What is Small Intestine
The small intestine is a long tube in the digestive system that absorbs 90% of the nutrients from the food we eat. It is called small intestine because of its diameter i.e. 1 inch although its length is more than the large intestine. The small intestine is a region of the alimentary canal that consists of the duodenum, the jejunum and the ileum. We will study each term one by one:-
- Duodenum: It is the shortest channel and is first of the 3 sections of small intestine. It starts from the stomach base by the pyloric sphincter and wraps around the head of the pancreas in a C-shape.
- Jejunum: The second part of the small intestine which represents the proximal two-fifths. It is the middle section of the small intestine which serves as the primary site of nutrient absorption. It extends from the duodenojejunal flexure to the ileum, though there is no distinct external demarcation between the two.
Ileum: It is the third part and final section of small intestine that empties into large intestine via the ileocecal sphincter. It extends from the jejunum to the ileocecal junction, and together with the jejunum is 6 to 7 meters long
Conditions of intestine requiring surgery
Many of the conditions are listed below which causes infections, inflammation, ulcers, and obstructions in this digestive tract leading the doctor to make intestinal surgery:-
- Small bowel obstruction
- Small bowel infection
- Ischemic enteritis
- Chronic inflammation
Bowel Obstruction: It is a blockage of the small & large intestine by something there than Fecal impaction. This can be assessed & diagnosed through the following techniques:-
- Physical Exam
- Complete blood count (CBC)
- Electrolyte panel
- Abdominal x-ray
- Barium enema
- CT Abdomen
Acute Bowel Obstruction:
Acute bowel obstructions occur suddenly, may have not occurred before, and are not long-lasting. Treatment may include the following in case of subacute bowel obstruction:
- Fluid replacement therapy in which body gets the fluids in normal amounts. Some medications and Intravenous (IV) fluids may be given.
- Electrolyte Correction in which requisite fluids such as sodium, potassium, chloride are inserted in blood with the help of infusion.
- Blood Transfusion in which infusion of whole blood or part blood is given to the person.
Nasogastric or Colorectal Tube in which nasogastric tube is inserted through the nose and esophagus into the stomach & colorectal tube is inserted through the rectum into the colon. It is done to reduce the swelling, remove fluid and gas buildup, and relieve pressure.
In case of mechanical obstruction
Surgery is the required to relieve the mechanical obstruction and open up intestines .
Crohn's disease is a chronic inflammation and irritation of your digestive system. It commonly affects your small intestine and beginning of the large intestine. The disease may also affect the other part of your digestive system like mouth, anus etc. Crohn’s disease is an inflammatory bowel disease (IBD). If not taken care, it may become worse over the period of time.
Crohn's disease can happen to anyone and any age group of people although people having the age of 20-29 are more likely to have this disease with a family member, sibling or parents have an IBD or who smoke cigarettes.
Complications of Crohn’s disease?
Complications of Crohn’s disease are as given below:
- Intestinal Obstruction: This will thicken the wall of the intestine and will get blocked by narrowing down due to thickness. A partial or complete intestinal obstruction is also called a bowel blockage, as it can block the movement of food or stool through your intestines.
- Fistulas: In this disease, inflammation can expand through the wall of the intestine and can create tunnels or fistulas. Fistulas are an abnormal passage between two organs or between the organ and outside the body. Fistulas may become infected.
- Abscesses: Inflammation may also go through the intestine walls may lead to Abscesses which are painful, swollen, and pus-filled pockets of infection.
- Anal fissures: Anal fissures are small tears in your anus that may cause itching, pain, or bleeding.
- Ulcers: If inflammation goes through the digestive system may lead to ulcers and open sores in your mouth, intestines, anus or perineum.
Malnutrition: As the name says, it is the deficiency of right amount of nutritions, vitamins, minerals which needs to maintain for the healthy organs and tissues.
One may also experience the Inflammation in other areas like joints, eyes, and skin. Apart from this, if you have Crohn’s disease in your large intestine, you are more likely to experience colon cancer. So better to know the chances & symptoms and protect yourself from developing the colon cancer.
Symptoms of Crohn's Disease
Following are the most common Symptoms of Crohn's disease:-
- Cramping and pain in your abdomen
- Weight loss
- Eye redness or pain
- Feeling tired
- Joint pain or soreness
- Nausea or loss of appetite
Skin changes that involve red, tender bumps under the skin
Causes of Crohn's Disease
According to experts & researchers, following factors are responsible to cause Crohn's disease.
- Autoimmune reaction (contradiction of immune system with healthy cells)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen antibiotics, and birth-control pills
- A high-fat & low fiber diet
Diagnosis of Crohn's Disease
Doctors may typically use a combination of tests or methods to diagnose Crohn’s disease:-
- Physical exam in which doctor will check the bloating in your abdomen
- Stethoscope to listen to the sounds in abdomen
Taps on abdomen to check for tenderness and pain and to see if your liver or spleen is abnormal or enlarged
- Lab Tests
- Upper Gastrointestinal (GI) series
- Computed Tomography (CT) scan- it may diagnose the disease as well as the complications thereof.
- Intestinal endoscopy
- Colonoscopy- a flexible narrow tube with the tiny camera (Colonoscope or endoscope) is inserted to look inside the rectum and colon. The doctor may also examine the ileum to look for the signs of Crohn’s disease.
- Upper GI Endoscopy and Enteroscopy
- Capsule endoscopy - In which camera containing capsules will be swallowed that will allow the doctor to have an image inside the digestive tract. The doctor will prescribe you not to eat or drink anything before performing this test. Anaesthesia is not required to follow this test. You are not required to stay in the hospital or doctor’s office for long. You may leave the office after swallowing the capsules. The camera will record and transmit the images to the small received worn by you. The doctor will downloads the images and will review. The swallowed camera capsules will safely pas through the bowel moments which can be flushed.
These tests are also ruled out to check the other diseases like ulcerative colitis, diverticular disease, or cancer, that cause symptoms similar to those of Crohn’s disease.
Treatments for Crohn's Disease
There is no single procedure or technique to treat the Crohn’s disease. It may treat with any of the techniques or group of treatments such as medicines, bowel rest, and surgery. The goal of treatment is to reduce the inflammation in intestines and to prevent flaring-ups of symptoms.
Many doctors will refer the medicine to the patients, although medicines will not cure the Crohn’s disease, but may reduce the symptoms. Some of the medicines are:-
- Aminosalicylates: It includes balsalazide, mesalamine, olsalazine. This medicine contains 5- aminosalicylic acid (5-ASA) which helps control inflammation. It will be referred to treat the patients newly diagnosed the Crohn’s disease.
- Corticosteroids: It is also named as steroids which helps to reduce the activity of immune system and inflammation. This include budesonide, hydrocortisone, methylprednisolone
- Immunomodulators: This medication reduce immune system activity, resulting in less inflammation in your digestive tract. These may take several weeks to 3 months to start working. Immunomodulators include 6-mercaptopurine or 6-MP, azathioprine, cyclosporine
- Biologic therapies: it will target and neutralise the protein to reduce inflammation in the intestines. It will help you to get remission if other medicines are not responding quickly. Biologic therapies include adalimumab , certolizumab, infliximab and natalizumab
2. Bowel Rest
If you are facing severe Crohn's disease symptoms, then you may be asked to rest your bowel system by not eating or drinking anything. Bowel rest involves taking several nutrients rich fluids only prescribed the doctors. Doctors may prefer to insert a feeding tube into the stomach or may give intravenous (IV) nutrition by a special tube through the vein in your arm. You may stay at the hospital or take the treatments at home. In most of the Crohn’s cases, Bowel rest heals the intestines.
Doctors or surgeons may recommend you to treat the following through the surgery:-
- Life-threatening Bleeding
- Intestinal obstructions
- Side effects from medicines
Symptoms when medicines do not improve your condition
The following surgical methods and measures will be taken to cure the Crohn’s disease:-
- Small Bowel Resection It is a surgery to remove the parts of the small intestine. It is done in the case of intestinal obstruction or severe Crohn’s disease in your small intestine. The two types of small bowel resection are:
- Laparoscopic Surgery
- Open Surgery
- Subtotal Colectomy:- It is also called large bowel resection .It is performed when you are suffering from intestinal obstruction, a fistula, or severe Crohn’s disease in your large intestine.
- Proctocolectomy:- It is done to remove entire colon and rectum.
- Ileostomy:- It is a stoma, opening in the abdomen. The surgeon will bring the end of your ileum through an opening in the abdomen and attaches it to your skin, creating an opening outside your body. The stoma is about three-quarters of an inch to a little less than 2 inches wide and is most often located in the lower part of your abdomen, just below the beltline. A removable external collection pouch, called an ostomy pouch/ ostomy appliance, connects to the stoma and collects stool outside your body. Stool will pass through the stoma instead of the anus. The stoma has no muscle, so it cannot control the flow of stool, and the flow occurs whenever peristalsis occurs. If you have this type of surgery( proctocolectomy ), you will have the ileostomy for the rest of your life.
Eating & Diet habits during Crohn's Disease
Doctors may ask you to make changes in your diets by reducing or avoiding the quantity of carbonated, or “fizzy,” drinks, popcorn, vegetable skins, nuts, and other high-fiber foods. He may advise you to eat smaller meals frequently, drinking more liquids, keeping a food diary to help identify foods that cause problems. The doctor may prescribe you following diets depending upon the symptoms, complications, and medicines:-
- high calorie
- lactose free
- low fiber
- low salt
Get the immediate consultation with the Expert surgeon to diagnose and treat Crohn's Disease.