Crohn's disease , IBD , IBS Flashcards
What is Crohn’s disease ?
How does it work - why does it happen ?
Chronic transmural inflammation of the bowel ( a type of inflammatory bowel disease ——> affects anywhere along the GI tract (mouth to anus)
- immune related disorder —–
triggered by pathogen (pathogen enters through defective mucosa layer / epithelial barrier (usually prevents this ) - let the more easily through ( found in Crohn’s disease patients. ——>
—————————> but the immune response is large and uncontrolled - dysfunction in one of the steps in inflammatory response so unregulated ———————————> destruction of cells in the GI tract ( due excess free radicals . proteases , platelet activating factor - released due to immune response )
- layers - mucosa , submucosa , muscle , serosa )
0 once the pathogen invades the mucosa , the immune response invades further into he deeper layers. ——————————————-. Immune cells arrange themselves into granulomas ( big mass of immune cells trying to encapsulate the foreign body ) ————————> ulceration occurs ( craters form in intestinal wall - due to the inflammation and damage ) - DAMAGE IS BEYOND SUBMUCOSA - (TRANSMURAL ) - from mucosa to serosa.
thought to be linked to genetics —-> more likely to get if there is a family history.
(ulcerative colitis - effects just the large intestine)
Ulcerative colitis vs Crohn’s disease ?
Ulcerative colitis - damage from mucosa to submucosa.
Crohn’s disease - transmural - mucosa to serosa
UC - areas of inflammation - continuous lesion - progresses from distal to proximal colon.
CD - areas of inflammation (discontinuous ) scattered - cobblestone appearance - SKIP LESIONS - inflammation then no inflammation
UC - Large intestine.
most commonly - rectal and sigmoid colon (proctitis - inflammation of the anus + lining of the rectum - lower part of large intestine. )
CHARCTERISTICS - inflammation can spread from rectal / sigmoid area proximally ( DISTAL TO PROXIMAL ), up the ascending colon (LEFT SIDED COLITIS - if it reaches transverse C - EXTENSIVE COLITIS ).
CD - affects anywhere in GI tract
most commonly - ILEUM + COLON ( cecum ) - ileocecal area
2nd most - ILEUM ( small intestine )
3rd most - COLON - Crohn’s Colitis ( CD in the large intestine )
perianal inflammation.
UC - can be cured by surgical removal
CD - not cured by surgical removal.
Symptoms of CD ?
RLQ Pain - area associated with ileum.
0 Diarrhoea +
Blood in stool -
damage to intestinal wall ( damage to large intestine results in inability to absorb water - h20 excreted —- diarrhoea
0 Malabsorption -if small intestine is affected —-> absorption of nutrients interrupted.
0 Fever
0 Weight loss
0 Anorexia
0 mass or fullness may be palpable
0 Tenesmus - incomplete bowel movement - feel the need to pass stools , but bowel empty.
0 Muscle spasm’ s - of inflamed intestine ( this can contribute to the abdominal pain )
Complications of the transmural spread of inflammation seen in CD ?
0 lympeodema ( damage to lymphatic system due to inflammation——-> causes build up of lymph fluid in the body tissues. )
0 enlargement of mesenteric lymph nodes.
0 Thickening of bowel wall and mesentery
0 Hypertrophy of muscularus mucosae ( outermost layer of mucosa ) ——> Fibrosis —-> stricture formation —–> bowel obestruction )
0 Abcesses
0 Fistulas
0 Graulomas
0 increased risk of cancer in diseased areas.
if in colon - increased risk of colorectal cancer.
Complications of the transmural spread of inflammation seen in CD ?
0 lympeodema ( damage to lymphatic system due to inflammation——-> causes build up of lymph fluid in the body tissues. )
0 enlargement of mesenteric lymph nodes.
0 Thickening of bowel wall and mesentery
0 Hypertrophy of muscularus mucosae ( outermost layer of mucosa ) ——> Fibrosis —-> stricture formation —–> bowel obestruction )
0 Abcesses *
0 Fistulas *
0 Graulomas
0 increased risk of cancer in diseased areas.
if in colon - increased risk of colorectal cancer *.
0 perforation.
What is IBD ?
Inflammatory Bowel Disease :
Ulcerative Colitis
Crohn’s Disease
What to avoid when diagnosed with Crohn’s ?
0 Smoking - aggravating factor - increases severity.
(UC - smoking decreases severity)
Also assess risk of osteoporosis.
Assess calcium intake.
uc
Active phase
