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Epidemiology!
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Crohn’s Disease
BY: Brent Movson, Allison Cobb, Alma Hernandez
History1682- Giovanni Battista Morgagni first noticed disease in 20 year old patient.
1913- T. Kennedy Dalziel noted patients had “Intestinal obstruction”
1932 Crohn's was officially diagnosed and named in by Burril Bernad Crohn
Proposed to Medical Association in New Orleans In a lecture speech titled "Terminal Ileitis.”
1996 Study on twins suggested a genetic link between Crohn’s and the people it infects
Epidemiology!
Epidemiology!• Crohn’s is commonly found in North America
and Eastern Europe• Crohn’s Prevalence rate ranges from 26 to
198.5 cases per 100,000 persons. • The Incidence rates range from 3.1 to 14.6
cases per 100,000 persons per year.
Epid
Epidemiology
• Found in Eastern European Countries• People who are more prone to Disease:• Ashkenazi Jews• Smokers• Hereditary genetics
Ashkenazi Jews
• People of Jewish decent are more likely to get disease
• Two-to-eight times more common in Ashkenazi Jews
• Doctor’s don’t know why it infects Jewish people
Smoking• Smoking has been shown not only to increase
the risk for Crohn’s disease but also WORSEN the course of the disease
• Smokers may be less responsive to certain treatments and are more likely to develop a recurrence of Crohn’s disease after surgery
• Jacque Cosnes from Rothschild Hospital
Genetics
• Siblings are more susceptible to have it• If one sibling has CD, than it is 30% more likely
the other sibling has it as well• People with family history of CD are at a 10
times greater risk of contracting it
Etiology• There is no mode of
transmission• Crohn’s is an autoimmune
disorder caused by genetic factors
• It is acquired heretically• The gene NOD2 determines
the way bacteria is handled in the body and when this gene is damaged or mutated Crohn’s happens
Etiology Cont.• Individuals with Crohn’s have a defect in
this gene called fibrostenosing, which means they form very narrow and blocked bowel complications very quickly and require surgery to remove damaged parts of the intestines and other organs affected by Crohn’s
• There have been studies done to determine whether diet and smoking cigarettes cause or have a relation to Crohn’s like previously thought but a poor diet and cigarette addiction only make Crohn’s symptoms worse, they do not cause it.
Pathology•Crohn’s is an autoimmune disease that usually presents first signs of symptoms between the ages of 15 and 35• Usually they manifest in the small intestine, the ileum to be exact, but it infects the entire GI tract among many other organs• the patients immune system attacks healthy tissues along the lining of the intestine which causes severe swelling of the intestines and ulcerations• the most common form of Crohn’s attacks the Ileum and colon
Symptoms• Abdominal pain. The pain often is
described as cramping and intermittent, and tender.
• Abdominal pain may turn to a dull, constant ache as the condition progresses.
• Diarrhea. Some people may have diarrhea 10 to 20 times a day.
• They may wake up at night and need to go to the bathroom.
• Crohn's disease may cause blood in stools, but not always.
Symptoms Cont.• Loss of appetite.• Fever. In severe cases, fever or other symptoms that
affect the entire body may develop.• A high fever may mean that the patient have a
complication involving infection, such as an abscess.• Weight loss. Ongoing symptoms, such as diarrhea, can
lead to weight loss.• Too few red blood cells (anemia). Some people with
Crohn's disease develop anemia because of low iron levels caused by bloody stools or the intestinal inflammation itself.
People with Crohn’s may also experience…
• Sores in the mouth. • Nutritional deficiencies, such as
lowered levels of vitamin B12, folic acid, iron, and fat-soluble vitamins, because the intestines may not be able to absorb nutrients from food.
• Bowel obstructions• Because there is some immune
system involvement, you also may have symptoms outside the digestive tract, such as joint pain, eye problems, a skin rash, or liver disease.
Symptoms Cont.
• Signs of disease in or around the anus. These may include: • Abnormal tunnels or openings called fistulas that sometimes
form between organs. These develop because Crohn's disease causes inflammation and ulcers in the deep layers of the intestinal wall. Fistulas may form between parts of the intestine or between the intestine and another organ such as the bladder, vagina, or skin.
• A fistula may be the first sign of Crohn's disease.• Pockets of infection (abscesses). • Small tears in the anus (anal fissures).• Skin tags that may resemble hemorrhoids. These are caused
by inflamed skin.
Fun picture of the colon!!!
How to know if you have Crohn’s?
• Colonoscopy, Proctoscopy
Colonoscopy
Treatment• THERE IS NO CURE FOR
CROHN’S!• Inflammation can be treated or
reduced by using medications, surgery and/or special diets
• The goal of treatment is to reduce the symptoms, control the autoimmune response, and maintain the body’s ability to fight disease.
Surgery• Used as treatment to repair the presence of an intestinal fistula, abscess
or ulcer.• PROCTOCOLECTOMY- surgical removal of the rectum and all or part of
the colon.• ILEOSTOMY- surgical opening constructed by bringing the end or loop of
small intestine (the ileum) out onto the surface of the skin. Intestinal waste is collected in an external pouch attached to the skin.
• INTESTINAL RESECTION- surgical procedure in which a part of the large or small intestine is removed.
• More than one surgery may be needed because disease frequently recurs in another area of the intestines.
Diet• Diet alone cannot prevent Crohn’s Disease.• However, when flare ups occur, symptoms can be made worse with milk,
alcohol, hot spices or fiber. • You can reduce abdominal discomfort and cramping during flare ups by:• Eating smaller meals throughout the day.• Reducing the amount of greasy or fried foods.• Restricting the intake of high fiber foods.• Limiting the consumption of milk and milk products.• Intestinal inflammation tends to lead to dehydration and malabsorption.• A visit with a dietitian is recommended to make sure there is an adequate
supply of nutrients and fluids.
Relevance to Society• Incidence of Crohn’s Disease appears to be
rising.• The theory that MAP is possibly the etiological
agent is a concern because MAP is present in our food chain