1. Megan Blackburn
FSHN 450
Inflammatory Bowel Disease Case Study
CSU ID: 830130344
I have not given or received any unauthorized assistance on this assignment:
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2. What in Mr. S’s history and physical findings are consistent with the diagnosis of
Crohn’s?
 Recent episodes of diarrhea accompanied by abdominal pain
 Acute severe RUQ, LUQ, RLQ, LLQ pain
 Weight Loss (~25 lbs)
 101.5 Temperature (Fever)
 Loss of appetite
 Lactose Intolerance
Explain each laboratory finding (please use table format):
Lab Value Normal Range Patient Value Reasonfor Deviation
Albumin: 3.5-5.0 g/dl 3.2 g/dl Decrease due to
diarrhea.
Prealbumin: 18-38 mg/dl 11.0 mg/dl Unintended wt.
loss/Malnutrition
Glucose: 70-99 mg/dl 82 mg/dl N/A
Na+: 136-144 mEg/L 136 mEg/L N/A
K+: 3.5-5.0 3.7 mEg/L N/A
Cl-: 98-107 mEg/L 101 mEg/L N/A
Creat: 0.4-1.2 mg/dl 1.8 mg/dl Malnurition
BUN: 8-23 mg/dl 11 mg/dl N/A
AST: 10-37 U/L 35 U/L N/A
ALT: 4-40 U/L 22 U/L N/A
Alk Phos: 40-120 E/L 120 U/L N/A
CRP: <0/8 mg/dl 2.8 mg/dl High level of CRP
caused from Chron’s
Disease
Cholesterol: 120-99 mg/dL 149 mg/dl N/A
LDL-C: 100-130 mg/dL 101 mg/dl N/A
HDL-c: <60 mg/dl 48 mg/dl N/A
HgB: 14.6-17.5 g/dl 12.9 g/dl Deficiency of Iron
Hct: 41-51% 38.9% Deficiency of Iron
MCV 78-93 87 fl N/A
WBC: 3.2 x 103-10.6x103 11.1 x103/mm3 Infection/Stress
RBC: 4.7-6.1 x106/mm3 4.9 x106/mm3 N/A
Ferritin: 30-320 ng/ml 16 ng/ml Deficiency of Iron
PT: 12.0-15.5 sec 15 sec N/A
Vit D: >30 ng/ml 22.7 ng/ml Dietary Deficiency
What are the potential nutritional consequences of Crohn’s Disease?
 Malnutrition and weight loss due to decreased oral intake
 Protein losses from fistulae
 Loss of appetite (in fear of abdominal pain)
 Kidney Stones

3.  Calcium Loss
 Imbalanced electrolytes
 Anemia
Why was Mr S previously prescribed a low fiber diet in the period following diagnosis?
 Since fiber is difficult for the body to digest, eating a low fiber diet may decrease
daily bowel movements and ease symptoms of Chron’s disease.
 After partial resection of bowel surgery/recovery he will have to continue a bland,
low-fiber diet.
Is Mr. S a candidate for short bowel syndrome syndrome (SBS)? Explain your rationale.
 Mr. S could be a candidate for SBS if he is getting surgical resection of 65-75%
of his small intestine. It is not stated how much resection of his small intestine is
getting removed.
If patient develops SBS subsequent to surgery, what is the recommended MNT?
(You do not need to recommend specific TPN) He will be NPO and on TPN for 7 – 10
days before transitioning to solid foods. Discuss MNT during the adaptation period and
then after adaptation.
During Adaption:
 Stimulated by trophic hormones, nutrients, and drugs.
 Occurs via: structural changes in the SI, functional changes, and colon adaption
After Adaption:
 Restrict fluid with meals
 Lactose free
 Low fiber
 Energy: 35-40 Kcal/Kg
 Protein: 1.5 g pro/Kg
 Oral supplements Ca, Mg, Zn
 Consumption of complex carbohydrates
 Avoid simple sugars
Support your MNT recommendation with a recent journal reference. Include the full
citation in acceptable reference format and a copy of the abstract from the article.
Abstract: Short bowel syndrome (SBS) is characterized by nutrient malabsorption
and occurs following surgical resection, congenital defect, or disease of the bowel.
The severity of SBS depends on the length and anatomy of the bowel resected and
the health of the remaining tissue. During the 2 years following resection, the
remnant bowel undergoes an adaptation process that increases its absorptive
capacity. Oral diet and enteral nutrition (EN) enhance intestinal adaptation;
although patients require parenteral nutrition (PN) and/or intravenous (IV) fluids
in the immediate postresection period, diet and EN should be reintroduced as soon
as possible. The SBS diet should include complex carbohydrates; simple sugars

4. should be avoided. Optimal fat intake varies based on patient anatomy; patients
with end-jejunostomies can tolerate a higher proportion of calories from dietary fat
than patients with a remnant colon. Patients with SBS are prone to deficiencies in
vitamins, minerals, and essential fatty acids; serum levels should be periodically
monitored and supplements provided as needed. Prebiotic or probiotic therapy may
be beneficial for patients with SBS, although further research is needed to determine
optimal protocols. Patients with SBS, particularly those without a colon, are at high
risk of dehydration; oral rehydration solutions sipped throughout the day can help
maintain hydration. One of the primary goals of SBS therapy is to reduce or
eliminate dependence on PN/IV; optimization of EN and hydration substantially
increases the probability of successful PN/IV weaning.
Citation:
Matarese, Laura E. Nutrition and Fluid Optoimization for Patients With Short Bowel
Syndrome. Journal of Parenteral & Enteral Nutrition. 2012; 37: 161-170.
Calculate Mr. S’s energy and protein requirement post-op (when he is on TPN):
 Energy Requirements: 25-30 Kcal/kg(63.6): 1590-1908 kcal/day
 Protein Requirements: 0.8-1 g/kg(63.6): 50.88-63.6 kcal/day
How will you adjust this requirement when he begins to eat solid food (assume SBS).
What will you monitor to determine if this is correct?
I will measure his Albumin, Prealbumin, CRP, Hgb, Hct, and Vitamin D levels. I will
also monitor his weight, and make sure he is gaining his weight back in a healthy manor.
Also, it is important to monitor if his symptoms have dismissed, or if they are returning.
 Energy: 35-40 kcal/kg(63.6)
o 35 kcal * 63.6 = 2,226 kcal/day
o 40 kcal * 63.6 = 2,544 kcal/day
o 2,226-2,544 kcal/day
 Protein: 1.5 g/kg
o 1.5g * 63.6 kg = 95.4 g/kg
Select one nutrition problem and write two PES statements: one in the clinical domain
and one in the behavioral domain. For each PES statement, establish a goal and
appropriate intervention
PES: Inadequate oral intake R/T loss of appetite/fear of abdominal pain AEB
unintended 25# wt. loss.
Goal: Recommend that Mr. S find a diet that doesn’t make him have abdominal
pain/Chron’s symptoms.
Intervention: Complex Carbohydrates, Low fiber, Lactose free diet, Avoid simple
sugars, restricted fluid with meals.
(Next one on back)

5. PES: Food and nutrition-related knowledge deficit R/T return of abdominal
symptoms AEB diarrhea, malnutrition, and extreme weight loss.
Goal: Recommend that Mr. S changes his diet and practices it strictly. Recommend
that Mr. S get the adequate knowledge about Chron’s disease and SBS.
Intervention: Educate Mr. S about foods to avoid so symptoms do not return as
heavily. Educate Mr. S about proper “treatment” for Chron’s disease and SBS.