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05-25-2012, 05:59 PM   #31
Mom2oneboy
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Tess, Sorry to hear that you are at another decision crossroad! It just never stops does it?!? I have no doubt you will gather all the information you need to make a decision that is right for Stephen. Heck, between you and Dusty and Julie, you could open a practice :-). Love all the "gut" details above. I will save them to my Crohn's Info file for future use!
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Shelley
11yr old son
dx Crohn's 2/2012
Currently on VSL #3
Started EN 4/2
Methotrexate 6/6/12
Remicade 09/30/12

Life is not about waiting for the storms to pass...It's about learning to dance in the rain.
05-28-2012, 09:38 AM   #32
Tesscorm
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"Makes complete sense now?"
LOL... okay, exam time... let's see if I really 'understand' For all I know, I could think I understand and still be completely wrong!

But, from what Dusty explained, the way I understand it is...

The terminal part of Terminal Ileum simply refers to the end of the ileum and the term must be taken in context within the discussion. (Oooh, now that's clear, isn't it?)

So, for example, picture a road with 100 houses. If you are standing in front of the 1st or 2nd house and you say you live at the end (ie terminal) of the street, you could be referring to any house within the last 40-50 on the street. However, if you're standing in front of the 90th house and you say you live at the end (terminal), you are probably referring to the last, 2nd or 3rd last house on the street.

So, when talking about the small intestine (keep in mind, I think this is very 'simplified' and the numbers are complete guesses and 'abstract' - just trying to put a visualization to a 'descriptive' term), if the discussion is centering on the entire small bowel (7 metres/700 cm), then the terminal ileum could be made in reference to the last 100-200 cm (so inflammation of the TI could be 100-200 cm). However, if you are discussing inflammation limited to the ileum (4 metres/400 cm), then the terminal ileum might be used to refer to only the last 50 cm of the small bowel.

I hope that made sense?? And please correct me if I'm wrong???
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Tess, mom to S, 22
Diagnosed May 2011

Treatment:
May-July 2011 - 6 wks Exclusive EN via NG tube - 2000 ml/night, 1 wk IV Flagyl
July 2011-July 2013 - Supplemental EN via NG, 1000 ml/night, 5 nites/wk, Nexium, 40 mg
Feb. 2013-present - Remicade, 5 mg/kg every 6 wks
Supplements: 1-2 Boost shakes, D3 - 2000 IUs, Krill Oil

Last edited by Tesscorm; 05-28-2012 at 10:35 AM.
05-28-2012, 11:52 AM   #33
crohnsinct
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Believe it or not it is making sense now. Thanks for restating it. Our doc said Olivia's ilium looked good and that was "good news". Also said small bowel looked good but now I have been reading that they really don't see all much of the small bowel with the endoscopy and colonoscopy. She had inflammation in her stomach, colon and rectum. Typical mom is now wondering if there could have been inflammation in small bowel somewhere...not overly concerned just wondering.

What does "folding onto itself" mean and why would an inflamed section that overlies another cause inflammation in the other?

7 meters!!! Really?! Geez...O is so tiny I couldn't imagine fitting anything even half that size in her.
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Daughter O dx 2/1/12 at age 12
Crohns & Remicade induced Psoriasis
Remicade
Vit d 2000IU
Multi vitamin plus iron
Calcium

Previously used - Prednisone, Prevacid, Enteral Nutrition, Methotrexate oral and injections, Folic Acid, Probiotics, Cortofoam

Daughter T dx 1/2/15 at age 11
Vitaligo, Precoscious puberty & Crohn's
Remicade
Vit D 2000IU

Previously used, Exclusive Enteral Nutrition, Methotrexate (injections and oral), Folic Acid, Entocort,IBD-AID Diet
05-28-2012, 11:53 AM   #34
Farmwife
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Same here crohnsinct!

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05-28-2012, 12:21 PM   #35
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My printer will be running too.

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05-28-2012, 12:34 PM   #36
Tesscorm
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Endoscopies and colonoscopies can't get into the small intestine. As far as I know, scopes can just get into the beginning of the small intestine because of the curves/loops. To see those, you need other tests (MRE, ultrasound, not sure which others...).

Folding onto itself - you've seen pictures of the intestines... the small bowel is the 'thinner' tube that curves all around:

Starting at the stomach: connected to the stomach, there's a tube that's slightly curved (sort of shaped like a "C") (duodenum), the duodenum then continues behind (I think) the large colon and then begins to loop all around (those loops don't have space between them, just lie on top of one another which is why inflammation in one loop can begin to affect/spread to another loop). (Beginning section of the loops is the jejunum, remainder is the ileum.)

Near your right hip area, the small intestine connects to the large intestine (fatter tube) (at this connection, the TI area, there is the ileo-'something' valve that controls the flow between the two sections and a small round part called the caecum (I believe appendix is attached to this). The first part of the large colon/intestine is called the ascending colon, this is the part that goes up from your right hip to around the rib cage, it then goes across from right to left (forget what this is called... trans-something maybe?) and then turns down towards your left hip (descending colon), this then connects to your rectum (but there may be more parts here, don't know this part of it )

I'm pretty sure I've got this 'layout' correct BUT... I'm NOT an expert! Dusty could come in here and give me a big, fat "F" .
05-28-2012, 01:13 PM   #37
crohnsinct
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...now got the anatomy but I would think if there was inflammation in a section laying on another the walls of the intestine would protect it from "passing" to the other...or does it go through the wall to the other or is it just the pressure from the inflamed that closes up the other it is laying on? Forgive me for being so dense.

I don't know why I am so interested in the small intestine as that is supposedly not where my daughter's disease is...perhaps a nice distraction.

Yeah...I got the colon down pat...unfortunately they tell me they only found 6 cm of healthy colon in O during colonoscopy a better percentage than if her disease were in small but still yucky!
05-28-2012, 01:31 PM   #38
Tesscorm
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I'm not sure how the inflammation spreads... I guess it goes 'through the walls'.


...I don't know why I am so interested in the small intestine as that is supposedly not where my daughter's disease is...perhaps a nice distraction.
-- haha, amazing how our interest in reading material changes...
05-28-2012, 02:47 PM   #39
DustyKat
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A+ Tess! Go to the top of the class!

crohnsinct, think about when you say that you couldn't imagine fitting 7 metres of small bowel into O. That's it exactly! To do so the is bowel "concertinaed" in there, like having sausages lying side by side.
Now the thing with Crohn's is that the inflammation/infection can infiltrate all layers of the bowel, that is why fistulas and abscesses aren't a feature of UC, and can therefore penetrate the bowel and create problems that way but even without it doing that inflammation causes swelling and when the bowel loops are in such close proximity to each other that swelling causes it to press against the next loop of bowel and it in turn becomes inflamed. What happens if you put a hot straightening iron on top of the vanity, the top of the vanity becomes hot, does that make sense?
The process of inflammation inside your body is no different to what happens elsewhere. What happens with a wound on your skin that becomes inflamed and infected? It swells, becomes hot and leaks fluid. Put that inside your small bowel and it causes one loop to press against the next and the leaking fluid then has a tendency to further "stick" the bowel loops together. You will often see people say that surgeons have said to them that "it was a jumbled mess" and this is why.
An inflamed portion of bowel just doesn't do this to adjacent bowel loops but can produce the same effect to any other structure it comes into prolonged contact with...ureters, ovaries, prostate, bladder, uterus, muscles and so on. This constant contact and inflaming is what also has the potential to cause fistulas to develop from bowel to bowel and bowel to organ.

Probably as clear as mud now!

Dusty. xxx
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05-28-2012, 03:15 PM   #40
Tesscorm
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Thanks Dusty!

I believe this is why when Stephen has a backache, I immediately think of his Crohns. He had a backache for months before being diagnosed, we thought it was an old injury, hits in hockey, slouching, etc. and, initially, the GI did not believe it was connected (now he does ). However, as soon as he started treatment (Flagyl and EN), his backache went away and rarely bothers him now... but, when it does, I think it's when his Crohn's flares up and he has his 'off' days...
05-28-2012, 03:22 PM   #41
crohnsinct
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O.K. ewww! I get it now and it sounds awful and painful and I guess I am happy now that O doesn't have any small bowel involvement...haha or so they say...and if not could it be UC? Second guessing docs has become my new past time
05-28-2012, 03:22 PM   #42
Farmwife
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WOW Dusty.
Your absolutely Fabulous!!!
I will be saving that explanation and reading it to my husband.
In all my research you put it the BEST I've ever read it.
I'm still scared out of my mind but least it's a little clearer.

Farmwife
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