Crohn's Disease Essay

Crohn’s Disease

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Crohn’s disease (CD) is an idiopathic, chronic, relapsing illness, characterized by transmural inflammation of the bowel. The ulcerations and inflammatory process of CD can attack any part of the gastrointestinal (GI) tract, from the oropharynx to the perianal area, causing fibrosis and fistulization, ultimately leading to obstruction (Hendrickson, Gokhale, & Cho, 2002). In the United States, on a yearly basis, CD affects over 201 adults per 100,000, and 43 children per 100,000. CD occurs most often between the ages of 15 and 30 years, with a second peak occurrence between 60 and 80 years old (Feldman, Friedman, & Brandt, 2010). The primary sites for CD are the terminal ileum (distal portion of small intestine), ileocecal area (the area between the ileum and the cecum), and the proximal large colon. On visual inspection areas of diseased bowel segments are separated by areas of normal healthy bowel, referred to as skip lesions. The cobblestone appearance of CD is a result of the crisis-crossing pattern of the transverse and longitudinal mucosal ulcerations (Hendrickson et al., 2002; McCance, Heuther, Brashers, & Rote, 2010). Microscopically the CD lesion starts off as a central inflammatory infiltrate that gradually invades the superficial bowel mucosa. The infiltrate passes through the deep mucosal layers with granuloma formation. The granuloma can potentially extend through the entire intestinal wall into the mesentery and lymph nodes. Neutrophil invasion into the intestinal crypts of Lieberkuhn ensues, leading to cryptitis and abscess development. The end product of abscess formation is total destruction of the crypts. Fibroses and atrophy follow with potential fistulization (Feldman et al., 2010; Wu, Coash, & Nachimuthu, 2010). The exact etiology of CD is unknown, but it is widely accepted that CD is initiated by an inappropriate immune response in individuals that are genetically predisposed. The immune system becomes activated,...