Hospital therapy. Diagnosis of Crohn's disease (most important)

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Hospital therapy. Diagnosis of Crohn's disease (most important)

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48. Diagnosis of Crohn's disease

Diagnosis and differential diagnosis. In a clinical blood test during an exacerbation, leukocytosis, anemia, and an increase in ESR are detected. Changes in the general analysis of urine appear in severe form, characterized by the addition of amyloidosis of the kidneys (proteinuria).

A biochemical blood test reveals hypoproteinemia, hypoalbuminemia, an increase in a-globulins, a decrease in the content of iron, vitamin B12, folic acid, zinc, magnesium and potassium.

The data of scatological examination allow to indirectly assess the level of the lesion. In the coprogram with small intestinal localization of the process, polyfecal matter, steatorrhea, creatorrhoea are found; with the colon - an admixture of mucus, leukocytes, erythrocytes.

X-ray diagnostics allows you to establish the localization and prevalence of the pathological process in the intestine. Areas of the affected intestine alternate with areas of the unchanged intestine. The altered loops become rigid, the picture is mosaic with small filling defects and with the penetration of contrast beyond the intestinal wall in the form of pockets. The intestine in the affected area acquires the character of finely fringed, with the formation of pseudodiverticula. The contractile capacity of the intestinal wall is reduced or completely lost, the evacuation of barium slows down. An uneven narrowing of the intestinal lumen is observed, as a result, it becomes so narrow that it takes on the form of a lace. Above the zone of narrowing, the intestine expands.

Endoscopic diagnosis is of decisive importance in the verification of the diagnosis. For Crohn's disease, the most characteristic is the change in the antrum of the stomach and the initial section of the duodenum. Endoscopically, it is possible to detect a circular narrowing of the antrum, resembling tumor stenosis.

The initial period of Crohn's disease is characterized by poor endoscopic data: a dull mucous membrane, against which erosions of the aphthae type are visible, surrounded by whitish granulations. The vascular pattern is absent or smoothed out. In the lumen of the intestine and on its walls, purulent mucus is determined. In clinical remission, the described changes may disappear completely. As the disease progresses, the mucosa becomes unevenly thickened, has a whitish color, and large superficial or deep fissure ulcers are noted. The intestinal lumen narrows, making it difficult to advance the colonoscope. Colonoscopy makes it possible to perform a targeted biopsy of the mucous membrane in any part of the colon and in the terminal ileum. In Crohn's disease, the pathological process begins in the submucosal layer, so the biopsy should be performed in such a way that a portion of the submucosal layer enters the biopsy material. In connection with the above, in 54% of cases the morphological substrate of the disease is not detected.

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