Crohn’s disease (CD) is a chronic inflammatory disease of the intestines that causes ulceration in the small and large intestines, but affects the digestive system between the mouth and the anus. Once the disease begins, it tends to be a chronic, recurrent condition with periods of remission and disease exacerbation. The disease tends to be more common in relatives of patients with Crohn’s disease. Crohn’s disease affects males and females at the same rate, normally between the ages of 10 and 30 y/s. Jewish people form Eastern European have a higher chance of CD.
Genetic susceptibility and altered immunologic response to the normal bowel flora are the risk factors of CD. In addition, “Increased suppressor T cell activity, alterations in immunoglobulin A (IgA) production, macrophage activation, luminal flora, antigens, and susceptibility genes are factors associated with Crohn disease” (McCance & Huether, 2012, p. 909). Overall, this paper is focusing on the steps of Crohn’s disease to cause ulcers in the small intestine, colon or both, their symptoms, their complications and pathogenic changes. To begin, there are five different types of Crohn’s disease are to be known.
1. Lleocolotis affects the small intestine (ileum and colon) 2. Lieitis, it is also affecting the ileum same as lleocolotis. 3. Gastroduodenal Crohn’s disease, affecting the stomach and duodenum (first part of small intestine) 4. Jejunoileitis, affects the jejunum, which is the upper half of the small intestine. And 5. Crohn’s colitis, which affect only the colon. But some people do have more than one area of the digestive track is affected. Crohn’s disease is known as “skip lesions” because the inflammation affects sections of the intestine, but not others (McCance & Huether, 2012, p. 909).
Crohn’s disease causes small, scattered, shallow, crater-like ulcerations (erosions) on the inner surface of the bowel. Within time, the erosions become deeper and larger, after becoming true ulcers it caused scarring and stiffness of the bowel. As the disease progresses, the bowel become increasingly narrowed and making it obstructed (Banks, Present, & Steiner, 1983) In details, the first step of crohn’s disease affecting intestine is, after erosions become deeper and larger, ulcers took place, where the ulcer puncture holes in the walls of the small intestine and the colon by creating a tunnel between the intestine and adjacent organs.
Moreover, ulcer tunnel reach to different part of body and affect them in a different ways. For example, when the ulcer tunnel reaches an adjacent empty space inside the abdominal cavity, a collection of infected pus is formed which cause a fistula to develop. However, when a fistula develops a tunnel that leads from one loop of intestine to another or that connects the intestine to the bladder, vagina, or skin. (Banks, Present, & Steiner, 1983). Furthermore, the pathogenesis of CD starts from the chronic inflammation from T-cell activation leading to tissue injury is implicated in the pathogenesis of Crohn disease.
After activation by antigen presentation, unrestrained responses of type 1 T helper (Th1) cells predominate in Crohn disease as a consequence of defective regulation. Th1 cytokines such as interleukin (IL)-12 and TNF-? stimulate the inflammatory response. Inflammatory cells recruited by these cytokines release nonspecific inflammatory substances, including arachidonic acid metabolites, proteases, platelet activating factor, and free radicals, which result in direct injury to the intestine. (McCance & Huether, 2012, p.909).
Moreover, people who are suffering from CD may have these complications rarely. Bloody diarrhea, intestinal bleeding, abscesses, colon become bigger (megacolon), erythema nodosum , an ulcerating skin condition especially on the ankles, and inflammation of the liver are the complication of CD people who has to suffer from it. People who are suffering from Crohn’s disease might have experience of irritable bowels, diarrhea, weight loss, and the right lower quadrant abdominal pain, mimicking acute appendicitis.
Diarrhea is more common because it may be a result of a partial bowel obstruction, excessive growth of bacteria in the small bowel, poor absorption of nutrients and bile acids and inflammation of the large intestine. In cases where the ileum is affected, the person might be anemic, due to malabsorption of vitamin B12, folic acid and vitamin D. The diagnosis and treatments include surgery to correct complications such as fisula, abscess, or obstruction but there are chances to reappears.
People who have long-standing disease should undergo frequent endoscopy for cancer screening. In conclusion, be aware of Crohn’s disease symptom. And if it is a genetic problem than make your health checking every year because the symptoms and the activity of the disease can come and go. There are many medications are available to control the activity of the disease. Surgery ca n improve the quality of life in selected individuals, but disease does recurrence after surgery. The disease can have complications, both within and outside of the intestine.