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Aug31
A CLOSER LOOK AT CROHN'S DISEASE
Collectively known as inflammatory bowel disease, Crohns and ulcerative colitis produce chronic, uncontrolled inflammation of the intestinal mucosa. The underlying cause of IBD isnt clearly understood but research clearly suggests that bacteria and viruses or proteins ( antibodies) cause the immune system to overreact and produce inflammation in the GI tract. Two known antibodies that are sometimes found in the serum of patients with IBD are antineutrophil cytoplasmic antibodies( ANCA) and antisaccharomyces cerevisiae antibodies( ASCA). Infact ASCA are diagnostic markers for crohn's disease whereas ANCA are more likely to be identified in the serum of patients with ulcerative colitis. There are other antibodies associated with IBD as well
Crohns disease is seen in young and older adults. Its an inflammatory disorder affecting mostly the distal ileum and colon. The intestinal lining ulcerates and scar tissue develops. Generally seperated by normal tissue, fistulas, fissures, and abscesses form. The wall of the bowel thickens and becomes fibrotic which causes a narrowing of the bowel lumen. Formation of granulomas, inflammatory masses that result from a collection of immune cells called macrophages also occur in many patients. Sometimes the lesions have a cobblestone appearance. A fibrotic bowel with abscesses and granulomas can lead to perforation. Crohns disease results in malabsorption of water and nutrients, which may lead to fluid and electrolyte imbalances. Patients experience abdominal pain and cramping in the right lower quadrant of abdomen, especially after a meal. Inflammation of the bowel mucosa prevents water absorption, and the patient may experience more than 10 bloody diarrhea episode each day. Anorexia, weight loss, cachexia, weakness and fatigue are common. Fever may be present from the inflammatory process or due to infection. Anemia results due to poor dietary intake or poor absorption of vitamins and nutrients. Lesion that bleed may also lead to anemia. Bright red blood may be observed in the stool because of bleeding lesions or excoriation of anal mucosa due to frequency and amount of diarrhea.
Diagnostic endoscopy confirms the presence of intestinal lesions. A barium study of the upper GI tract wil commonly show a constriction of the terminal ileum in the patient with Crohns disease. This constriction is known as the string sign. There are "skip areas" seen unlike what is seen in ulcerative colitis where the lesion is continuous. IBD can mpact other areas of the body in addition to the GI system, including the eyes, liver, joints and skin. Systemic complications that occur in IBD include nephrolithiasis, cholelithiasis and pyelonephritis.


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