Crohn's disease

Crohn's disease, scientifically known as Crohn's disease, is a gastrointestinal disease of unknown cause that can occur in any part of the gastrointestinal tract. Typical symptoms include abdominal pain, diarrhea, intestinal obstruction, etc. Because it is a chronic disease, it is prone to relapse and is difficult to cure. Repeated relapses may even lead to the death of the patient. We need to have a comprehensive understanding of the causes and symptoms of Crohn's disease. Let’s take a look below.

Etiology: The cause of this disease is unknown, and it may be related to infection, genetics, humoral immunity and cellular immunity. Crohn's disease is a proliferative lesion that penetrates all layers of the intestinal wall and can invade the mesentery and regional lymph nodes. The lesions are limited to the small intestine (mainly the terminal ileum) and colon, but both may be affected simultaneously, usually the ileum and right colon. The lesions of this disease are distributed in segments, separated from the normal intestinal segments, with clear boundaries and the characteristics of skip areas. Pathological changes are divided into acute inflammation stage, ulceration stage, stenosis stage and fistula formation stage (perforation stage). In the acute phase, the main symptoms are intestinal wall edema and inflammation; in the chronic phase, the intestinal wall thickens and becomes stiff, the affected intestine becomes tubular in shape, and the upper end is dilated. Typical lesions on the mucosal surface are: 1. In the early stage of ulcer, there are shallow small ulcers, which later become longitudinal or transverse ulcers. Longitudinal ulcers that penetrate deep into the intestinal wall form more typical fissures, which are distributed along the mesenteric side, and there may be abscesses in the intestinal wall. 2. Pebble-like nodules are small island protrusions formed by edema and cell infiltration in the submucosal layer, coupled with fibrosis and scar contraction after ulcer healing, making the mucosal surface like a pebble. 3. Granulomas do not have caseation, which is different from tuberculosis. 4. Fistulas and abscesses The fissures in the intestinal wall are essentially penetrating ulcers, which cause adhesions and abscesses between the intestines, between the intestines and organs or tissues (such as the bladder, vagina, mesentery or retroperitoneal tissue, etc.), and form internal fistulas. If the lesion penetrates the intestinal wall and reaches the outside of the body through the abdominal wall or the tissue around the anus, an external fistula is formed.

Clinical manifestations include abdominal pain, diarrhea, abdominal mass, fistula formation and intestinal obstruction, which may be accompanied by fever, anemia, nutritional disorders and extraintestinal damage to the joints, skin, eyes, oral mucosa, liver, etc. This disease may recur and persist. 1. Digestive system manifestations (1) Abdominal pain is located in the right lower abdomen or around the umbilicus and is spasmodic and intermittent. It is accompanied by bowel sounds and worsens after meals and is relieved after defecation. If the abdominal pain persists and the tenderness is obvious, it indicates that the inflammation has spread to the peritoneum or abdominal cavity, forming an abscess. Severe abdominal pain and tense abdominal muscles may be caused by acute perforation of the diseased intestinal segment. (2) Diarrhea is caused by inflammatory exudation, increased motility and secondary malabsorption in the affected intestinal segment. The symptoms are intermittent at first, and then become continuous mushy stools without pus, blood or mucus in the later stage. If the lesion involves the lower colon or rectum, there may be mucus, blood in the stool, and a feeling of tenesmus. (3) Abdominal masses are most common in the right lower abdomen and around the umbilicus, and are caused by intestinal adhesions, thickening of the intestinal wall and mesentery, enlarged mesenteric lymph nodes, internal fistulas, or local abscess formation. (4) Fistula formation is one of the clinical characteristics of Crohn's disease. Transmural inflammatory lesions penetrate the entire layer of the intestinal wall to the extraintestinal tissue or organ, forming a fistula. Fistulas can lead to other intestinal segments, mesentery, bladder, ureters, vaginal retroperitoneum, etc. External fistulas lead to the abdominal wall or perianal skin. (5) Anorectal lesions: A small number of patients have lesions such as fistulas, abscess formation, and anal fissures around the anus and rectum.

2. Systemic manifestations (1) Fever Fever is caused by intestinal inflammatory activity or secondary infection. It is usually intermittent low-grade fever or moderate fever. A few cases present with remittent fever and may be accompanied by toxemia. (2) Nutritional disorders include weight loss, anemia, hypoproteinemia, vitamin deficiency, calcium deficiency, osteoporosis, etc. caused by loss of appetite, chronic diarrhea and chronic wasting diseases. (3) During the acute attack period, there are disorders of water, electrolyte, acid and base balance. 3. Extraintestinal manifestations: Some patients have iridocyclitis, uveitis, clubbing, arthritis, erythema nodosum, pyoderma gangrenosum, oral mucosal ulcers, chronic hepatitis, pericholedochal inflammation, sclerosing cholangitis, etc., and occasionally amyloid degeneration or thromboembolic diseases.

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