APPROACH TO MANAGEMENTGoals of treatment are directed at inducing and then maintaining remission of symptoms and mucosal inflammation. Once the diagnosis of UC is confirmed, the anatomic extent is assessed endoscopically. The key question to be addressed at this point is whether the inflammation is “distal” (i.e., limited to below the splenic flexure and thus within reach of topical therapy) or “extensive” (i.e., extending proximal to the splenic flexure, requiring systemic medication). Therefore, a delineation of the proximal margin of inflammation, if not achieved on initial evaluation, is desirable at some point in the management of the case once the patient’s condition permits. From a practical standpoint, the anatomic extent and clinical severity of an acute attack determine the approach to therapy. Therapeutic decisions rarely are based upon histologic severity of inflammation. cialis professional Based upon clinical and endoscopic findings, the disease is characterized as to its severity and extent. Severity is defined as mild, moderate, or severe [8] . Patients with mild disease have less than four stools daily, with or without blood, no systemic signs of toxicity and a normal erythrocyte sedimentation rate. Moderate disease is characterized by more than four stools daily but with minimal signs of toxicity. Severe disease is manifested by more than six bloody stools daily, and evidence of toxicity as demonstrated by fever, tachycardia, anemia, or an elevated erythrocyte sedimentation rate [8] . Generic Zithromax 500mg


So Many Advances in Medicine, So Many Yet to Come