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Hemorrhoids are one of the most
common diseases. Word «hemorrhoid»
translated from Greek language means
«bleeding», which directly connected
with the most prevalent symptom of this
disease – there is blood outflow from
anus. Hemorrhoids are equally common
among male and female. Frequently
females mark acute haemorrhoidal
thrombosis; usually it happens during
third trimester of pregnancy    
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Anorectal abscess signifies
inflammation of the fat in one of the
spaces surrounding the anorectum.
Infection from rectum by anal glands,
which are situated in anal crypts of the
anal canal penetrate perianal tissue.
Crypt abscess always is at the level of
the dentate line. The reasons of crypt
abscess are different: constipation,
hemorrhoids, anal fissure ecc. Anal
gland infection is also the principal
cause of anal fistulas.  
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Anal fissure is a spontaneously
appeared linear tear (ulcer) in the anal
mucosa. Anal fissure is quite common.
Among proctology disease this is one
of three the most frequent (11%-15%
or 20-23 cases amongst 1000 people).
Anal fissures are more prevalent
among young and middle- age females.    
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 Constipation.   Now constipation is
one of the most common conditions that
bring a patient to see a physician in al
the world.  For example, 2.5 million
people with constipation (1.2% in the
general population) visit each year
doctors and even more numbers try
to solve this problem by themselves
using laxatives. What is constipation?
Constipation is not separate disease.
There is symptom of many illness.  
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.
Ulcerative colitis is chronic recurrent
bowel disease, which is based on
manifest diffuse non-specific
inflammation of the mucosa of the
rectum and colon.
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Cron`s colitis is chronic, recurrent,
inflammatory disease of unknown
etiology that affects the gastrointestinal
tract This disease is characterized by
skip lesion and transmural inflammation,
and it can be affect any segment of the
gastrointestinal tract. This illness also
has tendency to early, local and system
complications.   
Read_______

Polyps and polyposis syndromes.
The definition of polyp is not clear at all.
Presently, only epithelial glands
excrescence, which rises above mucosa,
is called true polyp.   
 Read_______

 
Rectal cancer. These days rectal
cancer without exaggeration is the
problem of global degree.   
Read_______

Colon cancer.  Measurement of (CEA)
carcinoembryonic antigen, which was
found in embryonic cellules of
gastrointestinal tract, is another
direction in the early detection of colon
and rectal cancer.
Read_______
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Home >>Diseases >> Crohn`s disease

Crohn`s disease.

Crohn`s disease is chronic, recurrent, inflammatory disease of unknown etiology that affects the local and system
complications.  

Epidemiology
Prevalence of Crohn`s disease in our country is approximately 8-10 of cases per 100 000 of people.   
Last years the quantity of inflammatory bowel disease (Crohn`s disease and Ulcerative colitis) cases increased in economically
developed countries. Circa 2 to 4 of new cases of Crohn`s colitis per 100 000 people are detected annually, prevalence is 30-50
of cases per 100 000 of people.

Etiology and pathogenesis

Etiology of Crohn`s disease is still not clear. Most of specialists think that Crohn`s disease is conditioned by several different
etiological factors, which provoke autoimmune inflammation.
Principal etiological theories are:
- infectious theory (Mycobacterium paratuberculosis, measles virus)
- genetic theory (Congenital defect of intestinal immune system)

Patomorphology

Inflammation involves all layers of intestine. Infiltrates, ulcers, abscesses, strictures and fistulas, granulomas are typical for
Crohn`s disease.
Granulomas in intestinal wall                                       Ulcer – fissure involving all intestinal layers
Localization of Crohn`s disease
Localization
Frequency of involvement  
Ileocecal area   
45
Proximal part of small intestine
30
Primary involved esophagus, stomach, duodenum or perineum

5
Multiple localization
40
Bowel
25
Crohn`s disease classification

- ileocolitis
- colitis
- ileitis

Crohn`s disease current
- acute
- chronically uninterrupted  
 
Activity of Crohn`s disease can be identified by Best’s index.
Criterion
Estimation (points)
Coefficient
Bowel movements per week (7days)
*2
Intensity of stomachache during week
From 0 to 3 points
*5
Health during the week
From 0 to 4 points
*7
Amount of complications during week
*20
Reception of opiates during week
No – 0 Yes - 1
*30
Infiltrates in stomach
No – 0 Suspect – 2 Yes – 5   
*10
-47 Ht for men and – 42Ht foe women
*6
Real wait / ideal wait * 100
*1
Total 0 – 700
Less than 150 points is remission. 150-300 points is mild form, 301-450 – moderate form, 450 points and more is severe form.

Clinical features

There are four classical symptoms of Crohn`s disease: stomachache, diarrhea, loss of wait and fever. However, these
features can be minimal.

 
Stomachache usually is permanent but increase after stress and eating. Fistula of abscess formation determines pain
increasing. Intestinal obstruction determines intensive pain, sickness, and vomit. These symptoms can simulate appendicitis.     

Diarrhea. Bowel movement can be up to 10-15 times per day (can be also during the night). Feces usually are liquid about
200g/per day. Every eating provokes bowel movement. Rectal bleeding is not so typical (less than 50% of patients). If
rectum is involved patient can admit tenesmus.    

Loss wait is determined by abdominal pain, anorexia and decreased absorption.
Sometimes complications (fissures, anorectal abscesses, anal fistulas), which appear quite early, a can be the first symptoms
of disease.  

Frequency of symptoms of primary Crohn`s disease
Symptom
Frequency
Intestinal symptoms
Abdominal pain
77%
Diarrhea
0%
Bleeding
0%
Anal fistulas
0%
Extra-intestinal symptoms
Wait loss
0%
Fever
0%
Anemia
0%
Articular pain  
0%
Eye disorders
0%
Skip areas
A – stricture                                       В – linear ulcers, mucous around is not involved
3. Barium enema
4. Ultrasonography of stomach and endorectal ultrasound examination
5. Histological verification
6. Specific markers detection (pANCA is typical for ulcerative colitis and ASCA, which is typical for Crohn`s disease).

Differential diagnosis of Crohn`s disease with Ulcerative colitis
Differential diagnosis, first of all, should include acute appendicitis, antibiotic-associated colitis, infectious colitis,
ischemic bowel disease and diverticulitis, intestinal tuberculosis ecc.  

 Read also Treatment of Crohn’s disease
Examinations:

1. Laboratory tests
2. Colonoscopy with biopsy
Cecum




Thin segment of ileum with ulcers

Pseudo-diverticul

Stricture  

Symptoms

Frequency –Crohn`s disease

Frequency - Ulcerative colitis

Thickening of intestine wall

xxx

x

Stricture

xxx

x

Skip areas involved

xx

_

pANCA

_

x

ASCA

x

_

Linear ulcers

xx

_

Deep fissures and fistulas

xx

_

Full-thickness involvement

xxx

x

Submucosal infiltration

xxx

x

Submucosal thickening, fibrosis

xxx

xx

Ulcer through all walls

xxx

xx

Fissure

xxx

x

Local granulomas

xx

_

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