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How do we manage adenomas in UC? If the lesion is a sporadic adenoma, then a colectomy is by no means necessary. This assumes, of course, that you performed extensive sampling of the flat mucosa throughout the colon, including targeted biopsies of mucosa around any polyps. Data indicate that you must obtain at least 33 random biopsies from around the colon in order to exceed 90% sensitivity for identifying prevalent dysplasia. More biopsies are better, typically using 4-quadrant sampling at 10-cm stations throughout the colon.

Pap smears should continue even after the HPV vaccination is administered. What if there's evidence of dysplasia on a Pap smear? If there's dysplasia, then it becomes more difficult to justify continuing AZA/6-MP. In this case, you should ensure the HPV has been serotyped, if present. The high-risk 16 and 18 serotypes require closer scrutiny and complicate the decision making. Stopping AZA/6-MP in this setting is a tough call and partly depends on just how bad the disease gets while off therapy.

Anterior uveitis Inte nse inje ction Same as scleritis. around the iris, with less intense injection peripherally. Same as scleritis. Same as scleritis. “Tough Stuff”Vignettes 23 Vignette 6: “Intractable” IBD A 32-year-old woman presents to you for a second opinion about her IBD. She was first diagnosed with UC 18 months ago after she developed rectal bleeding and mucus discharge during week 34 of pregnancy, initially attributed to pregnancy-related hemorrhoids. Colonoscopy subsequently revealed left-sided colitis and proctitis with chronic architectural distortion on biopsy.

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