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Crohn’s Disease


Crohn’s disease can affect any part of the gastrointestinal tract. It is a chronic inflammation that develops in the gastrointestinal tract which can involve all the layers of the bowel. The pathogenesis is associated with T-cell activations which lead to tissue injury. Complications of Crohn’s disease involve small bowel obstruction, intestinal strictures; free perforation, abscesses, toxic megacolon and fistulae.

Crohn’s Disease Treatment in Ernakulam

 

 

Causes

  • Diet and stress
  • Heredity
  • Genetics
  • Environmental factors
  • Immune system breakdowns

Signs and Symptoms

  • Rectal bleeding
  • Diarrhoea
  • Urgency to move bowels
  • Feeling of incomplete evacuation
  • Perianal fistulae and abscesses
  • Abdominal pain and cramps
  • Constipation which subsequently leads to bowel obstruction
  • Fever
  • Weight loss
  • Fatigue
  • Night sweats
  • Irregular menstrual cycles
  • Nausea and vomiting
  • Bone loss

Diagnosis

  • Physical examination: focus on temperature; weight; nutritional status; abdominal tenderness; palpable mass; findings on rectal examination; segments of the bowel reveal microperforation
  • Routine lab studies: CBC; chemistry panel; inflammatory markers; stool studies
  • Serologic tests: pANCA; ASCA
  • Barium contrast: study for pseudodiverticula
  • Small bowel follow-through: upper GI SBFT for the terminal ileum
  • CT scan: for extramural complications
  • Ileocolonoscopy: to take multiple biopsies
  • Upper GI endoscopy
  • MRI: magnetic resonance imaging can evaluate perianal and pelvic disease while investigating for perianal fistulae
  • Radionucleotide scanning: assesses the severity and extent of the disease

Treatment

Diarrhoea during Crohn’s disease is treated pharmacologically due to acute C.difficile infections. Anti-inflammatory and immunosuppressant medications such as sulfasalazine are prescribed for small bowel and colon inflammation. Diet modifications and nutritional therapy are important modalities to facilitate bowel resting.

Indications for surgery: formation of intra-abdominal abscesses; fistulae that are medically intractable; symptoms persist in spite of high-dosage corticosteroid therapy; fibrotic strictures with obstruction; toxic megacolon; cancer; perforation; bleeding;

Recommended surgical procedures are: bowel resection; ileocolostomy; strictureplasty; total or segmental colectomy; proctectomy or total proctocolectomy

We are approached for several complications of IBD and Crohn’s disease all of which we have treated successfully for many years now.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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