An Assignment On Crohn’s Disease : Healthcare Management Assignment

Introduction: Case Study On Crohn’s Disease

Allman (2012) refer the inflammation of digestive system or in scientific terms, the gastrointestinal tract as the Crohn’s disease in Healthcare Management. It is a form of the Inflammatory Bowel Disease (IBD). It possesses the feature of long-persisting and life-long continuing. A patient suffering from this disease may enjoy remissions or short and long periods of healthy life along with relapses when symptoms are evident actively (Baumgart and Sandborn, 2012). Unfortunately, the Crohn’s disease is not curable until now.  However, patients can enjoy good healthCare services and relief from the painful symptoms through regular medications and surgeries in some cases. This assignment provides a sound knowledge of the Crohn’s disease by shedding light on important aspects as reasons, pathology, treatment, reduction measures and results.

1.  Causes of Crohn’s disease:

The inflammation of gastrointestinal tract as evident in Crohn’s disease may occur because of reaction to an injury or irritation to body thereby causing swelling, redness, and pain (Cho and Brant, 2011). The real and confirmed reason for the origin of Crohn’s disease is yet unknown. Although major advances in genetics reveal a combination of factors responsible for the Causes of Crohn’s disease.

These factors include genetic factors as inherited genes by a person. The other factors are certain specific intestinal bacteria that stimulate the abnormal reaction of the immune system. The environmental triggers are also considered as factors adding to the development of Crohn’s disease in an individual. These environmental factors include viruses, stress, smoking and diet (Allman, 2012). It clearly reflects the fact that Crohn’s disease is a result of the combination of the bacterial, environmental and immune factors in the genetically susceptible persons.

Nursing Case Study reveals the involvement of more than 72 genes in half of the overall risk evident in the Crohn’s disease. Of all the environmental factors, the smoking is the most eminent factor raising the risk of developing Crohn’s disease in tobacco smokers much higher than that in the non-smokers. Gastroenteritis is also considered as a cause for the initiation of Crohn’s disease (Marks et al. 2010).

Genetic- Nursing Case Study reveals the frameshift mutation in NOD2 gene (or CARD15 gene) associated with Crohn’s disease. It involves 30 more genes with known biological functions. Crespi (2009) highlight the overlapping of the susceptibility loci for IBD and mycobacterial infections, which are quietly considerable.

Immunological factor- Marks et al. (2010) stated that the impairing of macrophage functions resulting in immunological deficiency and abnormality due to various genetic, microbial or environmental factors lead to the microbially induced inflammation in colon consisting of a high bacterial level. Some scientists present the idea that the evolution of a human immune system in presence of parasites and lack of modern hygiene standards accounts for the weak immune system leading to the onset of diseases as Crohn’s disease.

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Microbial- Scientists studied and opined that the Mycobacterium avium subspecies paratuberculosis (MAP) is a causative microbe for Crohn’s disease depicting the responsible role in causing a similar disease in cattle (Johne’s disease). Lalande and Behr (2010) support the view by pinpointing the fact that in genetically susceptible persons the NOD2 gene shows a decline in the killing of the MAP by macrophages. Enteroadherent E. coli are also associated with this disease as patients with Crohn’s disease show an increased number of Adherent-invasive E. coli (AIEC, capable of intracellular survival) in them.

Scientists also highlight the psychrotrophic bacteria as Listeria and Yersinia species contributing to Crohn’s disease. The production of mannins by MAP helps in protecting itself and other bacteria as well from phagocytosis accounts for various secondary infections. However, Baumgart and Sandborn (2012) argue that there is yet lack of clarity of relationship between the specific bacteria and Crohn’s disease.

Environmental- Case Studies shows that Crohn’s disease incidence is higher in urban and industrialized areas thus indicating an environmental component responsible for the disease. The ratio of omega-6 to omega-3 polyunsaturated fatty acids increases in the disease. Hormonal contraception is a causative factor raising its incidence among women. Allman (2012) stated that dietary particles (microscopic) found in toothpaste, affects immune systems forms a small part of causative agent for the Crohn’s disease.

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Figure 1: Causes for Crohn’s disease

(Source: Baumgart and Sandborn, 2012, p.1595)

2.  Pathology:

Different persons show different variations of symptoms for the Crohn’s disease depending on its condition from mild to severe. The remissions and relapse periods in the disease is also variable from person to person. Abdominal pain, diarrhea, fatigue, tiredness, mouth ulcers, anemia, weight loss and loss of appetite are the major symptoms evident in Crohn’s disease. Depending on the areas of gut where the disease has taken place, the Crohn’s disease is of 6 types, namely, Terminal ileal or ileocaecal (in ileum), colonic (in colon), gastroduodenal (in oesophagus, stomach or duodenum), perianal (in anus area) and oral Crohn’s (in mouth) (Anna and Borowiec, 2011).

The Crohn’s disease leads to anal lesions (with granulomas), which are clinically distinctive with the possibility of being recognised through simple anal inspections. These lesions are also helpful in detecting intestinal lesions. It may even lead to the Business development of metastatic cutaneous lesions in areas like axilla, submammary area and inguinal region (Allman, 2012). The pathological observations of the disease reveal the fact that the Crohn’s disease has the probability of affecting the colon. It is not an infectious disease.

The family history of IBD is the initiating diagnosis for Crohn’s disease on the appearance of its specific symptoms. The diagnosis is confirmed through tests and physical examinations as Blood tests, stool tests, endoscopy, barium X-ray tests, MRI (Magnetic Resonance Imaging) and CT (Computerised Tomography) scans (Crespi, 2009).

The blood tests confirm the presence of anemia, inflammation in the body. Stool tests confirm the reasons for diarrhea as infection or not. On confirmation of inflammation endoscopy, x-ray or CT scan is executed. As per symptoms, the GI endoscopy or gastroscopy for upper gut, sigmoidoscopy or colonoscopy for ileum or colon is used. Capsule endoscopy is used for obtaining the pictures of the whole gut. However, Anna and Borowiec (2011) argue that it is not suitable for persons with structure. The barium x-ray tests outline the gut by coating the gut lining through barium sulfate, a chalky substance. The MRI and CT scans give the severity of the inflammation and its location. MRI scans utilize magnets and radio waves while the special x-ray to build 3D image is used by the CT scans. Ultrasound is also used sometimes.

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Figure 2: Methods for diagnosis of Crohn’s disease

(Source: Crespi, 2009, p.183)

3.  Measures for reduction of Crohn’s disease:

The immediate quitting smoking habit is the major step towards the prevention of Crohn’s disease as per Healthcare Management. Although there is no strong evidence to stop the incidence of Crohn’s disease, yet having a balanced healthy diet with freshly cooked food than consuming processed food is helpful. Cho and Brant (2011) suggest that in order to reduce the relapse of the Crohn’s disease frequently, the patients need to undergo periodic tests at regular intervals as specified by the consulting doctor. It will enable the clinical practitioner to keep a check on the severity of the disease. It also enables the monitoring of the effectiveness of treatment given to the patient.

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The patients who underwent surgery for Crohn’s disease can have a reduced rate of the disease incidence by treating them with Mesalamine drug in 2.4g/day that lowers the endoscopic and symptomatic incidence of the disease after 2 years (Anna and Borowiec, 2011). The immune-suppressors as 6-MP and azathioprine (AZA) along with antibiotics provides good evidence of reducing the incidence of Crohn’s disease. An antibiotic as Ornidazole is effective enough to lower the incidence rate at 12months in post-operative patients with Crohn’s disease.

In Healthcare Management the infliximab is also very effective in reducing the incidence of Crohn’s disease. There is strong evidence proving its efficacy to reduce incidence by preventing the disease recurrence in a postoperative patient after 4years through treating with intravenous infliximab (5mg/kg) and a low weekly dose of oral methotrexate (10mg/week) (Anna and Borowiec, 2011). The Adalimumab (ADA) dose of 160/80/40mg every two weeks to patients with Crohn’s disease depicts a steep lowering of the rate of endoscopic recurrence and clinical recurrence. Another continuous biological therapy by certolizumab pegol (brand name-Cimzia) is also found effective to reduce the incidence of Crohn’s disease for up to 18months.

4.  Treatment and results of Crohn’s disease:

Allman (2012) opines that the patients suffering from Crohn’s disease may be treated medically or surgically or combining both the techniques. Mild conditions prefer to be kept untreated. Some patients can benefit from dietary therapy. Crespi (2009) suggest that the type of Crohn’s disease occurring in the person is a major determinant for the treatment of the disease.

The treatment of Crohn’s disease indicates working with the aim to control the active symptoms, maintain remission thereby preventing relapse. Smoking being identified as the major reason for Crohn’s disease needs to be stopped immediately. The recommendation of checking for bowel cancer through colonoscopy every eight to nine years since the onset of the disease is extremely important as we described in Healthcare Management.

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The drug treatment for Crohn’s disease is mainly on-going in nature. Anti-inflammatory drugs as 5 ASAs or aminosalicylates comprising the mesalazine (brand names-Pentasa, Octasa, Salafalk), sulphasalazine (Salazopyrin) and balsalazide (Colazide) are used most commonly. Apart from these symptomatic and antibiotics find use in the treatment of Crohn’s disease. The Immunosuppressants as azathioprine (Imuran), methotrexate, mercaptopurine or 6MP (Purinethol) and tacrolimus helps in treating the immune system abnormalities evident in Crohn’s disease. The methoxtrate or a thiopurine helps in preventing recurrence of the active symptoms of Crohn’s disease (Anna and Borowiec, 2011).

Corticosteroids as budesonide (Entocort), prednisolone and hydrocortisone are useful in the treatment of Crohn’s disease in persons who are newly diagnosed with the disease. Anti-TNF drug or biological drugs as adalimumab (Humira) and infliximab (Remicade) are also effective. The symptomatic medicines reduce common symptoms as constipation, diarrhea, constipation, and pain. Anti-diarrhoeal as Ioperamide (Arret) and Cholestyramine (Questran), bulking agents as Fybogel, Painkillers as aspirin and paracetamol are quite effective in treating this disease. The antibiotics used in treating Crohn’s disease are metronidazole (Flagyl) and ciprofloxacin (Baumgart and Sandborn, 2012).

Although in Healthcare Management these medicines are effective for the treatment of the Crohn’s disease, yet their consumption must be strictly as per doctor specification. It is because depending on the condition, certain drugs may be effective for some people while proving detrimental to others. For instance, the bulking agents may result in blockage in presence of stricture in the patient. Some of the painkillers as non-steroidal anti-inflammatory drugs (NSAIDS) may trigger a recurrence of the disease (Lalande and Behr, 2010).

Crespi (2009) identifies the need of undergoing a surgery 10 years down the lane for patients suffering from this disease. However, in Crohn’s disease treatment the surgery is avoided as much as possible. Certain abscesses are required to be treated through surgeries only. Currently, surgical treatments are adopted in Crohn’s disease patients when other treatments fail to control the symptoms. Strictureplasty or Stricturoplasty and resection are the two most common surgeries evident in the treatment of Crohn’s disease.

Rare operational management of proctocolectomy, ileorectal anastomosis, Partial colectomy, and ileostomy are evident in severe cases. Dietary treatments as having a special liquid food for a certain number of weeks as per requirement are also evident in the treatment of Crohn’s disease. Anna and Borowiec (2011) however argue that it is more effective in children only than in adults.

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The current Healthcare Management assignment reveals the major causes of Crohn’s disease (CD) as genetic frameshift mutation of NOD2 gene, environmental factors, deficiency in the innate immune system, and microbes as a MAP as the major causative reasons for the CD. The terminal ileal, ileocasecal, oral, gastroduodenal, colonic and perianal are the prime types of CD depending on the site of occurrence. The Case study Help identifies diarrhea, abdominal pain, anemia, mouth ulcers, etc as main symptoms of the disease. CD is diagnosed through blood tests, endoscopy, MRI, etc. Quitting smoking, regular check-ups, AZA is the controlling or reducing measures for a CD. Biological agents as Infliximab, Adalimumab, and Certolizumab pegol are most effective for reducing the incidence and treating CD.

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