Medical Nutrition Therapy for an

Ulcerative Colitis Exacerbation

Myranda Vig

University of Maryland College Park

11/16/2020
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Table of Contents

Page

I. Executive Summary 2

II. Case Report 3-5

III. Hospital Course of the Patient 6-7

IV. Nutritional Treatment 7-8

V. Case Discussion 9 - 10

VI. Appendices 11 - 14

VII. Glossary 15

VIII. References 16
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Executive Summary

Ulcerative Colitis (UC) is a chronic disease and one of the main types of inflammatory
bowel disease (IBD). With UC and Crohn’s disease being a type of IBD, 1.3% of US adults are
diagnosed with this condition1. A UC flare will cause the lining of the colon or rectum to become
inflamed, developing sores and/or ulcers. Symptoms include anemia, weight loss, loss of
appetite, fatigue, bleeding from the rectum, growth failure in children, rectal pain, urgency to
defecate, fever and sores on the skin. Abdominal pain and blood or pus in stools being the most
common symptoms. Mild to moderate symptoms are seen in most individuals 2.

Different types of UC include Ulcerative Proctitis, Left-Sided Colitis, Proctosigmoiditis,

and Extensive Colitis. In ulcerative proctitis, inflammation is limited to less than 6 inches of the
rectum. Left-sided colitis will cause continuous inflammation from the rectum to the splenic
flexure. Proctosigmoiditis is included in left-sided colitis, causing inflammation front the rectum
to the lower segment of colon. Extensive colitis affects the entire colon, causing inflammation
from the rectum and beyond the splenic flexure3.

The cause of UC is not entirely known. UC may run in families with a 1.6 - 30% chance
of development with a diagnosis of a first degree relative, and can develop at any time, 15 - 30’s
is the most common age when symptoms usually start2. Both men, women and any racial or
ethnic groups are equally affected3. Another possible cause may be an immune system response
malfunctioning to a virus or bacteria, with the immune system attacking the cells in the digestive
tract. Lifestyle factors such as diet and stress may aggravate UC and cause exacerbations. With
UC there are periods of remission, with no symptoms or flares, and this time can vary from
person to person3.

Diagnosis of UC may include laboratory tests of blood and stool, X-rays, sigmoidoscopy,
total colonoscopy, chromoendoscopy, and biopsy. All these tests are used to diagnose UC and
which type, as well the test based on medical history, physical exam, and a variety of medical
tests3. Managing symptoms and regulating the immune system are the main goal in UC due to no
cure. Individuals with UC can live a completely normal life with the use of medications, diet,
and less common surgical interventions to remove affected portions.

Certain foods may aggravate/ trigger symptoms including high fiber, spicy, dairy, and
high fat foods. Focusing on a variety of foods with different types of nutrient profiles are
important to promote healing, replace nutrients, and prevent flare ups. Malnutrition is less
common because the flare ups happen in the lining of the large intestines rather than the small
intestines. With malnutrition being less common, it still may be seen in some cases. With sores,
ulcers, abdominal pain, increased bowel movements and bloody stools this may make eating
uncomfortable and painful, leading to decreased intake, nutrient loss, absorption issues, and
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possible malnutrition. Removal of the colon is considered when medical therapy is not
successful. The surgeon will recommend the best options based on an individual basis. Removal
of the entire colon and rectum with an ileostomy, or an internal pouch to preserve the bowel
integrity may be considered3.

Case Report

General Information:
XX, a 19 year old Hispanic female previously admitted 4 times in the last year, was admitted
from the emergency room on 11/16/2020 with symptoms of significant diarrhea, vomiting and
generalized body weakness for 1 week with a diagnosis of Ulcerative Colitis (UC) exacerbation.
The patient was discharged home on 11/22/20.
Social History:
XX is neither working or attending school; she lives with her parents in a single story home with
no siblings. Patient denies alcohol, illicit drugs or tobacco use. Patient is currently uninsured
with a Medicaid application pending since the last admission on 11/2020.

Medical/Surgical Data:
Past Medical and Surgical History
Patient has a past medical history of ulcerative colitis originally diagnosed in 2019 with 15 total
hospital admissions for flare – ups including 4 in 2020. She has microcytic, hypochromic anemia
suspected secondary to ulcerative colitis. Has received multiple outpatient blood transfusions.
Patient receives Remicade injection every 2 months (last infusion October 1st). Previously on
sulfasalazine and steroids but failed and switched to Remicade. Patient has received 2 - 3
infusions every 8 weeks, with symptoms starting around 6 weeks.

Admitting Exam
Blood pressure of 97/47 (hypotensive), rapid heart rate/pulse (consistent with tachycardia) with
normal temperature and respiration rate. History and Physical noted a very tired appearance, a
soft abdomen and no edema with h/o intermittent nausea and vomiting for 1 month.

Procedures
Blood Transfusion: 11/17/2020
Colonoscopy procedure on 11/19//2020.

Medications and Lab Results

See appendix for a list of home and in-house medications and laboratory results.

Diagnostic Tests
- Computerized Tomography Scan (CT Scan) 11/16/2020: Demonstrated diffuse
thickening of the entirely of her colon
- Colonoscopy 11/19/2020: Ulcerative colitis with extensive pseudopolyp formation with
associated swelling and edema
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- C. Diff 11/19/2020: Negative

Food Allergies and Intolerances

None Reported

Nutritional History from Initial Encounter:

Diet history
Patient, with a history of (h/o) multiple hospitalizations for UC since diagnosis, reported
decreased appetite and intake for 1 month prior to admission (PTA) due to nausea and vomiting.
She indicated tolerating small portions of fruit and eggs with no intake of fried, greasy, dairy or
spicy foods. The patient noted prior consumption of Ensure Clears and Ensure Enlive to improve
intake and being familiar with “a healthy diet for ulcerative colitis”; prior education included low
fiber and low-fat diet intake. The patient reported about a 30# unintended weight loss in the past
6 months; her goal weight was not determined, but the patient did not indicate she wanted to
regain all of the weight she had lost.

Weight history

Date Weight BMI comments

12/23/19 85 kg (187 #) 33.1 Measured on admission

3/22/20 72.8 kg (160.0 #) 28.3 Measured at hospital

6/19/20 72.8 kg (160#) Measured at hospital

UBW reported of 68.1
kg (150 #)

10/31/20 58.8 kg (129.3 #) 22.9 Measured on admission

11/18/20 62.2 kg (136#) 24.1 Measured on

admission
UBW reported of 68.1
kg (150 #)
TOTAL WEIGHT 51 lb (26%) Significant weight
LOSS in 1 year loss

Height - 5’3”
UBW – reported - 68.1 kg (150 #)
IBW (Hamwi) - 52.2 kg (115#).
Admitting weight as percentage of IBW – 119%
BMI calculation - https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
Physical activity level
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No information was available from the chart or the patient on physical activity pta. Given the
degree of anemia as well as statements (frequent episodes of diarrhea) at admission – it is
presumed that the patient had not been involved in significant cardiovascular activity pta.

Nutrition Focused Physical Examination (NFPE). Despite unintended weight loss, the patient
appeared well-nourished with no signs of fat or muscle loss with a BMI that was within normal
limits. NFPE was not indicated by facility standards.

Estimated Nutrient Needs

Source Kcal requirements Protein Fluid requirements

requirements

Facility standards 1555 - 1870 kcal/day 74 - 93 g/day 1555 - 1870 mL/day

(25 - 30 kcal/kg) (1.2 - 1.5 g/kg) (1 mL/kcal)
EAL N/A N/A N/A

Other Evidence - 1617 - 1866 kcal/day 62 - 93 g/day N/A

based Source** (26 - 30 kcal/kg) (1-1.5 g/kg)

Online Nutrition 1555 - 2180 kcal/day 62 - 93 g/day N/A

Care Manual (25-35 kcal/kg) (1-1.5 g/kg)

Other evidence-based source:

https://www.crohnscolitisfoundation.org/sites/default/files/legacy/science-and-
professionals/nutrition-resource-/nutrition-fact-sheet-for.pdf

Other Factors Influencing Intake

Pt was taking an iron supplement prior to admission. No information about cultural food intake
was obtained as patient felt too ill to provide a more detailed diet recall and intake.

Hospital Course of the Patient

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Day 1 (11/16/2020). Vital signs (temperature-wnl, pulse 100/tachycardia, respiration rate

12/wnl, blood pressure - 97/47). Patient admitted feeling extremely weak with nausea and
vomiting; dehydration secondary to fluid loss noted. Abdomen soft, nontender, bowel sounds
(BS) present in 4Q, no organomegaly. Emergency CT of abdomen/pelvis with contrast
completed. Fluid repletion included rapid 2L IV infusion (.9NS) followed by IV fluid at 100
mL/hr (.9NS) with lactic acid levels being checked every 6 hours as Remicade use is associated
with development of lactic acidosis. Relevant medications: IV Solu-Medrol (40 mg) IV every 6
hours, iron supplement and calcium gluconate. Stool output: Watery diarrhea with blood in it.
Emesis of ingested material, unable to keep anything down. Diet: NPO; Oral Intake: nothing.

Day 2 (11/17/2020). Vital signs (temperature-wnl, pulse 91/nl, respiration rate 20/nl, blood
pressure - 92/52); patient reported no nausea, vomiting or abdominal pain but was weak and
sick-looking per physician. Abdomen was soft and nontender with BS active. Gastrointestinal
(GI) consult indicated continued rehydration with consideration of possible colectomy. IVF
hydration increased to 150 mL/hour; IV Solu-Medrol changed from TID to QID. Physician goal
was too replete with IV calcium, potassium, and magnesium. Patient was transfused with 2 units
of PRBC; GI prophylaxis medications were added. Stool output: None reported. Diet: Updated to
clear liquid diet and tolerating well. Oral Intake: 50 - 75% of clear liquids.

Day 3 (11/18/2020). Vital signs (Stable); patient reported feeling tired and in some pain. GI:
Soft, nontender, non-distended abdomen. Colonoscopy ordered for tomorrow with Bowel prep
(Golytely) started. Medications; Continued steroids and Proton pump inhibitor (PPI) drugs; oral
potassium added in addition to IV potassium in IV fluids. IVF (.9NS) at 150 mL/hour was
infused. Stool output: 1 liquid movement, with small amounts of blood. Diet: Clear liquid diet,
NPO after midnight. Oral intake: 50 - 75% of clear liquids.

Day 4 (11/19/2020). Vital signs (Stable); patient denies abdominal pain, nausea, vomiting, and
diarrhea. Positive BS. Continued with IV steroids, and replacement electrolytes. Colonoscopy
findings included extensive pseudopolyp formation with swelling and edema especially on the
left side of the colon extending up to the mid ascending colon. Multiple biopsies were obtained
from the ascending colon from transverse colon and the sigmoid colon. Diet: NPO prior to
procedure then advanced to GI soft diet with lactose restriction. IV fluid input .9NS at 100
mL/hour. Oral intake: No intake NPO.

Day 5 (11/20/2020). Vital signs (Stable); patient denies nausea, vomiting, diarrhea and
abdominal pain. GI: Soft, nontender, non-distended abdomen. Surgery consult found no
indication for emergent surgical colectomy, but in future might be necessary if medical
management fails. Medications: IV steroids changed to oral steroids, vitamin D initiated (for low
ionized calcium levels). IV hydration (.9NS) at 150 mL/hr. continued with calcium gluconate,
and electrolyte replacement as needed. Diet: GI soft diet with lactose restriction. Oral Intake:
75% of GI soft diet. Stool output: 1 bowel movement, no blood.

Day 6 (11/21/2020). Vital signs (Stable); patient reported no nausea, vomiting, or diarrhea and
asking to go home. GI: Abdomen soft, nontender, mildly distended. Medications: oral steroids,
daily iron, vitamin D, multivitamin, electrolyte replacement, Remicade infusion initiated with
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continued infusions every 6 weeks. Discharge planning: l follow up with GI, and colorectal
surgery. Diet: GI soft, lactose restriction. Oral Intake: 75% of GI soft diet. Stool output: 1 bowel
movement, no blood.

Day 7 (11/22/2020). Vital signs (Stable); patient with no abdominal pain, or blood in stool. GI:
Abdomen soft, nondistended, appropriately tender. Medication: Remicade infusion, oral steroids,
iron, vitamin D, multivitamin, electrolyte replacement as needed. Patient discharged to home.
Stool output: 1 bowel movement, no blood.

Nutritional Treatment

Nutrition Assessment. Medical Diagnosis: Referral for decreased appetite/wt. change. Found
to have ulcerative colitis exacerbation.
Age: 19 years old Labs:
Gender: Female Na: 124 L
Weight: 136 lbs. (62.2 kg) K: 2.2 L
Ideal Body Weight: 115 lbs. (52.2 kg) BUN: 30 H
Usual Body Weight: 187 lbs. (85 kg) - Cr: 1.27 L
12/21/19 Ca: 5.6 L
Height: 5’3” (160 cm)
BMI: 24.3 kg/m2 Medications:
% IBW: 118% Dulcolax, Ferrous Sulfate, Methylprednisolone,
% UBW: 73% Protonix, Polyethylene Glycol, KCl (40 mEq
% Weight loss: 26% in 1 year per day),
NS @125 mL/hr.
PMH
Ulcerative Colitis, Iron deficiency Anemia

Symptoms
Diarrhea, vomiting, nausea, decreased Current Diet
appetite, weight loss Clear liquids, NPO 11/19 for procedure

Diet History
Consumes no fried, greasy, dairy, or spicy
foods at home. Patient has had past
education on low fiber and low-fat diet.
No known food allergies
Nutrition Diagnosis – utilize PES Statements
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Severe protein-calorie malnutrition in the context of chronic illness related to inadequate

energy intake 2/2 altered GI function as evidenced by meeting <75% estimated energy needs
for at least the past month and 26% weight loss over the past year, current NPO status, and
meeting <50% of estimated nutrient needs for x 5 days.
Nutrition Intervention – Nutrition prescription, Interventions with goals

Nutrition Prescription: Intervention with goals

Estimated Energy: 1555 - 1870 kcal/day
(25 - 30 kcal/kg)
Estimated Protein: 74 - 93 g/day
(1.2 - 1.5 g/kg)
Estimated Fluid: 1 mL/kcal
Nutrition Monitoring and Evaluation
1) Meals and Snacks: Advance to GI soft
diet once medically able
2) Medical Food Supplement: Add Ensure
Clear once daily (Mixed Berry - per pt)
3) Coordination of Care: Replete lytes as
needed

Indicator Criteria
1) Amount po 1) Diet advanced; >75% of estimated
2) GI energy needs met by follow up
3) Electrolytes 2) N/V continues to improve
3) WNL

Present Nutritional Therapy

Date Diet

11/16 NPO

11/17 Clear Liquid Diet

11/18 Clear Liquid Diet

11/19 NPO

11/20 GI Soft Diet with lactose restriction

11/21 GI Soft Diet with lactose restriction

11/22 Discharge Diet: Regular

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Case Discussion

Medical Considerations

The large intestine (colon) along with the mouth, esophagus, stomach, small intestine and rectum
make up the digestive tract. The large intestines include: the cecum, ascending colon, transverse
colon, descending colon, and sigmoid colon. Approximately 5 feet long and responsible for
processing indigestible food material after absorption of most nutrients takes place in the small
intestine4. The large intestine absorbs water, vitamins, and electrolytes while also forming and
driving feces for elimination. In the case of Ulcerative Colitis (UC), an inflammatory disorder
that falls under inflammatory bowel disease (IBD), inflammation and ulcers develop along the
large intestine affecting the normal function.

The pathophysiology of UC is not fully understood; development of UC may be influenced by

environmental factors such as diet, abnormal immune response, microbiome, and genetics 3.
Under normal conditions an immune response to fight an infection or illness would cause
temporary inflammation that eventually clears away. Persons with UC experience prolonged
inflammation with white blood cells accumulating in the large intestine resulting in the
development of ulcers, along with chronic inflammation3. Symptoms include diarrhea,
abdominal pain, blood in stool, extra intestinal manifestations, nutritional deficiencies,
malnutrition, and delays in growth for children5. Diagnosis involves medical history, physical
exam, and a series of medical tests such as blood test, fecal matter test, x-rays, endoscopy and
biopsy3.

Men and women are equally affected with a higher prevalence of IBD in North America, central
and northern Europe, including Scotland; incidences are increasing in countries adopting
Western type lifestyle diet factors5. A diagnosis of UC can be treated with medications and
regular doctor visits while maintaining the same life expectancy as individuals without the
diagnosis.

UC has no known cure and involves periods of remission with periods of flare ups or
exacerbation. These periods of flare ups may lead to escalation of therapy, hospitalization, and/or
a colectomy in severe cases6. Treatment involves reducing symptoms, achieving remission,
preventing complications such as infection, possible surgery, and improving the patient’s quality
of life. The extent of the disease, inflammation severity, and the patient’s preferences, cost and
comorbidities are all factors when deciding treatment options. In the past medical therapy was
limited to corticosteroids, but more medication options are expanding. Current medications
include mesalamine, corticosteroids, azathioprine, anti-tumor necrosis factor 𝛼 agents, and Janus
kinase inhibitors7. Etrasimod, an oral sphingosine 1-phosphate receptor modulator is in
development for immune mediated inflammatory disorders that may be used to treat UC 7.
Although XX received corticosteroids and saw improvement, many patients still experience
adverse effects signaling a need for additional therapies. XX diet upon advancement was lactose
restricted which has been recommended in the UC population after a flare up. Studies have
shown that restricting lactose had similar relapse rates compared to children on a normal diet,
indicating further need for UC dietary studies6.
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Nutritional Therapy

Similar to most patients experiencing UC flare ups, XX experienced loss of appetite, weight loss,
low energy, nausea, diarrhea, and vomiting during her UC exacerbations. As a result, XX
experienced significant weight loss in the last year. The weight loss was related to the symptoms
of UC resulting in overall poor energy intake. XX reported poor appetite for 1 month leading to
admission and tolerating small portions of fruit and eggs. While in remission XX still avoids
fried, greasy, spicy, and dairy foods while trying to focus on salads and rice while at home. XX
had prior UC diet education regarding low-fat and low fiber foods to limit inflammation. The
patient did not consume oral nutrition supplements at home as the patient did not like the taste.

Upon admission, XX received suboptimal nutrition for four days due to NPO status and diet
upgrade to clear liquid. Once the diet advanced to clear liquids, XX consumed Ensure clear once
daily for added nutrition support. NPO and clear liquid diet status was indicated due to the need
for bowel rest and colonoscopy procedure. As well, XX experienced poor appetite due to nausea
and was given Zofran to help. After the colonoscopy XX diet advanced to GI soft with lactose
restriction for two days.

The Nutrition Care Manual recommends limiting fiber when experiencing inflammation,
diarrhea, abdominal pain, or taking prednisone. It’s also recommended to consume small meals
or snacks every 3 – 4 hours, with protein included in every meal. Once inflammation is mild and
no longer taking prednisone, whole grains and a variety of fruits and vegetables may be added
into the diet slowly8. The Crohn’s and Colitis foundation lists the following as possible triggers
for UC flare ups: “insoluble fibers (that are hard to digest), lactose, non-absorbable sugars,
sugary foods, high fat foods, alcohol or caffeinated beverages and spicy foods'' 9. This may
explain why XX had been instructed during flare ups in the past to adhere to a low fat, low fiber
diet. WebMD suggests that in a non-flair state the consumption of high fiber foods may be
helpful if only to assist in forming “more firm” stools with a goal of 20-30gm/day, if tolerated10.
This site also promotes consumption of fish oil, flaxseed oil as well as probiotic supplements. It
is also recommended to be tested for lactose tolerance in a stable, non-flare up state as many
persons will still tolerate some lactose – that allows a diet to be less restrictive. Since XX has
had so many flare ups of disease she may not have gotten the point of being able to eat what is
recommended when UC is stable.

XX reported following this diet at home and being familiar with what foods were and were not
tolerated. XX tolerated diet advancement of GI soft diet with lactose restriction and was
upgraded to regular diet on day of discharge. XX reported improved appetite, abdominal pain,
nausea, and vomiting with no diarrhea or bloody stool.

Implications of Findings to the practice of Dietetics

Some UC patients may be at increased risk for malnutrition due to poor absorption of vitamins,
and poor intake resulting from UC symptoms and flare ups. A Registered Dietitian is a crucial
part of the care team in providing proper diet education for the patient during times of flare ups
and times of remission. Properly discussing reintroducing or eliminating foods is critical for
improved remission rates.
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Appendices

Lab Reference Range 11/16 11/17 11/18 11/19 11/20 11/21 11/22

Na 135-145 mEq/L 129 130 124 135 137

K 3.5-5.0 mEq/L 3.4 2.4 2.2 3.3 3.5

Cl 95-105 mEq/L 92 101 97 111 113

CO2 23-30 mmol/L 24 16 17 20 23

BUN 7-18 mg/dL 27 26 30 17 11

Creatinine 0.51-1.10 mg/dL 2.90 1.51 1.27 0.69 .48

Glucose 70 - 125 115 76 111 76 132

mg/dL(fasting)

Calcium 8.5-10.2 mg/dL 5.3 4.7 5.6 6.9 6.6

(total) (lab raised
error?) to 6.7

Ionized 4.8 - 5.6 mg/dL - 5.4 - 7.6 7.3

Calcium
(calculated)

Magnesium 1.2-2.2 mg/dL - 1.1 - 1.8 -

Phosphorous 2.5-4.5 mg/dL - - 4.30 - -

AST 0-35 U/L - 34 - 81 56

ALT 0-35 U/L - 21 - 43 33

Bilirubin 0.3-1.2 mg/dL - .70 - .30 .40

Albumin 3.5-5.5 g/dL - 1 - 1.2 1.4

RBC 4.2-5.9 3.82 2.78 - 3.93 -

HCT 41%-51% 29.2% 21.4% 32.8% 31.5% 28%

HGB 13-17 g/dL 9.5 6.9 10.9 10.2 8.9

MCV 80-100 fL 76.4 77 - 80.2 -

MCH 28-32 pg 24.9 24.8 - 26 -

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WBC 4.5-11x109 /L 23.24 17.71 - - 13.17 - 10.18

Adjusted calcium (mmol/L) = Total calcium (mmol/L) + 0.02 [40 – serum albumin
(g/L)]. – source: https://www.aacc.org/cln/articles/2019/june/ionized-versus-albumin-adjusted-total-
calcium#:~:text=To%20overcome%20this%2C%20various%20nomograms,albumin%20(g%2FL)%5D.

PTA Medications

Medication Name Dosage Medical function Nutrition Side

effect

Remicade, IV 5 mg/kg, Every 2 TNF alpha/ tumor Headache, stomach

months necrosis factor pain, nausea
blocker that reduces
inflammation given
in moderate to
severe ulcerative
colitis

Slow Fe 1 Tablet, PO, Daily Iron supplement or Upset stomach,

replacement dark stools,
constipation,
heartburn

Inpatient Medications

Medication Name Dosage Date(s) of Medical Nutrition Side Effect

Administration Function

Ca Gluconate + 1 Gm 10 mL, 11/16, 11/18 Electrolyte In excess: polyuria,

NS IVPB, Once replacement polydipsia, stomach
pain

Feosol GEq 325 mg Tab, 11/16-22 Treats iron Upset stomach, dark
PO Daily deficiency stools, constipation,
anemia heartburn

Mg Sulfate + 2 Gm, IVPB, 11/16 Electrolyte Diarrhea

Premixed in Once replacement
sterile water

SOLU-Medrol 40 mg 1 mL, IV 11/16-19 IV steroid

PUsh, Q8h

Potassium 10 mEq 100 11/16-18 Potassium

Chloride mL, IVPB, Q2h repletion
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NS 1000 mL, IV, 11/16-17, 11/20- Rehydration

150 mL/hr 21

Tylenol 650 mg 2 Tab, 11/16-18, 11/21- Pain and fever NA

PO Q6h 22 reduction

Zofran 4 mg 2 mL, IV 11/16-18,11/21 Antiemetic Diarrhea

Push, Q6h

Dulcolax 5 mg 1 Tab, PO 11/17 laxative Abdominal cramps,

Q1H nausea, diarrhea

Protonix 40 mg 1 Tab 11/17-22 Proton pump

PO Daily inhibitor

Golytely 4,000 mL, PO, 11/17-18 Colostomy prep

Once

K-Lor 40 mEq 2 11/17 Potassium

Packet, PO Q4h replacement

KCl SR 20 mEq 40 mEq 2 Tab, 11/20-21 Potassium

PO Once replacement

Prednisone 40 mg 2 Tab, 11/20-22 Oral steroid Glucose intolerance,

PO fluid retention,
increased
susceptibility to
infection, increased
appetite

Ca Carbonate 500 mg 1 Tab 11/21-22 Calcium

replacement

Vitamin D 50,000 unit 1 11/21-22 vitamin

cap

Remicade 622 mg, IVPB, 11/21-22 TNF alpha/ Headache, stomach

once tumor necrosis pain, nausea
factor blocker
that reduces
inflammation
given in
moderate to
severe ulcerative
colitis

Fentanyl 25 mcg .5mL, 11/21 IV opioid pain

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IV Push Q5min medicine

Labetalol 2.5 mg .5 mL, 11/19 Antihypertensive Taste changes, nausea,

IV Push vomiting, dyspepsia

Morphine 2 mg 1 mL, IV 11/19 Pain relief Nausea, vomiting,

Push Q5min constipation,
decreased gastric
motility, diarrhea,
dysphagia, dry mouth

Percocet 1 Tab Q4h 11/19,11/21 Pain medication

– combination of
opioid and
nonopioid drugs
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Glossary

Biopsy: An examination of tissue removed from a living body to discover the presence, cause or
extent of a disease.
Bowel prep: Cleansing the colon before colonoscopy, involves taking medication that causes
frequent, loose bowel movement to empty the colon.
Chromoendoscopy: Endoscopic technique that uses stains during endoscopy to highlight
differences in mucosa, as well as dysplastic and malignant changes that are not apparent in white
light.
Crohn’s Disease: Type of inflammatory bowel disease. It causes inflammation of your digestive
tract in different areas for different people, which can lead to abdominal pain, severe diarrhea,
fatigue, weight loss and malnutrition.
Colonoscopy: Exam used to detect changes or abnormalities in the large intestines and rectum.
CT Scan: Combines a series of X-ray images taken from different angles around your body and
uses computer processing to create cross-sectional images of the bone, blood vessels and soft
tissue inside your body.
Irritable Bowel Disease: Term used for Chron’s Disease and Ulcerative Colitis, characterized
by chronic inflammation of the gastrointestinal tract.
Pseudopolyps: Projecting masses of scar tissue that develop from granulation tissue during the
healing phase in repeated cycle of ulceration.
Sigmoidoscopy: Test that looks at the rectum and lower part of the intestine.
Ulcerative Colitis Exacerbation: Worsening or increase in severity of ulcerative colitis and its
signs and symptoms.
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References

1. Centers for Disease Control and Prevention. Data and statistics, 2020.
www.cdc.gov/ibd/data-statistics.htm. Accessed February 13, 2021.
2. U.S. National Library of Medicine. Ulcerative colitis, 2020.
https://medlineplus.gov/ulcerativecolitis.html. Accessed February 13, 2021.
3. Crohns and Colitis Foundation. Overview of ulcerative colitis.
https://www.crohnscolitisfoundation.org/what-is-ulcerative-colitis/overview.
Accessed February 13, 2021.
4. Azzouz LL, Sharma S. Physiology, large intestine. In: StatPearls. 2020.
5. Gkikas K, Gerasimidis K, Milling S, Ijaz UZ, Hansen R, Russell RK. Dietary strategies
for maintenance of clinical remission in inflammatory bowel diseases: are we
there yet. J. Nutrients. 2020; 12.
6. Kayal M, Shah S. Ulcerative colitis: current and emerging treatment strategies. J Clin.
Med. 2019; 94(9).
7. Sandborn WJ, Peyrin-Biroulet L, Zhang J, Chiorean M, Vermeire S, et al. Efficacy and
Safety of etrasimod in a phase 2 randomized trial of patients with ulcerative
Colitis. J. Gastro. 2020; 158:550-561.
8. Nutrition Care Manual. Inflammatory bowel disease (IBD): Chron’s disease and
ulcerative colitis nutrition therapy.
https://www.nutritioncaremanual.org/client_ed.cfm?ncm_client_ed_id=181.
Accessed February 13, 2021.
9. Crohns and Colitis Foundation. What should I eat, 2021.
https://www.crohnscolitisfoundation.org/diet-and-nutrition/what-should-i-eat.
Accessed April 25, 2021.
10. Pathak N. UC and nutrition: What is your diet missing, 2020.
https://www.webmd.com/ibd-crohns-disease/ulcerative-colitis/uc-nutrition.
Accessed April 25, 2021.