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REGIONAL ENTERITIS (Crohn’s Disease) - Copy.pptx

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DR.P.S SUDHAKAR

Regional enteritis, also known as Crohn's disease, is a type of inflammatory bowel disease that can affect any part of the gastrointestinal tract but most commonly involves the terminal ileum. It is characterized by transmural inflammation and granuloma formation that leads to thickening of the bowel wall. While the exact cause is unknown, there are thought to be genetic and environmental factors involved. Symptoms vary depending on the location and severity of inflammation but commonly include abdominal pain, diarrhea, weight loss, and fever. Investigations include blood tests, imaging such as CT scans, and endoscopy. Treatment involves medications to induce remission such as steroids, antibiotics, immunosuppressants, and nutritional support. Homeopathic medicines

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REGIONAL ENTERITIS (Crohn’s Disease)
• It is a granulomatous, noncaseating (transmural) inflammatory condition of the ileum commonly and of the colon often. • It is independent of age, sex, socioeconomic status and geographic areas. • Rarely other parts of the GIT like colon, jejunum, stomach, duodenum, oesophagus can get involved. • Terminal ileum is most commonlyinvolved (60%). In 75% cases perianal is involved (fissure in ano).
Aetiology • Unknown, but a familial and infective nature is thought of. • Increased auto-antibodies. • Diet and food allergy. • It is slightly more common in females. • DNA of Mycobacterium para-tuberculosis was found in intestines of 60% of patient’s with Crohn‘s disease but anti-tuberculous drug therapy has not helped them. • Focal ischaemia as a vasculitis may be the cause. • Smoking is related to Crohn‘s disease as aetiology, as for relapse and for exacerbations.
Causes for Crohn’s • ™ Infectious—Mycobacterium paratuberculosis and atypical mycobacteria. It causes Johne’s disease in cattle • ™ Immunologic • ™ Environmental • ™ Jews are more prone • ™ Smoking, diet, OCPs (controversial), psychosocial factors
Pathology Transmural inflammation ↓ Granuloma formation with linear snake like ulcers ↓ Cicatrisation ↓ Thickening of the bowel wall (Hose pipe pattern) ↓ Adhesions ↓ Fistula formation
Main features of Crohn’s disease • Ileum—most common site of occurrence— 60% • ™ Rectal sparing is usual and common • ™ Skip lesion • ™ Hose-pipe pattern • ™ Linear ulcers and cobblestone appearance of mucosa • ™ Transmural
Clinical Features • It is common in young age group. • Abdominal pain and diarrhoea is the initial slow insidious presentation. • There is also asymptomatic period in between. • Diarrhoea is usually less severe without blood, pus or mucous. • Mild fever, weight loss, lethargy. • Crohn’s disease may present as tender, firm, resonant mass in right iliac fossa. • Obstruction, fistula formation, often perforation. • Bleeding which is usually chronic but occasionally massive can occur.
Clinical Features • Perianal disease with fissure, fistula, and abscess can occur in 25% of patients with small bowel Crohn’s. • It can be the only presentation of Crohn’s in 5% of cases. • 50% of colonic Crohn’s will have perianal disease. • Extraintestinal manifestations occur in 30% of Crohn’s disease.
Presentations 1. Acute presentations (5%) 2. Chronic Crohn’s
Acute presentations • It mimics acute appendicitis with severe diarrhoea. • Often there will be localised or diffuse peritonitis.
Chronic Crohn’s First stage • Mild diarrhoea, colicky pain, fever, anaemia, mass in right iliac fossa which is tender, firm, nonmobile along with recurrent perianal abscess. Second stage • is either acute or chronic intestinal obstruction due to cicatrisation with narrowing. Third stage • Fistula formation—enterocolic, enteroenteric enterovesical, enterocutaneous, etc.
Investigations • Plain X-ray abdomen, ultrasound abdomen. • Barium meal follow through or small bowel enema. • CT scan and CT fistulogram is useful method. • Colonoscopy • Blood tests for anaemia, protein loss, mineral and trace element loss like magnesium, zinc, and selenium. • Therewill be raised C reactive protein.
Complications of Crohn’s • Intestinal obstruction • ™ Stricture • ™ Bleeding • ™ Fistula formation • ™ Carcinoma small and large bowel • ™ Perianal abscess • ™ Peritonitis • ™ Pericolic abscess
Differential Diagnosis • Radiation enteritis and Yersinia enteritis. • Ulcerative colitis, acute appendicitis. • Intestinal tuberculosis, Salmonella, Shigella, CMV • Carcinoma ileum or caecum. • Differential diagnosis for mass in the right iliac fossa (carcinoma caecum, actinomycosis, appendicular mass, ileocaecal TB, ectopic kidney, mesenteric lymphadenitis).
Treatment • Medical • Cessation of smoking • Bed rest, protein and vitamin supplementations. • Often nasogastric tube nutrition or TPN is required. • Steroids are mainly used to induce remission of the disease in initial phase. • It is less useful for maintenance. • Dose is 20–40 mg/ • Antibiotics (Ciprofloxacin) are useful in controlling sepsis in fistula, colitis.
HOMOEOPATHY
• Mercurius Corrosivus: • It is the top natural Homeopathic medicine to treat patients suffering from Crohn’s disease. This is the best remedy for patients in whom blood and shreds of mucus membranes are passed along with the stool. Constant urge to pass stool but only scanty, hot stool of offensive odour is passed. After passing the stool, the urge reappears and the patient gets no satisfaction.
• Colchicum Autumnale: Patient complains of excessive jelly-like mucus in stool. The patients experience nausea of the extreme degree and even faint from the odour of cooking food, mainly eggs and meat.
• Arsenicum Album: It is a natural Homeopathic medicine of great help for the treatment of Ulcerative Colitis. The main symptom guiding its use is stool with an offensive odour and dark-coloured blood in it. The complaints get worse at night and the patient feelsa lot of weakness.
• Podophyllum: This is very beneficial remedy for Crohn’s Disease with diarrhoea and when the stool is watery, greenish and very offensive. The diarrhoea mainly gets worse in the morning but in the evening, the stool is normal. The patient can also complain of prolapse of rectum before or during stool.
• Nitric acid Great straining, but little passes, Rectum feels torn. Bowels constipated, with fissures in rectum.Violent cutting pains after stools, lasting for hours . Hæmorrhages from bowels, profuse, bright. Prolapsus ani. Hæmorrhoids bleed easily. Diarrhœa, slimy and offensive. After stools, irritable and exhausted. Colic relieved from tightening clothes. Jaundice, aching in liver.
• Phosphorus: cutting pains. A very weak, empty, gone sensation felt in whole abdominal Large, yellow spots on abdomen.Very fetid stools and flatus. Long, narrow, hard, like a dog’s. Difficult to expel. Desire for stool on lying on, left side. Painless, copious debilitating diarrhœa. Green mucus with grains like sago. Involuntary; seems as if anus remained open. Great weakness after stool. Discharge of blood from rectum, during stool.
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REGIONAL ENTERITIS (Crohn’s Disease) - Copy.pptx

  • 2. • It is a granulomatous, noncaseating (transmural) inflammatory condition of the ileum commonly and of the colon often. • It is independent of age, sex, socioeconomic status and geographic areas. • Rarely other parts of the GIT like colon, jejunum, stomach, duodenum, oesophagus can get involved. • Terminal ileum is most commonlyinvolved (60%). In 75% cases perianal is involved (fissure in ano).
  • 3. Aetiology • Unknown, but a familial and infective nature is thought of. • Increased auto-antibodies. • Diet and food allergy. • It is slightly more common in females. • DNA of Mycobacterium para-tuberculosis was found in intestines of 60% of patient’s with Crohn‘s disease but anti-tuberculous drug therapy has not helped them. • Focal ischaemia as a vasculitis may be the cause. • Smoking is related to Crohn‘s disease as aetiology, as for relapse and for exacerbations.
  • 4. Causes for Crohn’s • ™ Infectious—Mycobacterium paratuberculosis and atypical mycobacteria. It causes Johne’s disease in cattle • ™ Immunologic • ™ Environmental • ™ Jews are more prone • ™ Smoking, diet, OCPs (controversial), psychosocial factors
  • 5. Pathology Transmural inflammation ↓ Granuloma formation with linear snake like ulcers ↓ Cicatrisation ↓ Thickening of the bowel wall (Hose pipe pattern) ↓ Adhesions ↓ Fistula formation
  • 6. Main features of Crohn’s disease • Ileum—most common site of occurrence— 60% • ™ Rectal sparing is usual and common • ™ Skip lesion • ™ Hose-pipe pattern • ™ Linear ulcers and cobblestone appearance of mucosa • ™ Transmural
  • 7. Clinical Features • It is common in young age group. • Abdominal pain and diarrhoea is the initial slow insidious presentation. • There is also asymptomatic period in between. • Diarrhoea is usually less severe without blood, pus or mucous. • Mild fever, weight loss, lethargy. • Crohn’s disease may present as tender, firm, resonant mass in right iliac fossa. • Obstruction, fistula formation, often perforation. • Bleeding which is usually chronic but occasionally massive can occur.
  • 8. Clinical Features • Perianal disease with fissure, fistula, and abscess can occur in 25% of patients with small bowel Crohn’s. • It can be the only presentation of Crohn’s in 5% of cases. • 50% of colonic Crohn’s will have perianal disease. • Extraintestinal manifestations occur in 30% of Crohn’s disease.
  • 9. Presentations 1. Acute presentations (5%) 2. Chronic Crohn’s
  • 10. Acute presentations • It mimics acute appendicitis with severe diarrhoea. • Often there will be localised or diffuse peritonitis.
  • 11. Chronic Crohn’s First stage • Mild diarrhoea, colicky pain, fever, anaemia, mass in right iliac fossa which is tender, firm, nonmobile along with recurrent perianal abscess. Second stage • is either acute or chronic intestinal obstruction due to cicatrisation with narrowing. Third stage • Fistula formation—enterocolic, enteroenteric enterovesical, enterocutaneous, etc.
  • 12. Investigations • Plain X-ray abdomen, ultrasound abdomen. • Barium meal follow through or small bowel enema. • CT scan and CT fistulogram is useful method. • Colonoscopy • Blood tests for anaemia, protein loss, mineral and trace element loss like magnesium, zinc, and selenium. • Therewill be raised C reactive protein.
  • 13. Complications of Crohn’s • Intestinal obstruction • ™ Stricture • ™ Bleeding • ™ Fistula formation • ™ Carcinoma small and large bowel • ™ Perianal abscess • ™ Peritonitis • ™ Pericolic abscess
  • 14. Differential Diagnosis • Radiation enteritis and Yersinia enteritis. • Ulcerative colitis, acute appendicitis. • Intestinal tuberculosis, Salmonella, Shigella, CMV • Carcinoma ileum or caecum. • Differential diagnosis for mass in the right iliac fossa (carcinoma caecum, actinomycosis, appendicular mass, ileocaecal TB, ectopic kidney, mesenteric lymphadenitis).
  • 15. Treatment • Medical • Cessation of smoking • Bed rest, protein and vitamin supplementations. • Often nasogastric tube nutrition or TPN is required. • Steroids are mainly used to induce remission of the disease in initial phase. • It is less useful for maintenance. • Dose is 20–40 mg/ • Antibiotics (Ciprofloxacin) are useful in controlling sepsis in fistula, colitis.
  • 17. • Mercurius Corrosivus: • It is the top natural Homeopathic medicine to treat patients suffering from Crohn’s disease. This is the best remedy for patients in whom blood and shreds of mucus membranes are passed along with the stool. Constant urge to pass stool but only scanty, hot stool of offensive odour is passed. After passing the stool, the urge reappears and the patient gets no satisfaction.
  • 18. • Colchicum Autumnale: Patient complains of excessive jelly-like mucus in stool. The patients experience nausea of the extreme degree and even faint from the odour of cooking food, mainly eggs and meat.
  • 19. • Arsenicum Album: It is a natural Homeopathic medicine of great help for the treatment of Ulcerative Colitis. The main symptom guiding its use is stool with an offensive odour and dark-coloured blood in it. The complaints get worse at night and the patient feelsa lot of weakness.
  • 20. • Podophyllum: This is very beneficial remedy for Crohn’s Disease with diarrhoea and when the stool is watery, greenish and very offensive. The diarrhoea mainly gets worse in the morning but in the evening, the stool is normal. The patient can also complain of prolapse of rectum before or during stool.
  • 21. • Nitric acid Great straining, but little passes, Rectum feels torn. Bowels constipated, with fissures in rectum.Violent cutting pains after stools, lasting for hours . Hæmorrhages from bowels, profuse, bright. Prolapsus ani. Hæmorrhoids bleed easily. Diarrhœa, slimy and offensive. After stools, irritable and exhausted. Colic relieved from tightening clothes. Jaundice, aching in liver.
  • 22. • Phosphorus: cutting pains. A very weak, empty, gone sensation felt in whole abdominal Large, yellow spots on abdomen.Very fetid stools and flatus. Long, narrow, hard, like a dog’s. Difficult to expel. Desire for stool on lying on, left side. Painless, copious debilitating diarrhœa. Green mucus with grains like sago. Involuntary; seems as if anus remained open. Great weakness after stool. Discharge of blood from rectum, during stool.