GI Case Study Questions I. Understanding the Diagnosis and Pathophysiology 1. IBS is considered to be a functional disorder. What does this mean? How does this relate to Mrs. Clarke’s history of having a colonoscopy and her physician’s order for a hydrogen breath test and measurements of anti-tTG? 2. What are the Rome III criteria that were used as part of Dr. Mohammed’s diagnosis? Using the information from Mrs. Clarke’s history and physical, determine how Dr. Mohammed made his diagnosis of IBS. 3. Discuss the primary factors that may be involved in IBS etiology. You must include in your discussion the possible roles of genetics, infection, and serotonin. 4. Mrs. Clarke’s physician prescribed two medications for her IBS. What are they and what is the proposed mechanism of each? She discusses the potential use of Lotronex if these medications do not help. What is this medication and what is its mechanism? Identify any potential drug–nutrient interactions for these medications. II. Understanding the Nutrition Therapy 5. For each of the following foods, outline the possible effect on IBS symptoms. a. lactose b. fructose c. sugar alcohols 6. What is FODMAP? What does the current literature tell us about this intervention? 7. Define the terms prebiotic and probiotic. What does the current research indicate regarding their use for treatment of IBS? What guidance would you give Mrs. Clarke for choosing a probiotic? III. Nutrition Assessment 8. Assess Mrs. Clarke’s weight and BMI. What is her desirable weight? 9. Identify any abnormal laboratory values measured at this clinic visit and explain their significance for the patient with IBS. 10. List Mrs. Clarke’s other medications and identify the rationale for each prescription. 11. Determine Mrs. Clarke’s energy and protein requirements. Be sure to explain what standards you used to make this estimation. 12. Assess Mrs. Clarke’s recent diet history. How does this compare to her estimated energy and protein needs? Identify foods that may potentially aggravate her IBS symptoms. IV. Nutrition Diagnosis 13. Prioritize two nutrition problems and complete the PES statement for each. V. Nutrition Intervention 14. The RD that counsels Mrs. Clarke discusses the use of an elimination diet. How may this be used to treat Mrs. Clarke’s IBS? 15. The RD discusses the use of the FODMAP assessment to identify potential trigger foods. Describe the use of this approach for Mrs. Clarke. How might a food diary help her determine which foods she should avoid? 16. Mrs. Clarke is interested in trying other types of treatment for IBS including acupuncture, herbal supplements, and hypnotherapy. What would you tell her about the use of each of these in IBS? What is the role of the RD in discussing complementary and alternative therapies? VI. Nutrition Monitoring and Evaluation 17. Write an ADIME note for your initial nutrition assessment with your plans for education and follow-up. As you compose your ADIME note, ensure that you are incorporating the below: Identify appropriate components of the nutrition assessment. Calculate energy, protein, and fluid needs for this patient (use the appropriate lecture slides and the EAL for reference) Identify at least two nutrition problems indicated by the assessment and medical history. Next, identify the etiology of each nutrition problem. Write 2 PES statements for the case study (use the eNCPT standardized language for the diagnosis). Document the Nutrition Interventions that address the nutrition diagnosis/problems you identified; set SMART goals related to each intervention. Specify the nutrition prescription for this patient by recommending the appropriate dietary modifications for his diagnosis. Determine nutrition criteria for monitoring and evaluation for each nutrition diagnosis that you identified.