Case 11: Crohn’s Disease

Ashley Hayslip Nutr. 407

1. Inflammatory bowel disease is chronic inflammation of the digestive tract. It can include all parts of the GI tract or just certain portions. IBD includes ulcerative colitis and Crohn’s disease. Current medical literature reveals that immunity and heredity are the main causes of IBD development. 2. Many of the symptoms of ulcerative colitis and Crohn’s disease are similar. Both experience abdominal pain, diarrhea, and weight loss. Some symptoms that differ for Crohn’s disease are fever, fatigue, inflammation of the liver and bile duct, and malabsorption due to the fact that it can affect any part of the GI tract. 4. Mr. Sim’s previous weight loss and loss of appetite is an indication of Crohn’s disease. Abdominal pain, fever, and diarrhea are all signs of Crohn’s disease. 5. Some examples of extraintestinal symptoms of Crohn’s disease include joint pain, skin, liver, and eye issues. Mr. Sims is experiencing fatigue and unintended weight loss. 6. Corticosteroids are anti-inflammatory drugs that suppress inflammation when taken in large enough amounts. Mesalamine is a drug that reduces inflammation specifically in the colon. Humira is an anti-inflammatory that inhibits the production of TNF alpha (tumor necrosis factor alpha) in the colon. 7. Lab values that indicate a diagnosis of Crohn’s for Mr. Sim include an elevated CRP, low Hgb and Hct due to losses and possible malabsorption, increased ASCA (anti-saccharomyces cerevisiae antibody) and low transferrin and ferritin. 8. Mr. Sims is at an increased risk for many nutrient deficiencies due to altered intestinal structure and inflammation. 9. Short bowel syndrome is defined by a bowel length of 100 cm or less. However, someone whose bowel is longer but is still experiencing the decreased absorption associated with short bowel syndrome could be considered. Mr. Sims is technically not a candidate for short bowel syndrome. 13. Possible nutritional concerns with Crohn’s disease is dehydration and malabsorption of certain macronutrients and micronutrients, especially electrolytes. 14. The small intestine is approximately 6.9 meters long. A resection of 200 cm of the jejunum is a significant reduction, however it is not enough to be considered short bowel syndrome.

15. The jejunum, which was resected generally is the main absorber of many nutrients. The majority of macronutrient and micronutrients are absorbed in the jejunum, particularly the third portion of the jejunum. 16. 83 %UBW and BMI 21.3 17. 1272-1590 kcal/day initially (20-25 kcals/kg) 18. 76.3-95.4 g/day (1.2-1.5 g/kg) 19. An elevated CRP, low Hgb and Hct due to losses and possible malabsorption, increased ASCA (anti-saccharomyces cerevisiae antibody) and low transferrin and ferritin. 20. Unintended weight loss RT Crohn’s disease AEB 15% weight loss in last 6 months Altered nutrition-related laboratory values: total protein, ferritin, vitamin D, vitamin A, ascorbic acid RT resection of 200 cm of jejunum and proximal ileum AEB  ferritin, total protein, vitamin D 25 hydroxy free retinol, ascorbic acid. 23. Refeeding syndrome is when someone has been consuming a very low calorie diet and then suddenly begins to consume a large amount of calories. This influx of energy can result in electrolyte imbalance and can affect the heart rate dangerously. Refeeding syndrome can be avoided by introducing an increase in calories gradually over several days to weeks to ensure that electrolyte levels are not altered drastically. 26. Normal respiratory quotient (RQ) is 0.7-1.0. An ideal value is 0.85 which indicates that the body is utilizing a good mix of fats, protein, and CHO. Mr. Sims’ RQ is 0.88 which is normal, but should be monitored due to it being slightly elevated. 30. Mr. Sims’ UUN is -7.6 which indicates that he needs more protein consumption. An ideal UUN is positive 2-4 which indicates adequate protein intake. 31. First oral foods should be clear liquids. Mr. Sims needs to avoid high fiber foods, high fat foods. He should focus on high protein foods such as hydrolyzed protein products. 32. Primary nutrition cares involves toleration of diet with reduced diarrhea. Small frequent meals and snacks. Drink fluids separately of meals. Eat foods with probiotics or take a probiotic supplement. Take a multivitamin and protein supplement or high protein foods like cottage cheese, chicken, and fish. Avoid low fiber foods while experiencing symptoms. Be sure to peel fruits and cook vegetables.