Kerry Linne

10/23/17

Nutr 407

Case 12 Crohn’s disease

2) Crohn’s disease and Ulcerative colitis are both classified under the general term
of inflammatory bowel disease. Even though the two diagnoses are similar they still
show several distinct differences between the two. First, the onset of the two
diseases affects people at different points in their life. Ulcerative colitis usually
shows up in individuals in their 20-30 years of age range, and Crohn’s disease
typically affects individuals in their teens and early twenties. Next, Ulcerative colitis
usually damages the first two layers of tissue within the colon and rectum while
crohn’s disease damages all layers of the gastrointestinal mucosa. Also, serological
markers that include specific antibody testing have been used to distinguish
between the two disorders. Lastly, Ulcerative colitis patients are more likely to have
blood in their stool, while experiencing less abdominal pain and cramping compared
to crohn’s disease patients.

5) Mesalamine is a generic aminosalicylates medication that works as an anti-

inflammatory agent in the colon, while possibly acting as an immune suppressant.
Corticosteroids are also anti-inflammatory medications that mimic the actions of
cortisol. These medications work by redistributing white blood cells, which reduces
lymphocytes. Also, corticosteroids increase neutrophils while decreasing the
production on prostaglandins. Humira is a medication that is in a class of drugs
known as tumor necrosis factor (TNF) blockers. Individuals with Crohn’s disease
produce too much TNF, which attacks the GI tract causing inflammation. TNF
blockers work by binding to excess TNF to help reduce the amount of inflammation
that causes Crohn’s symptoms.

6) After reviewing Mr. Pages’ laboratory results, his albumin, hemoglobin, and
hematocrit levels were all low, while his C-reactive protein and ASCA levels were
high. These results are not surprising considering Mr. Page’s condition. Low albumin
levels are common, and low biochemical hemoglobin and hematocrit levels confirm
significant anemia. Also, ASCA and C-reactive protein are acute-phase reactants, and
have been found to be indicative of exacerbations for Crohn’s disease.

10) The majority of nutrients are absorbed in the beginning of the small intestine.
After a jejunal resection, the ileum is forced to take over the function of the jejunum
that was removed, which is to digest and absorb sugars, resistant starches, fiber,
lipids, and fluids. On the other hand, the ileum’s role is to absorb B12 and bile salts.
After undergoing the procedure to remove the proximal ileum it will be difficult to
absorb bile salts secreted into the GI tract, which can cause malabsorption of fats
and corresponding fat-soluble vitamins.
12) Mr. Page has lost 16% of his usual body weight, which is considered a severe
weight loss.

Percent Usual Body Weight = 83-84%

 (140/166) x 100 = 84%

 (140/168) x 100 = 83%

Percent Weight Change = 16-17%

 100-83 = 17%
 100-84 = 16%

Body Mass Index

 140#/2.2 = 63.6 kg
 5’9” = 69in/(39in/m) = 1.77m
 63.6kg/(1.77m)2 = 20.3 kg/m2

13) Mifflin-St. Jeor REE for men: 10(W in kg) + 6.25(H in cm) -5(age)+5

 10(63.6kg) + 6.25(177cm) – 5(35) = 5 = 1572 kcals

 1572 x 1.5 (stress factor) = 2358 kcals

Protein = 1.5-1.75 per kg of body weight

 1.5-1.7 x 63.6kg = 95.4-11.3 g protein/day

18) Refeeding syndrome is a condition that occurs when nutrition is administered to

rapidly, especially through intravenous method, during enteral or parenteral
nutrition therapy to patients who are moderately to severely malnourished. Mr.
page is at risk for this condition for the fact he is malnourished, and will be reliant
on parenteral nutrition post-surgery. There are several ways to limit ones risk of
developing refeeding syndrome and those include: monitor fluid intake, consume
fluids separate from meals, carbohydrate intake should be conservative, lactose-
free, and supplement with phosphorus, potassium, and magnesium.

26) There are several nutrition concerns for Mr. Page in regards to his rehabilitation
once he is discharged. First, he needs to pay extra attention to his protein and
energy malnutrition, as well as his vitamin B12, iron, zinc, calcium, magnesium, and
copper deficiencies. It would be recommended for Mr. Page consumes a
multivitamin daily to meet his RDA for all nutrients. It would be recommended for
Mr. Page to consume a variety of foods that are high in antioxidants like fruits and
vegetables. It is of upmost importance for Mr. Page to maximize his energy and
protein intakes in order to facilitate his rehabilitation. A food log will be important
to make sure he is reaching his daily consumption goals. Also, I would want to
reevaluate his weight and BMI measurements to make sure he is gaining weight to
get back to his healthy normal range of 166-168lbs. Lastly, it would be
recommended to get new lab test to check his total protein, albumin, and
prealbumin to see if they are back within reference range.