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Madeleine Holloway Tjan Friday section 1. Bowels are inflamed. Unknown causes.

. An agent triggers inflammation in the bowls 2. Similarities: Symptoms of Crohns disease and ulcerative colitis are similar both are from relatively unknown causes. Differences: UC is limited to the colon, Crohns can occur anywhere from the mouth to the anus, Crohns there are healthy parts of the intestine in between inflamed portions while UC is continuous inflammation of the colon. 4. Diarrhea, low body wt - %UBW = 83% -- indicates malnutrition, thin, apparent distress 5. Musculoskeletal manifestations, osteoporosis, dermatological manifestations. Ocular manifestations - pt has no hx of these symptoms, but has fever (indication of inflammation) and abdominal distention 6. Corticosteroids: powerful anti-inflammatory drugs, mesalamine; antiinflammatory and immunosuppressant , Humira: TNF inhibitor and downregulates the inflammatory response to autoimmune disease 7. Elevated CRP indicates inflammation 8. Vitamins and minerals are not being properly absorbed with food, excreted 9. Short bowl syndromes: bowl that is less than 100 cm., and nutrients are not properly absorbed because large part of SI is missing. No, because he has more than 100 cm of bowl 13. Malnutrition 14. 400 cm before sx, the SI is adaptable to change will known in 6 weeks the status of the absorption of the SI, and in 6 months it will be definitive 15. Most major nutrients are absorbed in the SI!! Large intestine: water, electrolytes, biosalts 16. %UBW: 83%, BMI: 20.7 17. 2000-2200 kCal/day 30 - 35 kCal/kg 18. 76-96 g/day 1.2-1.5 g/kg 19. Hg and Hct low, Transferrin (protein storage) low , CRP high, Micronutrients: Copper, Zinc, Selenium, Magnesium 20. Malnutrition R/T Crohns disease AEB %UBW and SGA (B)

Madeleine Holloway Tjan Friday section Low protein status R/T inadequate protein intake AEB negative N balance (-7.6). 23. YES 26. Ratio should be between .7-1. .7 = fats, .8 = protein, 1 = CHO .88 = utilizing mixed fuel, ideally this is a good zone Metabolic carts = data is the GOLD STANDARD 30. Giving 86.7 g protein in PN solution 85 mL/hr x 24 hrs = 2040 mLs 2040 mL /x = 1000 mL /42.5 g = 86.7 g protein 86.7 g of protein / 6.25 g = 13.8 g N2 18. 4 g N2 out (from lab) So . . . 13.3 18.4 + ( 3 fudge factor) = (- 7.6 ) negative N balance * fudge factor* - insensible losses (sweat, ect) This means he needs MORE PROTEIN 32. Continue vitamin and mineral supplementation Increase protein status: check prealbumin (2x a week) Return to normal wt achieve goal of 100% UBW Nutrition concerns = proper absorption