Gastroduodenal Crohn's Disease – Gastrointestinal System Example

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"Gastroduodenal Crohn's Disease"  is a good example of a paper no the gastrointestinal system.   Gastroduodenal Crohn's Disease is one of the archetypes of idiopathic inflammation of the bowel disease. Even though Crohn’ s disease affects inflammation of the gastrointestinal tract through the mouth to the anus, the most common include proximal colon and ileum while duodenum and stomach are rarely affected. Gastroduodenal Crohn’ s disease also exhibits certain clinical signs that are unusual thus call for different diagnostic and treatments including surgical, medical and endoscopic. This paper presents a case of an old man with gastroduodenal Crohn's disease, nutritional assessment and common medications that may be used to treat the patient’ s condition The Case This is a case of a 43-year-old man who was diagnosed with gastroduodenal Crohn's disease.

In the last 20 years, he had undergone a proctocolectomy with resection of 8 cm of distal ileum and the creation of ileostomy about 8 years ago. The symptoms presented by the client are postprandial fullness, vomiting, and intermittent nausea, mid epigastric, nonradiating abdominal pain and crampy. However, the client exhibited normal ileostomy thus took no medicine. Examination of the upper gastrointestinal tract shows enteral narrowing, duodenal narrowing, especially in the second portion. Dietary Assessment The appropriate method for dietary assessment is determined by the purpose and the target individuals.

However, an appropriate dietary assessment must report all foods consumed by individuals including the quantification, frequency and nutrient content of each one. The assessment of nutrient intake and physical activity levels were compared with national reference values (NRV), Recommended Daily Intake (RDI), Estimated Average Requirement (EAR) and Acceptable Daily Intake (ADI). Weighed food record is a dietary assessment method that involves an individual taking actual weights of foods and drinks prior to their consumption. The records also contain details of eaten foods including full description and the time of consumption.

High-calorie foods have been associated with high-risk factors of obesity, diabetes, atherosclerosis, and cardiovascular diseases especially when not accompanied by appropriate physical activity. In this respect, interventions to mitigate these risk factors are often effective if they are approached in multiple ways which address both physical activity and diet together (McCartney, 2013). The objective of this study is to assess the difference between dietary intake and energy expenditure compared to the National Reference values (NRV). The body fat is mostly being deposited at the lower part of the body of my client.

The determination of waist to hip ratio is important since it helps in predicting abdominal visceral adiposity in men and premenopausal women. Increased waist to hip ratio is an indication of increased visceral adiposity especially when there are no other medical conditions and can be evident even when there are no changes in the body mass index. In this regard, the distribution of more fat on the lower part of the body is not a concern.

As stated by Gibson (2005), the concentration of fat in the upper body or central region is associated with hypertension than when fat is distributed in the lower body. Skinfold is a simple and clear method that is very useful in indicating the overall regional fat distribution in the body. It can easily be used to rate individuals in terms of relative fatness and estimate the approximate size of the subcutaneous fat deposits within the body.

As stated by Barasi (2003), the intra-observer and inter-observer error are minimal, though cannot be used in obese children because of the inaccuracy. The main advantages of skinfold are that it does not require a lot of time, requires noncomplicated skills to use, and not expensive in terms of monetary value. However, skinfold as a method has several disadvantages a well. This method is not useful for individuals who are obese or too lean. It is also important to note that technical sources of errors are common and mostly concerned with the layer of subcutaneous fat underneath the skin. Impedance is a method that uses the principle that the presence of fat would impede the flow of electric current through the body.

As stated by Gibson (2005), since fat is not a good conductor of electricity, fat people will impede more current compared to those who are relatively lean.   The percentage of body fat is estimated by the relative resistance to the flow of current. The advantages are that it is a faster way of estimating fat taking about a minute to complete, can be used from one place to the other easily and require little knowledge for the operator to operate.

However, this method exhibits a higher standard error compared to all the three methods used in this study. This method also tends to underestimate overweight and obese people and overestimate lean people. Body mass index, on the other hand, provides an estimation of the appropriateness of the weight relative to height. This method requires little skills and not invasive to the body compared to the skinfold and thus can be well accepted across the board.

The major disadvantage is that the measurements are based on the overall weight of the body and height yet the bodyweight consists of many other components besides fat. Another disadvantage is that BMI on its own does not measure the fat composition and the general composition of the body, BMI also results to between 5% and 6% error and the last disadvantage is that it merely gives information on the appropriateness of weight in relation to a height which is irrelevant to body composition (McCartney, 2013). A common medication used to treat this condition This is a chronic disease that has no cure but can only be managed through the introduction of medication, dietary and nutritional programs.

In acute conditions, there is the use of treatment and these medications are usually to treat infections that arise or those that help reduce to reduce the inflammation that occurs. Acute treatments of Crohn’ s disease usually require the use of antibiotics and in cases of reduction of inflammation we use anti-inflammatory drugs like the corticosteroids. Medications for symptoms treatments include; prednisone, 5-aminosalicylic acid formulations, methotrexate, adalimumab, immunomodulators like azathioprine, certolizumab, infliximab, and natalizumab.

In cases of a severe attack of the Crohn’ s disease then Hydrocortisone should be administered. On the other hand, rapid acid suppression using a proton pump inhibitor may also be helpful in reducing the strength of the corrosiveness of the acid. In addition, gradual blood loss from the gastrointestinal tract can be controlled by iron supplements such as parenteral iron. Even though the medications: natalizumab, 5 amino-salicylic acid formulations, azathioprine, infliximab, methotrexate which in most cases is used in chemotherapy, certolizumab as well as the hydrocortisone are used, they should only be used in cases of Crohn's attacks that are severe(Longmore et al, 2007).

To treat infection in most instances the antibiotics are administered. These antibiotics are helpful in reducing bacterial infections as well as treating of overgrowth of the bacteria present in the gastrointestinal tract. The most common types of antibiotics prescribed are metronidazole, cephalosporins, ampicillin, sulfonamides,   tetracycline, while uses of corticosteroids such as prednisone as well as aminosalicylate are to manage the inflammations (Joos et al, 2004). There are some of these medicines however have shown to have some side effects while used for a prolonged period.

In case of severe gastrointestinal bleeding nutritional advice on intake of iron-rich foods is given where patients are advised to take small food portions but regularly or more often. There is also a need to increase fluid intake so as to counter the chances of dehydration while there is a need to give a nutrient supplement to the overall well being of the patients. Use of nutritional and herbal medications and possible side effects The use of nutritional diets and herbal medications are highly encouraged in the treatment of the disease since they have minimal side effects.

The herbal/ nutritional that can be administered are good diets, fish oil, and probiotics besides the use of homeopathy in the treatment of Crohn’ s disease. The last option that may be used in the treatment of Crohn’ s disease is by use of bypass surgery with gastrojejunostomy which is used to bypass gastroduodenostomy, stricturoplasty, duodenal stricture, and duodenojejunostomy.

References

Barasi M.E. (2003). Human Nutrition: A Health Perspective (Second Edition). Boca Raton, FL: Taylor and Francis Group.

Gibney M.J., Lanham-New, S.A., Vorster, H, Cassidy, A. (2009). Introduction to Human Nutrition: Second Edition, West Sussex: John Wiley & Sons.

Gibson, R.S., (2005). Principles of Nutritional Assessments: Second Edition, Oxford: Oxford University Press.

McCartney, D., Younger, K., Walsh, J., O'Neill, M., Sheridan, C., & Kearney J. (2013). “Socio-economic differences in food group and nutrient intakes among young women in Ireland.” British Journal Of Nutrition, 110, 11, p. 2084

Longmore, Murray; Ian Wilkinson; Tom Turmezei; Chee Kay Cheung (2007). Oxford Handbook of Clinicial Medicine (7th ed.). Oxford University Press. pp. 266–7

Joos S, Brinkhaus B, Maluche C, Maupai N, Kohnen R, Kraehmer N, Hahn EG, Schuppan D (2004). "Acupuncture and moxibustion in the treatment of active Crohn's disease: a randomized controlled study". Digestion 69 (3): 131–9.

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