Crohn's disease Health, Medicine, Nursing Coursework

Topic:
"Using medical terminology, discuss Crohn's disease an inflammatory bowel disease.

Clinical Features
The clinical presentation of Crohn's disease is variable. The initial symptoms are often so nonspecific that the diagnosis may be delayed by several months. The most common symptoms are diarrhea, abdominal pain, and weight loss. Bleeding is more common with rectal involvement. Fever occurs in one third of patients. In later stages of the disease, there might be constipation because of intestinal narrowing, fistulas, and adhesions. Weight loss, vitamin deficiency, and anemia secondary to malabsorption are common in the chronic stages of the disease. The most common extra-abdominal manifestations, found in one third of patients, are arthritis, skin lesions, liver disease, and eye lesions. The diagnosis is established by colonoscopy, x-ray studies, and mucosal biopsy. Crohn's disease has a chronic course. Cases that are resistant to medical therapy require surgical treatment, which includes resection of the involved intestine.
□ Did You Know?
Crohn's disease was described for the first time in the Journal of American Medical Association (JAMA) in 1932 by Drs. Crohn, Ginsburg, and Oppenheimer. Those days JAMA listed the authors of medical papers alphabetically, and that peculiar editorial rule determined the name of the disease, which it still carries today.

Crohn's Disease

Crohn's disease is a chronic inflammation of the GI tract that most often involves the terminal ileum and the colon. In about 50% of cases the disease affects both the terminal ileum ("terminal ileitis") and colon, in 30% of cases it is limited to the ileum, and in 20% of cases it is limited to the colon. The appendix is involved in most cases, and occasionally, Crohn's disease even may present clinically as acute appendicitis. In a small number of cases (1% to 2%), the disease involves the esophagus, stomach, or other abdominal organs, such as the fallopian tubes. Approximately one third of all patients also have extraintestinal inflammatory lesions in the joints, skin, liver, or eyes.
Pathology
The earliest pathologic changes in typical Crohn's disease involve the terminal ileum and are known under the name of aphthous ulcers. These shallow mucosal defects typically overlie the lymphoid aggregates forming the Peyer's patches, which suggests that immune cells may be involved in their pathogenesis. The inflammation does not remain limited to the mucosa but extends through the entire wall of the intestine (transmural inflammation). This is often associated with the formation of granulomas (50% of cases). Chronic inflammation is also associated with fibrosis of the muscularis and serosa. The wall of the intestine is thickened and rigid (Figure 10-12). The mucosa has a cobblestone appearance in which the fibrotic defects appear as "seams" surrounding the remaining patches of the mucosa (the "cobbles"). The fibrotic intestine may be narrowed (intestinal strictures). The inflammation of the serosa leads to adhesions with adjacent intestinal loops and the formation of fistulas. Anal involvement is often associated with formation of fissures.Bfigure 10-12 Crohn's disease. A, A thickened intestinal wall and a narrowed lumen are shown. B, The mucosa has a cobblestone-like appearance.