Disorders of the Gastrointestinal System, 2nd Edition
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● Fluid imbalance. ● Peritonitis. ● Ulcers elsewhere in the GI tract (mouth sores, anus).
(RBC) analysis may indicate anemia and decreased folate and vitamin B12. Serum may be checked for antibodies commonly linked with Crohn’s, such as the anti-Saccaromyces cerevisiae antibody (ASCA). ● Sigmoidoscopy and colonoscopy : These studies may show patchy or discontinuous areas of inflammation that help distinguish Crohn’s disease from ulcerative colitis, which causes continuous inflammation. Sigmoidoscopy is not the recommended diagnostic tool for Crohn’s disease, as it visualizes only a small portion of the GI tract. Treatment focuses on controlling the inflammatory process and symptom re - duction. For children, it is important to monitor growth patterns and intervene carefully when necessary. The first steps are supportive measures, including med- ications, dietary changes, nutritional sup- port, bowel rest, and stress reduction. Surgery is never a first initiative because it is not a cure, and the recurrence of symp- toms after surgery is common (Ghazi, 2019). Initial treatment measures may include the following (Ghazi, 2019): ● Administering medications such as sulfasalazine to reduce inflammation. ● Administering immunomodulators to reduce the response to antigens, especially if a fistula is present. ● Administering corticosteroids, especially if anti-inflammatories have been unsuccessful. ● Administering a biologic therapy such as infliximab that targets a certain protein associated with inflammation. ● Administering antidiarrheal drugs. Note that such drugs are contraindicated if bowel obstruction
The differential diagnosis depends on the patient’s history, physical examina- tion, and findings from various diagnos - tic tests that may include the following (Ghazi, 2019): ● Barium enema : Although this test was previously used regularly to assess for Crohn’s disease, it is contraindicated in those with a bowel perforation and can cause peritonitis, so recently other imaging studies have gained favor related to this diagnosis. ● Stool analysis : A fecal occult blood test can detect small amounts of blood in feces. The stool should also be tested for bacterial, viral, and parasitic infections to rule out infectious causes. ● Endoscopy : There are several approaches to endoscopy if upper GI areas are of concern for disease. One is capsule endoscopy. The patient swallows a capsule with a camera, which transfers images of the entire gastrointestinal system until the capsule is passed into the stool. This can be useful but does not provide the level of detail that many providers require for diagnosis or the ability to biopsy. So if suspicions are raised using this technique, additional testing is still likely necessary. ● MRI and CT scan : MRI can be useful in assessing for abscesses, fistulas, blockages, and other complications of Crohn’s, but CT scanning has become the preferred radiologic method for Crohn’s diagnosis. ● Blood studies : An elevated WBC count is often present. Red blood cell
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