Crohns disease is a type of inflammatory bowel disease, resulting in swelling and dysfunction of the intestinal tract. Crohns disease can affect any area of the GI tract, but it most commonly affects the lower part of the small intestine, called the ileum. The cause of Crohns disease is unknown. No infectious agent has been identified as the cause of Crohns disease. Still, some researchers have theorized that some type of infection may have originally been responsible for triggering the immune system, resulting in the continuing and out-of-control cycle of inflammation that occurs in Crohn's disease. Other evidence for a disorder of the immune system includes the high incidence of other immune disorders that may occur along with Crohn's disease. The inflammation of Crohn's disease is nearly always found in the ileocecal region. The ileocecal region consists of the last few inches of the small intestine, which moves digesting food to the beginning portion of the large intestine (CCFA, 2009). However, Crohn's disease can occur anywhere along the digestive tract. It is estimated that as many as 1.4 million Americans have IBD -- with that number evenly split between Crohn's disease and ulcerative colitis. Males and females appear to be affected equally. Crohn's disease may occur in people of all ages, but it is primarily a disease of adolescents and young adults, affecting mainly those between 15 and 35.Â However, Crohn's disease can also occur in people who are 70 or older and in young children as well. In fact, 10 percent of those affected -- or an estimated 140,000 -- are children under the age of 18 (Crohn's Disease, 2008).
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Multiple etiologies have been suggested towards inflammatory bowel disease, but the exact cause of this disease is unknown. However, there is strong evidence that suggests that inflammatory mediators play an important role in the pathologic and clinical characteristic of this disorder. Cytokines, released by macrophages in response to various antigenic stimuli, bind to different receptors and produce autocrine, paracrine, and endocrine effects. Cytokines differentiate lymphocytes into different types of T cells. Helper T cells, type 1, are associated principally with Crohn's disease, whereas Th-2 cells are associated principally with ulcerative colitis. The immune response disrupts the intestinal mucosa and leads to a chronic inflammatory process (Sarvotham, K 2009). Crohn's disease consists of segmental involvement by a nonspecific granulomatous inflammatory process. The most important pathologic feature is that Crohn's disease is transmural, involving all layers of the bowel, not just the mucosa and the submucosa, which is characteristic of ulcerative colitis. Crohn's disease can affect any portion of the gastrointestinal tract from the mouth to the anus (CCFA, 2009). Furthermore, Crohn's disease is discontinuous, with skip areas interspersed between one or more involved areas. Late in the disease, the mucosa develops a cobblestone appearance, which results from deep longitudinal ulcerations interlaced with intervening normal mucosa. The 3 major patterns of involvement in Crohn's disease are: (1) disease in the ileum and cecum (occurring in 40% of patients), (2) disease confined to the small intestine (occurring in 30% of patients), and (3) disease confined to the colon (occurring in 25% of patients). Rectal sparing is a typical but not constant feature of Crohn's disease. However, anorectal complications are common. Much less commonly, Crohn's disease involves the more proximal parts of the gastrointestinal tract, including the mouth, tongue, esophagus, stomach, and duodenum. Crohn's disease causes 3 patterns of involvement: inflammatory disease, strictures, and fistulas (Sarvotham, K 2009). Crohn's disease is generally diagnosed using clinical, endoscopic, and histologic criteria. Histologically, transmural non-necrotizing lymphoid granulomas are characteristic of Crohn's disease. However, they may not be found in a given case of Crohn's disease, and no single finding is absolutely diagnostic for one disease or the other. Furthermore, approximately 20% of patients have a clinical picture that falls between Crohn's disease and ulcerative colitis; they are said to have indeterminate colitis. The incidence of gallstones and kidney stones is increased in Crohn's disease because of malabsorption of fat and bile salts. Gallstones are formed because of increased cholesterol concentration in the bile, caused by a reduced bile salt pool. Patients who have Crohn's disease with ileal disease or resection also are likely to form calcium oxalate kidney stones (Sarvotham, K 2009). With the fat malabsorption, unabsorbed long-chain fatty acids bind calcium in the lumen. Oxalate in the lumen normally is bound to calcium. Calcium oxalate is poorly soluble and poorly absorbed; however, if calcium is bound to malabsorbed fatty acids, oxalate combines with sodium to form sodium oxalate, which is soluble and is absorbed in the colon. The development of calcium oxalate stones in Crohn's disease requires an intact colon to absorb oxalate. Patients with ileostomies do not develop calcium oxalate stones (Sarvotham, K 2009).
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Treatment may include drugs, nutrition supplements, surgery, or a combination of these options. The goals of treatment are to control inflammation, correct nutritional deficiencies, and relieve symptoms like abdominal pain, diarrhea, and rectal bleeding. At this time, treatment can help control the disease by lowering the number of times a person experiences a recurrence, but there is no cure. Treatment for Crohn's disease depends on the location & severity of disease, complications, and the person's response to previous medical treatments when treated for recurring symptoms. Some people have long periods of remission, 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. Someone with Crohn's disease may need medical care for a long time, with regular doctor visits to monitor the condition.
Because body and mind are so closely interrelated, emotional stress can influence the course of Crohn's disease-or, for that matter, any other chronic illness. Although people occasionally experience emotional problems before a flare-up of their disease, this does not imply that emotional stress causes the illness (CCFA, 2009). There is no evidence to show that stress, anxiety, or tension is responsible for Crohn's disease. No single personality type is more prone to develop Crohn's than others, and no one "brings on" the disease by poor emotional control (CCFA, 2009). Also, this is a type of disease that does not "show" that a person is sick. A person with this disorder can look completely normal, and on the outside you cannot tell that anything is wrong with them. On the contrary, however, this person has a serious disease that is hard to treat, and they are usually going through a lot of problems. In many cases, this can cause severe emotional and mental stress. People cannot understand that just because they don't "look sick" does not mean they don't have a serious medical problem. These sorts of things often skew medical professionals assessment and treatment plan. Now-a -days, there are drug seekers, hypochondriacs, and attention seekers that pretend to have an illness, or buy into a syndrome that may not be accurate. People with Crohn's often get thrown into these categories simply because people cannot look at them and tell they have a condition.
Attacks of diarrhea, pain, or gas may make people fearful of being in public places. In such a situation, EMS is usually the first involved. It is important to understand that this disease can be very embarrassing and it is important to speak with the patient in a private place and remove them from an uncomfortable situation immediately.
As the degree of inflammation increases, systemic symptoms develop, including low-grade fever, malaise, nausea, vomiting, and sweats. Fever, dehydration, and abdominal tenderness are also common, and develop in severe ulcerative colitis, reflecting progressive inflammation into deeper layers of the colon. The presentation of Crohn's disease is generally more insidious than that of ulcerative colitis, with ongoing abdominal pain, anorexia, diarrhea, weight loss, and fatigue. One half of patients with Crohn's disease present with perianal disease, and occasionally, acute right lower quadrant pain and fever, mimicking appendicitis, may be noted (Sarvotham, K 2009). Commonly, the diagnosis is established only after several years of recurrent abdominal pain, fever, and diarrhea. Weight loss is observed more commonly in Crohn's disease because of the malabsorption associated with small bowel disease. Patients may reduce their food intake in an effort to control their symptoms. Recurrences may occur with emotional stress, infections or other acute illnesses, pregnancy, dietary indiscretions, use of cathartics or antibiotics, or withdrawal of anti-inflammatory or steroid medications. In 10-20% of cases, patients present with extraintestinal manifestations, including arthritis, uveitis, or liver disease (Sarvotham, K 2009). In the field you need to evaluate for signs of localized abdominal pain, although abdominal tenderness is common. They have high fever; lethargy; chills; tachycardia; and increasing abdominal pain, tenderness, and abdominal distention (CCFA, 2009). The physical examination should include a search for localized abdominal tenderness, melena or blood in the stool, feverish skin, and signs of sepsis.
While Crohn's is a serious chronic disease with many complications, it is not considered a fatal illness. Most people with the illness may continue to lead productive lives, even though they may be hospitalized from time to time, or need to take medications. In between flare-ups of the disease, many individuals feel well and may be relatively free of symptoms. Even though there is no cure at this time, with all of the continuous research and education programs, the treatments and drugs in effect have already improved the health and quality of life of people dealing with Crohn's disease.
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