Case Scenario: RD is a 29 yo F admitted with intractable diarrhea…
Case Scenario:
RD is a 29 yo F admitted with intractable diarrhea and abdominal pain. She has a PMH of Crohn’s disease and has had two previous resections of the small bowel. She frequently has pain in the RLQ after eating. She claims the pain often gets so bad that she is afraid to eat and has been progressively consuming below her caloric needs. She currently takes Asacol and Lomotil to manage the symptoms of Crohn’s disease. After undergoing a colonoscopy, an obstruction resulting from stricture in the terminal ileum was discovered. Emergency surgery was performed to remove the obstruction and a resection was done with the remaining intestine. RD’s gastroenterologist recommends bowel rest and expects her to have a full recovery.
HT: 5’4″ WT: 110# UBW: 122#
Diet: NPO Meds: Asacol, Lomotil
Alb. 2.7 Pre-Alb. 17
Na: 138 Cl: 98 BUN: 5
Glucose: 80
K: 3.6 CO2: 25 Cr: 0.8
Nutrition Care Questions:
What is a common complication of Crohn’s disease that may require surgery?
Which type of medication would most likely be prescribed for RD during the acute phase of Crohn’s disease?
RD’s frequent diarrhea most likely puts her at risk of which nutrient deficiency?
Which condition would most likely place RD at risk of folate deficiency?
Which types of foods would the nutritionist suggest for RD in rehabilitation during a period of remission?
Solution
The emergence of intestinal strictures is a typical Crohn’s disease consequence that may call for surgery. This happens as a result of inflammation that causes the intestinal wall to thicken, narrowing the lumen and obstructing the gut. In the case of RD, she needed immediate surgery to clear a blockage brought on by a stricture in the terminal ileum and to perform a resection.
The drug most likely to be administered for RD during the acute stage of Crohn’s disease is lomotil. Lomotil, an antidiarrheal drug, works by slowing down the intestine’s motion, which lowers the frequency of bowel movements and enhances the stool’s consistency.
Due to her recurrent diarrhoea, RD is probably at danger of having an electrolyte and mineral deficiency, specifically a potassium, sodium, and magnesium deficiency. Dehydration and electrolyte imbalances can result from diarrhea’s excessive loss of fluids and electrolytes.
RD is at risk for a folate deficit due to a history of small bowel resection. Because folate is absorbed in the small intestine, any damage to this region may result in folate malabsorption.
The nutritionist would advise RD to have a well-balanced diet that includes a variety of nutrient-dense meals while undergoing rehabilitation in a time of remission. Lean meats, whole grains, fruits, and vegetables should all be a part of this. things that are heavy in fat, fibre, or spices should be avoided by RD since they may make her symptoms worse. Instead, she should try to eat things that are simple to digest. To make sure that RD is getting all the nutrients she needs each day, the nutritionist could also suggest a multivitamin or mineral supplement.
