Crohns Disease Causes » Small Bowel http://crohnsdiseasecauses.com Help, Cures and Support for Crohns Disease Sun, 13 Jun 2010 21:07:04 +0000 http://wordpress.org/?v=2.9.2 en hourly 1 Pathophysiology of Crohns Disease http://crohnsdiseasecauses.com/pathophysiology-of-crohns-disease/ http://crohnsdiseasecauses.com/pathophysiology-of-crohns-disease/#comments Fri, 28 May 2010 13:01:08 +0000 Dr Joe Stevenson http://crohnsdiseasecauses.com/?p=156 Crohns disease begins with crypt inflammation and abscesses, which progress to tiny focal aphthoid ulcers. These mucosal lesions may develop into deep longitudinal and transverse ulcers with intervening mucosal edema, creating a characteristic cobblestoned appearance to the bowel.

Transmural spread of inflammation leads to lymphedema and thickening of the bowel wall and mesentery. Mesenteric fat typically extends onto the serosal surface of the bowel. Mesenteric lymph nodes often enlarge.

Extensive inflammation may result in hypertrophy of the muscularis mucosae, fibrosis, and stricture formation, which can lead to bowel obstruction. Abscesses are common, and fistulas often penetrate into adjoining structures, including other loops of bowel, the bladder, or psoas muscle.

Fistulas may even extend to the skin of the anterior abdomen or flanks. Independently of intra-abdominal disease activity, perianal fistulas and abscesses occur in 25 to 33% of cases; these complications are frequently the most troublesome aspects of Crohns disease.

Noncaseating granulomas can occur in lymph nodes, peritoneum, the liver, and all layers of the bowel wall. Although pathognomonic when present, granulomas are not detected in about half of patients with Crohns disease.

The presence of granulomas does not seem to be related to the clinical course.Segments of diseased bowel are sharply demarcated from adjacent normal bowel (“skip areas”); hence, the name regional enteritis. About 35% of Crohns disease cases involve the ileum alone (ileitis); about 45% involve the ileum and colon (ileocolitis), with a predilection for the right side of the colon; and about 20% involve the colon alone (granulomatous colitis), most of which, unlike ulcerative colitis (UC), spare the rectum.

Occasionally, the entire small bowel is involved (jejunoileitis). The stomach, duodenum, or esophagus is clinically involved only rarely, although microscopic evidence of disease is often detectable in the gastric antrum, especially in younger patients. In the absence of surgical intervention, the disease almost never extends into areas of small bowel that are not involved at first diagnosis.

There is an increased risk of cancer in affected small-bowel segments. Patients with colonic involvement have a long-term risk of colorectal cancer equal to that of UC, given the same extent and duration of disease.

Possibly related posts: (automatically generated)

]]> http://crohnsdiseasecauses.com/pathophysiology-of-crohns-disease/feed/ 0 Crohns Disease Surgery http://crohnsdiseasecauses.com/crohns-disease-surgery/ http://crohnsdiseasecauses.com/crohns-disease-surgery/#comments Fri, 08 Jan 2010 16:27:47 +0000 Dr Joe Stevenson http://crohnsdiseasecauses.com/?p=113 Two-thirds to three-quarters of patients with Crohn’s disease will require surgery at some point during their lives. Surgery becomes necessary in Crohn’s disease when medications can no longer control the symptoms. It may also be performed to repair a fistula or fissure.

Another indication for surgery is the presence of an intestinal obstruction or other complication, such as an intestinal abscess. In most cases, the diseased segment of bowel and any associated abscess is removed; this is called a resection. The two ends of healthy bowel are then joined together in a procedure called an anastomosis. While resection and anastomosis may allow many symptom-free years, this surgery is not considered a cure for Crohn’s disease, because the disease frequently recurs at or near the site of anastomosis.

An ileostomy also may be required when surgery is performed for Crohn’s disease of the colon. After the surgeon removes the colon, he brings the small bowel to the skin, so that waste products may be emptied into a pouch attached to the abdomen. This procedure is needed if the rectum is diseased and cannot be used for an anastomosis.

The overall goal of surgery in Crohn’s disease is to conserve bowel and return the individual to the best possible quality of life. Surgery does not cure Crohn’s disease, but corrects an immediate problem that cannot be resolved using medication. Four types of surgery are commonly performed on individuals with Crohn’s disease:
•    Partial bowel resection, to remove a diseased portion of intestine
•    Strictureplasty
•    Correction of fistulas
•    Draining of an abscess

It is estimated that about 75% of individuals who live with Crohn’s disease will require surgery at some point in their lives, and that 75% of those who have one surgery will need at least one subsequent surgery.

Partial Bowel Resection
Resection is usually performed when a portion of intestine has been so damaged by disease that a permanent partial obstruction has formed. The most common areas removed are the terminal ileum, the ileocecal valve, and a small portion of the large intestine. Usually, the surgeon will attach (anastomose) the healthy ends of intestine together during the procedure.

Sometimes, however, there is mild inflammation throughout the intestine, preventing such reattachment. In these cases, a temporary ostomy is created. The ostomy allows intestinal contents to drain directly out of the body into a collecting bag through the abdominal wall. The ostomy is usually closed and the bowel reattached six to eight weeks after the initial surgery.After surgery, disease tends to occur above

Possibly related posts: (automatically generated)

]]> http://crohnsdiseasecauses.com/crohns-disease-surgery/feed/ 0 Crohns Disease Disability http://crohnsdiseasecauses.com/crohns-disease-disability/ http://crohnsdiseasecauses.com/crohns-disease-disability/#comments Sun, 13 Sep 2009 16:03:22 +0000 Dr Joe Stevenson http://crohnsdiseasecauses.com/?p=75 Colitis or Crohn’s Disease, NACC has produced a range of different benefit guides relating to incapacity benefit and disability living allowance. Crohns disease (CD) frequently presents during early adulthood, a peak time of work productivity. There are limited data from the United States on work disability from CD. We performed this study to identify clinical factors associated with permanent work disability in a CD tertiary referral cohort.

Methods: Cases were identified as patients who received permanent work disability compensation from the social security administration (SSA) related to CD. Four control patients who were not receiving work disability were selected for each case. Multivariate logistic regression was performed to identify characteristics that were independently associated with work disability.

Results: A total of 737 patients with CD were seen in our center, and 185 CD patients were included in our study (37 disability cases, 148 controls). On multivariate analysis, an SIBDQ score ≤50 (OR 12.44, 95% CI 4.45-34.79), undergoing two or more GI surgeries (OR 7.09, 95% CI 2.63-19.11), and two or more medical hospitalizations (OR 2.76, 95% CI 1.03-7.37) were significantly associated with work disability in CD. Disease location (small bowel vs colon), type (inflammatory, stricturing, or fistulizing), or specific treatment strategies were not associated with work disability in our analysis.

Conclusion: Permanent work disability administered through social security was encountered in 5.3% of the Crohn’s patients followed in our cohort. Patients who consistently report low quality of life, or have frequent flares requiring surgical intervention or hospitalization for medical management, may be at risk for CD-related work disability.
The statistics of the German social security system were used to analyse the epidemiology of inflammatory bowel disease (IBD) in Germany and to assess its impact on disability.

Patients granted disability pension for IBD were compared with a control group of patients disabled from other causes. Crohns disease and ulcerative colitis led to disability in significantly younger patients than other diseases. Disability from Crohns disease was 2.0-fold more common in women than men (95% confidence interval: 1.8-2.3), while disability from ulcerative colitis was similar in both sexes.

White collar employees were affected by both diseases more frequently than blue collar employees, the ratio being 1.3 (1.2-1.5) in Crohns disease and 1.6 (1.4-1.8) in ulcerative colitis. Although IBD is relatively rare, it has severe socioeconomic implications, because compared with other diseases, predominantly young age groups become disabled

Possibly related posts: (automatically generated)

]]> http://crohnsdiseasecauses.com/crohns-disease-disability/feed/ 0