Introduction
Crohn disease is a chronic idiopathic condition in which there is inflammation of the gastrointestinal tract at any segment from the mouth to the anus (Ghazi et al, 2013).
Eponym
Crohn's disease has several alternative eponyms including Crohn's colitis, Crohn-Lesniowsky disease, Crohn-Lesniowsky syndrome, Enteritis regionalis Crohn and Morbus Crohn (Whonamedit 2013). some clinicians; Burrill Bernard Crohn, Gordon Oppenheimer and Leon Gizburg presented a group of clinical cases at a conference of the American Medical Association in 1932 and subsequently, the disease was attributed to these authors. It was also said that although Burrill Crohn was the least experienced of the three clinicians, his name appeared first in the journal for "alphabetic reasons" and the disease was subsequently attributed to that name. (Whonamedit, 2013).
Symptoms
The classical presentation of Crohn disease is that of pain in the abdomen with accompanying diarrhea. It could also be complicated by fistula formation or even obstruction of the intestines. The disease is a chronic one and there are periods of remission and periods of flares.
The patient could also present with some other symptoms that are not specific to only Crohn disease, including bleeding from the rectum, fever, anorexia, loss of weight, nausea and vomiting, malnutrition and loss of bone mass.
The individual could also have psychological issues, including depression, coping difficulty and anxiety. Pediatric patients could also present with growth failure which could precede the appearance of gastrointestinal symptoms by years (Ghazi et al, 2013).
Diagnosis
The diagnosis of Crohn disease starts from taking a good history of the symptoms. Afterwards, a thorough physical examination may reveal the following findings. The vital signs may be normal or there could be tachycardia if the patient has anemia or dehydration. In the gastrointestinal system, there could be normal findings or findings in keeping with an acute abdomen; depending on the severity of symptoms. The gastrointestinal examination includes an assessment of the tone of the rectal sphincter, detection of gross abnormalities in the mucosa of the rectum and the presence of blood in the feces.
The genitourinary system could reveal skin tags, ulcers, fistulas or abscesses. There could be scarring of the skin around the anus. Musculoskeletal examination may reveal possible arthralgia or arthritis more likely of the large joints than the small joints. Examination of the skin may reveal pallor or jaundice, mucocutaneous ulcers, erythema nososum or pyoderma gangrenosum. Ocular examination may reveal episcleritis or uveitis. Also, as mentioned earlier, a failure of the pediatric patient to thrive could be the heralding signal that the patient has Crohn disease (Ghazi et al, 2013).
There is no specific test for Crohn disease. However, the investigations ordered are important in facilitating the management of the disease. A complete blood count, Chemistry panel, Liver function tests, serology are all investigations that may be helpful (Kumar & Clarke, 2005).
Imaging studies facilitate the visualization of the gastrointestinal tract with a view to identifying pathognomonic characteristics of the disease.
Barium contrast study, plain abdominal radiography, computed tomography of the abdomen, Magnetic resonance imaging of the pelvis and Tecnetium-99m imaging are some of the imaging modalities that can be used to evaluate the disease.
Endoscopic examination of the gastrointestinal tract may also be necessary in evaluating the patient. Endoscopy and biopsy, colonoscopy, ileocolonoscopy, small bowel enteroscopy are some of the procedures (Ghazi et al, 2013).
Pharmacotherapy
Corticosteroids (like prednisolone, methylprednisolone) may be useful in managing the inflammation that accompanies the disease. Immunosuppressive agents (e.g. mercaptopurine, methotrexate) can also be used to reduce the immunological reaction that generates the inflammation. Monoclonal antibodies (e.g. infiximab, adalimunab) can also be used.
antibiotics like metronidazole or ciprofloxacin may have a role in eradicating infections. Agents that sequestrate bile acid like cholestyramine and colestipol can also be used. Anticholinergics like hyoscyamine or propantheline also have a role (Ghazi et al, 2013).
Surgery
There is no surgical cure for Crohn disease. However, patients may require some form of surgical intervention during their lifetime (Kumar & Clarke, 2005).
Some of these procedures include Bowel resection of the affected part. Ileocolostomy or ileostomy of the proximal bowel could also be done. the patient could also need surgery to drain a septic focus. A bypass surgery can also be done to bypass certain affected parts of the bowel (Ghazi et al, 2013).
Prognosis
The prognosis of the condition is good if the patient is diagnosed early and management is instituted.
REFERENCES
L Ghazi et al (2013). Crohn Disease. Medscape Reference. Medscape. Retrieved on 2nd of October, 2013 from <http://emedicine.medscape.com/article/172940-overview>
WhoNamedIt (2013). Crohn's Disease. Whonamedit. Retrieved on 2nd October, 2013 from http://www.whonamedit.com/synd.cfm/1397.html
P Kumar & M Clarke (2005). Crohn Disease. Clinical Medicine 6th Edition. Elsevier
