Crohn's Disease (cont.)
How does Crohn's disease affect the intestines?
In the early stages, Crohn's disease causes small, scattered, shallow,
crater-like areas (erosions) on the inner surface of the bowel. These erosions
are called aphthous ulcers. With time, the erosions become deeper and larger,
ultimately becoming true ulcers (which are deeper than erosions) and causing
scarring and stiffness of the bowel. As the disease progresses, the bowel
becomes increasingly narrowed, and ultimately can become obstructed. Deep ulcers
can puncture holes in the wall of the bowel, and bacteria from within the bowel
can spread to infect adjacent organs and the surrounding abdominal cavity.
When Crohn's disease narrows the small intestine to the point of obstruction,
the flow of the contents through the intestine ceases. Sometimes, the
obstruction can be caused suddenly by poorly-digestible fruit or vegetables that
plug the already-narrowed segment of the intestine. When the intestine is
obstructed, digesting food, fluid and gas from the stomach and the small
intestine cannot pass into the colon. The symptoms of small intestinal
obstruction then appear, including severe abdominal cramps,
nausea,
vomiting,
and abdominal distention. Obstruction of the small intestine is much more likely
since the small intestine is much narrower than the colon to begin with.
Deep ulcers can puncture holes in the walls of the small intestine and the
colon, and create a tunnel between the intestine and adjacent organs. If the
ulcer tunnel reaches an adjacent empty space inside the abdominal cavity, a
collection of infected pus (an abdominal abscess) is formed. Patients with
abdominal abscesses can develop tender abdominal masses, high fevers, and
abdominal pain.
When the ulcer tunnels into an adjacent organ, a channel (fistula) is formed.
The formation of a fistula between the intestine and the bladder
(enteric-vesicular fistula) can cause frequent
urinary tract infections and the
passage of gas and feces during urination. When a fistula develops between the
intestine and the skin (enteric-cutaneous fistula), pus and mucous emerge from a
small painful opening on the skin of the abdomen. The development of a fistula
between the colon and the vagina (colonic-vaginal fistula) causes gas and feces
to emerge through the vagina. The presence of a fistula from the intestines to
the anus (anal fistula) leads to a discharge of mucous and pus from the fistula's
opening around the anus.
How is Crohn's disease different from ulcerative colitis?
While ulcerative colitis causes inflammation only in the colon (colitis)
and/or the rectum (proctitis), Crohn's disease may cause inflammation in the colon,
rectum, small intestine (jejunum and ileum), and, occasionally, even the
stomach, mouth, and esophagus.
The patterns of inflammation in Crohn's disease are different from ulcerative
colitis. Except in the most severe cases, the inflammation of ulcerative colitis
tends to involve the superficial layers of the inner lining of the bowel. The
inflammation also tends to be diffuse and uniform. (All of the lining in the
affected segment of the intestine is inflamed.) Unlike ulcerative colitis, the
inflammation of Crohn's disease is concentrated in some areas more than others
and involves layers of the bowel that are deeper than the superficial inner
layers. Therefore, the affected segment(s) of bowel in Crohn's disease often is
studded with deeper ulcers with normal lining between these ulcers.
Next: What are the symptoms of Crohn's disease? »
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