Crohn's disease: signs and danger of intestinal pathology, therapy and forecast. General symptoms of crown disease and the course of the disease Symptoms of narrowing of the intestinal lumen in Crown's disease
Crohn's disease is called chronic inflammatory disease The intestines, which is characterized by the formation of ulcerations on the intestinal mucous membrane, on the site of which granulomas will subsequently grow, spikes and strictures are formed, which narrows the intestinal lumen and violates its permeability. Most often, Crohn's disease amazes the delicate intestine, namely the iliac rim (terminal Ileit, regional Ileit, transmural Ileit), but can occur throughout the intestine (granulomatous enteritis, granulomatous colitis, regional enteritis, etc.). In addition, with the disease there are multiple extraordinary manifestations.
Crohn's disease in children has favorite localization in a duodenum and a cister, often completely striking the small intestine (eunoileitis).
Men and women are subject to the disease to the same extent, the average age of ill from 20 to 30 years. Crohn's disease in children is usually manifested in adolescence - 12-12 years old.
At the moment, the disease is considered incurable, the purpose of the treatment of Crohn's disease is to maintain the intestines in a state of long-term remission and facilitating the symptoms in exacerbation, as well as the prevention of complications.
Until now, the causes of Crohn's disease are unclear. Researchers identified several factors that are important in the mechanism chronic inflammation intestines, however, the launcher in the pathological process is not known. The facilitating factors include:
- Failure in the immune system of the body. In the management mechanism of inflammation plays an important role of an autoimmune component, that is, a pathological response immune system On the organism's own fabrics, as well as on those intestinal microorganisms that are not pathogenic and are necessary for appropriate food:
- Hereditary predisposition. It is known that people with Crohn's disease often relatives suffer from chronic inflammatory bowel diseases, such as ulcerative colitis;
- Damaging effect external factors: unhealthy food, bad habits, Wrong lifestyle, infection.
The triad of the main symptoms of Crohn's disease includes pain in the stomach, chronic diarrhea and weight loss.
The abdominal pain (abdominal pain) is most often manifested in the right lower part of the ileum (Ileit of Krone), is stupid, more than character. Sometimes there is no pain, and in the lower right of the abdomen there is an unpleasant severity and driving.
In case of Crohn's disease, the appetite is often reduced, but even if it is not changed, there is still a missing, and often quite significant.
Approximately 30% of patients with symptoms of crown disease are disorders from the anal opening and rectal: rectal cracks, swelling and irritation of anus, which can cause pain during defecation, as well as the release of mucus and blood from the anal hole.
Crohn's disease in children has some features of the flow. For children with this disease, a strong weight loss, loss, sometimes full, appetite, delay in development is characterized. One of the symptoms of Crohn's disease in children is the rise of temperature to high numbers, often accompanied by pain in the joints.
Extra case symptoms of crown disease can be misled when diagnosis. These include: arthritis, arthrosis, biliary and renal disease, hepatitis, inflammation of the mucous membrane of the eye and mouth, as well as skin manifestations - dermatitis, eczema, rash and long non-healing ulcers.
Diagnosis of Crohn's disease
Diagnosis of the disease is carried out in the presence of characteristic symptoms of crown disease using the following studies:
- Endoscopy. The method consisting in the introduction of a tool in the intestines consisting of a flexible tube equipped with a video camera and a light source with which the mucous membrane of the straight and colon is investigated.
- Intestinal radioscopy. Methods using a contrast agent, allowing to detect neoplasms, granulomas and areas of narrowing in a small intestine;
- Biopsy of the intestinal mucosa. The fabric for histological studies is taken during colonoscopy. In laboratory conditions, changes in the mucous membrane are analyzed;
- Laboratory research methods. Complete and biochemical blood tests, urine, analysis and bakpospases are carried out, as well as a deployed immunological analysis of blood.
Treatment of Crohn's disease
As mentioned above, the Crohn's disease belongs to the incurable diseases at the moment. However, the treatment of Crohn's disease is not just necessary, but should be consistent and constant to maintain the normal quality of the patient's life. In the absence of adequate treatment, the Crohn disease always has an unfavorable forecast, as it leads to the development of one or more severe complications, and often not only on the side of the intestine, many of which carry a direct threat to life.
Crohn's disease conservative treatment, with the development of complications resort to operational intervention.
Medical treatment of Crohn's disease during the exacerbation period is to use antidiare drugs, anti-inflammatory (hormonal therapy with corticosteroids), antibacterial drugs and drugs that are overwhelming the excessive activity of the immune system (immunosuppressants).
During remission, the treatment of Crohn's disease is reduced to the observance of diet and maintain healthy image Life.
Diet with Crohn's disease limits the use of severe, coarse food, which causes an irritating effect on the intestinal mucous membrane, as well as fats and milk. It is recommended to be easily accurate and easily friendly food, with a limited use of fermented milk products, gentle for the gastrointestinal tract. It is extremely important that the diet in Crohn's disease was balanced, since anemia and vitaminosis are frequent because of the poor digestion of food.
Gastroenterologists recommend individual selection of dishes: during the period of exacerbation, a rigidly limited diet of the first table, then gradually introducing individual products and monitor the response to them. The exacerbation products are excluded from the diet completely. Diet with Crohn's disease should be respected constantly, throughout life. It is especially important to follow these rules in the Crohni disease in children, since otherwise the disease may hardly affect the physical development of the child.
Complications of Crohn's disease
Crohn's disease can cause severe complications to which include: fistulas, fistulas and intestinal diverticulus, intestinal cancer and biliary tract, intestinal obstruction, peritonitis, intestinal abscesses, intestinal perforation. Most of these complications require emergency surgical care.
Another complication group is extraordinary manifestations that can achieve any severity.
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Crohn's disease is a disease, which is based on a chronic inflammatory process amazing all shells (mucous, submucous, muscular) gastrointestinal tract.
The incidence of Crohn's disease in the world is 45-95 cases per 100,000 population.
It begins chronic illness At a young age between 15 and 35 years.
Anatomy and physiology of the small intestine
Since the Crohn's disease is most often affected by the delicate intestine (80% of cases), so I will describe anatomy and physiology fine intestine.Anatomy of the small intestine
The delicate intestine begins on the gastroincing of the stomach and ends with a iliac-sloppy hole. The small intestine is divided into 3 parts: duodenum, skinny and iliac.1. The duodenum - is the widest and in the shortest small intestine. The duodenal length is 20 centimeters.
The lumen of the duodenum opens the liver and pancreas ducts. The intestine continues to digest food, started in the stomach. The duodenal mucosa contains glands. These glands allocate mucus to protect the intestine from mechanical and chemical irritation.
2. The skinny intestine is an intestinal department containing a villus and plenty of folds.
3. The ileum - contains the feathers of plaques (a kind of lymph nodes), which protect the intestine from harmful bacteria.
The small intestine consists of 4 layers:
- Serous shell - outer sheath of the small intestine.
- Muscular shell. Consists of smooth muscle fibers.
- Sweet layer. The layer is represented by connecting tissue with vessels and nerves located in it.
- mucous membrane. It consists of intestinal epithelium, which is involved in the digestion and suction process.
Physiology of the small intestine
Functions of the small intestine:1. Contact function. With the help of rhythmic movements (peristalities), food is pushed by the small intestine. The peristalistic serves not only for the movement of food by the intestine, but also for the separation of the food lump in smaller parts. The separation process serves for better rubbing and mixing food with intestinal juice.
The contractile ability is under neurohumoral control.
From the side of the nervous system, control is carried out using a wandering nerve and sympathetic nerve fibers.
Humoral regulation is carried out using biologically active substances. For example, the Mothilin preparation stimulates the peristaltics, and various peptides reduce peristaltic activity.
2. Digestive function.
Fats are split under the influence of pancreatic lipase and bile.
Proteins are digested with the so-called protease (tripsin, chymotrypsin), which split proteins to amino acids.
Carbohydrates are digested in a duodenalist under the action of pancreatic amylase.
3. Suction function. Fats after splitting to fatty acids come into the cells of the small intestine, from where connecting with various transport systems, fall into lymph, and then in the blood.
Proteins, digested to amino acids, are absorbed by active transport.
Carbohydrates are absorbed under the action of various mechanisms and come into the cells of the intestinal epithelium.
Water and electrolytes. Water is absorbed under the action of osmosis and passive diffusion. Sodium and chlorine are absorbed by attaching to organic compounds. Calcium absorption occurs with the help of active transport.
4. Endocrine function - consists in the isolation into the blood of various biologically active substances.
Secretin - peptide, which stimulates the production of pancreatic juice, stimulates the yoy outlet. Also inhibits the production of hydrochloric acid by the stomach.
Cholecystokinin - stimulates the release of bile from the gallbladder.
There are also many other biologically active substances affecting the processes of digestion and suction.
5. Immune function. The mucous membrane of the small intestine is a barrier for pathogenic microbes.
Causes of Crown's Disease
There are several theories about the causes of the disease. 1. Infectious theory. Adherents of this theory believe that the cause of the disease is the pathogenic (capable of causeing a disease) of the Flora. Different types of bacteria and viruses cause inflammation in a thin or fat intestinal departments.
2. The theory of the formation of antigens. The basis of this theory is the appearance of antigens, to any food or non-pathogenic (not capable of causeing a disease) of the FLORE. These antigens along with food or bacteria remain on the intestinal walls. The body produces antibodies against them. Then these antibodies are connected to antigens. Immune response is carried out with the development of various factors leading to inflammation.
3. An autoimmune theory. This theory states that inflammatory process It lies the process of appearance of autoantigen (normal antigens of the organism's own cells). Normally, immunich learns its antigens and does not occur a immune response. Authors of theory believe that autoantignenes appear for inexplicably reasons in various departments digestive tract. The body begins to destroy their own cells, which leads to inflammation.
Also involve the presence of a genetic factor. The so-called family predisposition.
What happens in the digestive tract?
For Crohn's disease, a segmental (partial) defeat from several centimeters to several meters is characterized. And the disease can be in any partdigestive tract.
Crohn's disease more often affects the delicious intestine of 75-80% of cases. In 20% of cases, the defeat is located in other digestive tract (fat intestines, stomach, esophagus). Most often occurs a combined lesion (for example, a part of the small intestine and a large intestine segment).
The defeat of the intestine is intermittent, that is, after the affected area, it is necessary normal, and then amazed again.
Characteristic macroscopic (which can be seen not an armed look) signs of illness:
- erosion of various shapes
Ulcers of various depths that alternate with a normal mucous membrane. This feature figuratively called the "cobblestone pavement"
Stenosis (narrowing), while the intestine segment becomes thickened and solid
Fistula - a channel forms a message between different organs or tissues. There is no fistula.
Microscopic (visible only under the microscope) Signs:
- Inflammation of all intestines
Lymphatic edema
Epithelial granuloma - consists of a variety of different cells of epithelial origin. These granulomas can be located in different bowel bed layers, but more often are in the mucous membrane or submucosal shells.
Symptoms of Crohn's disease
All symptoms can be divided into local (local) and general.Local symptoms:
- pain in the abdomen of various intensity. Pains may be new or cutting. Usually appear after a while after meteorism (bloating)
- diarrhea (liquid chair) - the severity of diarrhea depends on the degree of intestinal lesion
- title with blood impurity (the amount of blood depends on the degree of lesion)
- possible near the recycled abscesses (limited purulent disease)
- Weight loss with severe disease can be substantial (tens of kilograms)
- Temperature is usually not high to 38 degrees
- Eye symptoms (take away - inflammation of the vascular shell of the eye, conjunctivitis - inflammation of the mucous membrane of the eye)
- Skin symptoms (redness)
- Malgia (muscular pain), arthralgia (joint pain)
- Vasculitis - inflammation of vessels
- Violation of blood coagulation with the formation of thrombov
1. Easy degree
- frequency diarrhea up to 4 times a day
- Chair with a rare blood presence
- Temperature up to 37.5 degrees
- Normal Pulse (70-80)
2. Middle degree
- frequency diarrhea more than 6 times a day
- Chair with blood
- Pulse 90.
- Possible complications
3. Heavy degree of illness
- frequency diarrhea more than 10 times a day
- Chair with plenty of blood
- temperature of about 38 degrees
- Pulse over 90
- Presence of complications
The course of the disease
The disease depends on the degree of lesion. But in general, the disease tends to spread the process to a healthy intestine. The disease proceeds with exacerbations and incomplete remissions. Among patients in remission are approximately 30% of patients throughout the year carry outgradation and approximately 50% of patients suffer an aggravation for 2 years. Gradually remissions become short, and the symptoms during the exacerbation increase.Diagnosis of Crohn's disease
When symptoms appear, the disease should be consulted by a gastroenterologist or therapist.Conversation at the doctor
Doctor will ask you about complaints. Especially inequately asked about the chair and its characteristics. At the end of the conversation will ask you about nutrition.
Inspection
With visual inspection, you can see an increase in abdomen in volume (swollen stomach). The doctor will definitely examine the eyes and skin Covers. In the case of any eye symptoms The advice of the ophthalmologist will be appointed. If skin symptoms are present, the dermatologist is assigned.
Palpation (tackling) belly.
With surface palpation, high sensitivity zones are detected in the projection of the small intestine.
With deep palpation, diseases of the disease are detected.
General blood analysis
In the blood test, characteristic features are:
- Reducing the amount of hemoglobin less than 110 grams / liter
- an increase in the number of leukocytes (leukocytosis) greater than 9x10 to 9 degrees
- increasing the speed of sedimentation of red blood cells View more than 15
Blood chemistry
- Reducing the number of albumin
- the presence from the reactive protein indicates the acute phase of inflammation
- increasing the fraction of Gama - Globulinov
- increasing the number of fibrinogen
Immunological analysis of blood
Present different kinds Antibodies in the blood. Especially often find cytoplasmic antine-hydrophilic antibodies.
X-ray study
1. X-ray abdomen. It is done to eliminate such complications as perforation (run) of any intestinal separation, toxic expansion of the colon.
2. Irigography - X-ray studies using double contrast (contrast and air).
Radiological signs of the disease
- segmental (partial) intestinal lesion
- thickening and reducing the mobility of the intestinal walls
- ulceration or ulcers in an early stage
- ulceration is not constant shape (as stars or round)
- The estate resembles a "cumen bridge"
- Stenosis (narrowing of the lumen)
- Partial blockage of guts
Endoscopic study is a mandatory study. This study is necessary for visual confirmation of the diagnosis and to take a biopsy (piece of fabric) for the study under the microscope. And it is done in various departments of the digestive tract. Sometimes the defeat can be in the stomach and in the esophagus, so they make fibrogastroduodenoscopy to eliminate the defeat of these departments. To visualize a large intestine, a colonoscopy is used. The study of the entire small intestine is very expensive and problematic, therefore limited to the above-mentioned studies.
Any endoscope consists of a tube, different lengths, chambers and a light source. The camera increases the image several times, and then transfers it to the monitor.
Endoscopic criteria:
- defeat of various sections of the intestine
- no vascular drawing
- Longitudinal ulcers
- Relief of the intestine similar to "cobblestone"
- Defects in the intestine wall (fistulas)
- mucus mixed with pus in the lumen
- narrowing of the gossip
Complications of Crohn's disease
- swiss (messages between different organs or tissues). As a rule, an purulent process is accompanied, so surgical treatment.
- abscesses B. soft tissues. Abscess - limited purulent inflammation, in this case, near intestinal structures. Treatment only surgical.
- massive bleeding most often lead to anemia (decrease in erythrocytes and hemoglobin), as well as in severe cases and shock.
- split intestine with subsequent peritonitis. Peritonitis (inflammation of the peritoneum) is a very severe complication of Crohn's disease, as it leads to severe intoxication of the body.
Vasculitis is inflammation of predominantly small vessels.
Treatment of Crohn's disease
Effective treatment of Crohn's disease is possible only from a gastroenterologist's doctor! The aggravation of the disease is treated exclusively in the hospital! Mode
In the period of exacerbation, bedding is recommended until the patient's condition improves. In the period not complete remission, the mode is ordinary.
Diet with Crohn's Disease
The purpose of the diet is to reduce the likelihood of mechanical, thermal and chemical irritation of the intestine.The meal temperature should not be below 18 degrees and not higher than 60 degrees Celsius. Recommended fractional food 5-6 times a day not by large portions.
In the case of severe exacerbation, 2 hungry days are recommended. That is 2 days without food, but with a mandatory admission of 1.5-2 liters of water per day. If the aggravation proceeds not in severe, instead of hungry days, unloading days are recommended. For example, such options are possible:
- 1.5 liters of milk per day
- 1.5 liter kefir per day
- 1.5 kilogram finely grated carrots per day
- or 1.5 kilogram purified from peel and finely chopped apples
After 2 hungry days or unloading days, go to the diet that you need to keep constantly.
Prohibited products
- Alcohol
- Fatty grade meat and fish
- Any species of spices
- sharp seasoning
- horseradish, mustard, ketchup
- ice cream, ice drinks
- Wheat, pearl porridge
- legumes
- Any semi-finished products
- Cannedize
- severe and smoked products
- Fried dishes
- Mushrooms
- chips, crackers
- carbonated drinks
- Frozing from a feather and warm dough, cakes
- Chocolate, coffee, strong tea
Products recommended for use
- mucous (oat and manna) porridge
- Dried bread from flour 2 grades, cookies
- low-fat cottage cheese, milk, in a small number of sour cream
- Eggs in the skey one per day
- Soups on non-fat meat (beef, chicken), with adding, such as rice or potatoes
- Vermichel
- boiled and baked vegetables
- Meat not fatty varieties in boiled, liver and chopped (cutlets)
- Fish not fatty varieties in boiled form or bay fish
- From berries and fruits It is recommended to make compotes, frost, jam, jams
- Juices are not acidic and desirable diluted with water and in limited quantities (glass per day)
- not fatty cheese, pies from homemade no fat meat
If a patient has a strong diarrhea and a significant loss in weight diet is adjusted to more calorie foods (more meat products in the diet).
Medical treatment of crown disease
Preparations from group of aminoalcylates are used. For example, Mesalazine 3-4 grams per day or sulfaselazine 4-6 grams per day distributing a dose of 4 receptions. Doses of preparations gradually decrease after remission.Corticotropic drugs:
1. The prednisone is used inside or intravenously at a dose of 40-60 milligrams per day for 1-4 weeks, followed by a decrease in the dose. The dose is reduced by 5 milligrams during the week.
2. Recently, budesonide is more often used. This drug causes fewer side effects than prednisone. Budesonide is applied at a dose of 9 milligram per day.
Metronidazole - antibacterial drugused to suppress intestinal microbes. It is used in a dosage of 10-20 milligrams per kilogram of body weight.
As a rule, these drugs in the exacerbation phase are combined, for example sulfosalazine with metronidazole or prednisone with metronidase.
After remission, Mesalazin is used in small doses.
Preparations that are used, in case the above described drugs do not help.
Azatioprin 2.5 milligram per kilogram of body weight or methotrexate 10-25 milligrams per week with a mandatory reception of folic acid.
With very pronounced exacerbation, it is used or when any complications of the disease appear, infliximab in a dosage of 5 milligrams per kilogram of body mass is used. The dose must be broken into 3 parts. This preparation is administered intravenously mixed with saline. Moreover, the first dose is appointed immediately 2 doses in 2 weeks, and 3 doses in 4 weeks. Infliximab is a drug with immunomodulatory action.
In the case of infectious complications, antibiotics are prescribed from a group of cephalosporins or macrolides.
Surgical treatment is appointed in case of severe complications. For example, with intestinal obstruction (blockage) or fistulas. As a rule, resection (removal) of the affected area is used.
According to statistics, 60% of patients for 10 years need surgical intervention. As well as 45% of patients undergoing communication with Krone's disease need over the next 5 years in re-operation.
Prevention of crown disease
An important element of prevention is proper nutrition, including an exception to excessively oily food, as well as the restriction of consumption of silicone, smoked and pepper.
Used intact food to reduce the risk of incidence of intestinal infection.
It is necessary to avoid stress, mental or physical overvoltage at work.
If the work implies a constant voltage to change it to easier.
It is necessary to strengthen the nervous system. In case of stress, apply sedatives.
What features is Crohn's disease in children?
Crohn's disease can occur in children of any age. The most common disease aged 13-20 years. Boys and girls are sick approximately equally often. Features of the symptoms of Crohn's disease in children:
- The main symptom is diarrhea. The frequency of the chair can reach 10 times a day or more. Periodically, blood impurities may be present in the stool.
- Pain worried all children. As in adults, they can be of different intensity.
- Loge in growth, sexual development. Especially with the serious course of the disease.
- Of extortiece manifestations Crohn's disease in children most often meet: arthritis, joint pains, aphtose Stomatitis , journal Erythema, violation of vision.
Can Krone disease transform into cancer?
Crown disease is a precious bowel disease. Malignant rebirth is one of its most difficult complications. Like almost any other malignant tumor, gut cancer, developed against the background of Crohn's disease, can not manifest himself for a very long time, and being diagnosed in late stages, it often has time to give metastases, germinate to other bodies - it makes it difficult to treat and significantly worsens the forecast. . 
Malignant rebirth of the intestine can be found with the help of endoscopic studies - colonoscopy. Patients who are recommended to regularly pass a colonoscopy:- Suffering from crown disease non-specific ulcerative colitis, polyposis and other precancerous intestinal diseases.
- Strongly suffering in abdominal pains, the cause of which is unknown, and it failed to identify with other diagnostic methods.
- People over 50 years old, even those who have health in the norm.
What are the forecasts for Crohn's disease?
Factors depends on Krone's disease:- Prevalence of defeat - length of a part of the intestine, affected by the pathological process.
- Severity of impairment of suction- The degree of violation of the intestinal functions caused by the disease.
- Availability of complications. For example, if Crohn's disease complicated by development malignant tumor, - adenokarcinoma- the forecast is worsening.
When defeating the rear pass and the rectum usually comes to improve after the operation.
On average, mortality among patients suffering from crown disease is about 2 times higher than among healthy people of the same age. Most often, patients die from complications and operations.
The doctor must constantly observe the patient's condition and on time to appoint examinations aimed at identifying complications. It helps improve forecasts. In Europe and some cities of Russia (Moscow, Irkutsk, St. Petersburg), specialized centers for the diagnosis and treatment of inflammatory bowel disease have been created.
What is the difference between Crohn's disease and nonspecific ulcerative colitis?
Crohn's disease and nonspecific ulcerative colitis - diseases accompanied by the development of inflammation in the intestinal wall. They may be accompanied by similar symptoms. Distinguish one disease from another mayor after evaluating symptoms and survey. At about 10% of cases, the diagnosis remains unclear. In such cases, the "unspecified colitis" is diagnosed. | Crohn's disease | Nonspecific ulcerative colitis | |
| In which intestinal department is developing a pathological process? | In 75% of cases - in the small intestine. Other intestinal deposits may be affected. | In a straight and colon. |
| What do they find during endoscopic research? |
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| What features are detected on radiographs? |
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Does disability give a crown disease?
In case of crown, a disability group can be assigned if the defeats are quite severe. A disability group is assigned after the passage of medical and social expertise (ITU), to which the patient sends the attending physician. Disability groups that can be assigned in Crohn's disease:
| Characteristics of violations | The degree of disruption of working capacity, self-service ability, movement | Group of disability |
| I degree of limitation of self-service ability. I Degree of disability. | III |
| II degree of reduction in self-service ability. II degree of reduction of ability to move. II-III degree of dismisability. | II. |
| III degree of reduction of self-service ability. III degree of reduction of ability to move. | I. |
Differential diagnosis for Crohn's disease: What diseases may be accompanied by similar symptoms?
There are quite a few diseases whose symptoms are similar to the symptoms of Crohn's disease. First of all, suspicion of the doctor may fall into the following pathologies.:- Malignant intestinal tumors.
- Chronic infections.
- Diffuse Connective Tissue Diseases: systemic Red Volchanka, dermatomiosit, systemic sclerodermia.
- Dieseneria, Salmonellosis and other intestinal infections.
- Non-specific ulcerative colitis (nym).
- Chronic nonsense colitis.
- Chronic enteritis.
How does Krone disease occur during pregnancy? Is it possible to give birth with such a diagnosis?
The question of pregnancy during the crown disease is quite complicated. Many doctors know little about whether a woman can get pregnant with such a diagnosis, as a pregnancy occurs against the background of Crohn's disease, there are safe treatment methods. Some doctors unreasonably tell women that they will not be able to get pregnant that their pregnancy is contraindicated. In 2008, under the leadership of the European Crohn Crohn Crohn and Colitis Organization (European Crohn`s and Colitis Organization), 500 women participated. It and some other studies helped answer many questions.
Can a woman with Crohn's disease get pregnant?
It was previously that only 66% of women with Krone's disease are capable of conceiving a child. Today, scientists are known that only about 10% of patients are fruitless.The main reasons, due to which women with Krone's disease will be pregnant less often than healthy:
- Unwanted women to have a child. Or the doctor may unreasonably tell the patient that she has contraindications for pregnancy. Such women are constantly using contraception.
- High Activity Crown Disease. In this case, monthly periods are broken.
- Safety process in small pelvis. It is often occurs after the transferred operation.
A favorable outcome of pregnancy depends on how active the disease is during conception. Therefore, during pregnancy planning, it is important to attend a doctor in time and fulfill all the recommendations.
How does Krone disease affect pregnancy?
If the activity of the disease is high, then only half of pregnancies takes place without complications. With inactive disease, most women (80%) complications do not occur.Basic complications during pregnancy associated with Krone's disease:
- premature birth (with an active disease, the risk rises by 3.5 times);
- spontaneous miscarriage (with active disease, the risk rises by 2 times);
- futal hypotrophy;
- more often there is a need for a cesarean section.
How can pregnancy affect Crohn's disease?
According to the statistics of exacerbation of the disease in pregnant women, there are no more than those of non-empty.- If, at the time of pregnancy, Krone's disease was in the remission stage - in 2/3 women, it continues to remain inactive.
- Similarly, if at the time of pregnancy occurrence, the disease was active - activity will continue or intensify about 2/3 of women.
- after childbirth;
- after abortion;
- if with the onset of pregnancy, the woman independently ceased treatment.
Can a woman suffering from Krone's disease, give birth independently?
In general, with a given disease, independent birth is possible, but such patients often have to resort to Cesarean section.Indications for Cesarean section in pregnant women suffering from Crohn's disease:
- high activity of the disease;
- availability ileostomas - iliac messages with leather;
- lesion of the skin around the anus;
- scars of crotch.
| Name of sanatorium | Where is? | Description |
| "Kraulka" | Tula region | Medical factors:
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| "Krasnozhersky" | Novosibirsk region | Medical factors:
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| "Red Glinka" | Samara Region | Medical factors:
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| "Crystal" | Kemerovo Region. | Medical factors:
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| "Krasnoyarsk Zagorie" | Krasnoyarsk region | Medical factors:
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| "Mashuk" | Stavropol region | Medical factors:
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| "MARICAL WATER" | Karelia | Medical factors:
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Is it possible to cure Crohn's disease finally?
Crohn's disease is a chronic disease that cannot be pulled completely. Treatment helps only facilitate the course of the disease. In all patients, Krone disease is waveled: periods of improving the state are replaced by new exacerbations.Nevertheless, many patients can live full life. In the most favorable cases, a person may not experience symptoms of the disease for many years and decades.
Is the Crohn disease?
Crown disease is not an infection. Therefore, from a sick person can not be infected, even if we use with him a common kitchenware, personal hygiene subjects.Also, Crohn's disease is not oncological pathology, although it is called the pre-sorcelary disease. It only increases the risk of intestinal cancer. If the surveys take place in a timely manner, then, in the event of a tumor, it can be revealed to early stages, the chances of the cure at the same time are greatly rising.
What are the extraordinary manifestations of Crohn's disease?
In case of Crohn, not only the intestines are often affected, but many other organs. Such manifestations of the disease are called extraordinary
- nodic erythema - inflammation of the vessels of the skin and subcutaneous fatty fiber;
- angiit- inflammation of the vessels of the skin;
- gangrenoza pyodermia - Chronic necrosis (samples) of the skin.
- hepatosis - violation of the exchange in hepatic cells, accumulation of fat and dystrophy in them;
- sclerosing cholangitis - chronic disease of biliary tract, in which connective tissue grows in their walls;
Crown's disease is called an inflammatory disease of the intestine of unclear etiology, which affects predominantly the small intestine. A distinctive feature of this disease is a segmental damage to the intestine and involvement in the inflammatory process of all shells of the intestinal wall.
The incidence rate of Crohn's disease around the world is low and is between 2 to 4 cases per 100 thousand people, but recently there is an increase in incidence.
The disease is mainly striking young people aged 18 to 35 years and even teenagers, as well as persons over 60 years old.
Anatomical and physiological features of the small intestine
In the small intestine, it is customary to distinguish three departments:
- duodenum;
- the intestine;
- iliac.
In the duodenalist, which is the widest, but shortest colon department, the digestion process continues. In the intestine, the bile and juice of the pancreas in drives.
In a tekhchka through multiple patches, nutrients are actively absorbed.
In the ileum also absorb nutrients, but here there are also organs of the immune system - poker plaques.
The wall of the small intestine consists of the following shells:
- mucous;
- sublitty;
- muscular
- serous.
The delicious intestine performs a number of vital functions, among which are the following:
- motor - Promotion of key masses by intestines due to peristalsis;
- digestive - splitting nutrients such as fats, proteins and carbohydrates, enzymes of intestinal juice;
- suction - suction of nutrients, macro- and microelements, vitamins in lymph, and then to blood;
- excretory - secretion in the blood of biologically active substances, such as secretine, cholecystokinin and others that regulate the process of digestion;
- protective - mucosa of the small intestine prevents the penetration into the blood of pathogenic microorganisms.
After we disassemble the anatomy and the physiology of the small intestine, it will be easier for you to understand the essence of the problem.
Etiology of Crohn's disease
Despite high level The development of medicine, a reliable cause of the development of Crohn's disease, has not yet revealed. In the process of numerous studies, several etiological theories were put forward, consider them.
An autoimmune theory. Supporters of this theory adhere to the opinions that the intestinal wall is inflamed due to the malfunction of the immune system, which perceives the patient's antigens focused in the intestine, as foreign.
Infectious theory. The essence of this theory is that the disease causes pathogenic microorganisms, among which bacteria and viruses. But it was not yet possible to identify the pathogen yet, although there is an assumption that paraletberculse mycobacteria and measles virus can cause Core disease.
Hereditary theory . If you believe this theory, the krone disease is inherited.
Antigenic theory . The basis of this theory is the reaction of antibodies to antigens food products. Antigens are attached to the intestinal walls, where they are attacked by antibodies, as a result of which pro-inflammatory proteins are released and an inflammatory process occurs.
As you can see, different theories are different regarding the etiology of the Crohn disease, but none of them is confirmed. Most data still indicate that autoimmune processes are based on this disease.
Pathogenesis (mechanism of development) Crohn's disease
Crohn's disease amazes intestinal segments. If we talk simple words, then inflamed sections of the intestine alternate with healthy. The zone of damage to the intestinal wall can be both small and occupy the entire length of the intestine.
Crohn's disease can damage all digestive tube departments: esophagus, stomach, thin and thick intestine. But most often the pathological process is localized in the walls of the small intestine, especially in the region of the ileocecal department. Also, the disease is also affected by the iliac, after which it applies to other parts of the digestive tube.
The most common shape of the Crohn disease combined when not only the small intestine is amazed, but also part is thick.
When examining a sector of the intestine, affected by Krone's disease, you can see ulcers of various shapes and depths, which alternate with a healthy mucous membrane ("cobblestone pavement"). This feature is specific.
In addition, for Crohn's disease, the presence of stenosis and seals of the intestinal tube, as well as fistulas, which inform the cavity of the intestine with other bodies. With a given disease, the structure of the crypt and glazing cells does not change.
With histological examination of the intestinal of the intestine, affected by the disease, signs of inflammation of all its shells, swelling, erosion and epithelial granulomas, which are located in the mucous membrane and the sublifted layers and consist of epithelial cells (lymphocytes, plasmocytes, eosinophils, segmented leukocytes).
Epithelial granulomas for crown disease are called sarcoid, as they are gathering with such sarcoidosis, but their difference is that they do not have clear boundaries and are not surrounded by a fibrous rim.
If we talk about the difference between sarcoid granuli from those with tuberculosis, they are not exposed to curly necrosis.
Classification Disease Crown
Because clinical manifestations Crohn's disease directly depend on the localization of inflammation, its scale, stage, and the presence of complications, it is customary to distinguish between several forms of the disease.
Crohn's disease is divided by localization. A generally accepted is the classification of Bokach, according to which the following forms of the disease are distinguished:
- hero - defeat tochyan;
- ileit is the defeat of the ileum;
- eynoileitis is the simultaneous lesion of the skinny and iliac intestine;
- enterocolitis - combined lesion of thin and colon;
- granulomatous colitis - the lesion of the colon;
- defeat an anal area;
- difuzine intestinal lesion.
But more often in our country enjoy the classification of Fedorov-Levitan, which shares the Crohn disease for three forms:
- enteritis;
- enterocolitis;
- colitis.
Symptoms and clinical course of crown disease
For Crohn's disease, local, common and extraordinary manifestations are characterized.
Local signs
In patients, the following local diseases may be observed:
- abdominal pain, which is associated with meals and occurs 2-3 hours after meals, especially if the diet is violated. By nature, pain can be both a novel and cutting. Most often, pain is localized at the bottom of the abdomen on the right, so it can be confused with appendicitis;
- constant bloating;
- diarrhea;
- the presence of blood in feces;
- abdominal abscesses;
- internal and external fistula;
- anal and perianal lesions (, back passage,)
The intensity of symptoms depends on the shape, stage and prevalence of intestinal lesion.
General signs
Among the common symptoms of Crohn's disease, it is necessary to allocate such as:
- malaise;
- general weakness;
- unfinished loss of body weight;
- fever that occurs due to the formation of abscesses and infiltrates inside the abdominal cavity or due to
Extra case manifestations
With extraordinary damage to the disease, Crown, the following is observed:
- takes (inflammation of the vascular shell of the eyeball);
- conjunctivitis (inflammation of the mucous membrane of the eyeball);
- skin hyperemia;
- pain in the muscles and joints;
- aphtomatic ulcers;
- vasculitis (inflammation of the vascular wall);
- template to thrombosis.
The severity of the illness
The severity of Crohn's disease is determined by the severity of symptoms. Severe three severity of the disease, namely:
- easy;
- average;
- heavy.
For a light degree of crown disease, the following symptoms are characterized:
- diarrhea no more often four times a day;
- subfebrile fever;
- there are no diseases from other organs and systems.
Patients with a medium severity may complain about the following:
- liquid stool with blood admixture from 6 to 10 times a day;
- subfebrile fever;
- tachycardia;
- the appearance of complications.
With severe Crohn's disease, patients have the following symptoms:
- liquid stool with plenty of blood from 10 times a day;
- increase body temperature up to 38 ° C and higher;
- tachycardia (heart rate greater than 90 Д. / min.)
- symptoms of complications.
Crohn's disease is a chronic progressive disease with periods of exacerbation and incomplete remission. In some patients, the exacerbation of the inflammatory process in the intestines is observed 1 time per year, and others have 1 every two years. With the progression of the disease of the exacerbation, the symptoms are growing, and remissions become shorter.
Features of the course of Crohn's disease in pregnant women
Some specialists do not prohibit planning women pregnancy, while others are categorically against such a risk.
A few years ago a large-scale clinical studywhich allows you to find answers to questions about pregnancy and Crohn's disease.
In the process of this experiment, it was proved that infertility develops only among the tenth sickness of Crown.
Also were allocated the following reasonsWhy patients with this disease can not have children:
- unwillingness of the woman itself;
- severe course of the disease;
- spikes in a small pelvis, including in the appendages and the uterus.
- spontaneous abortion;
- fetal hypotrophy;
- premature genera (with active disease, risk rises by 3.5 times);
- the need for surgical delivery.
Pregnancy is not a provoking factor in the exacerbation of Crohn's disease.
In the process of observations, it was found that the risk of exacerbation of the disease is raised in the first 12 weeks of pregnancy, in the early postpartum period, after artificial interrupting pregnancy and during the termination of therapy.
Features of Crohn's disease in childhood
As mentioned earlier, young people, teenagers and even children are exposed to the crown. More often the disease is observed in children over the age of 13.
Based on clinical observations, it was possible to highlight a number of features of Crohn's disease in childhood, namely:
- diarrhea is the main sign of the disease;
- blood in feces is rarely present;
- pain syndrome has different intensity;
- children are lagging behind in physical development;
- children may have arthritis, arthritia, nodular erythema, reducing vision, ulcers of the oral cavity.
Diagnosis and treatment of crown disease in childhood are the same as in adult patients, only smaller doses of drugs are applied.
Complications of Crohn's disease
The following complications may develop in patients with Crohn's disease:
- bleeding;
- purpure of the intestine and peritonitis;
- toxic bowel dilatation.
- fistula;
- abdominal abscesses;
- intestinal obstruction;
- malignant rebirth.
Consider complications of Crohn's disease in more detail
Intestinal bleeding in patients with Krone's disease is rare. Blood can deep ulcers and cracks of the intestinal wall, but massive bleeding are rare.
Peritonitis (inflammation of the peritoneum) in the crown disease is a consequence of the penetration of intestinal content through the perforation of the intestinal wall. Push the addition of peritonitis can be highly indicators of body temperature (38 ° C and higher), severe weakness, strong pools In the stomach, arrhythmia, as well as on the voltage of the muscles of the front abdominal wall. But patients who receive systemically hormonal drugs, Symptoms The clinical picture of peritonitis can be lubricated.
Toxic intestinal dilatation in crown disease may occur due to the permanent reception of anti-anti-drug preparations, frequent tool Research intestines (colonoscopy, rectoroscopy) or the addition of secondary infection, as well as in the late stages of the disease.
Fistulas can be both outdoor and internal. Outdoor fistulas are observed in the anorectal zone and are a move unfolded by the epithelium, the inner mouth of which is located in the rectum, and the outer opens on the skin of the buttock or in the perianal folds. Internal fistulas connect the bowel cavity with other organs, spaces and cavities.
Abdominal abscesses arise due to the penetration of infection from the intestine in the abdominal cavity through fistula and are often localized in the right iliac region.
Intestinal obstruction is a pathognomonic symptom of Crohn's disease. In the early stages of the disease to obstruction, swelling and spasm of the intestinal wall are given, and later - scar changes. Due to the listed processes, the intestinal lumen decreases and the normal passage of the roam mass is disturbed. But the complete obstruction of the intestine in the disease Crown is not observed.
Crohn's disease is included in the list of precancerous diseases that can be the basis for the development of a malignant tumor. A feature against the background of this disease is distinguished by the mixing of the clinic, as active hormonal therapy is carried out, so the tumors are often detected in the later stages.
In addition to the complications described above, the patients appear anemia, steatheree, avitaminosis, hypoproteinemia, hypocalcemia, hypomagnemia and a shortage of other useful minerals. The listed states arise due to impairment of nutrients in the digestive tract, as well as due to the increased decay.
Also, Crohn's disease is almost all and accompanies Malabsorption syndrome,symptoms of which can be the only manifestation of the disease. In addition, in patients with this disease there is a high risk of osteoporosis.
Methods for diagnosing Crohn's disease
Diagnosis and treatment of Crohn's disease are engaged in such specialists as a physician and a gastroenterologist.
To your attention the patient survey algorithm in suspected Crohn's disease.
1. Subjective examination:
- collect complaints;
- collecting anamnesis of the disease;
- collect anamnesis of life.
2. Objective examination:
- inspection;
- palpation.
3. Additional diagnostic methods:
- laboratory diagnostic methods: general analysis blood, biochemical blood test, immunological tests and others;
- overview radiography of the abdominal organs;
- irigography;
- fibroezophagastroduodenoscopy;
- other.
When survey, the doctor draws attention to the patient's complaints, singularities, harmful habits, the presence of Crohn's disease in close relatives. Also, a patient must characterize its chair and character of the feet.
In case of examination, the patient may be increased by the belly due to meteorism, the mucous eye and skin is changed. If there are extraordinary manifestations of Crohn's disease, the patient is sent to a consultation to an ophthalmologist, a dermatologist, a dentist doctor, a rheumatologist doctor, etc.
Palpation of the belly allows you to detect pain areas.
For Crohn's disease, the following hematological changes are characteristic:
- malokroviya (reducing the amount of hemoglobin);
- leukocytosis;
- acceleration of ESP (erythrocyte sedimentation rate);
- reducing the number of albumin;
- the appearance of C-jet protein;
- raising the level of gamma globulin;
- an increase in the amount of fibrinogen;
- the presence of antibodies of different types.
The overview radiography of the organs of the abdominal cavity allows you to identify signs of intestinal perforation (sickle darkening over the liver) and toxic intestinal dilatation.
Irigography is a regenerative study of intestinal intestinal contrast. Barium and air are used as contrasts.
Fibrozophagastroduodenoscopy is carried out in order to fence the material on histological examination and to assess the prevalence of the process on the stomach and the esophagus.
With endoscopic studies, the following signs of Crohn's disease can be identified:
- segmental inflammation of the intestine;
- blur or complete absence of vascular pattern;
- symptom "Cobblestone Bridge"
- the presence of multiple longitudinal ulcers;
- fistulas intestinal wall;
- a large number of mucus with admixture of pus;
- stricking guts.
If you observe your undue weight loss, general weakness, poor appetite, chronic intestinal disorder, blend of blood in feces, flatulence and periodic abdominal pain, immediately consult a physician doctor or a gastroenterologist. The doctor after a careful examination will exclude or confirm the Crohn disease, and, if necessary, prescribe effective treatment, which will help stop the progression of the disease.
Differential diagnosis
Since the clinical manifestations of Crohn's disease are similar to other diseases, there is a need for them.
Often differential diagnosis Crown diseases are carried out with the following diseases:
- malignant neoplasms of the digestive tract;
- with hemorrhoids;
- infectious diseases with chronic flow;
- systemic autoimmune diseases (sclerodermia, red lupus, dermatomyomy and others);
- incortional group infections (salmonellosis, dysentery, yersiniosis and others);
- nonspecific ulcerative and non-compatible colitis;
- enteritis with chronic flow.
Methods for treating Crohn's disease
Only a specialist may choose an effective and safe method for treating Crohn's disease. Self-treatment does not always give the expected result, and sometimes even aggravates the course of the disease.
During the remission, patients can lead a normal lifestyle.
Also patients must stick to the diet all their lives, which we will talk about in more detail.
Medical therapy Crohn's disease
In the treatment of Crohn's disease, several groups of drugs are used, namely:
- aminoalcylates (Mesalazin, Sulfasalazine);
- glucocorticosteroids hormonal agents (Prednisone, budesonide);
- antibacterial drugs (metronidazole, cefotaxim);
- cyticostatics (Azatioprin, Methotrexate).
With the exacerbation of Crohn's disease, the listed drugs are combined. SAME effective schemes Treatment are the following:
- Sulfosalazine + metronidazole;
- Prednisolone + metronidazole.
After the relief acute manifestations Diseases are transferred to supporting therapy, which most often use Mesalazin.
With the ineffectiveness of non-correnent and hormonal anti-inflammatory funds, cytostatics are prescribed to the patient, for example, methotrexate.
Weak patients also conduct immunomodulatory therapy. The drug selection in this case is infliximab.
In case of bacterial complications of the Crohn disease, there is a need for antibiotic therapy with the preparations of a wide range of action, for example, cephalosporins or macrolides.
Surgery
In case of crown disease, resection of the affected sections of the intestine are carried out in order to restore the functions of the digestive tract.
When choosing a surgical approach, the advantage is given by laparoscopy. Laparoscopy accelerates the operation, reduces treatment costs and practically does not cause complications.
Surgical removal of the affected segment of the intestine does not exclude the risk of recurrence of the disease and the need for a re-operation.
The sick disease of the Crown, which led to severe complications, also shows the conduct of operational intervention.
Direct testimony to surgical intervention in crown disease are the following states:
- intestinal strictures, which violate the passage of carts;
- external and internal fistulas;
- purulent foci inside the abdominal cavity;
- intra-abdominal bleeding;
- the sodes of intestines.
At the strictures of the intestine, the affected segment of the intestine is removed, but if it is impossible to do this, an asset is formed. Pyloroplasty is carried out in patients with pylorostenosis.
For surgical treatment The fistulas perform their clothing or fully excised the fistulous move. Conducts conservative therapy to accelerate healing postoperative Ran. and increasing the resistance of the body.
In the case of intra-abrasion abscesses, a drainage operation and antibacterial therapy is carried out.
A brief overview of drugs that are used in the treatment of crown disease
Mesalazin
This is a non-steroidal anti-inflammatory drug, a classic representative of salicylate.
The effect of the drug is aimed at reducing inflammation.
It is used in the treatment of diseases of the digestive tract, such as Crohn's disease and nonspecific ulcerative colitis, with therapeutic and prophylactic purposes.
Mesalazin has a number of side effects, among which are most often observed in patients. allergic reactions, dyspeptic phenomena, headache, blood coagulation disorders.
Mesalazine is contraindicated to persons with intolerance to salicylate and its components, as well as with reduced blood coagulation, heavy kidney and liver pathologies.
In addition, the drug does not apply in children under two years old, in the last trimester of pregnancy and in nursing women.
- during the exacerbation period, they are taken inside 2 tablets (1000 mg) 4 times a day after meals;
- during remission, the supporting dose of the drug is 1 tablet per day (500 mg).
Prednisolone
Easy to classic glucocorticosteroid hormone.
The drug is widely used for treatment various diseases, including Crohn's disease.
With systemic reception, a number of side effects may give, among which are the following:
- violation exchange processes in the body (hypernatremia, swelling, hypokalemia, obesity, hyperglycemia, alkalosis and others);
- endocrine disorders (insufficiency adrenal pituitary glands and hypothalamus, growth disorder, Incenco Cushing syndrome and others);
- disorders of work of cardio-vascular system (arterial hypertension, arrhythmias, tendency to thrombosis);
- changes in organs digestive system (ulcers of the stomach and esophagus, nausea, vomiting and others);
- disorders of the nervous system (depression, apathy, delirium, psychosis, insomnia and others);
- allergic reactions and others.
Prednisone is not prescribed in viral, fungal and bacterial infections in the body of any localization, immunodeficiencies, peptic disease stomach, with acute and subacute of the myocardial infarction periods, severe heart failure, sugar diabetes, acute psychosis, as well as nursing mothers.
During pregnancy, prednisolone is assigned a strictly attending doctor when the expected effect of treatment exceeds the risks for the fetus.
Drug reception scheme for crown disease:
- during the exacerbation, 40-60 mg in the knocks are taken into or introduced. The course of treatment lasts from one week to a month. Reduce the dose of the drug gradually;
- during remission, the supporting dose of the drug is 5 mg per day.
An excellent alternative to prednisolone can be called budesonide, which is not inferior in efficiency, but has fewer side effects and contraindications.
Metronidazole.
This is an antibacterial and antiprotozoic agent used in crown disease for suppressing intestinal flora.
The drug is active in relation to clostridias, giardes, amoebam, trichomonas, gardnelands, bacteroids, peptococks and other gram-positive and gram-negative microorganisms.
Metronidazole apply to infectious diseasescaused by microbes that are sensitive to this drug (Amebiaz, Trichomoniasis, giardiasis, pneumonia, meningitis, gastritis, ulcerative illness of the stomach, colitis and others).
Side effects rarely occur in the form of dyspeptic manifestations, headaches, dizziness, as well as allergies on the components of the drug.
Metronidazole is contraindicated to persons with the intolerance of its components, as well as with severe liver failure, in the first trimester of pregnancy and breastfeeding.
The diagram of the use of the drug during the disease Crown:
- the daily dose is 10-20 mg / kg, which is divided into two receptions. The drug is applied orally and intravenously.
Methotrexat
It belongs to the drugs of the cytostatic group.
The drug is used in chemotherapy in malignant and systemic diseases.
Methotrexate is applied solely on the appointment of the attending physician according to its strict control, since the drug often causes side effects, such as nausea, vomiting, diarrhea, stomatitis, alopecia, bleeding, anemia, hepatitis and others.
The drug is contraindicated in pregnancy and severe kidney disease, liver and bone marrow.
Reception scheme: 10-25 mg 1 time in 7 days under the cover of folic acid.
People's methods for the treatment of crown disease
As a supplement of the main treatment, folk remedies and methods can be used.
Current medicine in no way can be used as monotherapy, since their effectiveness is not enough to stop the progression of Crohn's disease. Also before starting treatment with unconventional means, you must consult with your attending doctor.
Judging by the reviews of patients, the most effective are the following folk remedies.
- Green clay will help make a stool and reduce inflammation in the intestinal walls. The mineral is used inside 1 teaspoon daily in the morning on an empty stomach, it is predefined to dissolve it in 200 ml of warm water.
- Bloom of blueberries is another opposite means. To prepare a decoction of 50 grams of dry berries, blueberries are poured with 4 glasses of boiling water and boil on low heat for 15 minutes, after which they are filled and used inside throughout the day.
- Altea root is used to produce mucus. For this, raw flushed roots of the plants are soaked in cold water. Take daily 10 ml of mucus divorced in a glass of warm water, 2-4 times a day before meals.
- Alcohol tincture of yarrow. It is recommended to use inside 30 drops of medication 1 time per day.
- Infusion has a pronounced anti-inflammatory effect, so regular use this medicine It will help to reduce the severity of the symptoms of the disease. For the preparation of infusion, 1 tablespoon of raw materials should be pouring 250 ml of boiling water and let it stand for 2-3 hours. Take an infusion of 1 cup 3-4 times a day before meals.
- Infusion of Chaga is prepared as follows: Fresh mushroom is cut into small cubes, after which 1 tablespoon of raw materials are soaked at night in 500 ml of cold water. It is then boiled on a slow fire for 10-12 minutes, after which it is possible to last 2-3 hours under the lid. Take a decoction of 1 tablespoon 3-4 times a day before meals.
Features of nutrition in the disease Crown
Diet, with Crohn's disease, gentle and aimed at protecting the intestinal mucosa from various damage.
Powered with crown disease should be fractional. The recommended number of meals are 5-6 times a day. Portions of food should be small.
There are also requirements for the temperature of the dishes, which should be in the range of 18-60 ° C to eliminate the thermal damage to the intestinal mucosa.
In the period of exacerbation, experts recommend to make two unloading days when possible only water in the amount of 1.5-2 liters. Patients with light and medium-eyed degrees of gravity of the disease besides water, you can use 6 cups of milk or as much kefir. Also, dairy products can be replaced with 1.5 kilograms of carrots or apples, peeled and finely grated.
After unloading days, go to the diet, more precisely the power style that must be observed continuously.
In the menu of patients with Krone's disease must be present such dishes as:
- porridge on water;
- non-baking bread;
- cookies;
- low-fat cottage cheese, kefir, ryazhenka, yogurt, sour cream and milk;
- boiled eggs;
- vegetable soups;
- meat broths from dietary grades of meat and poultry;
- pasta pasta;
- vegetable stew;
- boiled or steamed meat;
- non-fat fish;
- sweet fruit juices;
- fruit purees and jams;
- meat low-fat pate.
In severe cases, when diarrhea disturbs the sick more often 10 times a day, the diet should be highly eligible and consist mainly of meat dishes.
Crohn's disease
Crohn's disease. What signs?
Methods for the prevention of crown disease
Since the reliable cause of the occurrence of Crown's disease was not identified, a special set of measures for the prevention of this disease is not developed.
Crohn's disease is a chronic inflammatory disease of the digestive tract, the etiology of which is reliably unknown. Most often, the delicious intestine is affected. The disease is dangerous by its complications that can lead to the death of the patient.
With timely appeal for medical help And adequate therapy is a favorable disease forecast, since it is possible to achieve a rack and long-term remission. But Croon's disease is finally, unfortunately, it is impossible.
Crohn's disease is a multicomponent inflammatory disease that affects all digestive system departments, with development in most cases of extra investigators. In case of crown disease, the inflammatory granulomatous process is affected by the musculoskeletal, articular, coating fabrics, an organ of vision. Feature of Crohn's disease - the formation of granuloma affecting the whole thickness of the digestive tube (Different departments of a thick and small intestine, stomach).
Causes of Crohn's disease
It is still failed to reliably find out the cause of Crohn's disease. Undoubtedly, several causal factors and initiating moments should take part in the development of such a disease. Hereditary conditionality (mutations in certain genes) is proved by the more frequent occurrence of Crohn's disease in blood relatives.
Crohn's disease develops more often in patients with certain shifts in the microbial landscape of the large intestine (dysbiosis). There is often a long-lasting diet in the form of recycled, refined food nutrients with a minimum amount of fibers and fiber. Crown disease (inflammation with a granulomatous process) can be exacerbated by the harmful effects of nicotine, alcohol, frequent, unreasonable use of some drugs (antibiotics).
Crohn's disease is reliably connected with the inflammatory process in the intestine and with special forms of intestinal sticks, which becomes capable of attaching to the cells of the epithelium of the digestive tube, to be embedded in them and multiply. Pervatory substances (cytokines) initiate migration of macrophages and cells responsible for the synthesis of local antibodies into an inflammatory hearth. This Crohn's disease differs from other bowel diseases.
As a result of the reproduction of the pathogen in macrophages (without their subsequent death) and stimulating the cells of the immune system, a granular is formed - a characteristic feature of such a disease as Crohn's disease.
In the intestinal localization, Krone's disease amazes more often the small intestine - Ileit (its distal) and a fat intestine (proximal part). Often, the kroon disease has a combined localization of inflammatory-granulomatous changes. Rarely observed an isolated lesion, an exciting stomach and DPK. The upper floor of the digestive tract during Crohn's disease, as a rule, is amazed simultaneously with the intestines. Almost always the Crohn disease is conjugate with granulomatous inflammatory changes (granulation) in the perianal area.
Crohn's disease, depending on the age, the originality of the immune response and the presence of concomitant pathology can flow in different ways. The flow may be sharp (gradual or lightning), chronic (persistent or continuously recurrent). In all cases, there is a specific response from immune lymphoid tissue (AFTs or clusters of lymphocytes), which determines the symptoms of Crohn's disease.
Symptoms of Crohn's disease
Crown's disease often has non-specific manifestations and symptoms (characteristic of many intestinal diseases). Therefore, often, the Crohn's disease is detected not immediately, often patients who have discomfort and numerous complaints, the correct diagnosis can be delivered in a timely manner. The disease is characterized by the segmentality of the lesion (inflammatory changes are limited in length), which determines the following symptoms of Crohn's disease:
- pain in the intestine (due to the lesion of a thick or small intestine). The difference of pain lies in its character (in the form of bruises, spasms), depending on the defecation and removal of gases (the intestine pain tends to decrease after the chair). Pain in the intestine can be localized in the right iliac region (with iley) and imitate acute appendicitis. Often pain in the intestine is localized in the anal area (cracks, ulcers);
- frequent unformed liquid chair is an a characteristic symptom Crohn's disease during exacerbation. The number of defecations can differ significantly. Sometimes there may be a delay of defecation (constipation);
- pathological impurities in feces (blood, mucus). Blood sections with the feces can have the character of little-changed blood (if the localization of Crohn's disease corresponds to the distal divisions of the thick, sigmoid and rectum). With a gastroduodenal localization (stomach and duodenal), Crohn's disease is distinguished by a chair on the type of melan (black, similar to the trigger of an unformed chair). Impurities in feces (blood, pus) are always present in exacerbation;
- increase the temperature reaction - often symptom of Crohn's disease during exacerbation;
- nausea due to intoxication and fever, sometimes vomiting - an important symptom in Crohn's disease, no appetite can achieve anorexia degree;
- asthenic manifestationspeculiar to any long-flowing inflammatory process, weight loss, reduced food consumption (reduced appetite) are non-specific symptoms of Crohn's disease, as they can occur under other pathologies;
- arthritis (inflammation of the joint surfaces) with the damage to the embracing tissues (granule), skin lesion (piederma), lip skin changes and inflammatory cheeks are extraordinary symptoms of crown disease and are not observed isolated from intestinal manifestations.
Complications of Crohn's disease
- stricking (stenosis of the intestine) of the or other division of the intestines. Stenosis of the intestine can lead to acute intestinal obstruction, as the inflammatory process has a granulomatous total character (that is, the entire thickness of the intestine of the intestine is captured). When scarring, it is observed by the stenosis of the body of the organ (intestinal obstruction). Sometimes the stenosis of the gut happens incomplete.
- the abscess of inflammatory hearth and the formation of infiltrate is a serious complication of Crohn's disease;
- acute intestinal bleeding in Crown's disease can be a direct threat to life for the patient;
- spreading the entire thickness of the intestinal wall, sometimes with the formation of fistula strokes (between intestinal loops, exterior, internal);
- dilatation (expansion) of colon as a result of toxic effects on the intestinal wall.
Diagnosis of Crohn's disease
Diagnosis "Crohn's disease" can be diagnosed with certain instrumental diagnostic techniques (endoscopy, regenerative methods). Under colonoscopy, the segmentation of lesions, linear ulcerative defects, erosion with a wedge of hypereminated tissues are detected. X-ray (survey) study of the colon allows you to identify motor disorders, expansion or narrowing of the intestine, complications (megalolon, intestinal obstruction).
To clarify the nature of the complications of the Crohn disease use computer tomography and MRI method.
When conducting endoscopic examination, A piece of affected fabric is taken for the subsequent histological assessment of the bioptate (the clusters of lymphoid cells (epithelioid, giant) and a characteristic sarcoid granule are revealed. During inspection, peptic and erosive surfaces with redness on the periphery and across inflammatory raids can be visualized.
Blood tests during crown disease, as a rule, show a sharply flowing inflammatory process. In the blood is determined increased content CRH, leukocytes, decrease in red blood indicators (anemia of varying severity), increase the rate of settlement of red blood cells.
Coprological study in the disease Crown reveals the inflammatory component (in the feces of impurities of leukocytes, pus, mucus).
Principles of Crohn's Disease Treatment
Crohn's disease is currently not fully cured. But really help the patient, significantly improve its condition, thereby cutting the exacerbation and lengthen remissions (when all manifestations of the disease disappear, or becoming less painful).
Crohn's disease treats a gastroenterologist, complicated forms - surgeon.
Mandatory in exacerbation is the bedding and a special gentle diet, enzyme, adsorbing, anti-inflammatory funds. During the fever, antipyretic and disinfect drugs are used.
The main method of treating Crohn's disease, to the appointment of a doctor, is the appointment of hormonal (glucocorticosteroid) drugs (budesonide, prednisone). GCS can be used for topical and overall impact. Doses and the duration of their reception are determined only by the doctor (taking into account side effect and contraindications).
With a serious flow, without a tendency to fast healing Defects are resorted to the appointment of immunosuppressive therapy and the use of antimetabolites.
Specific treatment of Crohn's disease can last several months and even years. With the right approach to the treatment and observance of all medical purposes, it is possible to achieve long-term remission and good quality The life of patients with Krone's disease. Croon's disease treatment during exacerbation periods and supporting therapy in remission may differ.
The sharp shape of Crohn's disease is less common. As a rule, while the pathological process is localized in the terminal segment of the ileum. Characteristic clinical signs The acute form of Crohn's disease are:
- growing pain in the right lower abdominal quadrant;
- nausea, vomiting;
- diarrhea, often with blood impurity;
- flatulence;
- increased body temperature, often with chills;
- thickened painful terminal segment of the ileum;
- leukocytosis, an increase in ESP.
Chronic crown disease
The chronic form of Crohn's disease is most common. Its manifestations are different depending on the localization of the inflammatory process.
Subcast Localization
The clinical symptoms of this form can be divided into a group of common and local symptoms.
General symptomsdue to intoxication and malabsorption syndrome and include: weakness, malaise, reduced performance, increase body temperature to subfebrile, weight loss, swelling (due to protein loss), hypovitaminosis (gumblence of gums, cracks in the corners of the mouth, pellagroid dermatitis, twilight vision), pain In the bones and joints (depletion of calcium salts), trophic disorders (dry skin, hair loss, nail fragility), adrenal failure (skin pigmentation, hypotension), thyroid gland (Responsibilities, endloughness of the face), sex glands (disruption of menstruation, impotence), parasite glands (Tethania, osteomalacia, bone fractures), pituitary gland (polyuria with low urine density, thirst).
Local symptoms:
- Periodic, and later constant stupid pains (with the defeat of the 12-rosewood - in the right epigastric region, the current intestine - in the left upper and middle part of the abdomen, the ileum - in the right-day lower quadrant of the abdomen).
- Chair semi-liquid, liquid, frothy, sometimes with admixture of mucus, blood.
- When sacring the intestine - partial signs intestinal obstruction (Catching pains, nausea, vomiting, gas delay, stool).
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