Today we discussed inflammatory bowel disease. Some important points:
Extraintestinal manifestations of IBD:
Eyes- uveitis
Skin- pyoderma gangrenosum, erythema nodosum
GI- PSC (esp UC)
Renal (stones- affects oxalate metabolism by unabsorbed bile salts binding Ca, allowing oxalate absorption)
Arthritis- Sero-ve, large joint asymmetric. Either peripheral, which parallels IBD or independent (axial)
Extent of UC (treatment):
pancolitis (oral meds), L sided (enemas), sigmoiditis/proctitis (suppositories)
Complications:
UC- bleeding, colon ca, toxic megacolon
Crohn's- aphthous ulcers, malabsorption, fistulae, abscess, strictures
Both: At higher risk for C. Diff, relatively hypercoagulable
Toxic megacolon: Non-obstructing dilation of the colon.
NB- TM can be from infectious causes as well.
Clinical: tachy, hypotension, fever, volume depletion, altered sensorium.
AXR: over 6cm at transverse, thumbprinting (big haustra), pneumatosis coli. Shown in above picture.
Flare treatment:
NPO (bowel rest)
NG
fluid resuscitation (esp attention to phos, K, Mg, albumin)
Possible antibiotics (esp. Crohn's) -cipro, flagyl, possibly vanco
IV steroids (e.g. Solumedrol 30mg IV bid)
DVT prophylaxis
Possible c-scope, although mucosa is very friable; may be deferred until inflammation settles.
Links:
Click here for a recent BMJ review of Crohn's disease
Click here for a Lancet review of new therapies for IBD
36 comments :
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Hello everyone i Am GREAT MARK and i am from USA i am here to give my testimony about an herbal doctor called Dr,Odaba I was heartbroken because i had very small penis,not nice to satisfy a woman, i have been in so many relationship, but cut off because of my situation, i have used so many product which doctors prescribe for me, but could not offer me the help i searched for. i saw some few comments on the internet about this specialist called Dr,Odaba and decided to email him on his email i saw on the internet,(drodabasolutionhome@gmail.com ) so I decided to give his herbal product a try. i emailed him and he got back to me, he gave me some comforting words with his herbal product for Penis Enlargement, Within three weeks of me use it, i began to feel the enlargement, " and now it just 4 weeks of using his products my penis is about 8 inches longer, and i had to settle thing out with my ex girlfriend , i was surprised when she said that she is satisfied with my performance in bed and i now have a large penis.thanks to DR Odaba for is herbal product. you can also reach him with his Email:Drodabasolutionhome@gmail.com though is..number WHATASPP him today on this number +2347063915230
THANK YOU FOR READING
I was married at 32 and immediately tried to get pregnant. When I was unable to conceive I had blood tests for fertility and was told that I had an FSH (follicle stimulating hormone) of 54 and would not be able to have children. Even though the doctors knew that I had been diagnosed with Hashimoto’s thyroiditis since age 25, no one bothered to check my thyroid levels. my TSH was measured at .001. My Synthroid dosage was lowered. a friend advise me to contact a spiritualist who help with fertility with his medicine, i collected his contact and explain my situation to him he prepared for me a herbal medicine which i took as describe by him. became pregnant very quickly, I had a successful pregnancy. I have my baby august 2017. to get pregnant at age 35 with my 2nd child in september 2019, thank you sir , this is his email contact if you require his help babaka.wolf@gmail.com or Facebook at priest.babaka
I was married at 32 and immediately tried to get pregnant. When I was unable to conceive I had blood tests for fertility and was told that I had an FSH (follicle stimulating hormone) of 54 and would not be able to have children. Even though the doctors knew that I had been diagnosed with Hashimoto’s thyroiditis since age 25, no one bothered to check my thyroid levels. my TSH was measured at .001. My Synthroid dosage was lowered. a friend advise me to contact a spiritualist who help with fertility with his medicine, i collected his contact and explain my situation to him he prepared for me a herbal medicine which i took as describe by him. became pregnant very quickly, I had a successful pregnancy. I have my baby august 2017. to get pregnant at age 35 with my 2nd child in september 2019, thank you sir , this is his email contact if you require his help babaka.wolf@gmail.com or Facebook at priest.babaka
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I am bold enough among many others to state that there is now a potent cure to this sickness but many are unaware of it. I discovered that I was infected with the virus 3 months ago, after a medical check-up. My doctor told me and I was shocked, confused and felt like my world has crumbled. I was dying slowly due to the announcement of my medical practitioner but he assured me that I could leave a normal life if I took my medications (as there was no medically known cure to Herpes). I went from churches to churches but soon found that my case needed urgent attention as I was growing lean due to fear of dying anytime soon. In a bid to look for a lasting solution to my predicament, I sought for solutions from the herbal world. I went online and searched for every powerful trado-medical practitioner that I could severe, cos I heard that the African Herbs had a cure to the Herpes syndrome. It was after a little time searching the web that I came across one Dr.Afrid (A powerful African Herbal Doctor), who offered to help me at a monetary fee. I had to comply as this was my final bus-stop to receiving a perfect healing. My last resolve was to take my life by myself, should this plan fail. At last it worked out well. He gave me some steps to follow and I meticulously carried out all his instructions. Last month, to be precise, I went back to the hospital to conduct another test and to my amazement, the results showed that negative,Dr.Afrid Can As Well Cure The Following Desease…Cancer,Hiv,Herpes, Hepatitis B,Liver Inflammatory,Diabetis,Fribroid, Dercum,fibromyalgia,Get Your Ex Back,Als,SYPHILLIS,Genetic disease, Parkinson's disease.Fibrodysplasia Ossificans Progressiva.You can free yourself of this Herpes virus by consulting this great African Herbal Doctor via this e-mail: drafridherbalhome@gmail.com or call and whatsapp him on +2349057260738 He will help you and his herb medication is sure. he has the cure on all disease ..
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I am John Danilla from UK( northern ireland), i want to share a
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Irrespective of receiving daily oral or future injectable depot therapies, these require health care visits for medication and monitoring of safety and response. If patients are treated early enough, before a lot of immune system damage has occurred, life expectancy is close to normal, as long as they remain on successful treatment. However, when patients stop therapy, virus rebounds to high levels in most patients, sometimes associated with severe illness because i have gone through this and even an increased risk of death. The aim of “cure”is ongoing but i still do believe my government made millions of ARV drugs instead of finding a cure. for ongoing therapy and monitoring. ARV alone cannot cure HIV as among the cells that are infected are very long-living CD4 memory cells and possibly other cells that act as long-term reservoirs. HIV can hide in these cells without being detected by the body’s immune system. Therefore even when ART completely blocks subsequent rounds of infection of cells, reservoirs that have been infected before therapy initiation persist and from these reservoirs HIV rebounds if therapy is stopped. “Cure” could either mean an eradication cure, which means to completely rid the body of reservoir virus or a functional HIV cure, where HIV may remain in reservoir cells but rebound to high levels is prevented after therapy interruption.Dr Afrid Herbal Medicine makes me believes there is a hope for people suffering from,Parkinson's disease,Schizophrenia,Cancer,Scoliosis,Fibromyalgia,Fluoroquinolone Toxicity
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Hi!!
I want to especially thank Dr. Godsent Yare for helping me get cured of the Genital Herpes Virus. I was diagnosed last 2 summers and my doctor said no cure for the virus. I was in big trouble until I saw this YouTube post-https://youtu.be/Uw-l6rfcOl4 online testifying about Dr. Godsent Yare, How he cured A lady with ALS/MND disease using his herbal healing cure. I contacted his base on the good testimonies I was seeing about him on the internet, how he cured so many people from different diseases and Viruses with his roots, herbs, and healing oil. I placed an order and received medicines after 4 working days and commerce treatment as instructed, now I'm happily sharing my own testimony to the world that I'm cured. If you need help to cure HSV1-2 or any other disease or virus, contact him today on his email; dryareherbalcurehome@gmail.com Or Call/Whatsapp his number on +2348164653711, +2348148010628. I hope that everyone reading this post should refer others who need help to cures to Dr. Yare's website; http://bit.ly/2dBFYeW for additional information. When people know better, they do better ! You will be glad you did.
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HELLO everyone! Still don’t know the right words to express my Gratitude to the Great DR.Imoudu After been diagnosed with the #herpes for the passed two years, i was given so many health prescription and advice with no improvement, I totally lost hope, until i found many testimonies of Great DR.Imoudu in an online research Like anybody would be, i advice anyone that is living with herpes can also contact him today, because he has the cure to any virus problem contact him on WhatsApp +2348109609753..
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HELLO everyone! Still don’t know the right words to express my Gratitude to the Great DR.Imoudu After been diagnosed with the #herpes for the passed two years, i was given so many health prescription and advice with no improvement, I totally lost hope, until i found many testimonies of Great DR.Imoudu in an online research Like anybody would be, i advice anyone that is living with herpes can also contact him today, because he has the cure to any virus problem contact him on WhatsApp +2348109609753..
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1...ALS CURE/DIABETES CURE/EPILESY/HPV CURE/LOOSE WEIGHT AND BODY/EX-BACK/HEPATITIS/
THANK YOU DR.Imoudu FOR YOU GOOD WORK IN MY LIFE..
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He also cure
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1) Love Spells
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3) Divorce Spells
4) Marriage Spells
5) Binding Spell.
6) Breakup Spells
7) Banish a past Lover
8.) You want to be promoted in your office/ Lottery spell
9) want to satisfy your lover
Contact this great man if you are having any problem for a lasting solution
through drafridherbalhome11@gmail.com
I am Elena, When I eventually found testimonies about this spell caster Dr.Ogedegbe, how he helped many people to get their lovers and broken homes back, i contacted him through his email address dr.ogedegbe6@gmail.com because I was absolutely desperate to get my husband back. Life without my husband was a real mess for me and my children. i wanted a dramatic change and I thought magic could be the solution. After discussing the resolution with Dr Ogedegbe, he gave me hope that he will restore my marriage. I felt confident that he will actually make my husband to return home and he did! It’s fantastic what this great spell caster have done for me, his help is priceless! I don’t know what I would have done without Dr.Ogedegbe ,he does his job so well he is organized and highly functional, i believe he is the best spell caster i can count on when it comes to all kinds of spell, I was floored that his spells worked, if you need help, contact him via email on dr.ogedegbe6@gmail.com or whatsapp him now on +2348109374702 ......
Dear Sir,
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Email: longmornprojectsfinance@gmail.com
Skype ID: longmornprojectsfinance@hotmail.com
Best regards
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It's awesome and amazing. My name is KATY WILLIAMS from the United States. Getting my husband back is what i least expected and could never imagine. I and my husband have been married for five years and we have been living happily but all of a sudden he changed completely and turned away from me but i never knew what was going on, and i tried to ask him but he refused to tell me what the problem is, and as time went on he sought for a divorce. I was so worried and confused. During my search for a way out, a friend of mine who had similar problem told me about a great spell caster called DR AHIELEKPEN who helped her with her situation. I never use to believe in spell casting in my entire life because i never thought it will work but i tried to give this man a chance and to my greatest surprise DR AHIELEKPEN got me a positive result and he was able to get my husband back to me. After the spell caster did his work, i discovered that my husband fell so much in love with me unlike before. This spell casting isn't brain washing but he opened up his eyes to see how much i love and needed him. Now i am a happy woman again and I don't know how am going to to thank DR AHIELEKPEN so i am using this opportunity to tell anyone having similar problem to visit him on his emeail address: drahielekpenspellhome76@yahoo.com OR WhatsApp:+2348054387655 his spells is so powerful. Once again thank you DR AHIELEKPEN and may your gods reward you for your good deeds..CALL or WhatsApp:+2348054387655
Hi everyone. I saw comments from people who already got their loan from challot and then I decided to apply under their recommendations and just few hours ago I confirmed in my own personal bank account a total amount of $30,000 which I requested for. This is really a great news and I am advising everyone who needs real loan to apply through their email (challotloan@gmail.com) I am happy now that i have gotten the loan I requested
My husband changed dramatically towards me, doesn’t communicate anymore.He disrespects me and accuses me falsely of infidelity because of wicked gossip …but I’m simply AMAZED at the results of Dr. Todd who did reunion love spell for me. Everything is going so well and EXACTLY how he said it would be. Even though it took 3 days to fully progress, it was so worth it because things are just about at perfection! How he took my situation and completely turned it around to give me exactly what I wanted is beyond me, but something I will never question and just be completely grateful, God Bless Dr.Todd for turning sorrow happiness. Dr.Todd's contact; manifestspellcast @ gmail. com
WhatsApp:+1 604 901 9747
i want to inform the public how i was cured of herpes Virus by a Doctor
called Dr ishiaku. i visited different hospital but they gave me list of
drugs like Famvir, Zovirax, and Valtrex which is very expensive to treat
the symptoms and never cured me. I was browsing through the Internet
searching for remedy on Herpes and i saw comment of people talking about how Doctor ishiaku cured them. I Was scared because i never believed in the
Internet but i was convince to give him a try because i was having no hope
of been cured of herpes so i decided to contact him on his email, i searched
his email on net and i saw a lot of people testifying about his goodness.
when i contacted him he gave me hope and send a Herbal medicine to me that
i took and it seriously worked for me, am a free person now without
problem, my HERPES result came out negative. You can contact him on his
Email: ishiakuherbalcure@gmail.com or whatsapp him via +2348180828544
and get all your problem solved.
1)Sickness of any kind
2)Help to CURE Hepatitis B, herpes, HIV/AIDS CANCER and BIPOLAR
3)Divorce, Breakup problem and To Re-unit
4)Pregnancy problem
5)Financial problem and Job promotion
6)To get a good and rich life partner
7)To Lose your wrath
8)to enlargement of manhood
My husband and I have been married for over 10 years. We met when I was 18 and he was 21. We’ve been through a lot emotionally together. There were several HUGE fights and painful situations in our marriage, but we always seemed to come out stronger on the other side. Out of the blue my husband just sprung the divorce talk on me, I was totally depressed until I found Dr.Todd website online and I ordered for a Love spell. You won’t believe my husband called me at the exact time this spell caster finished his spell work in 48hrs. I was totally amazed! He is wonderful and his spells work so fast. His Email: manifestspellcast@ gmail. com manifestspellcast.wordpress.com
WhatsApp:+1 604 901 9747
I want to especially thank Dr. Aroni for helping me get cured of the Genital Herpes Virus. I was diagnosed last 2 summer and my doctor said no cure for the virus. I was in big trouble until I saw this YouTube post-online testifying about Dr.Aroni, How he cured A lady with ALS/MND disease using his herbal healing cure. I contacted his base on the good testimonies I was seeing about him on the internet, how he cured so many people from different diseases and Viruses with his roots, herbs, and healing oil. I placed an order and received medicines after 4 working days and commerce treatment as instructed, now I'm happily sharing my own testimony to the world that I'm cured. If you need help to cure HSV1-2 or any other disease or virus, contact him today on his email;Aronilovespelltemple@gmail. com When people know better, they do better ! You will be glad you did.
my husband suffered from crohn's disease almost all his life and i can tell you that its really terrible, watching him get lean and pale worried me the more, he lost appetite, he was always and was unable to go to work again,he kept having sores in his mouth and the constant pain was making the situation worse. we kept going from one gastroenterologist to another, they were not helping the situation, they kept giving us different drugs and it was making it worse,they kept increasing the dosage, in 2016 when i went to CVS pharmacy to go and get another drugs for him, that was were i heard about dr folonsho a herbal doctor, who specializes in using natural roots and herbs to treat diseases and chronic pain. at first i was in doubt, because we have tried many options that were not helping and all the doctors we came across told us that there was no cure, and i believed, so i contacted this herbal doctor and he said he could help my husband,after i told him my problem, he said he has a herbal remedy that can heal my husband and reverse this illness completely and he will be back to his normal state of health, not having many alternatives anymore i requested for the herbal remedy,because the situation was getting worse, after using the medicine for about 3 weeks there was great improvement, and my husband was getting back to his normal self, its been 4 years now and my husband is still strong as ever, all thanks to dr folonsho, and may GOD continue to bless you, so if you are still suffering from this disease kindly contact dr folonsho today either through email drfolonsho@gmail.com or via whats app +2348073410606 or you can check out his website https://drfolonshoherbalhome.simdif.com/ and you will be glad you did, i wouldn't want someone to experience what my husband experienced
i want to inform the public how i was cured of herpes Virus by a Doctor called Dr ishiaku. I visited different hospitals but they gave me a list of drugs like Famvir, Zovirax, and Valtrex which are very expensive to treat the symptoms and never cured me. I was browsing through the Internet searching for remedies on Herpes and I saw comments of people talking about how Doctor ishiaku cured them. I Was scared because i never believed in the Internet but i was convinced to give him a try because i was having no hope of been cured of herpes so i decided to contact him on his email, i searched his email on net and i saw a lot of people testifying about his goodness. When I contacted him he gave me hope and send a Herbal medicine to me that i took and it seriously worked for me, am a free person now without problem, my HERPES result came out negative. You can contact him on his
Email: ishiakuherbalcure@gmail.com or whatsapp him via +2348180828544 and get all your problems solved.
1)Sickness of any kind
2)Help to CURE Hepatitis B, herpes, HIV/AIDS CANCER and BIPOLAR
3)Divorce, Breakup problem and To Re-unit
4)Pregnancy problem
5)Financial problem and Job promotion
6)To get a good and rich life partner
7)To Lose your wrath
8)to enlargement of manhood
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