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Crohn's disease affects the lining of the digestive tract. Doctors have not known its major cause and have stated that it may involve genetic and immunological influences. The disease tends to present itself through symptoms such as stomach cramps with diarrhea, which can be accompanied by constipation, and quickly getting fatigued. In some cases, fecal blood, drainage from a painful sore near the anus, mouth sores, leading to a lack of appetite, can be experienced. In some cases, Crohn's disease appears early in life with patients, whereby patients below the age of 15 might be infected and having a severe stage of the illness. According to Colombel et al. (2017), the average age at diagnosis of the disease is 27 years. Additionally, genetic influences are considered when analyzing the disease since they are likely to be more prominent in the younger-onset subgroup of patients.
Risk factors of the disease might include age, whereby anybody can be infected with the illness irrespective of the age. Nevertheless, the condition is prevalent at a young age below 30 years (Colombel et al., 2017). Ethnicity with the whites having the highest risk, family history with chances higher of you getting the disease if a relative or sibling had the disease are also some of the risk factors. Cigarette smoking is also a factor that has steered the development of Crohn's disease in many patients. Additionally, people living in urban centers, and the industrialized countries are also at high risk. Some drugs such as ibuprofen can also lead to inflammation of the bowel and worsen the condition of patients with Crohn's disease.
Description of the Normal Physiology of the Disease
The immune system plays a significant role in fighting various infections. However, the bowel or gastrointestinal systems are attacked and damaged by the immune system after a person has developed Crohn's disease. Moreover, the ileum is mostly struck by the disease in most cases. Consequently, the disease interferes with the system, causing the body to have difficulties when digesting food and getting rid of the waste (Colombel et al., 2017). Besides, the condition can involve any part of the gut, causing problems in the digestive system. Typically, in healthy individuals, immune responsiveness to dietary antigens and normal flora in the intestinal lumen is absent due to the activation of CD4+ T cells that usually secretes cytokines that inhibit inflammation. The cytokines are mainly the IL-10 and TGF-v. These cytokines suppress inflammation in the gastrointestinal system. Thus, patients with Crohn's disease have a defective immune mechanism, which results in uncontrolled inflammation.
Genes play a significant role in gastrointestinal mucosal immunity. The products of these genes are found on the mucosal barrier epithelium. For instance, the Human Leukocyte Antigen (HLA) studies demonstrate that Crohn's disease is less common in patients lacking HLA-DR7 and DQ4 alleles in their genetic makeup (Colombel et al., 2017). These alleles are responsible for the loss of intestinal mucosa response to inflammation; thus, people with these alleles are usually can develop Crohn's disease.
Pathophysiology of the Crohn's Disease
Inflammation in the mucosal layers of the digestive tract of the human body is the first stage of the disease. Moreover, the inflammation in small intestines is common among many patients. Pathophysiology of an illness can help doctors to learn more about how the disease affects an individual (Huether & McCance, 2016). Pro-inflammatory cytokines are also involved in the development of the disease, whereby T helper cells are activated by antigens, forcing them to release the cytokines. First, ulcers develop due to the inflammation, and if untreated, it forms fissure, which gives the track a cobblestone appearance. The cobblestone appearance and lack of treatment of the ulcers cause the mucosal lining of the digestive tract to have macrophages.
The accumulation of macrophages also forces the intestinal walls and the lumen to narrow and eventually block completely. In some cases, failure to treat an acute obstruction can lead to severe vomiting (Huether & McCance, 2016). Also, patients lose much water due to vomiting and can lead to metabolic alkalosis. This is followed by inter-current infections, whereby the common infection is enteric infections. Nevertheless, the infections are treatable with non-steroidal anti-inflammatory drugs. Doctors have also stated that patients with the disease might have a bowel obstruction, fistulas, fissures, and abscesses. Absorption of nutrients is also difficult in patients with the disease since they experience increased motility.
Furthermore, patients with the condition experience much pain, mouth sores, and nausea that discourage patients from eating well. Therefore, a reduction in nutrients uptake to the body is experienced, leaving the patient weak and vulnerable. Diseases such as fistula, which are as a result of chronic inflammations, occur, and the body may fail to take nutrients as they pass the areas of small intestines. Patients with Crohn's disease can also develop lymphedema and mesentery.
In this case, physicians have revealed that lymphedema and mesentery are influenced by the transmural spread of inflammation. Moreover, some patients may experience fibrosis and muscularis mucosae, which leads to bowel destruction (Torres et al., 2017). Some patients may also experience skin infections in the interior abdomen since the fistulas spread to these areas in some cases. Also, noncaseating granulomas may our in various areas such as the lymph nodes and the liver. Nonetheless, it is hard for clinicians to detect granumolas when pathognomonic is present. Physicians have also focused on segments of the infected bowel, whereby they are sharply demarcated from skip areas. Doctors have stated that about 45% of the cases involve the ileum and colon, while about 20% of the Crohn disease cases involve the colon alone (Torres et al., 2017). Moreover, many patients with Crohn's disease that involve the colon alone do not experience rectum infections, unlike in ulcerative colitis.
Doctors have also stated that the entire bowel may be affected in some cases. On the extreme, rare cases have been experienced, whereby stomach duodenum and the esophagus are clinically involved. The disease may also affect younger patients, whereby microscopic evidence is detectable in the gastric antrum. Consequently, Crohn's disease may affect people differently. Doctors have also categorized Crohn's disease into three principal patterns. Primarily inflammatory is one of the categories of the disease. After some years, the inflammatory evolves into primarily stenotic, which is the second category of the disease (Torres et al., 2017). The third category of the disease is the penetrating or fistulizing. Thus, different therapeutic approaches are needed for these categories. A genetic, molecular basis for the classification of this disease has also been encouraged.
There are various complications that people with the disease may face. For instance, patients whose small-bowel segments are infected can develop cancer. Moreover, colorectal cancer may develop in patients whose colon has been affected for a lengthy period. Nutritional deficiencies are also experienced in some cases where chronic malabsorption is involved. Besides, doctors have stated that vitamins D and B12 are mainly engaged in nutritional deficiencies (Torres et al., 2017). Toxic megacolon can also be experienced in some cases. Doctors have also encouraged patients with toxic megacolon to be treated with surgical intervention.
Description of the Clinical Manifestations
Crohn's disease is characterized by symptoms such as stomach cramps with diarrhea, which can be accompanied by constipation. Quickly getting fatigued, fecal blood, drainage from a painful sore near the anus, mouth sores leading to lack of appetite due to the unease in feeding and weight loss are also experienced. Not all the symptoms of the Crohn's disease will be manifested, and sometimes the symptoms might be mild or leave you fatigued and weak (Lichtenstein et al., 2018). At its worst stage, it can cause complications such as local complications that affect the intestine tract of the digestive system and the systematic complications which affect the whole body.
On the other hand, local complications may also be experienced, which include infections such as abscess, fistula, fissure, sibo (small intestinal overgrowth), malnutrition and malabsorption. Systematic complications are also common in some patients. Arthritis and eye problems are some of the most common systematic complications. Abscess comes from bacterial infection along the intestinal tract or near the anus. It forms a tender swelling with some pus that needs to be drained or administering some antibiotics to clear up the sore.
Fistulae are sores or ulcers that turn into openings that connect towards parts of your intestine (Torres et al., 2017). The sibo results from too much bacterial accumulation above the typical values in the intestinal tract leading to bloat, painful belly infection, and diarrhea. Strictures is the small or thick part of the intestines, which comes from the inflammation of the tract depending on the blockade results in painful abdominal discomfort such as bloat. On the other hand, malnutrition and malabsorption are as a result of the intestines not working at optimal to digest the food at their level and make use of the nutrients in the foodstuff leading to lack of vital body nutrients since most food digestion takes place in the small intestines. Systematic complications include arthritis, which is joint inflammation and lack of flexibility. The bone loss which can come from medications such as steroids, which can stop one's body from absorbing calcium needed in bone formation, skin diseases such as skin tags and eye problems occur.
Diagnostic Testing for the Disease
Various ways have been used in the diagnosis of the disease. Some of the commonly used methods entail laboratory, histologic, and radiologic findings. Doctors have also argued that laboratory investigations results can be nonspecific. Nevertheless, the laboratory examinations are useful in some cases since they help in supporting the diagnosis and managing the condition. The most commonly used laboratory testing methods include Complete Blood cell Count (CBC), chemistry panel, inflammatory markers, stool studies, and serologic testing (Feuerstein & Cheifetz, 2017).
CBC is essential in detecting anemia, malabsorption of vitamin B12, or leukocytosis seen in chronic inflammation abscess. On the other hand, chemistry panel entails electrolyte analysis that can determine a patient's hydration level and renal functions. The panel may entail markers such as C-reactive proteins (CRP) levels Erythrocyte Sedimentations Rates (ESR) that can analyze the activity of the disease. Stool studies are also essential since they help doctors to look for white blood cells and occult blood that may be present in individuals that are infected with the disease.
Another method of testing involves serologic testing. The testing is also vital since it helps physicians when differentiating ulcerative colitis from Crohn's disease. In this case, doctors may focus on anti-S cerevisiae antibodies since they are known to be associated with Crohn's disease. On the other hand, perinuclear Antineutrophil Cytoplasmic Antibodies (p-ANCA) are more common in ulcerative colitis.
In histology, foci of the small and large bowel can be involved, and doctors can focus on areas of pyloric metaplasia that may be seen. Doctors have also argued that histologic findings alone may not be re...
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