Crohn’s Disease

crohns diseaseWhat’s Crohn’s disease? Crohn’s disease is a long-term, or long lasting, disease that causes inflammation-aggravation or swelling-in the gastrointestinal (GI) tract. Most commonly, Crohn’s affects the start of the large intestine and the small intestine. But, the illness can change any area of the GI tract, in the mouth to the anus. Crohn’s disease is a chronic inflammatory disease of the GI tract, called inflammatory bowel disease (IBD). Ulcerative colitis and microscopic colitis will be the other IBDs that are common. Crohn’s disease frequently starts gradually and can become worse. Some people with Crohn’s disease receive attention from a gastroenterologist, a physician who specializes in digestive diseases.

What causes Crohn’s disease? The precise cause of Crohn’s disease is unknown. Researchers consider these variables may play a role in causing Crohn’s disease: -autoimmune reaction -genes -surroundings Autoimmune response. Scientists consider one cause of Crohn’s disease may be an autoimmune reaction-when an individual ‘s immune system attacks healthy cells in the body by mistake. Generally, the immune system protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful substances that are foreign. Researchers believe viruses or bacteria can incorrectly trigger the immune system to attack the interior lining of the intestines. This immune system reaction causes the inflammation, leading to symptoms. Genes. Crohn’s disease sometimes runs in families. Studies have shown that people who have a parent or sibling with Crohn’s disease might be more likely to develop the illness. Researchers continue to study the connection between the disease of Crohn and genes. Surroundings. Some studies indicate that certain things in the environment may boost the probability of a person getting Crohn’s disease, although the complete chance is low. Nonsteroidal anti- oral contraceptives2,1 antibiotics,2 and inflammatory drugs may somewhat increase the possibility of developing Crohn’s disease. A high fat diet may also slightly increase the possibility of getting Crohn’s disease.3 Some people erroneously believe that eating certain foods, stress, or mental distress can cause Crohn’s disease. Mental misery and eating particular foods do not cause Crohn’s disease. Occasionally the pressure of living with Crohn’s disease will make symptoms worse. Also, some individuals may find that certain foods can trigger or worsen their symptoms.

Do you know the signs of Crohn’s disease? The most typical signs of Crohn’s disease are -diarrhea -stomach cramping and pain -weight loss Symptoms and other general signs include -feeling tired -nausea or lack of appetite -fever Symptoms and signs of inflammation outside the intestines include -joint pain or soreness -eye irritation -skin changes that involve red, tender lumps underneath the skin The symptoms a person experiences where it happens and can vary according to the rigor of the inflammation.

How is Crohn’s disease diagnosed? A healthcare provider diagnoses Crohn’s disease together with the following: -physical examination -lab tests -upper GI series -computerized tomography (CT) scan – intestinal endoscopy The doctor may execute a number of medical tests to rule out other bowel diseases, including ulcerative colitis, irritable bowel syndrome, or celiac disease, that cause symptoms similar to those of Crohn’s disease. Medical and Family History Taking a medical and family history can help a health care provider diagnose Crohn’s disease and understand a sick patient’s symptoms. She or he will ask the patient to explain her or his -family history -symptoms -current and past medical conditions -present medicines Physical Exam A physical exam might help diagnose Crohn’s disease. Throughout a physical exam, the health care provider most commonly -tests for swelling, or abdominal distension -listens to sounds within the abdomen using a stethoscope -taps on the abdomen to test for tenderness and pain if the liver or spleen is enlarged or strange and confirm Laboratory Tests A healthcare provider may order laboratory tests, including stool and blood tests. Blood tests. A blood test involves drawing blood at the office or a laboratory of a medical care provider. The blood sample will be analyzed by a laboratory technologist. A healthcare provider may use blood tests to find changes in -red blood cells. A patient might have anemia when red blood cells are fewer or smaller than ordinary. Someone might have infection or inflammation somewhere in their body, when the white blood cell count is greater than normal. Stool tests. A stool test is the evaluation of a sample of feces. The individual will be given a container for keeping and catching the fecal matter at home by a doctor. The sample is returned by the patient to the health care provider or to a lab. A laboratory technologist will assess the stool sample. Health care providers typically purchase stool tests to rule out other reasons for GI ailments. Upper Gastrointestinal Series Fluoroscopy is a type of x-ray that causes it to be possible to see the internal organs and their motion on a video monitor. An xray technician performs this test in an outpatient facility or a hospital, plus a radiologist-a physician who specializes in medical imaging-interprets the pictures. This evaluation doesn’t require anesthesia. A patient should not eat or drink before the procedure, as directed by the physician. Patients should ask their healthcare provider about how you can get ready for an upper GI series. During the process, the patient sit or will stand in the front of an x-ray machine and drink barium, a chalky liquid. A patient may experience bloating and nausea for a short while following the test. For many days later, barium liquid in the GI tract causes light-colored or white stools. The patient will be given specific instructions about eating and drinking following the test by a doctor. Computerized Tomography Scan Computerized tomography scans use a mixture of x-rays and computer technology to produce pictures. For a CT scan, a physician may give the patient an injection of a special dye and a solution to drink, called contrast medium. CT scans require the patient to lie on a table that slides into a tunnel-shaped apparatus where the x-rays are shot. An xray tech performs the procedure in a hospital or an outpatient center, and the pictures are interpreted by a radiologist. The patient does not need anesthesia. CT scans can diagnose the complications found with the disease and also both Crohn’s disease. Intestinal Endoscopy Intestinal endoscopies are the most precise means of diagnosing Crohn’s disease and ruling out other possible conditions, for example ulcerative colitis, diverticular disease, or cancer. Intestinal endoscopies contain -capsule -colonoscopy Upper GI endoscopy and enteroscopy. A health care provider performs the process at an outpatient centre or a hospital. Technician or a nurse may give a liquid anesthetic to the patient or will spray the anesthetic on the rear of a patient’s throat. The throat is numbed by the anesthetic and calms the gag reflex. The nurse or technician will then place an intravenous (IV) needle in the individual ‘s arm or hand to provide a sedative. The health care provider carefully feeds the endoscope down the patient’s esophagus and into the belly. A tiny camera on the endoscope sends a video picture to a screen, allowing close assessment of the GI tract. With a special, longer endoscope, the health care provider examines the small intestine during a enteroscopy. The health care provider attentively feeds the endoscope to the small intestine using among these processes: -push enteroscopy, which runs on the long endoscope to examine the upper portion of the small intestine -single- or double-balloon enteroscopy, which use little balloons to assist transfer the endoscope to the tiny intestine The endoscope does not interfere with the patient’s breathing, and many patients fall asleep during the procedure. Capsule. Although this process can examine the entire digestive tract, health care providers use it generally to analyze the small intestine. The patient swallows a capsule containing a tiny camera. The camera will record and transmit images to some tiny receiver apparatus worn by the patient, as the capsule passes through the GI tract. When the recording is done, the health care provider reviews them on a video monitor and downloads the pictures. Colonoscopy. Colonoscopy is a test that works on the long, flexible, narrow tube using a light and tiny camera on one end, called a colonoscope or scope, to look in the patient’s rectum and entire colon. For the test, light anesthesia and pain medication help patients relax in most cases. The medical staff attempt to make her or him as comfortable as possible and will monitor a patient’s vital signs. For the test, the individual will lie on a table or stretcher while a colonoscope is inserted by the gastroenterologist to the patient’s anus and slowly guides it through the rectum and to the colon. The large intestine inflates with air to give a much better view to the gastroenterologist. The camera sends a video image of the intestinal lining into a computer screen, allowing the gastroenterologist to examine the tissues lining the colon and rectum. The patient several times may be moved by the gastroenterologist and adjust the scope for better viewing. After the scope has reached the opening to the tiny intestine, the gastroenterologist examines the lining of the colon and rectum again and removes it. A colonoscopy can reveal swollen and inflamed tissue, ulcers, and strange growths such as polyps-extra bits of tissue that grow on the interior lining of the intestine. In case Crohn’s disease is suspected by the gastroenterologist, he or she will biopsy the patient’s colon and rectum. A biopsy is a procedure that involves taking small bits of tissue for examination with a microscope. A health care provider will give bowel homework instructions that are written to patients to follow at home before the test. The health care provider may also give information about how to care for themselves following the task to patients.

Crohn’s disease is treated by a healthcare provider with – medicines – bowel rest – surgery Which treatment a person needs is dependent upon the severity of symptoms and the illness. Each person experiences Crohn’s disease differently, so health care providers correct treatments bring about, remission, or cause and to increase the person’s symptoms. Medicines Symptoms can be reduced by many while Crohn’s disease is not cured by any drug. The goals of medication treatment are – inducing and maintaining remission – improving the person’s quality of life Lots of people with Crohn’s disease need drug treatment. Health care providers will prescribe medications determined by the person’s symptoms: – aminosalicylates – corticosteroids – immunomodulators – biologic therapies – other medicines Health care providers use individuals newly diagnosed with Crohn’s disease who have moderate symptoms to be treated by aminosalicylates. Aminosalicylates comprise – balsalazide – mesalamine – olsalazine – sulfasalazine- a combination of sulfapyridine and 5- ASA A few of the common unwanted effects of aminosalicylates contain – abdominal pain – diarrhea – headaches – heartburn Corticosteroids, also known as steroids, help reduce the activity of the immune system and decrease inflammation. Health care providers prescribe corticosteroids for people with moderate to severe symptoms. Corticosteroids comprise – budesonide – hydrocortisone – methylprednisone – prednisone – acne – a higher probability of developing diseases – bone mass reduction – high blood glucose – high blood pressure – mood swings – weight gain Usually, health care providers do not prescribe corticosteroids for long- term use. These medicines can take several weeks to 3 months to start working. Immunomodulators include – 6- mercaptopurine, or 6- MP – azathioprine – cyclosporine – methotrexate Health care providers prescribe these medications to help people who do not respond to other treatments or to assist individuals with Crohn’s disease go into remission. Individuals taking these drugs may have the following side effects: – a low white blood cell count, which could lead to an increased chance of disease – exhaustion, or feeling tired – pancreatitis Health care providers most often prescribe cyclosporine simply to people who have acute Crohn’s disease because of the drug’s serious negative effects. Individuals should consult with their health care provider concerning the dangers and benefits of cyclosporine. Biologic therapies are medications that target a protein made by the immune system. Inflammation in the intestine decreases. Biologic therapies work quickly to bring in those who usually do not respond to other medications, particularly on remission. Biologic treatments include – adalimumab – certolizumab – infliximab – natalizumab – vedolizumab Health care providers most often give patients infliximab every 6 to 8 weeks in a hospital or an outpatient facility. Unwanted effects can sometimes add a toxic reaction to a higher probability of developing infections, especially tuberculosis and the medication. Other medications to deal with complications or symptoms may include – acetaminophen for mild pain. – antibiotics treat or to prevent fistulas and infections. – loperamide to aid slow or prevent diarrhea that is acute. Usually, this medicine is simply taken by people for brief intervals since it may raise the potential for developing megacolon. Bowel Rest Sometimes Crohn’s disease symptoms are intense and also someone may need to rest her or his bowel for a couple of days to a number of weeks. Bowel remainder includes drinking only clear liquids or having no oral ingestion. To give you nourishment to the individual, IV nutrition will be delivered by a doctor via a special catheter, or tube, inserted into a vein in the individual ‘s arm. Some patients stay in the hospital, while other patients are able to receive the treatment in the home. Generally, the intestines are able to heal during bowel rest. Surgery Even with drug treatments, up to 20 percent of people may need surgery to deal with their Crohn’s disease.1 Although surgery WOn’t cure Crohn’s disease, it could treat complications and improve symptoms. Health care providers most often recommend surgery to treat – fistulas – bleeding that is life threatening – bowel obstructions – side effects from medicines when they endanger someone ‘s well- being –  when a person’s state do not improve, symptoms A surgeon can perform various kinds of surgeries to treat Crohn’s disease: – small bowel resection –  subtotal colectomy – proctocolectomy and ileostomy Patients will receive general anesthesia. Most patients will stay in the hospital for 3 to 7 days following the surgery. Complete recovery may take 4 to 6 weeks. Small bowel resection. Small bowel resection is surgery to eliminate portion of a patient’s small intestine. When a patient with Crohn’s disease has a blockage or severe disorder in the small intestine, a surgeon might have to remove that segment of intestine. The surgeon inserts a laparoscope- a thin tube using a tiny light and video camera on the end- through the little incisions. The surgeon removes the diseased or blocked section of small intestine and inserts tools through the little incisions while watching the monitor. –  when one incision about 6 inches long in the individual ‘s abdomen is made by a surgeon –  open surgery. The surgeon remove or fix that section and will locate the diseased or blocked section of small intestine. Subtotal. A subtotal colectomy, also called a large bowel resection, is surgery to remove portion of a patient’s large intestine. When a patient with Crohn’s disease has a blockage, a fistula, or acute disorder in the large intestine, a surgeon might need to remove that section of intestine. A surgeon can perform a subtotal colectomy by While viewing the monitor, the surgeon removes the diseased or blocked section of the large intestine. –  when one incision about 6 to 8 inches long in the abdomen is made by a surgeon –  open surgery. The surgeon will locate the diseased or blocked section of small intestine and remove that section. Proctocolectomy and ileostomy. A proctocolectomy is operation to remove a sick patient’s entire colon and rectum. An ileostomy is a stoma, or opening in the abdomen, a surgeon creates from a portion of the ileum- the last section of the small intestine. The surgeon brings the end of the ileum via an opening in the individual ‘s abdomen and attaches it to your skin, creating an opening outside the patient’s own body. The stoma is about three fourths of an inch to a little less than 2 inches wide and is most often situated in the low portion of the individual ‘s abdomen, just below the beltline. A removable external set pouch, called ostomy appliance or an ostomy pouch and the stoma, connect and accumulates intestinal contents outside the individual ‘s body. Intestinal contents pass rather than passing through the anus through the stoma. The stoma does not have any muscle, so it cannot control the flow of intestinal contents, and the flow occurs whenever peristalsis occurs. Those who have such a surgery will have the ileostomy for the rest of their lives.



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