OVERVIEW
Crohn’s disease of the colon is an unexplained granulomatous inflammatory lesion, combined with fibrosis and ulceration, that may invade any part of the gastrointestinal tract; those that invade the colon are referred to as colonic Crohn’s disease.
Causes
The cause of Crohn’s disease is unknown and may be related to the following factors.
1. Genetic factors
It is related to genetic factors, with family aggregation, mostly related to HLA-DR4 serum antigen.
2. Infectious factors
May be related to viral infection.
3.Environmental factors
The incidence rate is higher among urban residents, which may be related to hygiene, living habits and mental conditions.
4. Immune factors
Low autoimmune function.
5.Other
Related to pregnancy, oral contraceptives, smoking, etc.
Symptoms
The onset of the disease is insidious, mostly seen in young people, the incidence of women is more than that of men. Early symptoms are often asymptomatic or mild, and it usually takes 1 to 3 years from the onset of symptoms to diagnosis.
1. Diarrhea
Mostly intermittent episodes, soft or loose stools, feces are mucus or pus. Difficulty in defecation and a sense of urgency may occur if there is anal or rectal pathology.
2. Abdominal pain
Recurrent abdominal pain in the right lower abdomen or around the umbilicus, which may be accompanied by nausea, vomiting, abdominal mass.
3. Fever
Low or moderate fever is a common symptom.
4. Malnutrition
There may be obvious emaciation or weight loss.
5. Perianal and perirectal lesions
Abscesses, sinus tracts and anal fistulas appear around the anus and rectum, and even rectal abscesses are formed.
6. Extra-gastrointestinal manifestations
It may be accompanied by polyarthritis, keratitis, conjunctivitis, corneal ulceration, dry skin and mouth and eyes.
7. Systemic symptoms
Systemic symptoms such as anemia, emaciation, fatigue, weight loss, growth retardation, etc. may occur.
Examination
1. Laboratory tests
The peripheral blood leukocyte count may be increased during the active phase. About half of the cases have increased erythrocyte sedimentation rate, positive fecal occult blood, and increased serum immunoglobulin.
2. Colonoscopy
This examination is important for the diagnosis of the disease, and the biopsy can be used to obtain a more accurate diagnosis.
3. X-ray examination
Thickening and hardening of the colonic pouch, pseudodiverticulum formation, pebble sign, fissure-like deep ulcers, sinus tract formation, intra-abdominal encapsulated abscess, and segmental stenosis of the intestinal canal in the late stage are seen.
4. Anal lesion examination
It is of greater diagnostic significance and may reveal non-caseating granulomas.
Diagnosis
The diagnosis of Crohn’s disease of the colon should be closely combined with the clinical as well as X-ray characteristic manifestations, i.e., coarsely disorganized mucosa, ulcer formation, pseudodiverticulum formation, segmental distribution, pebble sign, and in the later stage, there are intestinal stenosis, fistula and abscess formation and adhesion, and other characteristics.
Treatment
1. General treatment
Appropriate vitamin supplementation, hypoproteinemia or anemia can be appropriate amount of protein supplementation and blood transfusion.
2.Drug treatment
Give antispasmodics, corticosteroids, antibiotics and immunosuppressant treatment.
3. Surgery
Most patients eventually need surgery, and appropriate surgery can make 72% of patients’ symptoms disappear and quality of life improve. However, surgery is not a curative measure, and about 50% of the patients have recurrence after surgery, requiring reoperation or multiple surgeries. Therefore, careful consideration should be given to surgical indications, modalities, timing, and surgical management.
Nursing care
1. The less severe patients should pay attention to the combination of work and rest, and increase the rest time; the more severe patients should rest in bed.
2. Encourage patients to enhance confidence, relieve worries and actively cooperate with the treatment.