IBD/Lower GI Case Study

Gastrointestinal DisorderA 29 y/o Jewish F was admitted to the hospital with severe abdominal pain, h/o wt loss for no apparent reason (15# over the last 6 mos.) and diarrhea. Colonoscopy and Barium Enema identify segmental deep ulcerations located at the distal ileum and proximal ascending colon. Thickened red mucosa was also found interspersed with normal mucosa throughout the duodenum. The patient is also complaining of immobility due to stiffness. The pt. was started on metronidazole and prednisone.

Admission Labs:

Na+ 143

Cl- 104

K+ 3.5

BUN 5.0

MCV 106.0

Albumin 2.5

Prealbumin 7

Blood Sugar 160

Quantitative fat test 8 gms/24 hours

1) Given all the information above, what disease or syndrome do you feel that the patient has and be specific?

2) Since the pts. disease is active, what is the probable cause of the immobility?

3) Is there a “gold standard” that can be used to identify the level of the patient’s disease of syndrome activity? If so, what is it called?

4) Is this pt. diabetic? If no, then why is her blood sugar increased?

5) What biochemical parameter may indicate that a deficiency of a vitamin or mineral may already be present? What vitamin or mineral would you supplement this pt with?

6) Based on her Prednisone regimen, what substrates may have to be increased/decreased and why? Circle an arrow below that best represents you answer and justify you response.

CHO ↑ or ↓

PRO ↑ or ↓

FAT ↑ or ↓

7) Based on the areas of the gastrointestinal tract affected by the disease or syndrome, the absorption of the following may be altered:

a) Substrates:

Duodenum:

Ileum:

b) Vitamins:

Duodenum:

Ileum:

c) Minerals:

Duodenum:

Ileum:

8) The patients Urine Urea Nitrogen result was 28. Pt. was receiving central paraenteral nutrition providing 1825 calories and 80 gms protein. Based on this information, is the pt. in a positive or negative nitrogen balance? (Show work)

a)

b) How many grams of protein would need to be provided in order to provide for +2 → +4 nitrogen balance?

9) Based on the pts. diagnostic workups, what would be the best p.o. diet to have them follow post discharge from the hospital? Why?

10) How would you have assessed the patient’s nutritional status based on visceral protein results and what does the low BUN value indicate to you about the pts. prior to admission diet?