Crohn Disease

Crohn Disease
Introduction
Crohn disease is a recurrent, granulomatous type
of inflammatory response that can affect any area of
the gastrointestinal tract from the mouth to the
anus.
In nearly 30% of persons with disease, the
lesions are restricted to the small intestine; in 30%,
only the large bowel is affected; and in the remaining
40%, the large bowel and small bowel are affected. It
is a slowly progressive, relentless, and often disabling
disease.
The prevalence of Crohn disease is greatest in
the United States, Great Britain, and the
Scandinavian countries. The disease usually strike
people in their 20s or 30, with women being affected
slightly more often than men.
A characteristic feature of Crohn disease is the
sharply demarcated, granulomatous lesions that are
surrounded by normal-appear mucosal tissue. When
the lesions are multiply, they often are referred to
“as skip lesions” because they are interspersed
between what appear to be normal segments of the
bowel.
The surface of the inflamed bowel usually has a
characteristic “cobblestone” appearance resulting
from the fissures and crevices that develop and that
are surrounded by areas of submucosal edema.
They usually is a relative sparing of the smooth
muscle layers of the bowel, with marked
inflammatory and fibrotic changes of the submucosal
layer. The bowel wall, after a time, often becomes
thickened and inflexible; its appearance has been
likened to a lead pipe or rubber hose. The adjacent
mesentery may become inflamed, and the regional
lymh nodes and channels may become enlarged.
Anatomy and Physiology of the Gastrointestinal System
• Main function is to suffice the body’s nutritional

needs.
• Mainly composes of MUCOSA, SUBMUCOSA,
MUSCULARIS and SEROSA.
• Innervated by the myentric plexus, submucosal plexus
for intrinsic contractile stimulation ; vagus nerve for
parasym-pathetic stimulation; and thoracic and lumbar
splanchnic nerve for sympathetic stimulation .
• The blood supply is mainly supplied by the aorta and
braches to the many arteries.
Main Parts:
• Oral Cavity
• Esophagus
• Stomach
• Pancreas
• Liver
• GallBladder
• Small Intestines
• Large Intestines
Risk Factors:
• Age
• Ethnicity
• Family History
• Smoking
• Isotretinoin (Accutane) use
Pathophysiology
Increased permeability of the colon
Leakage of antigen in the colon surface
Abnormal response to the normal flora of the colon or failure to identify as self
Stimulates immune response
Epithelial cell damage and loss
Ulcerations of area are affected

Clinical Manifestations:
1. The primary problem is diarrhea ( 5 to 6 soft stools per

day).
2. Transmural inflammation (the entire wall of the
intestine is affected).
3. The ileum and ascending colon are commonly affected.
Inflammation is discontinuos (regional).
4. Stool is with pus and mucus.
5. Fistula formation. An abnormal opening that connects
the small and large intestines. The contenct of small
intestines become contaminated with feces from the
large intestines. Septicemia may occur.
6. Abdominal pain, weight loss.
Diagnostic
• X-ray
• Colonoscopy
Medications
• Salicylate Compounds
e.g., Sulfasalazine
• Corticosteroids
e.g., Prednisone
• Immunosuppressive Drugs
e.g., Cyclosporine, 6- mercaptopurine
• Antidiarrheal Drugs
e.g., atropine sulfate, loperamide
Complications:
• Fistula formation
• Abdominal abscess formation
• Intestinal obstruction
Surgical Management
• Ileostomy, Colectomy
Ileostomy stoma is found in the right lower
quadrant of the abdomen. Is has continuos watery
fecal drainage. It does not require irrigation.
Collaborative management:
1. Low fiber diet. To rest the bowels.
2. Total parenteral nutrition. If severe malnutrition is
present.
3. Steroid to relieve inflammation.
4. Azulfidine (Sulfisoxazole). It has antibiotic and anti-
inflammatory effect in the intestines.
5. Antibiotics like Flagyl (Metronidazole) and Cipro
(Ciprofloxacin) are prescribed to control secondary
bowel inflammation and infection.
CROHN'S DISEASE - INFECTION?
Gabe Mirkin, M.D.
Many recent studies show that most gastroenterologists
may be wrong when they do not prescribe antibiotics to treat
Crohn's disease. When a person has bloody diarrhea and
doctors find ulcers in the intestines, they look for cancer,
infection or parasites. When they can't find a cause, they
should say that they don't have the foggiest idea why the
person has intestinal ulcers. Instead, they deceive their
patients by saying that the person has Crohn's disease or
ulcerative colitis, and explaining that the person's immunity is
so stupid that it punches holes in the intestines, rather than
doing its job of killing germs.
They prescribe medications that suppress immunity or
cut out parts of intestine. The immunities of these patients
may not be so stupid that they attack and kill their own
intestinal cells. Normal intestines are so loaded with bacteria
that doctors can't possibly tell which belong there and which
may be causing disease. This treatment offers no cure and is
associated with many complications that shorten life.
Exciting research from France show that a variant of E. Coli, a
bacteria that lives in normal intestines, sticks to the intestinal
lining and produces an alpha hemolysis that punches holes in
the intestines to cause at least some cases of Crohn's disease
(1). Further studies show that heat shock protein can be
removed from the common intestinal bacteria, E. Coli, and
when given to mice, causes terrible bloody ulcers to form in
the intestines (1a).
The intestines looked under the microscope exactly the
same as those of people who suffer from ulcerative colitis or
Crohn's disease (1a). Extensive data show that people with
this condition have leaky intestines that allow germs to pass
into the bloodstream (2) and their immunities are trying to kill
these germs (3). Antibiotics can reduce swelling and ulcers in
Crohn's disease. Crohn's disease is contagious as people
married to partners with ulcerative colitis are more likely to
develop that disease (5). Dr. Joel Taurog of the University of
Texas in Dallas has shown that a bacteria called bacteroides
causes ulcerative colitis and Crohn's disease in mice who are
genetically programmed to have a HLA-B27, a special gene
that causes arthritis (6,7). Special tissue staining techniques
show that tissue taken from patients with Crohn's disease and
ulcerative colitis contain parts of two common bacteria called
E. Coli and streptococci (8).
Recent studies show that Crohn's disease can be
controlled by probiotics and prebiotics, introduced into the
colon by eating a diet rich in vegetables and whole grains and
taking specific good bacteria such as lactobacillus

Crohn Disease

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What are some of the characteristic features of Crohn's disease?

What are some risk factors for developing Crohn's disease?

Crohn Disease

• Main function is to suffice the body’s nutritional

Leakage of antigen in the colon surface

Stimulates immune response

Epithelial cell damage and loss

Ulcerations of area are affected

1. The primary problem is diarrhea ( 5 to 6 soft stools per

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