A 31-year-old man has suffered from Crohn disease for several years. Initially he was treated with diet and sulfasalazine,but for the past six months,he has been onmesalamine and corticosteroids. The later were started at an intravenous dosage equivalent to 300 milligrams of hydro cortisone per day,and eventually tapered to 20 mg per day by mouth. In the past month he has lost 10 pounds, and further work up reveals a fistula between the proximal jejunum and the terminal ileum. Surgery has been recommended to remove the fistula. He has a serum albumin of 4.5 g/dL, and normal reaction to skin antigens. Which of the following would be the most important medical preparation for this patient's operation?
A. Control the underlying disease with one week of azathioprine
B. Discontinue the steroids for two weeks prior to surgery
C. Give high doses teroids on the day of surgery,and taper to current dose over three days
D. Mechanical and antibiotic bowel preparation
E. Parenteral nutrition for one week preceding surgery
A. Control the underlying disease with one week of azathioprine
B. Discontinue the steroids for two weeks prior to surgery
C. Give high doses teroids on the day of surgery,and taper to current dose over three days
D. Mechanical and antibiotic bowel preparation
E. Parenteral nutrition for one week preceding surgery