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Doctors Lounge - Gastroenterology Answers
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| djberg98
- Mon Feb 21, 2005 2:35 am |
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Started Dec 22. Thought was flu, then gallbladder. Right upper quad pain, nausea/vomiting bouts of diarrhea. All gallbladder testing negative. Lab tests mostly within normla limits. Found out I am anemic. No blood in stools. Continuous low-grade temp since this started. Started with some foods, now all food irritates. Had normal Upper Endoscopy. Scheduled for Upper Barium next week. All symptoms point to textbook case of Crohn's. Any ideas? Pain is constant dull ache under lower part of right rib cage. Radiates to mid right side at times. Took nexium for two weeks without results.
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| Dr. Safaa Mahmoud
- Fri Jul 07, 2006 6:38 pm |
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 Dear djberg98,
The diagnosis of Crohn's disease is usually reached after exclusion of other causes that give Crohn's disease like symptoms. These conditions include, irritable bowel syndrome (IBS), colorectal cancer and diverticulitis.
Crohn's disease and ulcerative colitis are caused by inflammation of the wall of the GI tract. They are very similar in the pathogenesis hence, in the presenting symptoms, as they both lead to bouts of watery or bloody diarrhea and abdominal pain While, Ulcerative colitis occurs mainly in the large bowel (colon and rectum), Crohn's disease can occur anywhere in the digestive tract. Therapies used in the treatment of these diseases can result in long term remission of the symptoms, but not in cure.
Symptoms range from mild to very severe, and can arise suddenly or gradually over a long time.
1-Diarrhea which is due to water and salt secretion from the inflamed intestinal cells can be severe to affect sleep and the daily activity
2-Abdominal pain and camping result from the thickened wall due to scaring can be mild to severe associated with nausea and vomiting. Blood in stool is due injury of the inflamed wall by the passing food. It can be just an occult blood in stool to severe continuous bleeding..
3-Crohn's diseases causes scattered small ulcers that can coalesce forming a large one that can penetrate all the intestinal wall leading to serious situation..
4-Loss of appetite and weight are very common sequences of the disease. In addition other associated symptoms that occur outside the GI include fatiguability, arthritis, eye and sin inflammatory conditions, and hepatitis.
Blood tests help to check for anemia and circulating antibodies.
Colonoscopy and biopsy is the investigation of choice as it confirm the diagnosis by the presence of granulomas which are formed by inflammatory cell. In ulcerative colitis there is diffuse infiltration by inflammatory cells rather than the granuloma formations.
Free colonscopic examination dose not mean negative disease since the disease affects primarily the entire GI tract and usually starts in the small intestine, so a Barium follow through can help investigate the small intestine with a Small bowel X-ray.
Capsule endoscopy, a capsule that contains a camera inside is swallowed. The images it takes through its passage in the GI tract is displayed on a monitor and are checked for any abnormalities.
Best regards,
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