1. Inflammatory Bowel Disease Case Study
FSHN 450
Honor Pledge: "I have not given, received, or used any unauthorized
assistance."
Alysse Milano

2. Patient’s Value Normal Range Reason for variance
BMI: 20.7 18.5-24.9 Lower due to disease
BP 125/82 120/80 Normal
Albumin 3.2 g/dL 3.5-5 g/dL Low due to
inflammation
Prealbumin 11.0
mg/dL
20-50 mg/dL
Malnutrition
Glucose 82 mg/dL 70-90 mg/dL Normal
Na+ 136 mEq/L 135-145 mEq/L Normal
K+ 3.7 mEq/L 3.5-5.0 mEq/L Normal
Cl- 101 mEq/L 96-106 mEq/L Normal
Creat 1.7 mg/dL 0.6-1.2 mg/dL
BUN 11 mg/dL 7-20 mg/dL Normal
AST 35 U/L 8-48 U/L Normal
ALT 22 U/L 7-55 U/L Normal
Alk Phos 120 U/L 44-147 U/L Normal
CRP 2.8 mg/dL < 1mg/dL Swelling and/or
bleeding of intestines
Cholesterol 149
mg/dL
<200 mg/dL Normal
LDL-C 101 mg/dL
HDL-C 48 mg/dL
<100 mg/dL
<40 mg/dL Normal
Hgb 12.9 g/dL <13 g/dL Normal
Hct 38.9% <38-39% Normal

3. Needs Assessment:
Kcal w/ Harris Benedict (BEE): 66 + 13.7 (63.6 kg) + 5 (175.26 cm) – 6.8 (35) = 1576
Protein: 1.2 (63.6 kg) = 76 g
Fluid: 35 mL/kg/day = 2226 mL
1. It is evident that Mr. S has Crohn’s disease based on both his reported symptoms and
lab results. He has abdominal pain and episodes of diarrhea consistent with Crohn’s
disease. Additionally, his appetite is poor and he has had significant unintended weight
loss. From the lab results, the most obvious detector for Crohn’s is Mr. S’s CRP levels
which are elevated due to sources of inflammation within his body (specifically, chronic
inflammation in the intestines). Mr. S has low values for Vitamin K and pre-albumin
which can be linked to his reported poor appetite within the last month (and can be signs
of malnutrition). Additionally, Mr. S’s white blood cell count is high due to Crohn’s and
the increased need for defense in his body.
2. Overall, malnutrition is a significant issue in patients diagnosed with Crohn’s disease.
As shown in Mr. S’s case, poor appetite and resulting insufficient intake of food results in
nutrient deficiencies. Another major problem in Crohn’s disease is malabsorption since
the inflammation of the gut and overgrowth of bacteria can inhibit appropriate absorption
of nutrients. Loss of fat-soluble vitamins (like Vitamin K, A or D) can also occur in the
case of diarrhea, and specifically steatorrhea.
3. Mr. S was prescribed a low fiber diet after the initial diagnosis because of the potential
for stenosis (narrowing of lumen and resulting blockage of the bowel). In Crohn’s
disease, the intestines are inflamed, and blockages are more common. A diet high in fiber
could ultimately lead to unwanted blockages in the intestines.
4. Ultimately, Mr. S could be a candidate for short bowel syndrome depending upon how
much resectioning occurs in his bowel. The presentation suggest a partial resection will
be done, so I would not be concerned for SBS in Mr. S’s case since the resectioning is
MCV 87 fl 75-98 fl Normal
WBC 11.1 x103 mm
RBC 4.9 x 106 mm
3.8-11.0 x 103 mm
4.2-5.6 x106 mm
Slightly high due to
disease
Normal
Ferritin 16 ng/ml 24-336 ng/mL Not enough iron in
diet
PT 15 sec 11-13.5 seconds Vitamin K deficiency
Vit D 22.7 ng/ml 20-50 ng/mL Normal

4. only partial. However, if 65-75% of the small intestine is removed, and Mr. S’s ileo-
caecal valve is compromised, SBS could be an issue further down the road for Mr. S.
5. If Mr. S were to develop SBS subsequent to surgery, the recommended MNT during
the adaptation period would be an Elemental TPN since these components are broken
down into smaller components. After adaptation occurs, Mr. S should limit fluid intake
with his meals. Since he is allergic to milk, elimination of lactose should not be a
problem for him (lactose free is necessary). His diet should also be low fiber with 35-40
kcal/kg and 1.5 g protein/kg. Supplementation of Ca, Mg, and Zn may be necessary.
According to a meta-analyses conducted by Nguyen, et. al, an elemental formula given
orally over 22 days to 13 patients (with Crohn’s disease) resulted in improvement in
inflammatory indices1 .
6.
Energy Requirement Post-Op: (35-40 kcal/kg) = 2,227-2547 kcal/day
Protein Requirement Post-Op: (1.5 g pro/kg) = ~95 g protein/day
7. These requirements (shown above) for Mr. S differ from his needs once solid food is
incorporated into his diet. His basic needs have been calculated under the heading Needs
Assessment above. However, it will be important for Mr. S to restrict fluid, lactose and
keep his fiber low. Additionally, he may need oral supplements of Ca, Mg, and Zn. To
determine if these energy and protein requirements are correct, it will be important to
monitor Mr. S’s weight (and subsequent weight loss or gain) and any deficiencies in
albumin, electrolytes, or fat-soluble vitamins.
Nutrition Diagnosis (PES Statement): Altered nutrition-related lab values due to
Crohn’s disease as evidenced by low pre-albumin levels showing
malabsorption/malnutrition.
Goal: Establish supportive MNT, with regaining of appetite, to maintain weight and
prevent nutrient deficiencies.
Intervention:
1. Encourage healthy eating: nutrient dense foods, low fiber and lactose free diet.
Nutrition Diagnosis (PES Statement): Food and nutrition-related knowledge deficit
related to diagnosis of Crohn’s disease as evidenced by abscess and acute exacerbation of
Crohn’s disease.
Goal: Mr. S will learn how to achieve the appropriate nutrient/kcal balance in his diet
post-op in order to prevent further weight loss or nutrient deficiencies.
Intervention:

5. 1. Discuss with Mr. S the necessary kcal and protein requirements he needs. Emphasis on
a low fiber, lactose free, liquid restrictive diet should also be made.
References
1. Nguyen DL, Palmer LB, Nguyen ET, McClave SA, Martindale RG, Bechtold ML.
Specialized enteral nutrition therapy in Crohn’s disease patients on maintenance
infliximab therapy: a meta-analysis. Therapeutic Advances in Gastroenterology.
2015;8(4):168-175. doi:10.1177/1756283X15578607.