16 / 10 / 2017

ارسال شده توسط در اسلایدر | 0 نظر

Crohn’s Disease AND LAWSUIT. بیماری التهاب رودها خدا و مردم دانا هوشیار ند.

Crohn’s Disease AND LAWSUIT. بیماری التهاب رودها خدا و مردم دانا هوشیار ند.

Crohn’s Disease AND LAWSUIT. بیماری التهاب رودها خدا و مردم دانا هوشیار ند.

نویسنده و تر جمه  وتحلییل از سیید محمود جعفری .علوم تکنولوزی کشاورزی.
TO MR GEFF SESSION DEPARTMENT OF JUSTICE IN USA ,THIS IS LAWSUIT TO IRAN AND USA AND OTHER GOVERMENT, PLEASE I,NEED MY PASSPORT TO CAME TO USA.
o3iz_price2-e1486744511145.jpg t2x_محموداشاره_به_اب.png y5t1_jeef.jpg

Understanding Crohn’s Disease

What is Crohn’s Disease?

Illustration of Crohn’s Disease

Crohn’s (or Crohn) disease is a disease that usually affects the small intestine and less commonly the colon, but it is capable of involving the remainder of the gastrointestinal tract – the mouth, esophagus, and stomach. The chronic inflammation that is the basis of Crohn’s disease causes ulceration, swelling, and scarring of the parts of the intestine that it involves.
tla5_infographic_cd_us-map.jpg
Other names for Crohn’s disease include granulomatous enteritis, regional enteritis, ileitis, and granulomatous colitis when it involves the colon.
vb5a_kjuyt.jpg
ywwy_hgytr.jpg

What Causes Crohn’s Disease?

Child playing with DNA and molecular models.

The cause of the chronic inflammation in Crohn’s disease is unknown. The leading theory is that inflammation is initiated by bacteria that reside within the intestine. Whereas most inflammation usually is suppressed and the disease caused by the inflammation subsides, in Crohn’s disease the inflammation is not suppressed, and the inflammation continues. The continuing inflammation probably occurs because of environmental factors (i.e., the bacteria) as well as genetic factors that affect the immune system.

Crohn’s Disease in Children & Teens

Teen girl during doctor’s appointment with parents.

Crohn’s disease most commonly affects children in their late teens and young adults in their 20s and 30s. Nevertheless, it can affect infants and young children as well. Crohn’s disease is not rare; 100,000 teens and preteens in the U.S. have Crohn’s disease. For children, the social problems created by the symptoms of Crohn’s disease are difficult to deal with since the disease can restrict activities. The chronic inflammation also stunts growth and delays puberty that add to the social difficulties. Emotional and psychological factors always must be considered in young people with Crohn’s disease.

How Does Crohn’s Disease Affect the Intestines?

Illustration of a painful digestive system.

The first signs of Crohn’s disease are small ulcers, called aphthous ulcers, caused by breaks in the lining of the intestine due to inflammation. The ulcers become larger and deeper. With the expansion of the ulcers comes swelling of the tissue, and finally scarring of the intestine that causes stiffness and narrowing. Ultimately, the narrowing can cause obstruction to the flow of digesting food through the intestines. The deepening ulcers can fully penetrate the intestinal wall and enter nearby structures such as the urinary bladder, vagina, and other parts of the intestine. These penetrating tracts of inflammation are called fistulas.

How is Crohn’s Disease Different from Ulcerative Colitis?

Illustration showing Crohn’s Disease and Ulcerative Colitis comparison.

Both Crohn’s disease and ulcerative colitis are chronic diseases of intestinal inflammation. Whereas ulcerative colitis only involves the colonic portion of the gastrointestinal tract, Crohn’s disease can affect any portion of the gastrointestinal tract from mouth to anus.
vnf_crohns-disease.jpg ntp8_aid5107820-v4-728px-control-crohn_39;s-disease-with-diet-step-15.jpg

Whereas the inflammation of ulcerative colitis involves only the superficial lining of the colon, the inflammation of Crohn’s disease goes deeper into the intestinal walls and, as previously mentioned, even beyond the walls.
vztl_التهاب.jpg 7p5u_wilet.jpg uj14_irendaya.com_-455.jpg

Inflammation in ulcerative colitis is continuous, that is, the inflammation does not skip areas. Thus, the colon is involved from the most proximal margin of the inflammation – be that ascending, transverse or sigmoid colon – all the way to the anus. On the other hand, the inflammation of Crohn’s disease can be present in several portions of the intestines with skipped areas without inflammation in between.دارا و سارا فعلا گفت دو ملیار دلار به حساب سید محمود جعفری بانک ملی ایران  برای طرح دعوی لطفا برزیید تا بقیه یک به یک مشخص گردد. .یک میلیار هم که به سیل زدگان امریکا از ذخایر ایران در امریکا مقرر شد ریخته شود.
yf7t_img18091593.jpg

Symptoms of Crohn’s Disease

Images of abdominal pain, loss of appetite, fever and weight loss.

The most common symptoms of Crohn’s disease are abdominal pain and diarrhea. Other signs of inflammation frequently are present including fever and abdominal tenderness. Because symptoms can be worsened by eating, the intake of food is reduced, and this leads to loss of weight, and, less commonly, nutritional deficiencies. Slow continuous loss of blood into the intestine that may not even be recognizable in the stool can lead to iron deficiency anemia.

Complications of Crohn’s Disease

Double-contrast barium enema examination in Crohn colitis demonstrates numerous aphthous ulcers.

Several complications of Crohn’s disease have already been mentioned, including nutritional deficiencies, loss of weight, anemia, growth retardation, and delayed puberty. Two more serious complications also mentioned previously are strictures or narrowing of the intestine due to scarring and the formation of fistulas. Massive intestinal bleeding and perforation are unusual.

Other Complications of Crohn’s Disease

Images of a bone X-Ray, eye exam, back pain, and aphthous ulcer.

There are also extraintestinal manifestations of Crohn’s disease, some of which may be debilitating. These include arthritis, inflammation of the eye that can impair vision, skin diseases that vary from mild (erythema nodosum) to severe (pyoderma gangrenosum) gallstones, and loss of bone due to nutritional deficiencies. Most of these manifestations are believed to be due to inflammation that is occurring outside of the intestine.

Diagnosing Crohn’s Disease

Doctor examining stomach of young woman.

Although Crohn’s disease usually is not difficult to diagnose, the wide variation in severity of symptoms – from mild to severe – and the non-specific nature of the symptoms that mimic other intestinal inflammatory diseases (for example, diverticulitis), sometimes makes arriving at a diagnosis challenging.

  • The pattern of the symptoms and a family history of Crohn’s disease are very important in diagnosis.
    fe6m_39658_919.jpg 4krt_o,na.jpg vf6c_230016_488.jpg
  • Often, other more common intestinal inflammatory diseases need to be excluded, for example, intestinal bacterial and parasitic infections.
  • Stool may be examined for signs of inflammation such as blood or white blood cells. Fever and an elevated white blood cell count in the blood may suggest inflammation somewhere in the body.
  • Ultimately the inflamed bowel must be visualized and, if possible, biopsied. This can be done by barium X-ray studies, particularly a small intestinal barium X-ray, but probably better by colonoscopy with examination of the terminal ileum (which usually is involved in Crohn’s disease) that also allows for biopsies.
    3ba6_c4cd52527591f54f44812bc7c35ad5e4dad6210e.jpg qfnb_hdsssd.jpg zhmf_گوسفند.jpg
  • When inflammation does not involve the terminal ileum, it may be necessary to do capsule endoscopy (the swallowing of a tiny camera) or enteroscopy (fiberoptic endoscopy of the small intestine) to visualize the entire small intestine. Enteroscopy has the advantage over capsule endoscopy of allowing for biopsy as well as visualization.

Treating Crohn’s Disease

Doctor pointing at human digestive system on human anatomy model.

Treatment of Crohn’s disease is directed at reducing inflammation – treating flares in the activity of the disease, and maintaining remissions. The type of medication that is used depends on the severity of the inflammation and how well the disease responds to initial treatment. If inflammation does not decrease with initial treatment, more powerful medications are used though the risks for serious side effects increase. With severe disease, the more powerful medications may be used immediately.

Surgery in Crohn’s Disease

Teen male with post-op incisions from laparascopic ileocolectemy.

Surgery is avoided in Crohn’s disease if at all possible because of the high probability that inflammation will recur even when it appears that all inflammation has been removed during surgery. There are situations in which surgery often becomes necessary such as with strictures, intestinal obstruction, or symptoms that do not respond to any medical treatment. Usually, the surgery that is done is kept to the minimum that is necessary to take care of the complication. Surgery may include removal of parts of the intestine, stretching of strictures, and removal of fistulas but at times may require resection of the entire colon and the need for a colostomy or ileostomy.

Medication Choices

Medication choices for Crohn’s Disease.

The treatment of choice for Crohn’s disease is medication to control the inflammation. The primary goal is to relieve symptoms by treating flares and putting the disease into remission. A secondary goal is to postpone or prevent surgery. The choice of medication depends on the severity of the flare, the location of the inflammation, and the presence of complications of the disease.
i20f_11_13_0.jpg 1nkw_sb_1200.jpg=s1200x1200.jpg

  • Aminosalicylates and antibiotics suppress inflammation and are associated with the fewest side effects.
  • Corticosteroids are very effective at suppressing inflammation but are associated with serious side effects when used for prolonged periods of time.
  • Other medications suppress the immune system in general and can be used for prolonged periods of time.
  • Biologics are injectable medications that reduce inflammation by blocking the action of specific chemicals that are released by immune cells that provoke inflammation.

Other Therapy

Doctor holding prescription bottle of medicine.

Newer suppressors of inflammation and the immune system are being developed all of the time. Two general immunosuppressants are tacrolimus (Prograf, FK 506) and mycophenolate mofetil (CellCept). Newer biologics also are being developed.

Diet and Nutrition in Crohn’s Disease

Woman looking inside refrigerator.

Maintaining good nutrition with Crohn’s disease can be a challenge. Weight loss as well as specific vitamin and mineral deficiencies (for example, iron deficiency anemia) may occur. Patients whose inflammation still is active do not have much of an appetite so their intake of food is reduced or the types of foods they eat are restricted. Eating also makes the symptoms worse so they eat less. Finally, if a substantial portion of the small intestine is inflamed or surgically removed, the inflamed intestine may not absorb nutrients normally. Good nutrition depends on the control of inflammation, but when that is not achievable, it depends on supplemental vitamins, minerals, and calories.

Will I Have to Change My Diet?

Woman eating with spoon in mouth.

No specific foods are believed to provoke the symptoms of Crohn’s disease, although it always is recommended that if certain foods seem to exacerbate symptoms then those foods should be eliminated from the diet. The most commonly recommended dietary changes are reduced intake of milk and dairy products, but this recommendation is based primarily on the possibility of lactose intolerance, a genetic abnormality of milk sugar digestion that is unrelated to Crohn’s disease. If the relationship between milk and symptoms is not clear, it probably is a good idea to do a formal lactose tolerance test to learn for certain whether or not milk and milk products should be eliminated from the diet. It would be a shame to eliminate milk from the diet unless absolutely necessary since milk is an excellent source of calories, protein, vitamin D, and calcium.Coping with Stress

Crohn's disease stress management tips.

Active Crohn’s disease provides many stresses, and stress makes the symptoms of all diseases worse, including Crohn’s disease. The best treatment for the stress is successful suppression of inflammation. When inflammation cannot be suppressed, patients become depressed and angry. This interferes with relationships with friends and families, and it may be helpful to use support groups to help relieve some of the stresses caused by the disease. It also is important to stay as active as possible, readjusting activities to work around symptoms. Adequate rest is very important.

Crohn’s Disease Outlook

Doctor consulting with male patient.

For most patients, Crohn’s disease is a chronic illness with flares of disease activity and remissions. Appropriate medications, and occasionally surgery, however, will provide a reasonable quality of life for most patients. If there is progression of the symptoms of Crohn’s disease the progression usually is slow. The longer the disease is present the more likely are complications, some of which will require surgery (for example, strictures). In fact, surgery is required by most patients at some point in their disease. It is important to remember that Crohn’s disease usually recurs after surgery even if all visible inflammation is removed.
مطلب علمی دیگر در همین رابطه.

  • Treatment for Crohn’s Disease

How do doctors treat Crohn’s disease?

Doctors treat Crohn’s disease with medicines, bowel rest, and surgery.

No single treatment works for everyone with Crohn’s disease. The goals of treatment are to decrease the inflammation in your intestines, to prevent flare-ups of your symptoms, and to keep you in remission.

Medicines

Many people with Crohn’s disease need medicines. Which medicines your doctor prescribes will depend on your symptoms.

Image of a woman taking medications with a glass of water Many people with Crohn’s disease need medicines. Which
medicines your doctor prescribes will depend on your symptoms.Although no medicine cures Crohn’s disease, many can reduce symptoms.

Aminosalicylates. These medicines contain 5-aminosalicylic acid (5-ASA), which helps control inflammation. Doctors use aminosalicylates to treat people newly diagnosed with Crohn’s disease who have mild symptoms. Aminosalicylates include

Some of the common side effects of aminosalicylates include

Corticosteroids. Corticosteroids, also known as steroids, help reduce the activity of your immune system and decrease inflammation. Doctors prescribe corticosteroids for people with moderate to severe symptoms. Corticosteroids include

Side effects of corticosteroids include

In most cases, doctors do not prescribe corticosteroids for long-term use.

Immunomodulators. These medicines reduce immune system activity, resulting in less inflammation in your digestive tract. Immunomodulators can take several weeks to 3 months to start working. Immunomodulators include

Doctors prescribe these medicines to help you go into remission or help you if you do not respond to other treatments. You may have the following side effects:

    • a low white blood cell count, which can lead to a higher chance of infection
    • feeling tired
    • nausea and vomiting
    • pancreatitis

Doctors most often prescribe cyclosporine only if you have severe Crohn’s disease because of the medicine’s serious side effects. Talk with your doctor about the risks and benefits of cyclosporine.
l42y_`vks.jpg

67yw_body1.jpg o7n_تاعغف.jpg

Biologic therapies. These medicines target proteins made by the immune system. Neutralizing these proteins decreases inflammation in the intestines. Biologic therapies work quickly to help you go into remission, especially if you do not respond to other medicines. Biologic therapies include

Doctors most often give patients infliximab every 6 to 8 weeks at a hospital or an outpatient center. Side effects may include a toxic reaction to the medicine and a higher chance of developing infections, particularly tuberculosis .

Other medicines. Other medicines doctors prescribe for symptoms or complications may include

    • acetaminophen for mild pain. You should avoid using ibuprofen , naproxen , and aspirin because these medicines can make your symptoms worse.
    • antibiotics to prevent or treat complications that involve infection, such as abscesses and fistulas.
    • loperamide to help slow or stop severe diarrhea. In most cases, people only take this medicine for short periods of time because it can increase the chance of developing megacolon.

Bowel rest

If your Crohn’s disease symptoms are severe, you may need to rest your bowel for a few days to several weeks. Bowel rest involves drinking only certain liquids or not eating or drinking anything. During bowel rest, your doctor may

    • ask you to drink a liquid that contains nutrients
    • give you a liquid that contains nutrients through a feeding tube inserted into your stomach or small intestine
    • give you intravenous (IV) nutrition through a special tube inserted into a vein in your arm

You may stay in the hospital, or you may be able to receive the treatment at home. In most cases, your intestines will heal during bowel rest.
zp2c_hqdefault.jpg ialk_تصویر_وزیر_جهاد.jpg

Surgery

Even with medicines, many people will need surgery to treat their Crohn’s disease. One study found that nearly 60 percent of people had surgery within 20 years of having Crohn’s disease.8 Although surgery will not cure Crohn’s disease, it can treat complications and improve symptoms. Doctors most often recommend surgery to treat

    • fistulas
    • bleeding that is life threatening
    • intestinal obstructions
    • side effects from medicines when they threaten your health
    • symptoms when medicines do not improve your condition

A surgeon can perform different types of operations to treat Crohn’s disease.

ctbl_max.jpg h1m_aua.jpg c9qa_636326039071910699.jpg

For any surgery, you will receive general anesthesia . You will most likely stay in the hospital for 3 to 7 days following the surgery. Full recovery may take 4 to 6 weeks.

Small bowel resection. Small bowel resection is surgery to remove part of your small intestine. When you have an intestinal obstruction or severe Crohn’s disease in your small intestine, a surgeon may need to remove that section of your intestine. The two types of small bowel resection are

    • laparoscopic—when a surgeon makes several small, half-inch incisions in your abdomen. The surgeon inserts a laparoscope—a thin tube with a tiny light and video camera on the end—through the small incisions. The camera sends a magnified image from inside your body to a video monitor, giving the surgeon a close-up view of your small intestine. While watching the monitor, the surgeon inserts tools through the small incisions and removes the diseased or blocked section of small intestine. The surgeon will reconnect the ends of your intestine.
      upvb_jw,dv_d;_lkhtr.png 6dm6_عابدی_راد.jpg
    • open surgery—when a surgeon makes one incision about 6 inches long in your abdomen. The surgeon will locate the diseased or blocked section of small intestine and remove or repair that section. The surgeon will reconnect the ends of your intestine. f3rp_پارلمان.jpg jym_jim-clancy-main.jpg

Subtotal colectomy. A subtotal colectomy, also called a large bowel resection, is surgery to remove part of your large intestine. When you have an intestinal obstruction, a fistula, or severe Crohn’s disease in your large intestine, a surgeon may need to remove that section of intestine. A surgeon can perform a subtotal colectomy by

    • laparoscopic colectomy—when a surgeon makes several small, half-inch incisions in your abdomen. While watching the monitor, the surgeon removes the diseased or blocked section of your large intestine. The surgeon will reconnect the ends of your intestine.
    • open surgery—when a surgeon makes one incision about 6 to 8 inches long in your abdomen. The surgeon will locate the diseased or blocked section of large intestine and remove that section. The surgeon will reconnect the ends of your intestine.

Proctocolectomy and ileostomy. A proctocolectomy is surgery to remove your entire colon and rectum. An ileostomy is a stoma, or opening in your abdomen, that a surgeon creates from a part of your ileum. The surgeon brings the end of your ileum through an opening in your abdomen and attaches it to your skin, creating an opening outside your body. The stoma is about three-quarters of an inch to a little less than 2 inches wide and is most often located in the lower part of your abdomen, just below the beltline.

3myh_14dc-mueller1-master768.jpg oie1_jiping-putin_3301426b.jpg

A removable external collection pouch, called an ostomy pouch or ostomy appliance, connects to the stoma and collects stool outside your body. Stool passes through the stoma instead of passing through your anus. The stoma has no muscle, so it cannot control the flow of stool, and the flow occurs whenever occurs.

If you have this type of surgery, you will have the ileostomy for the rest of your life.

How do doctors treat the complications of Crohn’s disease?

Your doctor may recommend treatments for the following complications of Crohn’s disease:

    • Intestinal obstruction. A complete intestinal obstruction is life threatening. If you have a complete obstruction, you will need medical attention right away. Doctors often treat complete intestinal obstruction with surgery.
      oc49_fiyer.jpg 1rys_kakhg.jpg
    • Fistulas. How your doctor treats fistulas will depend on what type of fistulas you have and how severe they are. For some people, fistulas heal with medicine and diet changes, whereas other people will need to have surgery.
    • Abscesses. Doctors prescribe antibiotics and drain abscesses. A doctor may drain an abscess with a needle inserted through your skin or with surgery.
    • Anal fissures. Most anal fissures heal with medical treatment, including ointments, warm baths, and diet changes.
    • Ulcers. In most cases, the treatment for Crohn’s disease will also treat your ulcers.
    • Malnutrition. You may need IV fluids or feeding tubes to replace lost nutrients and fluids.
    • Inflammation in other areas of your body. Your doctor can treat inflammation by changing your medicines or prescribing new medicines.
      vb5b_https_fm.cnbc.com_applications_cnbc.com_resources_img_editorial_2017_08_29_104678501-3ed2-sb-082917-majorityhouston.600x400.jpg u4p8_rian_02622043-russia-and-china-as-best-frenemies-625.jpg

References

[8] Peyrin-Biroulet L, Harmsen WS, Tremaine WJ, Zinsmeister AR, Sandborn WJ, Loftus EV. Surgery in a population-based cohort of Crohn’s disease from Olmsted County, Minnesota (1970–2004). American Journal of Gastroenterology. 2012;107(11):1639–1701.

November 2016

6qx3_sesno-preview-wide2-1024x683.jpg
1t9j_کنگرو.jpg yiyj_ahjk.jpg

علائم و درمان بیماری کرون یا التهاب روده‌

کرون، بیماری التهابی روده‌هاست که اگرچه باعث زخم روده‌های کوچک و بزرگ می‌شود، اما ممکن است بر هر قسمتی از دستگاه گوارش (از دهان تا مقعد) تاثیر بگذارد.
6p8i_698569-guterres.jpgmvov_mil2_large.jpgxmg3_o,na.jpg

به گزارش خبرنگار سایت پزشکان بدون مرز، کرون را نباید با کولیت زخمی اشتباه گرفت، چرا که با وجود تشابه علل ابتلا، بیماری کولیت زخمی (کولیت اولسراتیو) یکی دیگر از بیماری های التهابی روده است.

علت این بیماری نامعلوم است. برخی محققان به عفونتی که توسط باکتری‌های خاص ایجاد می‌شود، مشکوک هستند.

lkp2_080306-mccain-bush-vmed-130a.grid-4x2.jpg 47zj_پوپ.jpg s8el_ایتالیا.jpg

2s3g_bank-melli-day.jpg k220_img18091593.jpg

از طرفی به نظر می‌رسد، فعال شدن سیستم ایمنی روده‌ها نیز در بیماری‌های التهابی آنها موثر است، چرا که التهاب، یک مکانیسم دفاعی مهم در برابر فعالیت سیستم ایمنی است.
سیستم ایمنی به طور طبیعی تنها در برابر عوامل خارجی مضر فعال می‌شود، ولی در اشخاص مبتلا به کرون، این سیستم به طور غیرطبیعی و در غیاب هر نوع عامل خارجی فعال می‌شود و این فعال شدن مکرر ـ که احتمالا ژنتیکی است ـ می‌تواند به التهاب و زخم مزمن منجر شود.
825t_calguardwhiteweb.jpg t3aj_hukop.jpg a1le_253.400.926.jpg

بررسی محققان medicinenet نشان داده است در روده افراد مبتلا به کرون، سطح بالایی از نوع خاصی از باکتری (اشرشیاکلی) وجود دارد که ممکن است در بیماری‌زایی تاثیر داشته باشند.
از طرفی اگرچه رژیم غذایی ممکن است بر علائم بیماری تاثیر بگذارد، اما بعید به نظر می‌رسد رژیم غذایی عامل بیماری باشد.

علائم بیماری کرون

علائم کرون شامل درد شکمی،‌ اسهال و کاهش وزن بدن است. البته علائمی که کمتر شایع است، مانند کاهش اشتها، تب، عرق شبانه، درد مقعد و گاهی خونریزی از مقعد نیز دیده می‌شود.
بیماری کرون ابتدا باعث زخم‌های کوچک روی سطح داخلی روده‌ها می‌شود که به مرور زمان، عمیق‌تر و بزرگ‌تر می‌شوند و می‌توانند باعث خشکی، باریک شدن و حتی انسداد روده شوند
علائم بیماری کرون، بستگی به محل ایجاد آن، گستردگی و شدت التهابی دارد.
uz0s_author_fred_little.jpg
gfmr_170903104526-gen-michael-hayden-sotu-9-3-story-top.jpg p4by_161111170736-melania-trump-first-lady.jpg
در کرون با التهاب روده بزرگ (کولون)، درد شکمی و اسهال خونی از علائم شایع است، ضمن این‌که فیستول مقعدی و آبسه‌های اطراف مقعد نیز ممکن است ایجاد شود.
التهاب روده کوچک نیز با درد شکمی، اسهال یا انسداد روده همراه است.

عوارض بیماری کرون

یک‌سوم بیماران مبتلا به کرون ممکن است بیماری‌های مربوط به ناحیه مقعدی داشته باشند که با ورم بافت اسفنکتر مقعد، ایجاد زخم یا شقاق در داخل اسفنکتر مقعد، ایجاد فیستول بین مقعد (یا راست روده) و پوست اطراف مقعد یا آبسه‌های اطراف مقعد همراه است که به تب و درد در این ناحیه منجر می‌شود.

سایر عوارض بیماری شامل ایجاد سوراخ در دیواره روده و در نتیجه ورود باکتری‌های داخل روده به ارگان‌های مجاور است.

در صورت انسداد روده با میوه‌ها و سبزیجات در حال هضم، مایعات و گاز معده می‌توانند وارد کولون شده و منجر به دردهای شکمی شدید، تهوع و استفراغ شوند.

تشکیل فیستول بین روده و مثانه می‌تواند باعث عفونت‌های مکرر سیستم ادراری و عبور گاز و مدفوع در حین ادرار کردن شود.
در صورتی که فیستول بین روده و پوست ایجاد شود، چرک و موکوس از شکاف کوچک و دردناکی روی پوست شکم خارج می‌شود، حال آن‌که ایجاد فیستول بین کولون و واژن، باعث خروج گاز و مدفوع از طریق واژن می‌شود. همچنین وجود فیستول از روده تا مقعد، منجر به خارج شدن موکوس و چرک از شکاف فیستول اطراف مقعد می‌شود.

گفتنی است ورم یا گشادشدگی کولون و پارگی روده از عوارض خطرناک است و معمولا هر دو نیاز به جراحی دارد.
41j2_منخع.jpg

از عوارض دیگر بیماری کرون، در درازمدت خطر افزایش سرطان روده کوچک و کولون است.
همچنین عوارض خارج روده‌ای،‌ اندام‌هایی مانند پوست، مفاصل، ستون فقرات، چشم‌ها و مجاری صفراوی را درگیر می‌کند.

عوارض پوستی این بیماری شامل لکه‌های قرمز رنگ دردناک روی پاها و زخم شدن پوست در اطراف مچ پاست.

در ادامه بیماری‌های دردناک چشم می‌تواند باعث مشکلات بینایی شود و آرتریت باعث درد، تورم و خشکی مفاصل دست و پا می‌شود. همچنین التهاب قسمت پایین کمر و ستون فقرات می‌تواند باعث درد و خشکی ستون فقرات شود.

همچنین التهاب کبد (هپاتیت) یا مجاری صفراوی و زردی پوست اتفاق می‌افتد. عفونت‌های باکتریایی و سیروز کبدی همراه با نارسایی کبد و نیز سرطان مجاری صفراوی از دیگر عوارض این بیماری هستند

تشخیص بیماری کرون

بالا بودن تعداد گلبول‌های سفید در تست‌های آزمایشگاهی، نشانه عفونت یا التهاب است.
همچنین کاهش گلبول‌های قرمز خون (کم‌خونی)، کاهش پروتئین خون و مواد معدنی که از طریق اسهال از دست می‌رود نیز می‌تواند نشان‌دهنده بیماری کرون باشد.

به گفته متخصصان Mayoclinic ، بررسی با اشعه ایکس باریوم نیز برای تشخیص محل، نوع و شدت بیماری، زخم‌ها، باریک شدن روده‌ها و فیستول‌های ایجاد شده به کار می‌رود.
البته کولونوسکوپی روش دقیق‌تری برای تشخیص زخم‌های کوچک یا نواحی التهابی کوچک در کولون است.

سی‌تی‌اسکن نیز می‌تواند تصاویری از داخل شکم و لگن را نشان دهد و بخصوص برای شناسایی آبسه‌ها مفید است.

آندوسکوپی با کپسول ویدئویی که حاوی یک دوربین بسیار ریز است و بلعیده می‌شود، تصاویر لایه داخلی روده کوچک را به گیرنده‌ای که روی کمر بسته می‌شود، ارسال می‌کند و باعث تشخیص زودهنگام نشانه‌های خفیف بیماری کرون می‌شود. البته این روش نباید در بیماران با انسداد روده کوچک انجام شود، چرا که کپسول ممکن است در پشت ناحیه مسدود شده گیر کرده و وضعیت را بدتر کند.

درمان بیماری کرون

در مورد درمان این بیماری باید گفت بیمارانی که علائم خفیف دارند، نیازمند درمان نیستند.

این بیماران معمولا دوره‌هایی از عود‌کردن بیماری (وخیم‌تر شدن التهاب) را متعاقب دوره‌هایی از بهبود نسبی (کاهش التهاب) که ماه‌ها تا سال‌ها طول می‌کشد، تجربه می‌کنند.

داروهایی که برای درمان کرون استفاده می‌شوند، شامل عوامل ضدالتهابی مانند ترکیبات ASAـ5 و کورتیکواستروئیدها و نیز آنتی‌بیوتیک‌های موضعی و تعدیل‌کننده‌های سیستم ایمنی هستند.

داروی ضدالتهاب مزال آمین برای بیماری در ناحیه روده کوچک بی‌تاثیر است.

کورتیکواستروئیدها نیز هر چند به کاهش التهاب کمک می‌کنند، اما عوارض جانبی زیادی از جمله پف کردن صورت، افزایش موی صورت، عرق شبانه، بی‌خوابی و بیش‌فعالی دارند و در درازمدت نیز موجب افزایش فشار خون، دیابت، پوکی استخوان، آب‌مروارید، آب‌سیاه و… می‌شوند.

این داروها تنها در مواردی تجویز می‌شوند که التهاب روده به درمان‌های دیگر پاسخ نمی‌دهد. در این میان داروهای بازدارنده سیستم ایمنی به طور مستقیم باعث کاهش التهاب می‌شوند.
لازم به ذکر است که مصرف داروهای بازدارنده سیستم ایمنی در درازمدت می‌تواند اثرات جانبی بسیاری از جمله خطر افزایش بیماری‌های عفونی مانند سل، هپاتیت B و سرطان را به همراه داشته باشد و به سایر ارگان‌ها نیز آسیب برساند.

نقش آنتی‌بیوتیک‌ها در بهبود فیستول‌ها و آبسه‌هاست، همچنین باعث کاهش باکتری‌های مضر روده و مهار سیستم ایمنی در روده‌ها می‌شوند.

سایر داروها از جمله داروهای ضداسهال، مسهل‌ها، داروهای ضددرد، مکمل‌های آهن، کلسیم، ویتامین D و ویتامین B12 نیز بسته به نیاز و شدت بیماری تجویز می‌شوند.

ممکن است پزشک برای استراحت دادن به روده‌ها و کاهش التهاب، یک رژیم غذایی مخصوص را از طریق تغذیه با لوله یا تزریق مواد مغذی (به صورت وریدی) توصیه کند.

همچنین در موارد تنگ شدن روده‌ها، برای کاهش خطر انسداد، غذای کم‌فیبر توصیه می‌شود. چنانچه تغییر در شیوه زندگی و دارودرمانی علائم بیماری کرون را بهبود نبخشد،‌ ممکن است پزشک، جراحی را توصیه کند.
i9wf_357232_849.jpg eri_محمود_در_میسوری.jpg

در این روش، بخش آسیب‌دیده دستگاه گوارش برداشته شده و سپس قسمت‌های سالم دوباره به هم متصل می‌شود.

همچنین ممکن است برای بستن فیستول‌ها و تخلیه آبسه‌ها از جراحی استفاده شود. ضمنا برای پیشگیری از بازگشت بیماری بهترین راه، استفاده از داروها، متعاقب جراحی است.

برچسب‌ها: تغییر اقلیم در جهان

+ نوشته شده در  سه شنبه چهاردهم شهریور ۱۳۹۶ساعت 7:5  توسط سید محمود جعفری

گذاشتن پاسخ

نشانی ایمیل شما منتشر نخواهد شد. بخش‌های موردنیاز علامت‌گذاری شده‌اند *

Top