Crohn's Disease, Pancreatitis, and Liver Conditions: Symptoms and Treatment

Crohn's Disease

Crohn's disease is an inflammatory condition of unknown cause, frequently affecting the ileum in young adults. It causes severe diarrhea with a tendency towards fistulization. It is also known as regional enteritis or terminal ileitis.

Clinical Manifestations

Acute Ileitis

Often confused with appendicitis, acute ileitis occurs in children and adolescents.

Chronic Form

• Insidious onset with diarrhea and fever
• Palpable mass
• Fistulas (20% of cases)

General Symptoms

• Pallor
• Depression
• Erratic polyarthritis

Treatment

Treatment involves a combination of medical and surgical approaches.

Acute Pancreatitis

Concept

Acute pancreatitis is an aseptic inflammation of a necroticohemorrhagic nature. It involves autodigestion of the gland by its own enzymes, such as trypsin, which are activated in situ.

Etiology

• Affects both sexes equally
• Typically occurs between 30 and 50 years of age
• Sudden onset
• Severe clinical course
• Mortality rate of 20%

Triggers

• Gallstones
• Obesity
• Binge eating
• Alcohol consumption
• Steroid use
• Abdominal injuries

Clinical Manifestations (Dielafoy's Pancreatic Drama)

• Abdominal pain: Extremely severe
• Irradiation: Pain radiates in a belt-like pattern
• Vomiting
• Reflex and paralytic ileus
• Tendency to collapse
• Derangement of pancreatic enzymes: Hyperamylasemia, hyperamylasuria, and hyperlipasemia

Treatment

• Continuous aspiration
• Antibiotics
• Pain management
• Vagal stimulation (e.g., atropine)
• Shock management
• Peritoneal dialysis

Liver Failure and Jaundice

Hepatocellular Insufficiency

Concept

Hepatocellular insufficiency is the inability of the liver cells to effectively carry out their metabolic functions. It appears when 80% of the parenchyma is affected.

Causes

• Acute hepatitis
• Chronic cirrhosis
• Intrahepatic or extrahepatic cholestasis
• Storage diseases (e.g., Wilson's disease, hemochromatosis)
• Vascular issues affecting the liver, such as hepatic artery lesions

Clinical Manifestations

1. Jaundice
2. Ascites
3. Hepatic encephalopathy
4. Endocrine disruptions:
   • Testicular atrophy
   • Loss of libido
   • Gynecomastia
   • Menstrual cycle disorders
   • Abnormal axillary and pubic hair
5. Skin signs:
   • Spider veins (spider nevi)
   • Telangiectasias
   • Palmar erythema
   • Loss of the nail lunula (valuable if present in all nails)
6. Circulatory signs:
   • Capillary pulse
   • Tachycardia
   • Precordial impulse
   • Systolic ejection murmur
   • Polycythemia
   • Hyperdynamic circulatory state
7. Other signs:
   • Non-specific general malaise
   • Fever
   • Hepatic fetor (a distinctive, musty breath odor)

Biological Syndrome

• Decreased albumin
• Lowered cholesterol
• Aminoaciduria
• Decreased clotting factors

Hepatic Encephalopathy (Hepatic Coma)

Concept

Hepatic encephalopathy refers to neuropsychiatric syndromes that occur in the course of hepatocellular insufficiency. It ranges from minimal initial symptoms to a state of coma.

Pathogenesis

The primary cause is ammonia toxicity to the nervous system. However, many factors are involved and interrelated.

Clinical Manifestations

Highly polymorphic and diagnosed based on the clinical context:

• Personality changes
• Mood swings
• Sleep disturbances
• Symptoms reminiscent of Alzheimer's disease
• Hallucinations
• Megalomania
• Schizoid or paranoid features
• Flapping tremor (asterixis)
• Hyperreflexia
• Babinski sign
• Dysgraphia

Clinical Grades

• Grade I: Mild mental disorders, memory loss, disorientation, flapping tremor
• Grade II: Increased drowsiness
• Grade III: Total loss of consciousness (coma)

Clinical Forms

• Acute
• Chronic

Jaundice

Further information on jaundice is needed to provide a comprehensive description.