Question

Case study:

Mr. P.T., age 19, has had Crohn disease, affecting the ileum and part of the jejunum, for 5 years and has had numerous exacerbations. Several members of his extended family have a history of Crohn disease.

1. Describe the pathophysiology of Crohn disease.

2. Suggest several possible exacerbating factors for Crohn disease.

3. Describe the common signs of an exacerbation.

4. Explain how nutritional deficits may occur with Crohn disease.

5. Mr. P.T. has delayed growth. (He is much shorter than his classmates.) Suggest several specific contributing factors to retarded growth in a young person.

6. Mr. P.T. has developed a fistula between the ileum and the bladder. Describe the effect of a fistula.

There is considerable risk of intestinal obstruction developing in Mr. P.T. at some point in the near future.

7. Explain how this obstruction could gradually form.

8. Suggest several manifestations of an acute obstruction in the ileum, and specify the reason for each one.

9. Describe the potential complications of an intestinal obstruction that is not treated promptly.

Answer 1

1.begins with crypt inflammation and formation of abscess which progress to aphthoid ulcer, mucosal lesions develop to longitudinal and transverse ulcers which gives its calssical cobblestone appearance,Transmural spread of inflammation leads to lymphedema and thickening of the bowel wall and mesentery, enlarges mesentric nodes, inflammations can lead to hypertrophy,fibrosis and sricture which inturn lead to intestinal obstruction.abscess and fistulas can develop, involvements of bowel segments leds to skip areas which is charactericstic feature.

2.exacebrating factors- young age,white ethinicity highest risk than others,history of disease in family,smoking, use of NSAIDs,environmental factors, including a diet high in fat or refined foods- pepole living in urban areas.

3.diarrohea, dysentry, abdominal pain, cramping, fever, fatigue,oral sores, reduced weight and appetite, fistula symptoms - pain while passing stools,Inflammation of skin, eyes and joints,Inflammation of the liver or bile ducts,Delayed growth or sexual development, in children.

4.Diarrhea, abdominal pain and cramping may make it difficult to eat or for your intestine to absorb enough nutrients to keep you nourished. It's also common to develop anemia due to low iron or vitamin B-12 caused by the disease.intestinal obstruction and ulcers also lead to poor nutrition intake.

5.familial short stature,systemic or chronic illnesses, or illnesses that affect the digestive tract, kidneys, heart or lungs,malnutrition,stress, endocrine disorders,genetic disorders, growth hormone deficiency,skeletal abnormalities, precaucious puberty, chromosomal abnormalities,idiopathic.

6.recurrent urinary tract infection,pneumaturia, fecaluria, pyuria,fever,dysuria , increased frequency.

7.Crohn's disease affects the thickness of the intestinal wall. Over time, parts of the bowel can scar and narrow, which may block the flow of digestive contents.Transmural inflammation results in thickening of the bowel wall and narrowing of the lumen,Bowel obstruction is caused initially by significant edema of the mucosa and associated spasm of the bowel.

8.stricture- If you have an intestinal stricture and you eat something that’s difficult to digest, the food you’ve eaten may lead to a bowel obstruction. Foods that can cause a bowel obstruction include raw vegetables, popcorn, or nuts.The stricture itself can also become inflamed and cause blockages as well.

adhesions- bowel gets adherent to surrounding structures causing obstruction.

ileocaecal intusucception-Intussusception occurs when a proximal segment of bowel telescopes into an adjacent distal segment,Causes include any lesion within the intestinal lumen or wall which alters peristalsis.

9.can lead to life threatning complications- tissue death- Intestinal obstruction can cut off the blood supply to part of intestine. Lack of blood causes the intestinal wall to die. Tissue death can result in a perforation in the intestinal wall, which can lead to infection.Infection-Peritonitis - infection in the abdominal cavity. It's a life-threatening condition that requires immediate medical and often surgical attention.