Disease Krone – the granulematozny inflammation of various departments of a digestive tract which is characterized chronic the recuring and progressing current. The disease Krone is followed by abdominal pains, diarrhea, intestinal bleedings. System manifestations include fever, decrease in body weight, defeat of the musculoskeletal device (artropatiya, sakroileit), an eye (episklerit, uveit), skin (a knotty eritema, a gangrenous piodermiya). Diagnosis of a disease Krone is carried out by means of a kolonoskopiya, a X-ray analysis of intestines, KT. Treatment includes a dietotherapy, anti-inflammatory, immunosuppressive, symptomatic therapy; at complications – surgical intervention.
Disease Krone – a chronic disease of digestive tract of inflammatory character. At a disease the Krone inflammatory process develops in an internal mucous membrane and submucous layers of a wall of digestive tract. Can be surprised mucous on any sites: from a gullet to a rectum, but the inflammation of walls of final departments of a small intestine (a podvzdoshny gut) most often meets.
The disease proceeds chronically, with alternation of bad attacks and remissions. The first symptoms of a disease (the first attack), as a rule, arise at young age – persons 15 have 35 years. The disease occurs equally often both at men, and at women. Genetic predisposition of a disease Krone is revealed - if relatives of a straight line have this disease, the risk of its development increases by 10 times. If the disease is diagnosed for both parents, the disease at such patients arises before 20 years in half of cases. The risk of development of a disease Krone increases when smoking (practically by 4 times), and also connection of a disease with oral contraception is noted.
Etiology and pathogenesis of a disease Krone
The reasons of development of a disease are finally not defined. According to the most widespread theory, in development of a disease the krone plays the main role pathological reaction of immunity to intestinal flora, I write, coming to intestines, other substances. The immune system notes these factors as alien and sates an intestines wall with leukocytes therefore there is an inflammatory reaction, an erosion and ulcer defeat of mucous. However, this theory has no authentic evidence.
The factors promoting development of a disease Krone:
- genetic predisposition;
- tendency to allergies and autoimmune reactions;
- smoking, abuse of alcohol, medicines;
- ecological factors.
Disease symptoms Krone
Intestinal displays of a disease Krone: diarrhea (at a heavy current the frequency of defekation can prevent normal activity and a dream), belly-ache (expressiveness depending on severity of a disease), disorder of appetite and weight reduction. At the expressed ulceration of a wall of intestines bleeding and detection of blood in Calais is possible. Depending on localization and intensity blood can be found bright red streaks and dark clots. The latent internal bleeding is quite often noted, at the heavy course of loss of blood can be very considerable.
At a long current formation of abscesses in a wall of a gut and the svishchevy courses in an abdominal cavity, in the next bodies (a bladder, a vagina), on the surface of skin is possible (around an anus). The sharp phase of a disease, as a rule, is followed by the increased temperature, the general weakness.
Extra intestinal displays of a disease Krone: inflammatory diseases of joints, eyes (episklerit, uveit), skin (a piodermiya, a knotty eritema), a liver and biliary tract. At early development of a disease Krone at children note a delay in physical and sexual development.
Diagnosis of a disease Krone
Diagnosis of a disease Krone is performed by means of laboratory and functional researches. The most informative techniques – a computer tomography and a kolonoskopiya. On the tomogram it is possible to find fistulas and abscesses, and the kolonoskopiya gives an idea of a state mucous (existence of the inflamed sites, erosion, intestines wall ulcerations) and allows to take a biopsy if necessary. Additional methods of diagnostics – an intestines X-ray analysis with baric mix. It is possible to receive pictures of both a thin, and large intestine – contrast baric mix fills a cavity of a gut and reveals narrowings of a gleam and ulcer defects of a wall, fistulas.
Laboratory methods of a research: the general blood test in which inflammatory changes are noted anemia, as a result of regular internal bleedings is possible; a koprogramma, a research a calla on the hidden blood. Sometimes apply capsular endoscopy of a digestive tract – the patient swallows of the capsule with the mini-video camera and the transmitter. The camera fixes a picture in a digestive tract in process of advance.
Treatment of a disease Krone
As causes of illness are unknown, pathogenetic treatment of a disease Krone is not developed. Therapy is directed to reduction of an inflammation, reduction of a condition of the patient to long remission, prevention of aggravations and complications. Treatment of a disease Krone – conservative, is carried out by the gastroenterologist or the proctologist. Resort to surgical intervention only in case of life-endangering complications.
The dietotherapy is prescribed all patients. Appoint a diet No. 4 and its modifications depending on a disease phase. The diet helps to reduce expressiveness of symptomatology – diarrhea, a pain syndrome, and also corrects digestive processes. Patients with the chronic inflammatory centers at intestines have violations of absorption of fatty acids. Therefore products with high content of fats promote strengthening of diarrhea and development of a steatorea (a fat chair).
In a diet the use of the products rendering irritant action on mucous a digestive tract (sharp, smoked, fried products, high acidity of food), alcohol, carbonated drinks, abuse of coffee is limited. The refusal of smoking is recommended. Fractional food – frequent meals of small portions according to the mode is applied. At a heavy current pass to parenteral food.
Pharmacological therapy of a disease Krone consists in anti-inflammatory measures, immunity normalization, restoration of normal digestion and symptomatic therapy. The main group of medicines – resolvents. At a disease Krone apply 5 aminosalycylates (, ) and medicines of group of kortikosteroidny hormones (Prednisolonum, a hydrocortisone). Kortikosteroidny medicines are used for removal of sharp symptoms and are not appointed for prolonged use.
Apply immunodepressants to suppression of pathological immune reactions (, , a methotrexate). They reduce expressiveness of an inflammation due to decrease in the immune answer, development of leukocytes. As antitsitokinovy cure for a disease Krone apply . This medicine neutralizes proteins-tsitokiny – factors of a necrosis of a tumor which quite often promotes an erosion and ulcers of a wall of intestines. At development of abscesses apply the general antibacterial therapy – antibiotics of a broad spectrum of activity (metronidazole, ciprofloxacin).
Symptomatic treatment is performed anti-diarrheal, laxatives, anesthetics, styptic medicines depending on expressiveness of symptoms and degree of their weight. For correction of exchange of the patient appoint vitamins and minerals.
Surgical treatment is shown at:
- development of fistulas and abscesses (opening of abscesses and their sanitation, elimination of fistulas);
- development of deep defects of a wall with long plentiful bleedings or the heavy course of a disease resistant to conservative therapy (a resection of an affected area of intestines).
Disease complications Krone
Krone the following states can be disease complications.
- Ulceration mucous, a perforation of an intestinal wall, bleeding, an exit of kalovy masses in an abdominal cavity.
- Development of fistulas in the next bodies, an abdominal cavity, on the surface of skin. Development of abscesses in an intestines wall, gleams of fistulas.
- Anal crack.
- Colon cancer.
- Weight loss up to exhaustion, violations of exchange owing to insufficiency of absorption of nutrients. Dysbacteriosis, hypovitaminoses.
Prevention and the forecast at a disease Krone
Ways of full treatment from this disease it is not developed today because the etiology and pathogenesis of a disease are up to the end not clear. However, regular adequate therapy of aggravations and observance of a diet and mode, medical recommendations and regular sanatorium treatment promote decrease in frequency of aggravations, reduction of their weight and improvement of quality of life.
Main, key moments of prevention of aggravations:
- dietotherapy, balance of food, application of vitamin complexes, necessary minerals;
- avoiding of stresses, resistance to stress development, regular rest, healthy mode of life, normalization of biorhythms;
- physical activity (easy physical activities reduce influence of stresses, normalize intestinal activity);
- refusal of smoking and abuse of alcohol.