Diagnose Me If You Can!

Diagnosing Crohn's seems to trend differently between children and adults.  Adults are usually diagnosed in the outpatient setting, whereas children are more likely to get diagnosed in the inpatient setting.

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In order to diagnose Crohn's disease, your doctor will gather a very thorough health history, asking you questions about your health history, your family's history, medications your taking or have taken, social practices (i.e. smoking/drinking history), etc.  He'll also perform a physical examination, looking at your eyes, listening to your heart, lungs, and stomach, and various other tests performed on a regular basis, as well as some more specific tests if Crohn's is suspected.  Your doctor will likely order a slew of blood tests, to include:

1. Albumin: Lower levels indicate inflammation, infection, poor nutrition, bad absorption in the intestine, and anorexia.

2. C-reactive protein: Higher levels indicate inflammation.

3. Erythrocyte sedimentation rate (ESR): Higher levels indicate inflammation.

4. Hemoglobin (iron-containing protein that attaches to red blood cells (RBC) - carries oxygen to the rest of your body): Lower levels indicate anemia, blood loss, and/or chronic disease.

5. Hematocrit: Often tested along with hemoglobin.  Lower levels indicate anemia (decreased levels of RBC's, and thus, capacity to carry ample oxygen to all parts of the body), iron deficiency, and/or blood loss.

6. Iron: Lower levels indicate anemia, chronic blood loss, chronic disease, and/or malabsorption of iron.

7. RBC count: Lower levels indicate anemia and/or blood loss.

8. White blood cell (WBC) count: Higher levels indicate infection and/or inflammation.

Video courtesy of Julio Alejandro Murra Saca via https://www.youtube.com/watch?v=l94f-6b8IZ4

In addition to the above-mentioned, and less invasive measures, the patient suspected of having Crohn's or any type of inflammation in the gut will likely undergo a colonoscopy (see video above).  Other imaging tests include wireless capsule endoscopy (see video below) and magnetic resonance enterography (type of MRI).

Video courtesy of Mohammad Khuroo via https://www.youtube.com/watch?v=yB-wm2x6wo

As the disease continues, or progresses, the ability to absorb nutrients from food diminishes.  In adults, this will usually result in loss of weight and malnutrition.  However, this can be detrimental in children, as they're smack dab in the middle of growth and development, so poor nutrition can permanently, and negatively, impact the aging/growth process for them.  

As discussed previously, more than 30% of patients will develop perirectal abscesses, fissures, or fistulas.  Remember that within the first 10 years of being diagnosed with Crohn's, about 50% of patients will require fistula surgery, and as much as 80% will require surgery over the course of their lifetime.  When this disease gets its claws latched in, it does not let go.

References:
Smith, C., & Harris, H. (2014, December 1). Crohn disease: Taking charge of a lifelong disorder. Nursing 2014, 37-38.