BLESS MAZWAYA

217001972

ASSIGNMENT 2

CASE STUDY 1
CASE STUDY 2

2.1 It is exudative diarrhea as the patient has blood in the stool due to ulceration of the

2.2The patient is steriod dependent, because the dose was increased after it provided remission for
years, which means the initial dose was now ineffective and that the paient administered the drug for
eight years and achieved remission and only relapsed eight years later, if it was steriod resistance the
patient would have relapsed sooner.

2.3 Azathioprine and sulfasalazine were included in the initial treatment because they both effective in
mainting remission and prevent relapse and because the child presented with acute inflimation where
sulfasalzine plus a steriod are effective for accute attacks.

2.4Because chrons disease causes inflamation and it activates the immune system that will also release
inflammatory mediators called cytokines which circulate the body and may cause aches and pains
around the joins. An that chron"s disease is an autoimmune disease.

2.5Because the patient developed antibodies against infliximab and the antibodies level were high
causing infliximab to be less effective.

2.6 Because the endoscopy showed involvement of gastric corpus, ileum and all segments of the colon
and rectum(occur in all the layers of the bowel) while ulcerative only happens on the colon.

2.7 Adalimumab and infliximab are both anti TNf alpha theraphy and they both suppress the immune
ssystem and reactivate latent TB,therefore, they both increases the susceptibility of TB

2.8 Thalidomide is less antigenic and accelerates TNF-α mRNA degradation, affects NF-kB activation and
reduces IL-12 production. Thalidomide costimulate Tlymphocytes with greater effect on CD8+ than
CD4+ T cells , which contributes to the protective immune response to Mtb infection.

2.9Ptients are tested for pregnancy before given thalidomide , since thalidomide is teratogenic,
thalidomide passes into semen, birth controls should be given to avaoid pregnancy while on the
regimen.

2.10 CPR is us an inflimation indicater and ESR is an indirect measure of the level of inflamtion in the
body.

2.11 since Thalidomide was effective, the calprotectin levels after thalidomide initiation they would have
been decreased than before thalidomide was initiated.

2.12 Infliximab is an immune suppressant which reactivates latent TB might have caused Mtb

Question 3
3.1 Possible therapies are magnesium chloride formulated in rectal enema that will accelerate GI
peristaltic mobility, this will aid in the removal of the fish bone.

3.2Mammalian GI tract is segmented because of complex diet , to enable alternating contraction and
relaxation of non-adjacent segments of the intestines, allowing mixing of food to form chyme and to
increase absorption.