- The first stage of diagnosis is the patient's questioning
- The second stage is the examination of the patient
- The third stage - how to pass the test
- What studies can confirm an undoubted diagnosis?
- The importance of endoscopy and biopsy evaluation
- How to distinguish Crohn's disease from nonspecific ulcerative colitis (NUC)?
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Crohn's disease is a poorly understood disease characterized by chronic segmental inflammation of the gastrointestinal tract and various organs. Lack of confidence in the causes of pathology causes difficulties in diagnosis. The examination is delayed, which negatively affects the results of treatment of patients.
Diagnosis of Crohn's disease is based on modern knowledge about the mechanisms of development and the causes of pathology. The test for Crohn's disease is suggested to pass through to all people with symptoms of prolonged disease of the gastrointestinal tract. It includes answers to questions on actual signs and a calculation of the probability of the disease.
The first stage of diagnosis is the patient's questioning
People meet at a doctor's appointment with a specialist, came with their complaints about health, suspicions, doubts, "secrets", which it is impossible to talk about with others. Since Crohn's disease is a class of inflammatory bowel diseases, there are common symptoms. They are to be determined when the patient is questioned.
- loss of appetite;
- occurrence of stomatitis with ulcers in the mouth;
- skin rashes;
- weight loss;
- abdominal pains of an acute and dull character associated with food or stress;
- diarrhea or constipation, the presence in the stools of visible mucus, pus, blood.
It is necessary to find out whether among blood relatives cases of diseases similar to Crohn's disease, possibly with a fatal outcome. These signs are not exact criteria of Crohn's disease, but help in drawing up a plan for differential diagnosis.
The second stage is the examination of the patient
When examining the patient, the doctor looks at the skin changes (erythema, pustular eruptions), the presence of sores on the gums, lips and mucous membranes of the mouth, an unclear temperature increase. When palpation of the abdomen is determined by the localization of the maximum pain in the course of the intestine, in the hypochondria, the protruding margins of the liver and spleen.
Possible patient reaction to touching in the area of maximum inflammation, identifying spastic contraction, bloated intestine
Checking the anus is necessary for painful defecation, bloody and purulent impurities in the feces. Children are examined by a pediatrician, with questions, addresses to parents. The child is not able to tell about the symptoms, often shy. Given the high susceptibility of the disease of boys in the teenage period, frankness does not have to be counted.
The third stage - how to pass the test
The test for Crohn's disease can be passed without a doctor's referral. Enough of their own suspicions for long-term intestinal disease. There is an opportunity to use the Internet version. It represents answers to simple questions (in the form of "yes" or "no").
What studies can confirm an undoubted diagnosis?
Diagnosis of Crohn's disease involved doctors: therapists, gastroenterologists, pediatricians, surgeons, proctologists, gynecologists, histologists. You may need to consult a dermatologist and oculist. A complete picture of the disease can be obtained after a laboratory and instrumental examination.
The results of blood tests show:
- leukocytosis, eosinophilia, thrombocytosis;
- acceleration of ESR;
- decrease in the level of erythrocytes, hemoglobin, iron, ferritin (chronic iron deficiency anemia);
- presence of C-reactive protein;
- violation of the ratio of protein fractions due to the growth of gamma globulins and decrease of albumins;
- growth of fibrinogen.
Biochemical tests for transaminases (alanine and aspartic) and alkaline phosphatase must be checked. In the immunological study, an increase in IgG and an IgA deficiency are recorded, detection of antibodies such as ASCA is considered a serological marker of the disease.
In the analysis of stool, it is checked:
- scrap - with a large number of undigested residues, fat, mucus can be judged on the violation of the absorption process;
- the presence of hidden blood is confirmed by the response of Gregersen;
- bacteriological culture is conducted to exclude the nature of inflammation caused by shigella, salmonella, iersiniosis, clostridia, tuberculous mycobacterium, dysentery amoeba, parasites and various helminthiases.
Specific and sensitive indicators include the determination of calprotectin level in the stool. It is a protein synthesized by neutrophils of the intestinal mucosa. It grows against the background of Crohn's disease, infectious lesions, ulcerative colitis, malignant tumors. Its increase is considered as an indicator of high activity of inflammation, a precursor of an early exacerbation (if the patient has a remission stage).
On the survey radiograph of the abdominal cavity, swollen loops of the intestine are visible. After carrying out the radiocontrast study with the necessary preparation, it is possible to identify areas of narrowing that are not filled with the contrast medium, asymmetric areas, deep ulceration, swelling, intestinal obstruction.
While research with a video camera is possible only in private clinics and refers to costly
Computer, magnetic resonance imaging, ultrasound is useful in diagnosis for the detection of intra-abdominal abscesses, enlarged lymph nodes in the mesentery.
There is a technique of magnetic resonance tomography with hydrocontrast.
It allows to reveal the extent of intestinal pathology, fistulous courses, narrowing. The contrast accumulates in the inflamed area and makes it possible to determine the distinctive signs of constriction due to inflammation (edema) and scars.
The importance of endoscopy and biopsy evaluation
In Diff. diagnostics, nothing can replace a visual examination of the gastrointestinal tract with the help of endoscopic technique. Modern devices make it possible to display the image on the screen, record for subsequent comparison and control (before and after treatment). If it is necessary to diagnose lesions in the area of the esophagus and stomach, fibrogastroscopy is performed.
Ileocolonoscopy is a method of examining all parts of the large intestine, the terminal part of the ileum. It is carried out under anesthesia. It is necessarily accompanied by taking material from a variety of sites for the subsequent biopsy. The picture is an indisputable proof of Crohn's disease.
For comparison, samples from affected and healthy tissues are taken
Endoscopic criteria of the disease are:
- obvious damage to various areas of the intestine;
- absence of a clear vascular pattern in them;
- presence of longitudinal ulcers;
- altered relief in the form of "cobblestone pavement";
- Detection of fistulas and fistulas in the intestinal wall;
- narrowing of the lumen;
- abundant mucus and pus.
How to distinguish Crohn's disease from nonspecific ulcerative colitis (NUC)?
To establish the correct diagnosis, it is necessary to exclude:
- sarcoidosis - more often affects the lungs, liver, skin, eyes, biopsy confirms a specific picture;
- tuberculosis of the intestine - gives positive samples for tuberculin, effective therapy with anti-tuberculosis drugs, usually manifests as a secondary lesion in the background of the pulmonary process;
- Behcet's disease - systemic vasculitis with ulceration of the mucous membranes and intestines of vascular nature;
- colitis radiation - there is a connection with radiotherapy, radiation dose;
- cholelithiasis - a mechanical obstruction causes constriction of the ducts of the gallbladder and pancreas, the symptoms are associated with a digestive disorder due to a delay in the intake of enzymes;
- malignant tumors of the intestine;
- systemic connective tissue diseases (lupus erythematosus, dermatomyositis, scleroderma) - gastrointestinal tract involvement is caused by vasculitis, ischemia of supply sites in the mainstream of mesenteric vessels, is clinically expressed in abdominal crises;
- intestinal infections - confirmed by bacteriological examination;
- chronic enteritis.
In the diagnosis, localization of the lesion is taken into account
Crohn's disease and ulcerative nonspecific colitis are included in the class of inflammatory bowel pathology. Symptoms are often the same. Differential diagnostics is considered to be the most complex, carried out according to several distinctive features, given in the table.
|localization of inflammation||in 2/3 cases at the junction of the small and large intestine, less often in other departments||in the colonic and rectum|
|endoscopic picture||sites of inflammation alternate with healthy tissues, there are fistulous movements, narrowing, ulceration||puffiness, friability of the mucous membrane, large bleeding surface, surrounded by inflammation, proliferation of granulation tissue, polyps|
|X-ray signs||asymmetrical alternation of affected areas and normal, narrowing, ulcers||changes are common throughout the colon, major ulcers, granulations|
Each tenth case remains outstanding, classified as "unspecified colitis." All these types of research allow not only to diagnose Crohn's disease, but also to reveal the degree of activity of the process. This helps to prescribe adequate therapy.