Question

1. Describe the pathophysiology of inflammatory bowel disease (IBD) by comparing Crohn's disease and ulcerative colitis.

2. Medically, what is recommended for the treatment of IBD?

3. What are the potential nutritional consequences of IBD?

4. Describe common nutrition therapy recommendations for IBD.

Answer 1

PATHOPHYSIOLOGY Crohn's disease Crohn disease begins with crypt us flammation and abscesses, which progress to ting focal aphthoid ulcers. These mucosal lesions may develop into deep longitudinal and transverse ulcers with intervening mucosal edema, creating a characteristic cobblestoned appearance to the bowel The common site of involvement is terminal ileum & night side of colon. Transmural spread of inflammation leads to lymphedema & thickening of the bowel wall and mesentry . Mesentric lymph nodes often enlarge Ulcerative colitis. - common site is rectum & a part of sigmoid colos. The inflammation caused by ulcerative colitis affects the mucosa and submucosa , & there is a sharp bades between namal & affected tissue only in severe disease is the muscularis involved. Lange mucosal ulcers with copious pueulent enudate characterize severe disease, Islands of relatively normal or hyperplastic Enflammatory mucosa project above areas of ulcerated mucosa. Fistulas and abscesses do not occur.

Features Macroscopic Site of involvement Type of involvement Ulcerative colitis Common site is rectum and a part of sigmoid colon Continuous with no skip areas Crohn's disease (regional ileitis) Common site is terminal ileum and right side of colon Discontinuous lesions, 'skip' areas present Deep, nonhaemorrhagic 'Cobblestone' appearance (deep ulcer with intervening oedematous thickened mucosa) characteristic Ulcers in intestines Appearance of intestinal mucosa Superficial and haemorrhagic Polyps and pseudopolyps present Ulceration, stricture and fistula-in-ano Common Uncommon Microscopic Inflammation Lesions Crypt abscesses Goblet cells population Width of mucosa Transmural Noncaseating granulomas Infrequent Normal Normal or increased Mucosal and submucosal Granulomas absent Frequent Loss of goblet cells Normal or reduced

2. Treatment of IBD usually involves eitha deug therapy or & suegery. Dengtherapy - Anti-inflammatory deugs - Immune system suppressors. - Antibiotics fa treating infections - Anti- diarrheal medications - dron supplements Calciumt vit D supplementi Surgery - Renoval of affected pations.

3. Potential nutritional consequences of IBD - Patients with IBD develop a relatine reduction in lean mass and increase in adiposity over time. This may occur due to chronically poor dietary intake increased rates of protein tuen over and gut loss of nutrients during phases of active disease or from the effect of disease treatments. Common nutritional theray recommendatiuus tor IBD • A diet rich in fruits & vegetables, lich in N-3 fatty auds and low in N-6 fatty ands is alcommended • Calories - calore needs are only slightly increased. • Protein - protein requirement is increased in active IBD, and intake should be increased to tz-159 (to 1.2-1.5 g kg ld in adults) • Adequate amounts of theids & electrolytes should be taken. Astandard multivitamins with minerals can be taken. each day. Increased risk of defeciencies of specific mutrients should be treated with an additional amount of those nutrients d e