Medical history (history of illness) represents an important component in the diagnosis of Crohn’s disease. Family history Is there a history of frequent gastrointestinal disease in your family? Social history Is there any evidence of psychosocial stress or strain due to your family situation? Current medical history/systemic history (somatic and psychological complaints). Do you have … Crohn’s Disease: Medical History
Endocrine, nutritional, and metabolic diseases (E00-E90). Food intolerances – such as lactose intolerance, fructose intolerance. Infectious and parasitic diseases (A00-B99). Pseudomembranous enterocolitis/pseudomembranous colitis – inflammation of the mucous membrane of the large intestine that usually occurs after taking antibiotics; it is caused by an overgrowth of the intestine with the bacterium Clostridium difficile. Tuberculosis (consumption) … Crohn’s Disease: Or something else? Differential Diagnosis
The inadequate nutritional status frequently encountered in Crohn’s patients, which is characterized by underweight, negative nitrogen balance, decreased serum albumin, reduced serum concentration of vital substances (micronutrients), has an extremely negative impact on the patients’ well-being as well as on the course of the disease. In children, malnutrition delays growth in length and puberty [5.1]. … Crohn’s Disease: Nutritional Therapy
The following are the most important diseases or complications that may be contributed to by Crohn’s disease: Respiratory system (J00-J99) Fibrosing alveolitis – disease of the lung tissue and alveoli (air sacs). Eyes and eye appendages (H00-H59). Episcleritis – inflammation of the connective tissue between the sclera and conjunctiva of the eye. Iridocyclitis – inflammation … Crohn’s Disease: Complications
Montreal classification of Crohn’s disease. Age of manifestation A1: <16 years A2: 17-40 years A3: > 40 years Localization L1: ileum (ileum; part of the small intestine). L2: colon (large intestine) L3: Ileocolic L4: Upper gastrointestinal tract (gastrointestinal tract). Biological behavior B1: non-stricting, non-penetrating. B2: structuring B3: internally penetrating B4: perianal penetrating Vienna classification of … Crohn’s Disease: Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore: Inspection (viewing). Skin and mucous membranes [erythema nodosum (nodular erythema), localization: Both extensor sides of the lower leg, on the knee and ankle joints; less commonly on the … Crohn’s Disease: Examination
1st order laboratory parameters – obligatory laboratory tests. Small blood count (Hb, platelets, leukocytes) [anemia (anemia), leukocytosis (increase in leukocytes/white blood cells), and thrombocytosis (increase in platelets/platelets) as signs of chronic inflammation are the most common changes in the blood count of patients with Crohn’s disease. MCV and MCH may provide evidence of deficiency] ESR … Crohn’s Disease: Test and Diagnosis
Therapy goals Remission induction (achieving disease calming in the acute relapse) and maintenance. Mucosal healing should be aimed for. Therapy recommendations Therapy recommendation depending on phase and intensity: Remission induction: Acute relapse M. Crohn’s with involvement of the ileocecal region (ileocecal valve: functional closure between the large and small intestines) and/or right-sided colon (large intestine … Crohn’s Disease: Drug Therapy
To prevent Crohn’s disease, attention must be paid to reducing individual risk factors. Behavioral risk factors Diet Food components, especially increased use of refined carbohydrates – white sugar, white flour products. Low consumption of dietary fiber High consumption of chemically processed edible fats Micronutrient deficiency (vital substances) – see Prevention with micronutrients. Consumption of stimulants … Crohn’s Disease: Prevention
The following symptoms and complaints may indicate the onset of Crohn’s disease: Abdominal pain (abdominal pain/abdominal tenderness) in the right lower abdomen and periumbilical (around the umbilicus) (approximately 80%) Diarrhea (about 70%), possibly with mucus admixtures; hemorrhagic diarrhea (bloody diarrhea), possibly with mucus admixtures (45% / 35%). Fatigue Growth retardation: weight stagnation (in children) or … Crohn’s Disease: Symptoms, Complaints, Signs
Pathogenesis (disease development) To date, it is not clear what causes Crohn’s disease. Genetic, familial, infectious, and immunologic causes are discussed. What is certain is a dysbalance of pro- and anti-inflammatory messenger substances. Among the proinflammatory (inflammation-promoting) cytokines, tumor necrosis factor (TNF) plays a key role. Etiology (causes) Biographic Causes Genetic burden Familial clustering – … Crohn’s Disease: Causes
General measures Nicotine restriction (refraining from tobacco use); reduces the risk of relapse (risk of recurrence) by approximately 50% – participation in a smoking cessation program, if necessary. Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day). Aim for normal weight!Determination of BMI (body mass index, body … Crohn’s Disease: Therapy
