Crohn's disease

Crohn's disease is a chronic, or long lasting inflammatory bowel disease, that causes inflammation, irritation or swelling in the gastrointestinal (GI) tract. Most commonly, Crohn's affects the small intestine and the beginning of the large intestine. However, the disease can affect any part of the GI tract, from the mouth to the anus. 

• Crohn's disease is a chronic inflammatory disease of the GI tract, called inflammatory bowel disease (IBD). 
• Sites most commonly affected, in order of frequency, the terminal ileum, right colon, ileum, jejunum.

Causes of Crohn’s disease

Crohn's disease is caused by a combination of these factors: 

• Immune system Disregulation 
• Genetics 
• Environmental factors
  

Clinical feature:

• Abdominal pain.-The pain often is described as cramping and intermittent, and the abdomen may be sore when touched. It may turn to a dull, constant ache as the condition gets worse. 
• Diarrhoea 
• Weight loss – may be due to patients staying away from food cause eating provokes pain, or may be due to malabsorption. 
• Loss of appetite
• Fever
• Fatigue
• Rectal bleeding
• Anal fissures
• Anal ulcer
  

During physical examination

• Sign of Anaemia
• Evidence of weight loss
• Abdominal tenderness (most marked over the inflamed area)
• Perianal skin tags, fissures or fistula
• Abdominal mass may be palpable due to matted loops of thickened bowel or intra-abdominal abscess.
  

Diagnosis 

• Full blood count (ESR increase, Hb Decrease, WBCs Increase)
• Bacteriology
• Stool (check for Blood, Microbes and WBCs)
• Endoscopy
• Barium X-Ray or other  X-Ray (Ulcer, stricture, fistula. it also give location and severity of disease)
• CT scan (Abscess)
• Video capsule endoscopy
• MRI 

Endoscopic finding:

• Deep Geographic & serpiginous Ulcers
• Transmural inflammation
• stenosis
• Patchy Area of inflammation 

Complication of Crohn’s disease

• Fistulas—abnormal passages, or tunnels, between two organs, or between an organ and the outside of the body. 
• anal fissures—small tears in the anus that may cause itching, pain, or bleeding. Most anal fissures heal with medical treatment, including ointments, warm baths, and dietary changes.
• ulcers. Inflammation anywhere along the GI tract can lead to ulcers or open sores in a person's mouth, intestines, anus, and 
• Cancer
• Hemorrhage

Treatment of crohn’s disease

The Principles of treatment are: 

• To reduce inflammation 
• To relieve symptoms of pain, diarrhoea, and bleeding 
• To eliminate nutritional deficiencies. 

Induction Of Remission 

• Corticosteroids- Budesonide (9mg once daily for 6 weeks with a gradual decrease within 2 weeks. Or Prednisolone- 40mg daily, reducing by 5mg/week over 8 weeks 
• Calcium and vitamin D supplements 
• Surgery is indicated if there are complications (fistula, abscesses and perianal disease, small bowel obstruction.Total colectomy