative therapy in severe forms of the disease as well as complications like strictures , Fistulas
Operative therapy is done with combination with intensive medication therapy
Prognosis - worse than U.C .
