Question

Inflammatory Bowel Disease: Ulcerative Colitis (UC) case study

Name: Ahmad                        Ward: surgical 12                   Room: 6 bed 2

Age: 24 years                          Physician: Jamal Khaled (unit C)

Diagnosis: Left-sided Ulcerative Colitis relapse with toxic megacolon. inflammation is presented in rectum up through the sigmoid and descending colon. He suffers from severe bloody diarrhea. Signs of Pulmonary Hypertension (PH) is presented too.

Medical history:

Ahmad is 24 years old Kuwaiti male diagnosed with inflammatory bowel syndrome (IBS) ten years ago. In the beginning X-ray was done and did not show any problem. In that time, he suffered from bloating, abdomen pain, cramping, rectal pain and fatigue. And it was getting worse with time. After two months he was diagnosed with ulcerative colitis by using colonoscopy, Flexible sigmoidoscopy, Montreal classification system (clinical, endoscopy and biopsy) and perinuclear antineutrophil cytoplasmic autoantibodies (pANCA). He had a long-time remission from the disease (just 2 times admitted with a relapse in last 10 years).

Now the Pt is reporting left side abdomen pain, bloody diarrhea, urgency and chest pain. He stopped taking his medication for 3 weeks (when he was traveling and forgot his medication bag). Simultaneously eczema was shown all over his body. Also, he complains of joins and bone pain. After his graduation from college he suffered from panic attacks, depression and suicidal thoughts. After few months he consulted a psychologist and prescribe medications to control his situation.

Finding: Sigmoidoscopy and radiography showed destruction and swelling of the mucosa and inflammation of the rectum, sigmoid and descending colon. The stool culture showed high level of Cal, Lf.

Medication plan:         Depo-Medrol 40mg/ml (increase it to 80mg/ml if needed), Dipentum (500mg), Imuran (2.5 mg/kg), Lomotil (20mgX2/day), flagyl (250 mg) and actinexl and Mutaflor (2 tablets/day) .

Surgical consult:          No signs for bowel obstruction

Tobacco use:               yes (electronic hookah)
Alcohol use:                No
Family history:            Identical twin with Crohn’s; mother (IBS) and father (hypertension)

Marital status:                         Single

Education:                   Unemployed (just graduated from college)
Occupation:                 -

Vital signs:

BP:                              162/97

Pulse:                           110

Temperature:               39.5 ^OC

Hight:                          180 cm

Current weight:           62 kg

Usual weight:              57 kg

Physical examination:

Abdomen:                   Abnormal bowel sound

Chest/lungs:                Shortness of breath (dyspnea), fatigue, dizziness

Skin:                            Pale and peripheral edema (+2)

Stool:                           Bloody diarrhea with mucus

Hair:                            hair loss

Biochemical tests results:

Chemistry                               H: high         L: low
Glucose (mg/dL)	141 H
Protein (g/dL)	5.2 L
Albumin (g/dL)	3.3 L
Prealbumin (mg/dL)	15 L
Alkaline phosphatase (U/L)	119
ALT (U/L)	21
AST (U/L)	22
C-reactive protein (mg/dL)	22 H
Hematology
WBC (3 103/mm3)	11.1 H
RBC (3 106/mm3)	3 L
Hemoglobin (Hgb, g/dL)	12.9 L
Hematocrit (Hct, %)	38 L
MCV	71 L
MCH	26 L
Platelet	278
Ferritin (ng/mL)	17 L
Iron (μg/dL)	62 L
Vitamin B12 (ng/L)	132 L
Folate (ng/dL)	15 L
Zinc, serum (μg/mL)	55 L
Vitamin D, 25 hydroxy (ng/mL)	19 L
Free retinol (μg/dL)	17.2 L
Ascorbic acid (mg/dL)	0.1 L
Stool culture
Calprotectin (Cal)	>200 µg/g (+ve)
Lactoferrin (LF)	(+ve)

Dietary intake:

He reported that he suffer from abdomen pain from some fresh fruits, vegetables, onions and carbonated beverages. So, he changed his diet in the last year. He follows ovo-vegetarian diet. But now he avoids eating initially to reduces pain and diarrhea. After his college graduation he quit the gym and lost his muscles mass.

Usual diet:

Breakfast: 2 egg + +1 whole wheat bread + 1 cup green smoothie

Snack: Green tea

Lunch: 1 cup white rice + vegetable suttee

Snack: Herbal tea +3 dates

Dinner: 1 fruit

24hours recall:

Nothing

Answer the following questions:

1. Plan a suitable diet for Ahmad to relief the symptoms of the disease and cover his needs.

Answer 1

Breakfast: 1cup of oatmeal with raisin, walnuts, and almonds
1 boiled egg
Snack: 1/2canned fruit
Lunch: 1/2mashed potatoes, 1 bowl white rice
  1/2 bowl cooked plain cereals
Snack: 1/2 bowl apple sauce
1 cranberry banana bread
1tsp of mayonnaise
Dinner: 1 bowl of scrambled egg noodles
1/2 bowl mixed green salad including spinach, carrot, and beans
Ovo vegetarian diet include only vegetables, fruits, legumes, beans and grains, all seeds, spices and fresh herbs, egg, mayonnaise, and baked foods. The patient following only Ovo vegetarian diet but having pain with fresh fruits, onions, and carbonated beverages.
Patient having inflammatory bowel disease, so patients need to include an IBD diet that should allows their Ovo vegetarianism and avoid pain and fulfill their nutritional needs.