Question

STUDY Patient with Short Bowel Syndrome Judi Morel is a 30-year-old economist with an 8-year history of Crohn's disease. Judi is 5 feet 7 inches tall. Nearly 3 years ago, she underwent a small bowel resection and remained free of active dis- ease for 2 years. During that time, her symptoms subsided; she was able to tolerate most foods without any problem and gained weight. Ten months ago, Judi experienced a severe flare-up of her Crohn's disease. Since that time, she has lost 15 pounds and currently weighs 118 pounds. She has experienced severe abdominal pain and fatigue that have persisted despite aggressive medical management that included intravenous nutrition, Five days ago, Judi underwent another resection, which left her with 40 percent of healthy small intestine. Her colon is intact. She is experiencing extensive diarrhea. 1. Describe the manifestations of Crohn's disease, and explain why surgery is sometimes performed as part of the treatment. Describe the complications of disease that may affert nutrient needs. 2. Using the BMI table in the back of the book, check the ide weight range for a person of Judi's height. What nutrition related concerns are suggested by Judi's recent weight What other nutrition problems did Judi probably experience as a consequence of Crohn's disease? 3. Discuss the complications that may follow an extensive in tinal resection. What factors may affect a person's ability to meet nutrient needs with an oral diet? 4. Describe the dietary progression recommended after an extensive intestinal resection. After Judi is able to eat solid foods, what factors may affect the type of diet that is recom mended for her?

Answer 1

Short bowel syndrome is described as the functional small intestine being small is unable to absorb the nutritional requirements leading to Dehydration, malnutrition and weightloss.

1. Crohn's disease is an inflammatory bowel disease caused due to idiopathic pathology leading to chronic inflammation of any part of the digestive tract commonly causing inflammation of the small intestine.

Surgery is at times Is the preferred method of treatment in the below cases:

1. Incase of cancerous lesions- people suffering with Crohn's disease are at a high risk of cancerous growth in colon. So it's better to respect it to prevent development of cancer.

2. Incase of ineffectiveness of medication- some medications during course of time become ineffective towards the disease. In such cases only method for control of disease is surgery.

3. Complications- there are a number of complications arising due to chronic inflammatory state such as Bowel abscess, bowel perforation, peritonitis, toxic megacolon, fistula formation in bowel etc. Such complications can cause medical emergency which can also be fatal. To avoid such complications also surgery is indicated.

Complications of Crohn's disease which affect the nutrition are as follows

A. Malabsorption - due to the inflammatory stage of the disease, the nutrition cannot be easily absorbed by the body leading to massive malnutrition.

B. Diarrhea - when Crohn's disease is affecting the small intestine, it causes massive diarrhea leading to severe undernourishment.

C. Nutritional deficiency- due inflammatory stage and diarrhoea, the body is unable to absorb adequate nutritional components necessary for body leading to anemia, vitamin deficiencies, osteoporosis.

D. Inadequate weight - these individuals will never be able to maintain normal weight due to undernourishment and also lead to physical and development delay especially among children.

2. Judith's height is 5 feet 7 inches and weight is 118 pounds.

As per BMI chart, Judith weight should be between 120-155 ponds.

Nutritional concerns that can affect Judith is malabsorption, extensive diarrhoea, malabsorption, nutritional deficiency and inadequate weight .

3. Since she has again undergone resection of the small intestine, she might have Bleeding, frequent diarrhea, dehiscence, incisional hernia, pus formation and stricture in small intestine and short bowel syndrome manifested by bloating, Heartburn, fatigue, Lactose intolerance and foul smelling stools.

Factors affecting the persons ability to meet nutrition through oral diet is Inability to consume food due to head or neck trauma or injury or surgery, Prolonged anorexia, severe protein energy malnutrition, Coma or depressed sensorium, liver failure, stress causing increasing metabolic needs such as burns and non-functional GI tract.

4. Dietary recommendation after surgery Includes the following:

A. Small frequent diet around 6-8 meals per day which should be eaten slowly and chewed well. Don't drink fluids or water in between your food intake.

B. High protein, low fibre and moderate fat and low sugar diet should be consumed. People with illeum resection should also take low oxalate diet.

C. Cooked well- any vegetables that are to be eaten raw may exert burden upon the digestive tract to work more. All vegetables and other food items should be cooked very well for easy break down.

D. Reduce intake of meat and animal source- digestion of meat may be burdensome to diseased colon. Its better to avoid immediately after surgery and to be taken in small portions after recovery.

E. Vitamins and mineral supplements- supplements or foods containing the micronutrients should be included in diet or may cause deficiency. Diarrhoea may cause sodium and potassium loss which should be replaced. Some may also be advised for Oral Rehydration Therapy to prevent Dehydration.

After starting to eat solid foods factors that may hinder as are follows:

1. Type of food- cooked foods is preferred than raw food. Peeled fruits are preferred than whole fruit. Semi solid or solid soft diets are preferred which are easy to be digested.

2. Refined foods or low fibre diet is preferred- fibre adds to bulk and which my pass through the GI tract quickly leading to inadequate absorption.

3. Type of cooking - spicy, fried, greesy and salted foods are not preferred as they might cause irritation to the GI tract.

4. Citrus fruits should be avoided as it may irritate the GI tract.