5 aminosalicylic acid mesalazine or sulfasalazine followed by corticosteroids

5 aminosalicylic acid mesalazine or sulfasalazine

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5-aminosalicylic acid (mesalazine) or sulfasalazine followed by corticosteroids to suppress the inflammatory response and alleviate painazathioprine and immunomodulatory agents (cyclosporine and tumor necrosis factor blocking agents) tacrolimus or vedolizumab are used for recurrent or serious diseasesevere unremitting diseaseiv fluids, hyperalimenation, surgical approaches include total proctocolectomy, endileostomy or ileorectal anastomosis or ileal pouch anal anastomosis (treatment of both ulcerative colitis and crohns)
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Crohn disease is similar to ulcerative colitis but it affects entire GI tract, including the large and small intestines. Ulceration tends to involve all layers of the lumen. “Skip lesion” fissures and granulomas are characteristic of Crohn disease. Abdominaltenderness, nonbloody diarrhea, and weight loss are the usual symptoms.Diverticulitiscause is unknownpredisposing factors:oolder age, genetic predisposition, obesity, smoking, diet, lack of physical activity, medication use (aspirin & nonsteroidal anti-inflammatory drugs), lack of dietary fiber,altered intestinal microbiota, visceral hypersensitivity, abnormal colonic motilityincreased intracolonic pressure, abnormal neuromuscular function and alterations in intestinal motility, they form at weak points in colon wall, arteries penetrate the tunica muscularis, colonic mucosa herniates through the smooth muscle layerLaplace’s law:oWall pressure increases as the diameter of a cylindrical structure decreases, pressure within the narrow lumen can increase enough to cause local ischemia and rupture the diverticulaManifestations:oCramping pain of the lower abdomen can accompany constriction of the thickened colonic wall, diarrhea, constipation, distention, flatulencoIf diverticula become inflamed: fever leukocytosis, tenderness of the lower left quadrantJaundiceJaundice (icterus) is a yellow or greenish pigmentation of the skin or sclera of the eyes caused by increases in plasma bilirubin concentration (hyperbilirubinemia). Obstructive jaundice is caused by obstructed bile canaliculi (intrahepatic obstructive jaundice) or obstructed bile ducts outside the liver (extrahepatic obstructive jaundice). Bilirubin accumulates proximal to sites of obstruction, enters the
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bloodstream, and is deposited in the skin and other connective tissues.BilirubinNormal yellow to green pigment of bile derived from the porphyrin structure of hemoglobinGastrointestinal bleed – upper and lowerUpperoEsophagus, stomach, or duodenumoFrank, bright red bleeding in emesis or dark, grainy digested blood (“coffee grounds”) in stooloCause:Bleeding esophageal or gastric varicesMallory-weiss tear and GE junction from severe retching, cancer, AV malformations or peptic ulcers and is associated with NSAIDs, aspirin, SSRI, and antiplatelet and anticoagulant medicationsLoweroJejunum or ileum, colon, or rectum oCause:Polyps, inflammatory bowel disease, diverticular disease, cancer, mucosal vascular ectasias or hemorrhoids
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