Clinical symptoms of Crohn's disease

The clinical picture of Crohn's disease is characterized by certain common to different localizations defeats symptoms as well as the specific characteristics inherent in some forms of the disease.
To the common symptoms include abdominal pain, diarrhea, fistulas, palpable conglomerates ("growth") in the abdominal cavity, the defeat of the anus.
Pain usually associated with inflammation of the walls of the colon or intestinal obstruction. Pain inflammatory nature can in different forms have different localization, often they are caused by the involvement of the peritoneum or the formation of an abscess. Usually they are combined with the muscles of the anterior abdominal wall.
When intestinal obstruction pain begins in 1-2 hours after eating, are cramping character, may be accompanied by nausea and vomiting, flatulence, Constipation is usually subacute, sluggish pace, with the change of deterioration and bright spaces. Sometimes stretched loop of intestine can prosuvalisya. Acute intestinal obstruction occurs in Crohn's disease is rare (Jones and others, 1968).
In Crohn's disease in the abdomen often felt like conglomerates that formed a single thickened loop of intestine or more loops, soldered together. This conglomerate may be suppuration, formed an abscess, located mostly in the right iliac fossa.
Defeat all the layers of the intestinal wall, characteristic of Crohn's disease, creates prerequisites for the formation of a fistula. The latter can be internal, external, inter-intestinal or intestinal-gallbladder. Spontaneous emergence of external fistula is rare, but they usually appear after surgery, especially after the opening of abscesses.
These fistulas are not heal up until the affected area of the intestine will not be resected.
Internal fistula are multiple and inter-intestinal can be asymptomatic. When the fistula between the remote intestine, such as the type of fistula jejuno-colica, there are more severe diarrhea, steatorrhea, water-electrolyte shifts.
Pathognomonic symptomatic gallbladder and intestinal fistula is pneumaturia, easily combined with urinary tract infection and penetration of feces into the urine.
Diarrhea are among the characteristic features of Crohn's disease, although their absence does not exclude the diagnosis of this disease. Violations of the chair can carry regular character, or remain constant.
Melaena is rare, on the reaction of yens Gregersen collection in many patients is positive. Diarrhea can be combined with strengthening abdominal pain. In the formation of fistulas and advanced lesions of the small intestine is persistent steatorrhea.
1/t of patients with Crohn's disease are found lesions of the anus, when granulomatous colitis their frequency reaches 80% (Panlley, 1963). Such lesions may be early and the only sign of the disease. It violates the integrity of the anal rings, there are bulging edematous skin folds, ulcers anus or perineum, cracks, recurrent abscesses, complicated by the occurrence of fistula. Lesions of the anus peculiar flaccid chronic, ulceration are usually painless, but slowly and quietly heal.
Crohn's disease during periods of exacerbation, usually accompanied by fever, at laboratory examination can take place neutrophilic leucocytosis, accelerated ROHE and anemia, often hypochromic type. In some cases, weight loss occurs, hypoproteinemia.
Among more rare extra-intestinal manifestations of the disease should be mentioned about the arthritis, iritah uzlovataya erythema, ulceration of the mouth. The importance of genetic factors in disease development is once again confirmed by the frequent combination with ankylosing spondylitis, which is genetically determined disease (Acheson, 1960).
Jones and others (1968) provide summary information on the incidence of some forms of Crohn's disease among 101 of the patient:
Duodenum 1
Widespread destruction of the small intestine .... 14 (4) *
The final ileum.........32 (4)
Ileocecal destruction . . 17 (1)
Iliac and thick intestine 27 (9)
Colon.........10 (7)
Of the materials shows that most often affects the end of the ileum and the cecum, but granulomatous colitis are not uncommon, especially in combination with damage to the small intestine.
The defeat of the esophagus. In the literature periodically messages that are descriptions of cases of Crohn's disease with a defeat of the esophagus (Heffernan and Kerkay, 1954; Anchen-bach and others, 1956; Pryse, Davies, 1964). Recently Gelfand and Krone (1968) observed diffuse esophagitis with dysphagia in a patient with Crohn's disease of the colon. Dysphagia has been fixed already in the beginning of the course of steroid therapy.
Lesions of stomach and duodenum. In 1966, Johnston and co-authors reported 13 cases of Crohn's disease with a defeat of the stomach, published in the literature. Currently, the number of observations exceeded 20 (Duprey and others, 1970). Usually attacked antrum. In patients, the pain in epigastralna area, often spastic nature, without a clear periodicity and rhythm. Gradually increasing asthenia, there are anorexia and cachexia. In violation of the evacuation function appear painful vomiting. Diarrhea is usually observed in case of combined lesions of the small intestine. For patients is the reduction of the motor and peristaltic activity of the stomach. As the progression of fibrosis in the stomach wall stenosis develops an output of the Department with the respective clinical manifestations. Lesions of stomach recognize, as a rule, in cases where diagnosed with Crohn's disease, another localization (thin or thick intestine).
In 1959 Richman and co-authors in special literature review devoted nonspecific granulomatous lesions, led 20 cases of defeats the gastro-duodenal zone. In all cases, the diagnosis was established only with the simultaneous typical changes in lean or ileum. Among 500 patients with Crohn's disease, traced in the Mayo clinic between 1950 and 1964, the defeat of the duodenum met only at 8. Jones and others (1966) provide clinical-radiological characterization another 8 such cases. Clinical manifestations resembled a typical duodenitis intermittent pain in epigastralna area, but in combination with diarrhea, vomiting, and sooner developing symptoms of high intestinal obstruction. The authors consider the most characteristic triad of symptoms : stomach ulcer-like abdominal pain, diarrhea, violation of the evacuation of the stomach.
The defeat of the small intestine. Crohn's disease with a defeat of the jejunum can on a particular area of diffuse to reach the intestine wall, there are forms with single or multiple Rubtsove narrowing of the intestinal lumen of the tube. Often, a combination of abdominal pain with steatorrhea.
The most frequently affected the final ileum. Such patients are typical common clinical symptoms of the disease (see above), but described and cases with erased manifestations, in which the big help in the diagnosis has detecting changes in the anus. The latter may lifetime evaluated by biopsy. Identification of granulomas sarcoidoma type is essential.
The defeat of the colon. Granulomatous colitis rarely diffuse, with the involvement of the entire colon and rectum, usually in him "mnogovektornosti where there are areas perfectly normal mucosa (Maratka, 1968). Most often patients complain of diarrhea, abdominal pain and weight loss, sometimes the only symptom of the disease is unexplained fever. The defeat of the distal colon and anus more often in the elderly. When lesions of the anus ulceration can wear widespread with capture of the perineum, in some cases suffer and sphincter.

* In brackets cases with lesions of the anus.