Hospital therapy. Etiology, pathogenesis, clinical picture of Crohn's disease (most important)

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Hospital therapy. Etiology, pathogenesis, clinical picture of Crohn's disease (most important)

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47. Etiology, pathogenesis, clinical picture of Crohn's disease

Crohn's disease is a chronic bowel disease with systemic manifestations; the morphological basis of which is granulomatous autoimmune inflammation of the gastrointestinal tract.

Etiology and pathogenesis. The etiology and pathogenesis of the disease are not well understood. The most popular are the infectious and immune concepts of the onset of the disease. In recent years, there have been reports of the etiological role of microorganisms of the genus Yersinia. However, it is difficult to establish whether these microbial agents are pathogens or commensals. At the same time, changes in the intestinal microflora play an important role in the pathogenesis of the disease.

Typically, a decrease in bifidum-type bacteria with a simultaneous increase in enterobacteria with signs of pathogenicity. Autoimmune mechanisms play a role in the development of the disease.

In Crohn's disease, autoantibodies (lgC, lgM) appear against intestinal tissues.

Classification. Classification (F. I. Komarov, A. I. Kazanov, 1992).

1. Course: acute; chronic.

2. Characteristics of the process: lesion within the small intestine; lesion within the ileocecal region; lesion within the colon.

3. Complications: narrowing of the intestine; toxic dilatation of the colon; fistulas; amyloidosis; nephrolithiasis, cholelithiasis; B12 deficiency anemia.

clinical picture. The clinical picture of Crohn's disease is characterized by considerable diversity, which is determined by the localization and extent of the pathological process in the intestine, the form of the disease and the addition of complications.

An objective study pays attention to the pallor of the skin, which correlates with the severity of anemia, swelling in the legs due to impaired absorption and protein metabolism. On palpation of the abdomen, flatulence and rumbling are noted.

During physical examination of the patient, pallor of the skin, subfebrile condition, body weight deficiency are determined, palpation reveals spasmodic bowel loops, pain in the paraumbilical zone, in the right iliac region.

In Crohn's disease, extraintestinal signs of the disease are noted: aphthous stomatitis, phlegmon and fistulas of the oral cavity, arthritis, resembling rheumatoid arthritis in the clinic, with characteristic symptoms of symmetrical lesions of small joints, stiffness in the morning. Typical changes in the eyes: iritis, iridocyclitis, maculopathy. The skin may develop erythema nodosa and pyoderma gangrenosum.

Diarrhea is characterized by an increase in the frequency of stools up to 10 times a day or more, polyfecal matter. The volume of the stool is determined by the anatomical localization of the process. Weight loss is noted in all patients.

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