Pathophysiology of Crohn’s Disease

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Crohn’s disease (CD) is mainly a disease of the gut. It usually comes as an inflammation that may affect any area between the mouth and the anus (Shanahan, 2002). This region is also known as the gastrointestinal tract. This disease has also been referred to as the regional enteritis. It is a form of inflammatory bowel disease.

The main symptoms of the disease include diarrhoea, abdominal pain, vomiting and consequently, weight loss. When the condition worsens, the faeces may be bloody and vomiting may be continuous. Other symptoms include the appearance of skin rashes, inflamed eyes, inability to concentrate and general tiredness.

There are several public health burden associated with the Crohn’s disease and this has prompted many health institutions to try to estimate the costs of the disease. For example, the Australian Crohn’s and Colitis Association (ACCA) was interested in looking at the actual figures. It commissioned the Access Economics to do the estimates (Access Economics Pty Limited [AEPL], 2007). Some of the burdens associated with the disease include the loss of earnings.

This is due to workplace separation and retirement at an early age. Australia estimated this cost to be $94.3 in 2005. Another issue caused by the disease is absenteeism from work. In Australia, statistics averaged that every employee was absent from work for at least 7.2 days from Crohn’s disease or the other related inflammatory bowel disease. CD also causes premature death (early death) and if the individual who died was a provider at the home, this means loss of income streams to the affected individuals.

The prevalence of the disease in Australia has been estimated to be comparable with other very common diseases. These include the Type 1 diabetes and schizophrenia. In 2005, it had been estimated that approximately 28000 people in Australia were living with Crohn’s disease. In addition, there were more than 770 new cases of the disease. This only shows the seriousness of the disease and the costs that are incurred annually due to the presence of Crohn’s disease (AEPL, 2007).

Detailed Pathophysiology

This involves the study of the effects of Crohn’s disease to the normal functioning of the human body. These include the physiological functions, mechanical functions and the biochemical functions. This disease usually causes various changes to these normal functions. The effects may be seen from cellular, organ or system levels.

Cellular level

Crohn’s disease has been established to induce an abnormal response in the immune system of the body (Shanahan, 2002). The immune system is composed of various cells that are responsible for protecting the human body from infections and diseases. The immune system also contains proteins referred to as cytokine.

The cells that are usually affected by this disease mainly have this protein. Unfortunately, when one has this particular disease, the immune system tends to react in a way that is not appropriate. In many situations, the disease causes the immune system to attack the red blood cells. This causes some of the symptoms that are associated with anaemia. Others include fatigue and pallor.

It is believed that the immune system mistakes the ‘good’ bacteria that are usually located within the intestinal area to be foreign bodies. This causes the immune system to immediately attack them to ‘protect the body’. This is done through the sending of white blood cells to the intestinal area. In so doing, they cause chronic inflammation. Consequently, the cells produce hazardous products that cause injuries to the bowel and some form of ulcerations (Satsangi, Jewell, & Bell, 1997). When this occurs, the victim starts to show symptoms characteristic to inflammatory bowel disease such as Crohn’s disease.

It has been determined that the molecules dissipated as fat is metabolised have a hand in the inflammatory effect in Crohn’s disease. The molecules may also be produced when there is an infection. These molecules are referred to as free radicals. They are sometimes known to cause the damaging of cells as they come in contact with other molecules in the body. The disease also increases the risk of blood clots, which is an issue of the cells.

Organ level

This disease usually affects the large and small intestines and other organs along the gastrointestinal tract. This means that any organ between the anus and mouth may be affected. However, it may also affect the surrounding organs. These may include the skin, vagina and the bladder. They may be described as external or internal depending on their positions. For example, the skin and bladder may be termed as internal, while the skin may be termed as external.

When it is manifested on the skin, it may come in the form of erythema nodosum. This usually comes about as red nodules. These appear on the shins. This condition is usually due to the inflammation of the subcutaneous tissues that are found in the inner layers of the skin. Another form of lesion of the skin is referred to as pyoderma gangrenosum. This type is usually painful.

This disease is also known to increase risks of bladder infection. This is also known as the urinary tract infections. This usually begins at the lower part of the urinary tract. These include the urethra and bladder. However, in most cases, the disease is usually mild and treatable. In addition, preventive measures against the bladder infections are usually available. However, if an individual develops a urinary tract infection, the individuals stand a greater risk of contracting other body infections.

Some of the preventive measures that have been suggested include proper body hygiene and the consumption of a lot of water daily. Females are also advised to wipe from the front to the back after urinating and not the other way round. Urinary tract infection or bladder infections should not be left untreated since it may lead to other more complicated infections of other organs. For example, it may lead to the infection of the kidney (Kirsner, 1988).

The system level

Crohn’s disease is also seen to manifest itself at a tissue level. The first system that is affected is the digestive system (Shanahan, 2002). This system is mainly responsible for the breaking down of food and the absorption of the nutrients in to the body. This is necessary to ensure growth and maintenance. This disease affects the gastrointestinal (digestive) tract.

An individual with Crohn’s disease experiences inflammations on the epithelial cells in the small or large intestines. This may have an effect in the physiological functions of the skin tissue (absorption). Since this region is also involved in secretion, this disease may affect the biochemical functions. Such intestinal symptoms have adverse effects on the victims.

This is because such individuals usually feel much better when they do not eat. This usually causes them to lose their appetite. For those whose small intestines have been affected extensively, there is usually likelihood to develop malabsorption of certain important nutrients. These nutrients include lipids and carbohydrates. This usually causes excessive weight loss.

The disease is known to affect the skeletal system, which mainly functions to support the body (Kirsner, 1988). This organ system is also important in that it helps provide sites for attachment for other organs. The disease may cause what is normally referred to as osteoporosis. This is the thinning of the bones.

This is dangerous since it increases the chances or risks of an individual sustaining bone fractures due to the weakened bone structure. This disease is also associated with seronegative spondyloarthropathy. This is a rheumatologic disease. This causes inflammation of joints characteristic of arthritis. It may also affect the knees and shoulders. It may also affect the small joints in the arms and legs. This usually affects the normal mechanical functions of the body parts affected since it inhibits joint mobility and functionality.

Another body system that is affected by Crohn’s disease is the circulatory system. This is because the blood is affected. The abnormal behaviour of the nervous system causes it to launch an attack to the useful red blood cells. This puts the individual at risk of anaemia. It also increases the risks of blood clot.

Crohn’s disease also affects the nervous system (Geboes & Collins, 2002). This is seen in the way it causes neurological complications. Studies have shown that up to 15 percent of patients with the disease develop these complications. The neurological complications manifest themselves in various ways. This may be in the form of strokes, seizures, myopathy, depression, headaches and peripheral neuropathy.

References

Access Economics Pty Limited [AEPL]. (2007). The economic costs of Crohn’s disease and ulcerative colitis. A proposal to ACCA.

Geboes, K., & Collins, S. (2002). Structural abnormalities of the nervous system in Crohn’s disease and ulcerative colitis. Neurogastroenterology & Motility, 10(3), 189-202.

Kirsner, J. (1988). Historical aspects of inflammatory bowel disease. Journal of Clinical Gastroenterol, 10(3), 286-297.

Satsangi, J., Jewell, D., & Bell, J. (1997). The genetics of inflammatory bowel disease. Gut, 40(5), 572-574.

Shanahan, F. (2002). Crohn’s disease. The Lancet, 359(9300), 62-69.

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