LG is a 24-year-old woman who presents with irritable bowel syndrome that began
ID: 137794 • Letter: L
Question
LG is a 24-year-old woman who presents with irritable bowel syndrome that began about 6 months previously following an episode of food poisoning.
Medical Diagnosis by MD: postinfectious irritable bowel syndrome (PI-IBS)
Initial Assessment of LG:
B/P: 115/70
Height: 5’3”
Weight: 112.8 lbs
BMI: 20.0
History:
LG was attending veterinary school in Grenada and had lived there for about 4 months. At the beginning of her second semester, she experienced a severe case of food poisoning. She is not certain of the cause, but suspected that it was jerk chicken purchased from a road-side food stall. She was very sick for about 1 week, and gradually began to feel somewhat better. However, since this acute illness, her GI function has not returned to normal. She complains of alternating diarrhea and constipation, intermittent severe abdominal cramps, and has no appetite. As a result of her symptoms, LG has lost about 7 lbs in the past 6 months. Due to these chronic symptoms, LG was forced to leave school and return home for better treatment.
Before this episode of food poisoning, she reports her GI function was normal. Her overall health before going to Grenada was fairly good. However, she notes that she has always been somewhat anxious and believes she has hypoglycemia, although it has never been diagnosed. Symptoms that make her believe she is hypoglycemic are periods of extreme fatigue and/or shakiness. She has passed out on a couple of occasions within the past two years. Lately she has noted increasing frequency of these symptoms, especially shakiness and feeling like she is going to pass out.
Her intake info is featured in the picture-
Medication and Supplements:
hyoscyamine- .375 mg capsule 30-60 minutes before meals
IBgard 3 x’s daily for cramps
Multi-vitamin
Caltrate
Align probiotic
Metamucil as needed
Laboratory Data:
LG had blood work done in Grenada, but results are not available. Blood work since she came home was normal except for mildly elevated liver enzymes and borderline anemia.
Dietary Intake:
LG has been following an elimination diet which is featured in the pictures given to her by her gastroenterologist.
Questions:
1. What is the major complaint to be addressed with LG?
2. What further information would you elicit? Keep in mind the four types of nutritional assessment- clinical, anthropometric, dietary, and biochemical. Explain your rationale for the assessments you suggest.
3. What is your assessment of the dietary plan LG is following? Do you have any suggested modifications? Explain your rationale for any suggestions you make.
AT&T 8:40 PM LG-Physician Dietary Reco… This is meant to be a general guideline and will vary with each patient If you have CELIAC DISEASE or SPRUE, avoid Wheat, Barley, Rye and their derivatives Y TOLERATED USE CA Oatmeal with berries Pasta Oum Chewing-ep Eggplant Skin Seeds Nuts Rice Fresh PeppeProble Lentil soup Split Pea Soup, Chic Peas ceberg Lettace Fish, Shrimp Stewed trnder meat Egg Yogur Homemade Chicken Soup Cole Slw Chamomile Teas Honey De Olive Oi Avecado Angle Food Cake Cuoumber Skin Potato Skin Sunflowr seeds Fried Foods Popoom Onion ChipCole Slaw Snapple, Gatorade High Fructose Symup Cold Cuts Strwwberries, Blueberrits Homemade Vegetable Soup Waffles, Pancakes Mashed Potatoes Baby LeafRed Leaf lettuce Small pieces of cooked carots,celery, zuochini with rice, pasta and couscous HINTS: Chew well nd eat slowly 6 small meals a day Use ehewable Vitamins and rinkluids in-between Recommended Calium Intake Menstruating women: 1200 mg/day Postmenopausal wosen that are not on estrogen 1500 mgday meals Also recommended: Vitamin D 400 mgiday Normal healthy maleis: 1000- 1200 mg/day Food log Probiotic Qike Fiber Medication aspreseribed h Blood work 0 Colonoscopy Endosoopy Stool tests for ro 1 of 1 30 Dashboard Calendar To Do Notifications InboxExplanation / Answer
1. What is the major complaint to be addressed with LG?
LG has to achieve normal bowel function.
The major complaints are occasional diarrhoea or constipation and anxiety. The problem of anxiety can be managed by regular counselling sessions and diversion therapy. The anxiety also adds to the bowel irritation.
2. What further information would you elicit? Keep in mind the four types of nutritional assessment- clinical, anthropometric, dietary, and biochemical. Explain your rationale for the assessments you suggest.
Dietary and Biochemical assessment can be done to assess the condition further. Any nutritional risks can be identified.
Dietary assessment can find out the foods she is consuming and any disparities between required and actual intake.
It can provide a typical meal and food pattern information and that can be used as a base for further planning.
The dietary assessment includes:
a. Diet Record:
The client’s record of all food and beverages consumed over three consecutive days usually two weekdays and one weekend day, using a portion-size guide.
b. 24-Hour Recall: Client is advised to report all foods and beverages consumed in the past 24 hours.
c. Food Frequency Questionnaire (FFQ): Frequency of usage of certain food and beverage items over a specific period of time (typically 1 year).
The Biochemical assessment can suggest the physiological changes occurred due to the problem. The deficiencies in Serum protein, particularly albumin level, The blood-forming nutrients: iron, folacin, vitamin B6, and vitamin B12, Water-soluble vitamins: thiamine, riboflavin, niacin, and vitamin C, The fat-soluble vitamins: A, D, E, and K, Minerals: iron, iodine and other trace elements, Levels of blood lipids such as cholesterol and triglycerides, glucose and various enzymes which are implicated in heart disease are usually identified.
The nutritional assessment can assess the impact of the disease on LG’s health and the care plan can be modified accordingly.
3. What is your assessment of the dietary plan LG is following? Do you have any suggested modifications? Explain your rationale for any suggestions you make.
As she is on the elimination diet she can avoid the non-vegetarian foods as the primary cause was believed to be the meat.
She can depend upon a bland diet for a few days as this will provide some rest to the GI system and regains its healthy functioning.
Avoiding raw foods can help in digestion.
Increase the intake of fluids like fresh fruit juices without added sugar, homemade soups etc. to improve the nutritional status and counteract fatigue.
Avoidance of the irritating foods like spices, alcohol, caffeinated beverages, dairy product is suggestible.
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