Read the following case study and discuss the questions:

Mr. Enson comes to the clinic reporting abdominal pain and watery diarrhea.

“Sometimes, it’s pretty severe,” he says. “It’s been that way for 2 days. The scary part is that I have a lot of blood in my stool now. It’s not like before. This is way more intense.”

Mr. Enson has a history of Crohn disease, which is now exacerbated by extensive inflammation. His history indicates that he has been taking antiinflammatory agents for several years despite complaining of nausea and heartburn from the drugs.

“I’ve already tried the steroid route,” he says. “I don’t want to ever do that again. I prefer the sulfasalazine. The trouble is that it doesn’t seem to be helping anymore. What can we try next?”

He has already been in drug trials for a new immune system suppressor, with no significant clinical change. Dr. Holly, Mr. Enson’s physician, suspects a resection may be necessary.

Dr. Holly examines his abdomen for tenderness, requests a white blood cell count, and assesses his pain. She also orders a computed tomography (CT) scan of his large intestine.

Mr. Enson’s white-cell count is high, which Dr. Holly had expected, and the CT scan reveals significant new damage to Mr. Enson’s gastrointestinal tract. She schedules him for a surgical procedure to close the fistulas, drain several abscesses, and remove a section of Mr. Enson’s colon.

1.      At one time, Mr. Enson assumed he had ulcerative colitis (UC) because both his brother and sister have it. What is the difference between UC and Crohn disease? How can a medical practitioner distinguish between the two?

2.      In preparing her patient for his surgery, Dr. Holly explains that Mr. Enson will undergo surgical resection of the most severely damaged segment of his colon. She will then create an artificial anus on Mr. Enson’s abdominal wall by incising the colon and bringing it out to the surface. She explains, “There are actually two procedural options for your resection, but I am confident this choice is the better of the two for your condition.” What are the two surgical options, and which one has she chosen?

3.      If Dr. Holly had chosen to remove a portion of Mr. Enson’s small intestine, then he would have been at increased risk for what syndrome?

Post your answers in discussion form, approximately 300 words.

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