Crohn’s Disease is a chronic condition grouped under Inflammatory Bowel Diseases (IBD) which causes inflammation of the gastrointestinal tract especially at the beginning of the colon and the end of the ileum. It can also affect the entire thickness of the bowel wall. This disease is usually manifested in symptoms such as: persistent diarrhoea, rectal bleeding, urgent need to move bowels, altered taste sensation, loss of appetite, sweating at nightime, fever, loss of appetite, sensation of incomplete evacuation of stool, constipation and in women, loss of normal menses (Greenstein p.400).
Apart from medication, the disease is also treated by surgery. About 90% of Cronh’s Disease patients require surgery as part of the treatment process in order to improve their quality of life. The point of surgery comes along when a patient develops a fistula, a fissure or an intestinal obstruction. Also, surgery is usually performed when the medication alone cannot control the symptoms. The procedure depends on the severity of the illness, the reason for surgery and the location along the gastrointestinal tract. It is performed by removing the diseased segment of the bowel (resection). After this, the two ends of healthy bowel are joined together in a process known as anastomosis (Greenstein p.403).
This disease has complications that may affect the nutrient needs of the patient. They include such symptoms as loss of appetite which is accompanied by increased body’s energy needs, especially during flare ups of the disease. Persistent diarrhoea renders the body unable of absorbing nutrients into the bloodstream. Loss of appetite denies the patient from consuming healthy foods essential for a good nutritional status while diarrhoea results in the inability of the patient to absorb nutrients into the blood stream and eventually, the patient becomes undernourished (Cherney p.2).
After an extensive intestinal resection a in Judi’s case, nutritional management should start early to prevent life threatening complications. It starts with a parenteral nutrition support where the patient has a catheter connected to a large blood vessel and nutrients are directly supplied to the bloodstream. However, this is stopped after sometime as it comes with its own complications. Non-parenteral nutrition support is initiated until intestinal readaptation occurs (Greenstein p.410). However, for some patients, solid food may not be introduced that fast in order to improve the quality of life. When Judi is able to feed on solid foods after surgery, some of the factors that may affect the type of diet recommended for her include:
The extent of the resection
The extent of diarrhoea occurring.
The symptoms of inflammation upon consuming food
Clinical Applications.
Determine an appropriate carbohydrate intake (in both grams and portions) for a man with Type 2 Diabetes who requires approximately 2600kcalories daily. Assume that he would benefit from a carbohydrate allowance that is 50% of his energy intake.
2600cal × 50/100 (of his energy intake) = 1300kcal of carbohydrates per day
1300kcal of carbohydrates per day/4kcal per gram of carbohydrates = 323g of carbohydrates per day.
He requires 325g of carbohydrates per day.
15g of carbohydrate = 1 serving = 1 carbohydrate portion
323g of carbohydrate/15g per 1 carbohydrate portion = 21.7 carbohydrate portions a day.
Using the food ratios for the different meals of the day as in Table 21.4, we have 6:6:3:7.5:3 for Breakfast : Lunch : Afternoon Snack : Dinner : Evening Snack respectively. Therefore, the carbohydrate allowance (325 g of carbohydrate) for each meal will be divided using these ratios.
Using the carbohydrate containing food groups and sample portion sizes from Table 21.5, a 1 day sample menu for this man would be as follows:
The 18 year old woman with Type 1 Diabetes that needs to know the correct dose of her insulin before her date at an uncertain restaurant can order a specific meal in specific servings which is similar to a common meal she has at home. This will enable her know the exact dosage of insulin she needs before the date.
The 45 year old male with a HbA value of 8.5% can talk to his wife since she handles all the meal preparations such that she can pack him lunch and some snacks to take t work. This way, he will not miss his meals and he can talk to a nutritionist to have an appropriate meal plan prepared for him.
The 75year old man with Type 2 Diabetes and has developed retinopathy may need to have his blood and cholesterol under control and also go for retinopathy screening.
Works Cited
Greenstein A.D. The Extra Intestinal Complications of Crohn’s Disease and Ulcerative Colitis: A Study of 700 patients. The Williams & Wilkins Co. 2010 Print.
Cherney K. Crohn’s Nutrition Guide. Oxford University Press. 2013. Print.
