Diagnosis - Case Study Example Along with this, there are anorexia and catabolic process of chronic inflammatory process of the disease. All these may combine to cause profound weight loss over a short period of time. 3. Since there is a component of malabsorption, Schilling test may be done to rule out Vit B12 deficiency. Electrolytes to rule out potassium, magnesium, and calcium deficiencies need to be done. Serum albumin would indicate hypoalbuminaemia indicating amino acid malabosrption or protein losing enteropathy. Air-contrast barium enema and CT scan need to be done to better delineate the terminal ileal involvement. Colonoscopic examination with rectal biopsy can yield the histologic nature of the disease. 4. Apart from other general measures like nothing orally, intravenous alimentation, fluid resuscitation, the medical therapy of first choice would have been sulfasalazine. This drug consists of a sulfapyridine moiety chemically bound to 5-aminosalicylate. This undergoes bacterial cleavage, the liberated sulfapyridine is absorbed, and the salicylate component exerts its anti-inflammatory action through inhibition of prostaglandin synthesis, thus reducing the inflammation. 5. 5. The complications that may arise out of this disease, that is, Crohn's disease are intestinal obstruction; fistula formation with contiguous intestinal lumen or urinary tract; small-bowel or colonic malignancy; bile salt malabsorption leading to increased gall stones; and increased incidence of urinary tract oxalate stones. 6. If there is associated chronic inflammation of the bone marrow, there may be anemia with decrease in the platelet count. The anaemia is variable, so are the red cell indices. Megaloblastic anemia with increased MCV is rare. 7. On the basis of these preliminary tests, the diagnosis would be Crohn's disease. This disease presents in a young adult with variable weight loss, right lower quadrant discomfort or pain, and diarrhoea. The diarrhoea is usually moderate often without gross blood. The patient looked pale due to anaemia, and mouth ulcerations were due to aphthous stomatitis, which is a common accompaniment. The right lower quadrant tenderness is consistent with the mass felt per abdomen that reflected adherent loops of bowel. As expected, the blood picture reflected anaemia and leukocytosis. The final diagnosis is made from the appearance of the distal ileum that showed narrowing and thickening of the intestinal wall. 8. The main risk factor is genetic predisposition to the development of the disease. Whites and Jews have increased incidences, and increased preponderance of disease in monozygotic twins support. Exact genetic linkage yet to be discovered. 9. The other risk factors that may be involved are, immune mechanism suggested by extra-intestinal manifestations, abnormalities of cell-mediated immunity, and psychological factors caused by stress. 10. There is considerable individual variation with respect to drug metabolism, hence effects of the drug. Drug metabolism is related to cytochrome P450 family of genes. In humans, enzymes encoded by P450 genes are located in the liver where they metabolize drugs. Through oxidative metabolism, these enhance water solubility of the drug to enhance its excretion. For drugs that are metabolized in this way, this process affects the blood levels of the compound, so the therapeutic efficacy, and sometimes, this is necessary to
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