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Crohn's Disease Nut Ax and Mgt (Biochem (Vitamin B12/Folate,…
Crohn's Disease Nut Ax and Mgt
Diagnosis
CAT scan / MRI
Biochemical markers
Montreal Classification
Colonoscopy (biopsy)
Classification of Extent
Uses the Montreal classification
E1
Procitis
Limited to rectum (proximal extent is distal to rectosigmoid junction)
E3
Extensive UC
Involvement extends proximal to splenic flexure (includes pancolitis)
E2
Left sided UC
Limited to portion of colorectum distal to splenic flexure
Anthro
Wt
Ht
BMI
Wt Hx
Biochem
Vitamin B12/Folate
Electrolytes
Vitamin D & Ca
Iron
CRP
Client Hx
Medical hx
Medications
Disease Status
Personal hx
Smoking/alcohol
Age
Social hx
Cooking/shopping
Employment
Living sit
PA/recreation
Nutritional Goals
Symptom mgt
Identify and address any malabsorption
Improve/maintain nutrition status
Wt stable
EER 100-125kJ/kg/d
EPR 1.2-1.5g/kg/d
If malnourished
EER 125-145kJ/kg/d
EPR 1.2-1.5g/kg/d
Look for disordered eating patterns
Address fad diets/avoidance foods
Diet Hx
EEI, EPI, EFI
Fluid Intake
Food restrictions/avoidances
Meal patterns
Dietary Interventions
During remission
Investigate IBS symptoms
Bile salt malabsorption
May require low fibre diet if strictures
B12 Levels
Address fad diets
Normal diet aiming for healthy wt
Expand over restricted diets
During flare up
Replace deficiencies
Keep hydrated
Small frequent meals
Low fibre diet
HPHE
Consider EN if malnourished/ inadequate EI
ONS
Definition
Can involve any part of GI predominantly in areas of:
Colon
Ileum (esp terminal)
May lead to fistula/stricture formation
Illeocolonic
Inflammation of
transmural
lining of GI (full thickness)
Classification
Montreal