Medical Nutrition Therapy Case Study: R.G. Presents with Inflammatory Bowel Dise
ID: 123817 • Letter: M
Question
Medical Nutrition Therapy Case Study:
R.G. Presents with Inflammatory Bowel Disease Description: R.G. was a colicky baby, even though she was breastfed. Her mother decided to continue to breast feed up to 8 months because she was accepting very few solids. As a toddler and preschooler, RG would fuss and refuse to eat some days for no apparent reason. She often complained of abdominal pains and cramps as she grew up and her parents tried to identify the reason for her pain. They thought she was lactose intolerant like some close relatives. By avoiding milk products, RGs products in her diet. They also gave her a low fiber diet by limiting whole grain breads and cereals. Although she had no appetite and was rater thin, she was still growing normally. Her parents were Jewish and both were tall and thin. Her intermittent abdominal pain and diarrhea continued into her teens and her doctor diagnosed her with irritable bowel syndrome and lactose intolerance and she was treated for iron and vitamin B12 deficiency anemia. In high school, she began to have sporadic diarrhea when she ate fatty foods and was stressed during examination periods. She began to develop joint pain and very fatigued which led her to drop ballet and become isolated from friends. She became sad and her school performance dropped. The next year she had more frequent episodes of diarrhea, lost more weight and felt depressed. It worsened to include skin rash, mouth ulcers, periodontal disease, and fever. She almost stopped eating as not to trigger bouts of pain. She mostly had soup and gingerale, with occasional plain white pasta or rice. Upon complaining of unbearable appendicitis like abdominal pain she went to the emergency room.
Question. Analyze the diet R.G. followed in the days prior to admission into the emergency room. Please explain.
Explanation / Answer
Diet for Inflammatory Bowel Disease
Inflammetory Bowel Disease (IBD) is a term utilized for two particular and separate maladies: Crohn's infection and ulcerative colitis. Wholesome suggestions are diverse for every infection and for every individual patient. It is critical to examine the medications that are ideal for you with an enrolled dietitian and with your specialist.
Dietary Management
Data with respect to dietary medicines for IBD is frequently confounding. Many individuals get data instructing them to maintain a strategic distance from whole nutritional categories or particular sustenances. Nonetheless, there is no compelling reason to maintain a strategic distance from sustenances unless they intensify your indications. It is best to confine as couple of sustenances as conceivable to expand the odds that you are getting an adjusted, nutritious eating regimen. This is vital for keeping up the capacity of your stomach related tract and your general wellbeing.
No particular eating regimen has been appeared to avert or treat IBD. Be that as it may, some eating routine techniques help control manifestations
Diet Recommendations for Ulcerative Colitis Flare
Take after a low deposit eating routine to calm stomach agony and looseness of the bowels. Stay away from nourishments that may build stool yield, for example, new foods grown from the ground, prunes and charged drinks. Diminishing moved desserts in your eating regimen, for example, juices, sweet and pop, to help diminish measures of water maneuvered into your digestive system, which may add to watery stools. Decline liquor utilization. Take a stab at fusing more omega-3 unsaturated fats in your eating regimen. These fats may have a mitigating impact. They are found in angle, including salmon, mackerel, herring and sardines. Patients regularly locate that littler, more successive dinners are better endured. This eating example can help expand the measure of sustenance you get in a day. Consider taking nutritious supplements if hunger is poor and strong sustenances are not endured well (see segment on prescribed fluid supplements).
Diet Recommendations for Crohn's Disease Flare
Take after a low buildup eating regimen to alleviate stomach agony and loose bowels. On the off chance that you have strictures, it is particularly imperative to dodge nuts, seeds, beans and portions. Maintain a strategic distance from sustenances that may expand stool yield, for example, new products of the soil, prunes and stimulated drinks. Frosty sustenances may help lessen looseness of the bowels. On the off chance that you have lactose prejudice, take after a without lactose consume less calories. Lactose narrow mindedness causes gas, swelling, cramping and looseness of the bowels 30 to a hour and a half subsequent to eating milk, frozen yogurt or a lot of dairy. A breath hydrogen test may affirm doubts of lactose prejudice. In the event that you have slick and putrid stools, you may have fat malabsorption. Treat fat malabsorption by following a low-fat eating routine. Talk about these indications with your specialist or nutritionist. Littler, more regular dinners are better endured and can amplify dietary admission. In the event that your hunger is diminished and strong sustenances not endured well, consider taking nourishing supplements (see area on prescribed fluid supplements).
Diet Progression Following Flares for Ulcerative Colitis and Crohn's Disease
Keep on following a low buildup eat less carbs and gradually mix it up of sustenances. Start with very much endured fluids and progress to delicate solids, at that point solids (see beneath for fluid and strong nourishment recommendations). Present maybe a couple things each couple of days and maintain a strategic distance from any sustenances that reason side effects. Add fiber to count calories as endured. Very much endured fiber sources incorporate delicate cooked vegetables, canned or cooked organic products, and starches like cooked oats and entire wheat noodles and tortillas. Between flares, eat a wide assortment of nourishments as endured. This incorporates natural products, vegetables, entire grains, lean protein, and low-fat and nonfat dairy items. Increment your calorie and protein consumption following a flare. Stomach agony, looseness of the bowels and diminished craving may have caused poor nourishment admission. Steroids used to treat flares likewise can build protein needs.
Suggestions for first foods after a flare include:
1) Diluted juices
2) Applesauce
3) Canned fruit
4) Oatmeal
5) Plain chicken, turkey or fish
6) Cooked eggs or egg substitutes
7) Mashed potatoes, rice or noodles
8) Bread — sourdough or white
Nutrient Deficiencies and Treatment
Ulcerative Colitis
Individuals with ulcerative colitis may have expanded requirements for the accompanying supplements. Inadequacies rely upon drugs utilized and the degree of blood misfortune and looseness of the bowels. Counsel your specialist or nutritionist on the off chance that you have worries about insufficiencies. Redress with supplements and supplement rich sustenances.
1) Folate — bigger risk with Sulfasalazine utilize
2) Magnesium — bigger risk with chronic diarrhea
3) Calcium — bigger risk with prednisone utilize
4) Iron — bigger risk with blood loss from ulceration of colon and/or clinical signs and symptom of insufficiency (anemia)
5) Potassium — bigger risk with chronic vomiting and diarrhea, prednisone utilize and/ or low blood levels of potassium
Crohn's Disease
Individuals with Crohn's malady might be at expanded hazard for inadequacies of the accompanying supplements. An assortment of elements influence chance for supplement lack including prescriptions utilized, parts of the stomach related tract expelled, level of irritation and the patient's capacity to take satisfactory nourishment. Counsel your specialist or nutritionist on the off chance that you have worries about insufficiencies. Supplement lacks are treated with supplements and supplement rich nourishments.
1) Vitamin B12 — bigger risk with extensive inflammation in the ileum (lower small intestine) or removal of the ileum.
2) Folate — bigger risk with Sulfasalazine use; extensive inflammation in the jejunum (middle portion of the small intestine) or removal of the jejunum.
3) Vitamins D, E and K — bigger risk with fat malabsorption; inflammation of large portions of the jejunum and/or ileum or removal of portions of the jejunum and ileum.
4) Vitamin A — bigger risk with fat malabsorption; disease involvement of the duodenum (upper small intestine) and/or upper jejunum.
5) Magnesium — bigger risk with extensive inflammation and/or removal of large portions of the jejunum and ileum, fistula losses and chronic diarrhea.
6) Zinc — bigger risk with extensive inflammation and/or removal of the jejunum, diarrhea, fistula losses, prednisone use or measured low blood levels of zinc.
7) Calcium — bigger risk with averting of dairy foods for lactose intolerance, fat malabsorption, prednisone use, extensive inflammation or surgery throughout the entire small intestine.
8)Potassium — bigger risk with chronic vomiting and diarrhea, prednisone use.