Please enable JavaScript.
Coggle requires JavaScript to display documents.
Crohn's Disease - Coggle Diagram
Crohn's Disease
Clinical Manifestations
-
-
- Urgent need to have a bowel movement
- Abdominal pain and cramping
- Sensation of incomplete bowel evacuation
-
-
-
-
-
- Fistulas of the anal area
-
- Painful and swollen joints
-
-
-
Incidence/Prevalence
- The average age of onset is 30 years
- CD typically peaks twice in individuals who have it: once between ages 20-30 and again around age 50
- CD is most common in North America and Western Europe
- CD is more common in females than males
- CD is also more common in Ashkenazi Jewish people as opposed to non-Jewish people
- 50% of people with CD have involvement in the ileum and the colon
- CD affects 3-20 in every 100,000 people
- More than 500,000 Americans are living with CD right now
- Individuals who smoke are twice as likely to develop CD than those who do not smoke
Diagnostics
- The first step in diagnosing CD is taking a look at the medical history of the patient to see if there are any hallmark signs that it could most likely be CD or even be something else
- Assessing for signs of infection or antibodies through the blood samples
- If there are increased levels of white blood cells or platelets, it could be indicative of inflammation caused by CD
- Antibody tests to distinguish between the likelihood of either CD or UC
- Assessing for blood in the stool
- Having blood in the stool is indicative of a digestive issue
- Assessing for bacteria or disease-causing organisms in the stool
- If there are abnormal bacteria or organisms found within the stool, this can rule out CD or lead to further testing for it
- X-rays, CT scans, and MRI scans
- Each can help to better visualize the GI tract
- Can diagnose complications of CD, such as fistulas or abscesses
- Barium swallow for an upper GI series picture
- Used to examine the inside walls of the colon
- Usually looking between the small intestine and colon for the purpose of CD diagnosis
- If granulomas are present, this is often a sign of CD
Pathogenesis
- Crohn's Disease is a chronic inflammatory intestinal disease
- People with CD will experience many flares and remissions throughout their lives once diagnosed
- It can affect any part of the GI tract, but most commonly is seen in the small intestine
- CD commonly affects the entire thickness of the mucosal wall in the bowel
- Innate immunity is involved due to defects in the mucous membrane barrier
- Adaptive immunity is involved due to its reliance on helper T cell lymphocytic response and T cells that are regulated by cytokines
- Increased migration of T cells to the site of inflammation alters the extracellular matrix through metalloproteins and adhesion molecules
- CD is sustained by the inflammatory cells interacting with integrins, adhesion molecules, and chemokines, all causing increased production of inflammatory cytokines and therefore, increased mucosal inflammation
- The immune and inflammatory responses trigger neutrophils to infiltrate the crypts in the small intestine
- Due to all of the neutrophils, abscesses form in the crypts, causing destruction of the crypts
- Granulomas then often form
- The mucosa becomes edematous
- Ulcers form and get deeper, potentially leading to fistulization
- The ulcers become chronic and CD continues to progress
Treatments
- Aminosalicylates to decrease inflammation of the lining of the GI tract
-
-
-
-
- Corticosteroids to suppress the immune system
-
-
- Antibiotics to treat any bacterial infection in the GI tract
-
-
-
- Chronic inflammation of the GI tract can cause narrowing or strictures in the intestines due to scar tissue buildup
- The strictureplasty widens the strictures in the jejunum and ileum without resecting any of the intestine
- Helps to prevent obstructions and blockages
- Protocolectomy and Colectomy
- Colectomy is the removal of the colon
- Protocolectomy is removal of the colon and the rectum
- This will alleviate many symptoms of CD
- Colectomy allows the patient to continue to pass stool through the rectum
- Protocolectomy results in an external pouch for the passing of stool
- Avoid foods that can trigger a flare-up
-
-
-
-
- Suggested methods for eating
- Eat 4-6 small meals per day
- Stay hydrated by drinking enough water that the urine is pale yellow
- Try not to fry food; boil, steam, or grill instead
- Have patient get to know what foods are right for them, and focus on meals with those items
Risk Factors
- Environmental risk factors
- Disturbances in the microbiome of the gut
-
-
-
- Hormone replacement therapy
- Cigarette smoking, current and former
- Diets high in fat, sugar, oil, and meat
-
-
-
-
- More commonly seen in Jewish and North Americans and less common in African Americans and Hispanics
- There is correlation between CD and mutations in the genes on chromosomes 5 and 10
- The risk of CD is increased with mutations to the ATG16L1, IL23R, IRGM, and NOD2 genes
- If a family member has any IBD, any other family member has a 15-30% chance of developing CD