Inflammatory Bowel Disease Case Study

1. Inflammatory Bowel Disease Case Study Rachel Lees Specialist Dietitian, HEFT

2. Aims To consider a Patient�s experience of IBD To gain an appreciation of the complexities of IBD & how this can impact on Dietetic input To reflect on the need to be flexible, there are often no absolutes with Dietetic Treatment! To remember we need to deliver Patient centred care

3. Patient Profile NR, a female Asian patient born in 1976 Diagnosed with Crohn�s Disease in 1999 � Thalassemia trait Vegetarian Avoids milk on cereal Height 1.60m, usual weight around 60kg

4. History 1 OP between Nov 02 �Dec 04 Weight 58.6kg, stable Crohn�s active Eating small vegetarian meals regularly +/- Fortisip 1 per day Anaemic, started on Iron. Discussed good sources of Iron in a Vegetarian Diet Advised to have a Colectomy, decided to delay this Drug Rx Methotrexate, Prednisilone, Calcichew D3 Forte Methotrexate - antimetabolite � alters immune functionMethotrexate - antimetabolite � alters immune function

5. History 2 Jan 2005 Admitted 20/1 with L sided abdominal pain & vomiting. Weight 55kg Diagnosis of Crohn�s Colitis +/- Perforation or Abcess Recommenced on supplements Theatre 30/1 for subtotal colectomy + Ileostomy. No evidence of small bowel Crohn�s seen in theatre

6. History 3 7/2/2005 Faecal peritonitis & sepsis Albumin 10, Mg 0.9 Re-laparotomy, abdominal drains ITU for Ventilation NG feeding commenced with Nutrison Protein Plus Complex Entero � Cutaneous Fistulae Diagnosed