{"id":380,"date":"2021-09-26T22:52:01","date_gmt":"2021-09-27T02:52:01","guid":{"rendered":"https:\/\/pressbooks.library.ryerson.ca\/dietmods\/?post_type=chapter&#038;p=380"},"modified":"2025-08-07T13:47:29","modified_gmt":"2025-08-07T17:47:29","slug":"gi_in-background","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/gi_in-background\/","title":{"raw":"Background","rendered":"Background"},"content":{"raw":"<h1>Conditions Covered in this Section<\/h1>\r\nThis \"Background\" section of the Inpatient GI module addresses three main conditions:\r\n<ol>\r\n \t<li>Inflammatory Bowel Disease (IBD)<\/li>\r\n \t<li>Ostomies<\/li>\r\n \t<li>Pancreatitis<\/li>\r\n<\/ol>\r\nAfter reviewing background information, you will be led through the Nutrition Care Process along with a relevant case study to apply your knowledge. The case study will be a complex case focused on IBD and ostomies. A summary of evidence, education, and recommendations will be provided for all topics.\r\n\r\nIt may also be useful to review the first section of the <a href=\"https:\/\/pressbooks.library.ryerson.ca\/dietmods\/chapter\/gi_out-background\/#The_Gastrointestinal_GI_Tract\">Background for Outpatient GI<\/a>, which provides a general overview of GI system components, digestion, and nutrient absorption.\r\n<h1>Inflammatory Bowel Disease (IBD)<\/h1>\r\n<div class=\"page\" data-page-number=\"13\" role=\"region\" aria-label=\"Page 13\" data-loaded=\"true\">\r\n<div class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Inflammatory Bowel Disease (IBD) is an inflammatory condition of the digestive tract, and consists of two main types: <strong>Crohn\u2019s Disease and Ulcerative Colitis<\/strong><\/span><span role=\"presentation\" dir=\"ltr\">. Their similarities and differences will be explored in this section. <\/span><span role=\"presentation\" dir=\"ltr\">Although the specific cause of IBD remains unknown, the main h<\/span><span role=\"presentation\" dir=\"ltr\">ypothesis relates to i<\/span><span role=\"presentation\" dir=\"ltr\">mmune system malfunction and heredity factors. <\/span><\/div>\r\n<div class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\"><strong>\r\nSymptoms<\/strong> may include: <\/span><\/div>\r\n<ul>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Severe diarrhea (with blood and mucus)<\/span><\/li>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Abdominal pain, fatigue<\/span><\/li>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Malabsorption of nutrients<\/span><\/li>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Anemia<\/span><\/li>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Weight loss<\/span><\/li>\r\n<\/ul>\r\n<span role=\"presentation\" dir=\"ltr\">As a result, IBD disrupts the body\u2019s ability to digest food, absorb nutrients and eliminate waste. It is e<\/span><span role=\"presentation\" dir=\"ltr\">stimated that up to <\/span><span role=\"presentation\" dir=\"ltr\">85% of hospitalized IBD patients <\/span><span role=\"presentation\" dir=\"ltr\">have protein energy malnutrition, based on <\/span><span role=\"presentation\" dir=\"ltr\">abnormal anthropometric and biochemical parameters.<\/span>\r\n<div class=\"textLayer\"><span style=\"text-align: initial;font-size: 1em\">\r\nAlthough specific causes of IBD are yet to be discovered, there are <strong>risk factors<\/strong> associated with IBD:<\/span><\/div>\r\n<\/div>\r\n<div>\r\n<ul>\r\n \t<li class=\"textLayer\"><strong><span role=\"presentation\" dir=\"ltr\">Age: <\/span><\/strong><span role=\"presentation\" dir=\"ltr\">Most people who develop IBD are diagnosed before they're 30 years old. Some people don't develop <\/span><span role=\"presentation\" dir=\"ltr\">the disease until their 50s or 60s.<\/span><\/li>\r\n \t<li class=\"textLayer\"><strong><span role=\"presentation\" dir=\"ltr\">Ethnicity: <\/span><\/strong><span role=\"presentation\" dir=\"ltr\">Caucasian\u2019s have the highest risk of the disease; but it can occur in any race. <\/span><\/li>\r\n \t<li class=\"textLayer\"><strong><span role=\"presentation\" dir=\"ltr\">Family history: <\/span><\/strong><span role=\"presentation\" dir=\"ltr\">You're at higher risk if you have a close relative, such as a parent, sibling or child with the <\/span><span role=\"presentation\" dir=\"ltr\">disease.<\/span><\/li>\r\n \t<li class=\"textLayer\"><strong><span role=\"presentation\" dir=\"ltr\">Cigarette smoking: <\/span><\/strong><span role=\"presentation\" dir=\"ltr\">Cigarette smoking is the most important controllable risk factor for developing Crohn's <\/span><span role=\"presentation\" dir=\"ltr\">disease. Although smoking may provide some protection against ulcerative colitis, the overall health benefits <\/span><span role=\"presentation\" dir=\"ltr\">of not smoking make it important to try to quit.<\/span><\/li>\r\n \t<li class=\"textLayer\"><strong><span role=\"presentation\" dir=\"ltr\">Non-Steroidal anti-inflammatory medications (NSAIDs): <\/span><\/strong><span role=\"presentation\" dir=\"ltr\">These include ibuprofen (Advil, Motrin), naproxen sodium <\/span><span role=\"presentation\" dir=\"ltr\">(Aleve), diclofenac sodium (Voltaren) and others. These medications may increase the risk of developing <\/span><span role=\"presentation\" dir=\"ltr\">IBD or worsen disease in people who have IBD.<\/span><\/li>\r\n \t<li class=\"textLayer\"><strong><span role=\"presentation\" dir=\"ltr\">Where you live: <\/span><\/strong><span role=\"presentation\" dir=\"ltr\">If you live in an industrialized country, you're more likely to develop IBD. Therefore, it may <\/span><span role=\"presentation\" dir=\"ltr\">be that environmental factors, including a diet high in fat or refined foods, play a role. People living in <\/span><span role=\"presentation\" dir=\"ltr\">northern climates also seem to be at greater risk.<\/span><\/li>\r\n<\/ul>\r\nSome of these are modifiable risk factors (such as cigarette smoking), while other factors are fixed (such as family history and ethnicity). <span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\"> It is important to note that diet and stress do not <em>cause<\/em> IBD, but still play a role in aggravating symptoms for those diagnosed.<\/span>\r\n\r\n<\/div>\r\n<div class=\"page\" data-page-number=\"14\" role=\"region\" aria-label=\"Page 14\" data-loaded=\"true\">\r\n<h2>Comparing Crohn's Disease and Ulcerative Colitis<\/h2>\r\n<span role=\"presentation\" dir=\"ltr\"><strong>Crohn's Disease<\/strong> is a chronic inflammatory <\/span><span role=\"presentation\" dir=\"ltr\">disease that may involve any area throughout <\/span><span role=\"presentation\" dir=\"ltr\">the entire digestive tract <span>\u2014 <\/span>anywhere from the mouth to the anus. However, it often affects the <\/span><span role=\"presentation\" dir=\"ltr\">terminal ileum within the small intestine. Inflammation can extend <\/span><span role=\"presentation\" dir=\"ltr\">through the entire thickness of the bowel wall, <\/span><span role=\"presentation\" dir=\"ltr\">resulting in diarrhea, [pb_glossary id=\"2444\"]strictures[\/pb_glossary], [pb_glossary id=\"2445\"]anal fissures[\/pb_glossary], <\/span><span role=\"presentation\" dir=\"ltr\">abscesses, and [pb_glossary id=\"2446\"]fistulas[\/pb_glossary].<\/span>\r\n\r\n<span role=\"presentation\" dir=\"ltr\"><strong>Ulcerative Colitis<\/strong> is an inflammatory disease that <\/span><span role=\"presentation\" dir=\"ltr\">begins at the anus and involves the inner <\/span><span role=\"presentation\" dir=\"ltr\">mucosa of the colon.\u00a0 The inflammation does not result in fistulas, although e<\/span><span role=\"presentation\" dir=\"ltr\">xtensive inflammation may require surgery to <\/span><span role=\"presentation\" dir=\"ltr\">remove affected area. Ulcerative proctitis, a <\/span><span role=\"presentation\" dir=\"ltr\">milder form of UC, occurs at a maximum of <\/span><span role=\"presentation\" dir=\"ltr\">20 cm proximal to the anus.<\/span>\r\n<h3><strong>Shared Complications of Crohn's Disease and Ulcerative Colitis\u00a0<\/strong><\/h3>\r\n<span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em;text-align: initial\">Ulcerative colitis and Crohn's disease have some complications in common and others that are specific to <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em;text-align: initial\">each condition.<\/span>\r\n\r\n<span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em;text-align: initial\">Complications found in both conditions may include<\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em;text-align: initial\">:<\/span>\r\n\r\n<\/div>\r\n<ul>\r\n \t<li><strong><span role=\"presentation\" dir=\"ltr\">Colon cancer:<\/span><\/strong><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\"> <\/span><\/span><span role=\"presentation\" dir=\"ltr\">having IBD increases your risk of colon cancer. General colon cancer screening <\/span><span role=\"presentation\" dir=\"ltr\">guidelines for people without IBD call for a colonoscopy every 10 years beginning at age 50. For those <\/span><span role=\"presentation\" dir=\"ltr\">with IBD, this test may need to be done sooner and more frequently.<\/span><br role=\"presentation\" \/><span role=\"presentation\" dir=\"ltr\"><\/span><\/li>\r\n \t<li><strong><span role=\"presentation\" dir=\"ltr\">Skin, eye and joint inflammation:<\/span><\/strong><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\"> <\/span><\/span><span role=\"presentation\" dir=\"ltr\">Certain disorders, including arthritis, skin lesions and eye <\/span><br role=\"presentation\" \/><span role=\"presentation\" dir=\"ltr\">inflammation (uveitis), may occur during IBD flare-ups.<\/span><br role=\"presentation\" \/><span role=\"presentation\" dir=\"ltr\"><\/span><\/li>\r\n \t<li><strong><span role=\"presentation\" dir=\"ltr\">Medication side effects:<\/span><\/strong><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\"> <\/span><\/span><span role=\"presentation\" dir=\"ltr\">Certain medications for IBD are associated with a small risk of developing <\/span><span role=\"presentation\" dir=\"ltr\">certain cancers. Corticosteroids can be associated with a risk of osteoporosis, high blood pressure and <\/span><span role=\"presentation\" dir=\"ltr\">other conditions.<\/span><br role=\"presentation\" \/><span role=\"presentation\" dir=\"ltr\"><\/span><\/li>\r\n \t<li><strong><span role=\"presentation\" dir=\"ltr\">Primary sclerosing cholangitis:<\/span><\/strong><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\"> <\/span><\/span><span role=\"presentation\" dir=\"ltr\">In this condition, inflammation causes scars within the bile ducts, <\/span><span role=\"presentation\" dir=\"ltr\">eventually making them narrow and gradually causing liver damage.<\/span><br role=\"presentation\" \/><span role=\"presentation\" dir=\"ltr\"><\/span><\/li>\r\n \t<li><span role=\"presentation\" dir=\"ltr\"><strong>Blood clots<\/strong>:<\/span><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\"> <\/span><\/span><span role=\"presentation\" dir=\"ltr\">IBD increases the risk of blood clots in veins and arteries.<\/span><\/li>\r\n<\/ul>\r\n<h3><span role=\"presentation\" dir=\"ltr\">Complications of Crohn\u2019s Disease<\/span><\/h3>\r\nThe complications specific to Crohn's disease are related to the deeply-penetrating nature of the inflammation, as well as its ability to affect any spot along the digestive tract. The severity and recurrence of complications is variable.\r\n<ul>\r\n \t<li><strong><span role=\"presentation\" dir=\"ltr\">Bowel obstruction:<\/span><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\"> <\/span><\/span><\/strong><span role=\"presentation\" dir=\"ltr\">Crohn's disease affects the full thickness of the intestinal wall. Over time, parts of the <\/span><span role=\"presentation\" dir=\"ltr\">bowel can thicken and narrow, which may block the flow of digestive contents. Patient\u2019s may require surgery <\/span><span role=\"presentation\" dir=\"ltr\">to remove the diseased portion of the bowel.<\/span><\/li>\r\n \t<li><strong><span role=\"presentation\" dir=\"ltr\">Malnutrition:<\/span><\/strong><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\"> <\/span><\/span><span role=\"presentation\" dir=\"ltr\">Diarrhea, abdominal pain and cramping may make it difficult to eat or for the intestine to absorb <\/span><span role=\"presentation\" dir=\"ltr\">enough nutrients to keep the patient nourished. It's also common to develop anemia due to low iron or <\/span><span role=\"presentation\" dir=\"ltr\">vitamin B12 caused by the disease.<\/span><\/li>\r\n \t<li><strong><span role=\"presentation\" dir=\"ltr\">Ulcers:<\/span><\/strong><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\"> <\/span><\/span><span role=\"presentation\" dir=\"ltr\">Chronic inflammation can lead to open sores (ulcers) anywhere in the digestive tract, including the <\/span><span role=\"presentation\" dir=\"ltr\">mouth and anus, and in the genital area (perineum).<\/span><\/li>\r\n \t<li><strong><span role=\"presentation\" dir=\"ltr\">Fistulas:<\/span><\/strong><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\"> <\/span><\/span><span role=\"presentation\" dir=\"ltr\">Sometimes ulcers can extend completely through the intestinal wall, creating a fistula \u2014 an <\/span><span role=\"presentation\" dir=\"ltr\">abnormal connection between different body parts. Fistulas near or around the anal area (perianal) are the <\/span><span role=\"presentation\" dir=\"ltr\">most common kind. In some cases, a fistula may become infected and form an abscess.<\/span><\/li>\r\n \t<li><strong><span role=\"presentation\" dir=\"ltr\">Anal fissure:<\/span><\/strong><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\"> <\/span><\/span><span role=\"presentation\" dir=\"ltr\">This is a small tear in the tissue that lines the anus or in the skin around the anus where <\/span><span role=\"presentation\" dir=\"ltr\">infections can occur. It's often associated with painful bowel movements and may lead to a perianal fistula.<\/span><\/li>\r\n<\/ul>\r\n[caption id=\"attachment_1824\" align=\"aligncenter\" width=\"362\"]<img src=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/art13_f1-300x168.jpeg\" alt=\"Two ulcers on the labial mucosa of the upper lip\" width=\"362\" height=\"203\" class=\"wp-image-1824 \" \/> Two ulcers on the labial mucosa of the upper lip. Photo by <a href=\"https:\/\/www.scielo.cl\/scielo.php?script=sci_arttext&amp;pid=S0718-381X2016000300013\">Universidad de La Frontera<\/a> , <a href=\"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/deed.en\">CC BY-NC 4.0<\/a>[\/caption]\r\n\r\n&nbsp;\r\n<h3>Complications of Ulcerative Colitis<\/h3>\r\nUlcerative Colitis may appear to have fewer complications than Crohn's, but it is important to remember that the inflammation may still require surgery, ultimately affecting nutrient absorption and increasing malnutrition risk. These complications can be life-threatening if not addressed.\r\n<div class=\"page\" data-page-number=\"19\" role=\"region\" aria-label=\"Page 19\" data-loaded=\"true\">\r\n<ul>\r\n \t<li><strong><span role=\"presentation\" dir=\"ltr\">Toxic megacolon:<\/span><\/strong><span role=\"presentation\" dir=\"ltr\">Ulcerative colitis may cause the colon to rapidly widen and swell, a serious condition <\/span><span role=\"presentation\" dir=\"ltr\">known as toxic megacolon.<\/span><\/li>\r\n \t<li><strong><span role=\"presentation\" dir=\"ltr\">Severe dehydration:<\/span><\/strong><span role=\"presentation\" dir=\"ltr\">Excessive diarrhea can result in dehydration<\/span><\/li>\r\n<\/ul>\r\n<\/div>\r\n&nbsp;\r\n\r\n<strong>Complications Summary Table\u00a0<\/strong>\r\n<table class=\"grid\" style=\"border-collapse: collapse;width: 100%;height: 221px\" border=\"0\">\r\n<tbody>\r\n<tr style=\"height: 17px\">\r\n<td style=\"width: 33.3333%;height: 17px;text-align: left\"><strong>Complication\u00a0<\/strong><\/td>\r\n<td style=\"width: 33.3333%;height: 17px;text-align: left\"><strong>Crohn's Disease<\/strong><\/td>\r\n<td style=\"width: 33.3333%;height: 17px;text-align: left\"><strong>Ulcerative Colitis\u00a0<\/strong><\/td>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<td style=\"width: 33.3333%;height: 17px\">Colon cancer<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<td style=\"width: 33.3333%;height: 17px\">Skin, eye, and joint inflammation<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<td style=\"width: 33.3333%;height: 17px\">Medication side effects<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<td style=\"width: 33.3333%;height: 17px\">Primary sclerosing cholangitis<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<td style=\"width: 33.3333%;height: 17px\">Blood clots<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<td style=\"width: 33.3333%;height: 17px\">Bowel obstruction<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\"><\/td>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<td style=\"width: 33.3333%;height: 17px\">Malnutrition<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\"><\/td>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<td style=\"width: 33.3333%;height: 17px\">Ulcers<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\"><\/td>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<td style=\"width: 33.3333%;height: 17px\">Fistulas<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\"><\/td>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<td style=\"width: 33.3333%;height: 17px\">Anal fissures<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\"><\/td>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<td style=\"width: 33.3333%;height: 17px\">Toxic megacolon<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\"><\/td>\r\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<td style=\"width: 33.3333%;height: 17px\">Severe Dehydration<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\"><\/td>\r\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"page\" data-page-number=\"20\" role=\"region\" aria-label=\"Page 20\" data-loaded=\"true\">\r\n<h2 class=\"textLayer\">Factors Altering Nutritional Status<\/h2>\r\nThere are many factors that can impact an individual's nutrition status in IBD. They may increase someone's risk of malnutrition, affect their ability to access or prepare food, and change their anthropometric data.\r\n\r\nReview the following factors and identify which are more closely related to Crohn's, Ulcerative Colitis, or both.\r\n<div class=\"page\" data-page-number=\"20\" role=\"region\" aria-label=\"Page 20\" data-loaded=\"true\">\r\n<ul>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Decreased nutrient intake <\/span><\/li>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Severe diarrhea <\/span><\/li>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Blood in stool <\/span><\/li>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Abdominal pain and cramping <\/span><\/li>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Fatigue<\/span><\/li>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Weight loss <\/span><\/li>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Nausea and vomiting <\/span><\/li>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Restrictive diets <\/span><\/li>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Side effects of medications (appetite suppression, taste alterations)<\/span><\/li>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Mouth sores <\/span><\/li>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Increased needs for healing (protein, vitamins and minerals)<\/span><\/li>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Malabsorption <\/span><\/li>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Surgical resections<\/span><\/li>\r\n<\/ul>\r\n<h2>Treatment Options<\/h2>\r\nTreatment for IBD falls into two main categories: medications and surgery. Drugs are primarily used to manage symptoms of IBD and reduce inflammation, the most common of which are explored in the \"Medications\" section below. Crohn's disease is more likely to require surgical treatment, with around 70% of individuals affected undergoing ileostomy or bowel resection (removal of parts of the intestine that are damaged from inflammation). The complications of each GI surgery are listed in the \"Surgery\" section below.\r\n\r\n<\/div>\r\n<\/div>\r\n<h3>Medications<\/h3>\r\nThe tables below provide an overview of medications used to reduce inflammation and manage symptoms of patients with IBD.\r\n<table class=\"grid\" style=\"border-collapse: collapse;width: 100%;height: 606px\" border=\"0\"><caption>Medications used for reducing inflammation in patients with IBD<\/caption>\r\n<tbody>\r\n<tr style=\"height: 17px\">\r\n<th style=\"width: 16.8186%;height: 17px\" scope=\"col\">Medications<\/th>\r\n<th style=\"width: 49.848%;height: 17px\" scope=\"col\">General Explanation<\/th>\r\n<th style=\"width: 33.3333%;height: 17px\" scope=\"col\">Examples<\/th>\r\n<\/tr>\r\n<tr style=\"height: 123px\">\r\n<th style=\"width: 16.8186%;height: 123px\" scope=\"row\">Sulfasalazine and 5-Aminosalicylates (5-ASA)<\/th>\r\n<td style=\"width: 49.848%;height: 123px\">These drugs limit the production of certain chemicals that trigger inflammation. This medicine is generally prescribed to help combat\u00a0<strong>milder attacks<\/strong> of Crohn's or UC.<\/td>\r\n<td style=\"width: 33.3333%;height: 123px\">Mesalamines, Sulfazine<\/td>\r\n<\/tr>\r\n<tr style=\"height: 87px\">\r\n<th style=\"width: 16.8186%;height: 87px\" scope=\"row\">Steroids<\/th>\r\n<td style=\"width: 49.848%;height: 87px\">Steroids aim to reduce inflammation. These drugs are used by patients who have <strong>moderate to severe\u00a0<\/strong>attacks.<\/td>\r\n<td style=\"width: 33.3333%;height: 87px\">Prednisone, Hydrocortisone<\/td>\r\n<\/tr>\r\n<tr style=\"height: 158px\">\r\n<th style=\"width: 16.8186%;height: 158px\" scope=\"row\">Immunomodulators<\/th>\r\n<td style=\"width: 49.848%;height: 158px\">This type of medicine alters how the body mounts an inflammatory response. Immunomodulators do supress the ability to fight infections in general. These drugs are used by patients who have\u00a0<strong>moderate to severe\u00a0<\/strong>attacks.<\/td>\r\n<td style=\"width: 33.3333%;height: 158px\">Methotrexate<\/td>\r\n<\/tr>\r\n<tr style=\"height: 151px\">\r\n<th style=\"width: 16.8186%;height: 151px\" scope=\"row\">Biologics<\/th>\r\n<td style=\"width: 49.848%;height: 151px\">These drugs target and block molecules involved in inflammation. These drugs are used to combat\u00a0<strong>moderate to severe\u00a0<\/strong>attacks.<\/td>\r\n<td style=\"width: 33.3333%;height: 151px\">Adalimumab (Humira)\r\n\r\nInfliximab (Remicase, Inflectra)\r\n\r\nVedolizumab (Entyvio)\r\n\r\nUstekinumab (Sterlara)<\/td>\r\n<\/tr>\r\n<tr style=\"height: 70px\">\r\n<th style=\"width: 16.8186%;height: 70px\" scope=\"row\">Antibiotics<\/th>\r\n<td style=\"width: 49.848%;height: 70px\">Antibiotics do not counteract inflammation directly but decrease infection that can cause severe inflammation.<\/td>\r\n<td style=\"width: 33.3333%;height: 70px\">Ciprofloxacin, Metronidazole<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n&nbsp;\r\n<table class=\"grid\" style=\"border-collapse: collapse;width: 100%;height: 329px\" border=\"0\"><caption>Medications used for managing symptoms in patients with IBD<\/caption>\r\n<tbody>\r\n<tr style=\"height: 15px\">\r\n<th style=\"width: 15.8055%;height: 15px\" scope=\"col\">Medications<\/th>\r\n<th style=\"width: 50.8611%;height: 15px\" scope=\"col\">General Explanation<\/th>\r\n<th style=\"width: 33.3333%;height: 15px\" scope=\"col\">Examples<\/th>\r\n<\/tr>\r\n<tr style=\"height: 70px\">\r\n<th style=\"width: 15.8055%;height: 70px\" scope=\"row\">Antidiarrheals<\/th>\r\n<td style=\"width: 50.8611%;height: 70px\">Used to treat diarrhea and works by slowing down the movement of the gut. Relieves symptoms of increased frequency and urgency.<\/td>\r\n<td style=\"width: 33.3333%;height: 70px\">Loperamide, Diphenoxylate, Cholestyramine<\/td>\r\n<\/tr>\r\n<tr style=\"height: 35px\">\r\n<th style=\"width: 15.8055%;height: 35px\" scope=\"row\">Antispasmodics<\/th>\r\n<td style=\"width: 50.8611%;height: 35px\">Relieves, prevents or lowers the incidence of muscle spasms.<\/td>\r\n<td style=\"width: 33.3333%;height: 35px\">Hyoscyamine, Dicyclomine<\/td>\r\n<\/tr>\r\n<tr style=\"height: 35px\">\r\n<th style=\"width: 15.8055%;height: 35px\" scope=\"row\">Bulk formers<\/th>\r\n<td style=\"width: 50.8611%;height: 35px\">Soak up water in the stool, thereby firming it up as well as reducing frequency.<\/td>\r\n<td style=\"width: 33.3333%;height: 35px\">Fybogel, Normacol<\/td>\r\n<\/tr>\r\n<tr style=\"height: 35px\">\r\n<th style=\"width: 15.8055%;height: 35px\" scope=\"row\">Bile salt binders<\/th>\r\n<td style=\"width: 50.8611%;height: 35px\">Prevent irritation of the gut by capturing bile salts.<\/td>\r\n<td style=\"width: 33.3333%;height: 35px\">Cholestyramine, Colestipol<\/td>\r\n<\/tr>\r\n<tr style=\"height: 35px\">\r\n<th style=\"width: 15.8055%;height: 35px\" scope=\"row\">Stool softeners<\/th>\r\n<td style=\"width: 50.8611%;height: 35px\">For softening feces to ease bowel movements.<\/td>\r\n<td style=\"width: 33.3333%;height: 35px\">Docusate<\/td>\r\n<\/tr>\r\n<tr style=\"height: 35px\">\r\n<th style=\"width: 15.8055%;height: 35px\" scope=\"row\">Analgesics<\/th>\r\n<td style=\"width: 50.8611%;height: 35px\">For pain reduction<\/td>\r\n<td style=\"width: 33.3333%;height: 35px\">Acetaminophen, Morphine, Hydrocodone, Oxycodone<\/td>\r\n<\/tr>\r\n<tr style=\"height: 52px\">\r\n<th style=\"width: 15.8055%;height: 52px\" scope=\"row\">Non-steroidal anti-inflammatory drugs (NSAIDs)<\/th>\r\n<td style=\"width: 50.8611%;height: 52px\">For pain control in joints (Note: some people find these drugs aggravate their abdominal pain and diarrhea).<\/td>\r\n<td style=\"width: 33.3333%;height: 52px\">Aspirin, Ibuprofen, Naproxen<\/td>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<th style=\"width: 15.8055%;height: 17px\" scope=\"row\">Acid reducing drugs<\/th>\r\n<td style=\"width: 50.8611%;height: 17px\">For \"heartburn\"<\/td>\r\n<td style=\"width: 33.3333%;height: 17px\">Cimetidine, Famotidine, Nizatidine<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h3>Surgery<\/h3>\r\n<span role=\"presentation\" dir=\"ltr\">Approximately 70% of people with Crohn\u2019s and 40% of those with Ulcerative Colitis will require surgery at some point <\/span><span role=\"presentation\" dir=\"ltr\">in their lives. <\/span><span role=\"presentation\" dir=\"ltr\">Surgery should not be regarded as a last resort, it is simply another treatment option. The m<\/span><span role=\"presentation\" dir=\"ltr\">ost common types of surgeries for people with IBS are <\/span><span role=\"presentation\" dir=\"ltr\">ileostomies or primary resection.<\/span>\r\n\r\n&nbsp;\r\n\r\n[caption id=\"attachment_1960\" align=\"aligncenter\" width=\"257\"]<img src=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Ileostomy_with_bag-257x300.jpeg\" alt=\"An ileostomy bag lies flat covering a stoma on the right side of a woman's abdomen.\" width=\"257\" height=\"300\" class=\"wp-image-1960 size-medium\" \/> An ileostomy bag is placed over the stoma to collect waste matter. Photo by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Ileostomy_with_bag.jpg\">Remedios44<\/a>, <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\">CC BY-SA 4.0<\/a>, via Wikimedia Commons[\/caption]\r\n\r\nThe table below summarizes nutrition complications after GI surgery, depending on the type of resection.\r\n<table class=\"grid\"><caption>Nutrition complications after GI surgery, by type of resection<\/caption>\r\n<tbody>\r\n<tr style=\"height: 17px\">\r\n<th style=\"height: 57px;width: 93.4375px\" rowspan=\"2\">Type of Resection<\/th>\r\n<th style=\"height: 10px;width: 38.1597px\" rowspan=\"2\" scope=\"col\">\u2191TG<\/th>\r\n<th style=\"width: 40.1389px;height: 10px\" rowspan=\"2\" scope=\"col\">\u2191BG<\/th>\r\n<th style=\"width: 91.1979px;height: 10px\" rowspan=\"2\" scope=\"col\">Fluid\/ electrolyte balance<\/th>\r\n<th style=\"width: 315.365px;height: 10px;text-align: center\" colspan=\"4\" scope=\"colgroup\">GI Function<\/th>\r\n<th style=\"width: 150.208px;height: 10px;text-align: center\" colspan=\"3\" scope=\"colgroup\">Malabsorption<\/th>\r\n<\/tr>\r\n<tr style=\"height: 35px\">\r\n<th style=\"width: 89.2708px;height: 47px\" scope=\"col\">Gastroparesis<\/th>\r\n<th style=\"width: 81.3195px;height: 47px\" scope=\"col\">Anastomotic Leak<\/th>\r\n<th style=\"width: 37.2917px;height: 47px\" scope=\"col\">Chyle Leak<\/th>\r\n<th style=\"width: 65.2951px;height: 47px\" scope=\"col\">Dumping Syndrome<\/th>\r\n<th style=\"width: 21.3542px;height: 47px\" scope=\"col\">Fat<\/th>\r\n<th style=\"width: 50.3299px;height: 47px\" scope=\"col\">Vitamin<\/th>\r\n<th style=\"width: 50.3993px;height: 47px\" scope=\"col\">Mineral<\/th>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<th style=\"width: 93.4375px;height: 17px\" scope=\"row\">Esophagastric<\/th>\r\n<td style=\"width: 36.7361px;height: 17px\"><\/td>\r\n<td style=\"width: 38.7153px;height: 17px\"><\/td>\r\n<td style=\"width: 89.7743px;height: 17px\">X<\/td>\r\n<td style=\"width: 87.8472px;height: 17px\"><\/td>\r\n<td style=\"width: 79.8958px;height: 17px\">X<\/td>\r\n<td style=\"width: 35.8681px;height: 17px\">X<\/td>\r\n<td style=\"width: 63.8715px;height: 17px\">X<\/td>\r\n<td style=\"width: 19.9306px;height: 17px\"><\/td>\r\n<td style=\"width: 48.9062px;height: 17px\"><\/td>\r\n<td style=\"width: 48.9757px;height: 17px\"><\/td>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<th style=\"width: 93.4375px;height: 17px\" scope=\"row\">Gastric<\/th>\r\n<td style=\"width: 36.7361px;height: 17px\">X<\/td>\r\n<td style=\"width: 38.7153px;height: 17px\"><\/td>\r\n<td style=\"width: 89.7743px;height: 17px\"><\/td>\r\n<td style=\"width: 87.8472px;height: 17px\">X<\/td>\r\n<td style=\"width: 79.8958px;height: 17px\"><\/td>\r\n<td style=\"width: 35.8681px;height: 17px\"><\/td>\r\n<td style=\"width: 63.8715px;height: 17px\">X<\/td>\r\n<td style=\"width: 19.9306px;height: 17px\">X<\/td>\r\n<td style=\"width: 48.9062px;height: 17px\">B12, D<\/td>\r\n<td style=\"width: 48.9757px;height: 17px\">Fe, Ca<\/td>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<th style=\"width: 93.4375px;height: 17px\" scope=\"row\">Pancreas<\/th>\r\n<td style=\"width: 36.7361px;height: 17px\">X<\/td>\r\n<td style=\"width: 38.7153px;height: 17px\"><\/td>\r\n<td style=\"width: 89.7743px;height: 17px\">X<\/td>\r\n<td style=\"width: 87.8472px;height: 17px\">X<\/td>\r\n<td style=\"width: 79.8958px;height: 17px\">X<\/td>\r\n<td style=\"width: 35.8681px;height: 17px\">X<\/td>\r\n<td style=\"width: 63.8715px;height: 17px\">X<\/td>\r\n<td style=\"width: 19.9306px;height: 17px\">X<\/td>\r\n<td style=\"width: 48.9062px;height: 17px\">A, D, E, K, B12<\/td>\r\n<td style=\"width: 48.9757px;height: 17px\">Fe, Ca, Zn<\/td>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<th style=\"width: 93.4375px;height: 17px\" scope=\"row\">Hepatocellular<\/th>\r\n<td style=\"width: 36.7361px;height: 17px\">X<\/td>\r\n<td style=\"width: 38.7153px;height: 17px\">X<\/td>\r\n<td style=\"width: 89.7743px;height: 17px\">X<\/td>\r\n<td style=\"width: 87.8472px;height: 17px\"><\/td>\r\n<td style=\"width: 79.8958px;height: 17px\"><\/td>\r\n<td style=\"width: 35.8681px;height: 17px\">X<\/td>\r\n<td style=\"width: 63.8715px;height: 17px\"><\/td>\r\n<td style=\"width: 19.9306px;height: 17px\"><\/td>\r\n<td style=\"width: 48.9062px;height: 17px\">A, D, E, K, B12, Folic acid<\/td>\r\n<td style=\"width: 48.9757px;height: 17px\">Mg, Zn<\/td>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<th style=\"width: 93.4375px;height: 17px\" scope=\"row\">Gall Bladder<\/th>\r\n<td style=\"width: 36.7361px;height: 17px\">X<\/td>\r\n<td style=\"width: 38.7153px;height: 17px\"><\/td>\r\n<td style=\"width: 89.7743px;height: 17px\">X<\/td>\r\n<td style=\"width: 87.8472px;height: 17px\">X<\/td>\r\n<td style=\"width: 79.8958px;height: 17px\"><\/td>\r\n<td style=\"width: 35.8681px;height: 17px\">X<\/td>\r\n<td style=\"width: 63.8715px;height: 17px\"><\/td>\r\n<td style=\"width: 19.9306px;height: 17px\">X<\/td>\r\n<td style=\"width: 48.9062px;height: 17px\">A, D, E, K, B12<\/td>\r\n<td style=\"width: 48.9757px;height: 17px\">Fe, Ca, Zn<\/td>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<th style=\"width: 93.4375px;height: 17px\" scope=\"row\">Bile Duct<\/th>\r\n<td style=\"width: 36.7361px;height: 17px\">X<\/td>\r\n<td style=\"width: 38.7153px;height: 17px\"><\/td>\r\n<td style=\"width: 89.7743px;height: 17px\">X<\/td>\r\n<td style=\"width: 87.8472px;height: 17px\"><\/td>\r\n<td style=\"width: 79.8958px;height: 17px\"><\/td>\r\n<td style=\"width: 35.8681px;height: 17px\">X<\/td>\r\n<td style=\"width: 63.8715px;height: 17px\"><\/td>\r\n<td style=\"width: 19.9306px;height: 17px\">X<\/td>\r\n<td style=\"width: 48.9062px;height: 17px\">A, D, E, K, B12<\/td>\r\n<td style=\"width: 48.9757px;height: 17px\">Fe, Ca, Zn<\/td>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<th style=\"width: 93.4375px;height: 17px\" scope=\"row\">Small Bowel<\/th>\r\n<td style=\"width: 36.7361px;height: 17px\">X<\/td>\r\n<td style=\"width: 38.7153px;height: 17px\"><\/td>\r\n<td style=\"width: 89.7743px;height: 17px\">X<\/td>\r\n<td style=\"width: 87.8472px;height: 17px\">X<\/td>\r\n<td style=\"width: 79.8958px;height: 17px\"><\/td>\r\n<td style=\"width: 35.8681px;height: 17px\">X<\/td>\r\n<td style=\"width: 63.8715px;height: 17px\"><\/td>\r\n<td style=\"width: 19.9306px;height: 17px\">X<\/td>\r\n<td style=\"width: 48.9062px;height: 17px\">A, D, E, K, B12<\/td>\r\n<td style=\"width: 48.9757px;height: 17px\">Fe, Ca, Zn<\/td>\r\n<\/tr>\r\n<tr style=\"height: 17px\">\r\n<th style=\"width: 93.4375px;height: 17px\" scope=\"row\">Colon or Rectum<\/th>\r\n<td style=\"width: 36.7361px;height: 17px\"><\/td>\r\n<td style=\"width: 38.7153px;height: 17px\"><\/td>\r\n<td style=\"width: 89.7743px;height: 17px\">X<\/td>\r\n<td style=\"width: 87.8472px;height: 17px\"><\/td>\r\n<td style=\"width: 79.8958px;height: 17px\"><\/td>\r\n<td style=\"width: 35.8681px;height: 17px\">X<\/td>\r\n<td style=\"width: 63.8715px;height: 17px\"><\/td>\r\n<td style=\"width: 19.9306px;height: 17px\"><\/td>\r\n<td style=\"width: 48.9062px;height: 17px\">B12<\/td>\r\n<td style=\"width: 48.9757px;height: 17px\">Na, K, Mg, Ca<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h1>Ostomies<\/h1>\r\nA<span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">n <strong>ostomy <\/strong><\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">is<\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\"> a change in the way urine or stool exits the body as <\/span><span style=\"font-size: 1em\">a result of a surgical procedure. Bodily waste is rerouted from its <\/span><span style=\"font-size: 1em\">usual path because of malfunctioning parts of the urinary or <\/span><span style=\"font-size: 1em\">digestive system. An ostomy can be temporary or permanent. <\/span>\r\n\r\n<span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">A<strong> stoma <\/strong><\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">is the opening created by the ostomy surgery. It is <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">located on the abdomen and is dark pink in color. For most <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">ostomies, a pouch is worn over the stoma to collect stool or urine. <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">For some people it is possible to have a continent diversion, <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">an <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">alternative to a conventional ostomy that eliminates the necessity <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">for a pouch.<\/span>\r\n\r\nThe three most common forms of ostomies are ileostomies, colostomies, and urosomies.\r\n\r\n<span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\"><strong>Ileostomy<\/strong>: <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">A surgically created <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">opening from the ileum, the lowest <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">part of the small intestine. The <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">intestine is brought through the <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">abdominal wall to form a stoma. <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">Ileostomies may be temporary or <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">permanent, and may involve <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\"><span role=\"presentation\" dir=\"ltr\">removal of all or part of the colon.<\/span><\/span>\r\n\r\n<strong>Colostomy<\/strong>: <span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">The surgically created <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">opening of the colon (large intestine) <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">which results in a stoma. A colostomy <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">is created when a portion of the colon <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">or the rectum is removed, and the <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">remaining colon is brought to the <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">abdominal wall. It may further be <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">defined by the portion of the colon <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">involved and\/or its permanence.<\/span>\r\n\r\n<strong>Urostomy<\/strong>: <span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">This is a general term for a <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">surgical procedure which diverts urine away <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">from a diseased or defective bladder. The <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">ileal or cecal conduit procedures are the most <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">common urostomies. Either a section at the <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">end of the small bowel (ileum) or at the <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">beginning of the large intestine (cecum) is <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">surgically removed and relocated as a <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">passageway for urine to pass from the <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">kidneys to the outside of the body through a <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">stoma.<\/span>\r\n<div class=\"page\" data-page-number=\"27\" role=\"region\" aria-label=\"Page 27\" data-loaded=\"true\">\r\n\r\n[caption id=\"attachment_1962\" align=\"aligncenter\" width=\"300\"]<img src=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.40.58-AM-300x243.png\" alt=\"An ileostomy bag covers the stoma on the right side of a person's abdomen.\" width=\"300\" height=\"243\" class=\"wp-image-1962 size-medium\" \/> Placement of an ileostomy bag. Photo by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Diagram_of_an_ileostomy_with_a_bag_CRUK_030.svg\">Cancer Research UK<\/a>, <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\">CC BY-SA 4.0<\/a>, via Wikimedia Commons[\/caption]\r\n\r\n[caption id=\"attachment_1965\" align=\"aligncenter\" width=\"300\"]<img src=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.23.40-PM-300x257.png\" alt=\"A colostomy bag attaches to a stoma on the left side of the abdomen, leaving a rectal stump.\" width=\"300\" height=\"257\" class=\"wp-image-1965\" style=\"color: #373d3f;font-weight: bold;font-size: 1em\" \/> Placement of a colostomy bag. Photo by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Diagram_showing_a_colostomy_with_a_bag_CRUK_061.svg\">Cancer Research UK<\/a>, <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\">CC BY-SA 4.0<\/a>, via Wikimedia Commons[\/caption]\r\n\r\n[caption id=\"attachment_1964\" align=\"aligncenter\" width=\"300\"]<img src=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.21.57-PM-300x288.png\" alt=\"The ureter is attached to a small piece of bowel called an ileal conduit. The ileal conduit carries urine out of the body through an opening called a stoma in the abdomen.\" width=\"300\" height=\"288\" class=\"wp-image-1964\" \/> The creation of a urostomy by way of an ileal conduit. <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Diagram_showing_how_a_urostomy_is_made_(ileal_conduit)_CRUK_124.svg\">Cancer Research UK<\/a>, <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\">CC BY-SA 4.0<\/a>, via Wikimedia Commons[\/caption]\r\n<h1><span style=\"text-align: initial;font-size: 1em\">Pancreatitis<\/span><\/h1>\r\nThe pancreas is an important gland in the digestive system, located behind the stomach in the upper abdomen.\r\n\r\n<\/div>\r\nThere are two <strong>main functions of the pancreas<\/strong>:\r\n<ol>\r\n \t<li><strong>Exocrine<\/strong>, which makes digestive enzymes\r\n<ul>\r\n \t<li>Enzymes such as amylase, lipase and gastric juices help to digest food<\/li>\r\n \t<li>The pancreas releases enzymes into progressively larger ducts towards the main pancreatic duct<\/li>\r\n \t<li>The enzymes then drain into the duodenum<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><strong>Endocrine<\/strong>, which makes hormones\r\n<ul>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">The Islets of Langerhans make insulin and glucagon<\/span><\/li>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">These hormones are released into the blood stream to c<\/span><span role=\"presentation\" dir=\"ltr\">ontrol blood sugar (glucose) levels<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n[caption id=\"attachment_1961\" align=\"aligncenter\" width=\"526\"]<img src=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Pancreas-300x151.jpeg\" alt=\"The pancreas is tucked between the duodenum of the small intestine, the spleen and splenic artery. Acinar cells in the pancreas secrete digestive enzymes that are carried through the pancreatic duct to the duodenum. Pancreatic islets throughout the organ make the hormones insulin and glucagon.\" width=\"526\" height=\"265\" class=\"wp-image-1961\" \/> An overview of the functions of the pancreas. Diagram by<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:1820_The_Pancreas.jpg\"> OpenStax College<\/a> , <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\">CC BY 3.0<\/a>, via Wikimedia Commons[\/caption]\r\n\r\n&nbsp;\r\n\r\n<span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\"><strong>Pancreatitis<\/strong> is inflammation in the pancreas. <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">It occurs when digestive enzymes become activated while still in the pancreas, irritating the cells of <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">your pancreas and causing inflammation. It can occur as <strong>acute pancreatitis<\/strong>, meaning it appears suddenly and lasts for days; or as <strong>chronic pancreatitis<\/strong>, which occurs over many years.\r\n\r\n<\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">With repeated bouts of acute pancreatitis, damage to the pancreas <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">can occur and lead to chronic pancreatitis. <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">Mild cases of pancreatitis may go away without treatment, but severe cases can cause life-threatening <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">complications. <\/span>\r\n\r\n<span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">Risk factors for pancreatitis: <\/span>\r\n<ul>\r\n \t<li><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">Excessive alcohol consumption<\/span><\/li>\r\n \t<li><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">Cigarette smoking<\/span><\/li>\r\n \t<li><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">Obesity <\/span><\/li>\r\n \t<li><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">Family history<\/span><\/li>\r\n<\/ul>\r\n<h2>Acute Pancreatitis<\/h2>\r\n<div class=\"page\" data-page-number=\"27\" role=\"region\" aria-label=\"Page 27\" data-loaded=\"true\">\r\n<div class=\"page\" data-page-number=\"30\" role=\"region\" aria-label=\"Page 30\" data-loaded=\"true\">\r\n\r\n<span role=\"presentation\" dir=\"ltr\"><strong>Signs and symptoms <\/strong>of acute pancreatitis\u00a0include <\/span><span role=\"presentation\" dir=\"ltr\">upper abdominal pain, fever, rapid pulse, nausea, and vomiting.<\/span>\r\n\r\n<span role=\"presentation\" dir=\"ltr\">Many causes of acute pancreatitis exist, with b<\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">iliary stones and <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">alcohol overuse causing around <\/span>70-80% <span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">of cases. Obstructive causes like gallstones and tumours may also occur. <\/span>Gallstones can get stuck in the common bile duct and press on the pancreatic duct, which blocks normal flow and leads to pancreatic injury. Other causes can include: t<span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">oxins such as scorpion bites, certain drugs (ex. azathioprine), trauma from surgical procedures or blunt trauma, and infections (viruses, bacteria, parasites). Metabolic causes for acute pancreatitis include <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">hypertriglyceridemia and hypercalcemia.<\/span>\r\n\r\n<\/div>\r\n<\/div>\r\n<div><\/div>\r\n<div>There are several <strong>classifications<\/strong> of acute pancreatitis that are defined differently:<\/div>\r\n<div class=\"page\" data-page-number=\"27\" role=\"region\" aria-label=\"Page 27\" data-loaded=\"true\">\r\n<div class=\"textLayer\">\r\n<div class=\"page\" data-page-number=\"31\" role=\"region\" aria-label=\"Page 31\" data-loaded=\"true\">\r\n<ul>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\"><strong>Mild<\/strong> acute pancreatitis<strong>: <\/strong><\/span>No organ failure, local or systemic complications<\/li>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\"><strong>Moderately severe <\/strong>acute pancreatitis: <\/span><span role=\"presentation\" dir=\"ltr\">Transient organ failure &gt; 48 hours, l<\/span><span role=\"presentation\" dir=\"ltr\">ocal complications<\/span><\/li>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\"><strong>Severe<\/strong> acute pancreatitis: <\/span><span role=\"presentation\" dir=\"ltr\">Persistent organ failure &gt; 48 hours, <\/span><span role=\"presentation\" dir=\"ltr\">local complications<\/span>\r\n<ul>\r\n \t<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\"><strong>Necrotizing<\/strong> acute pancreatitis:<\/span><span role=\"presentation\" dir=\"ltr\"> Inflammation associated with [pb_glossary id=\"2447\"]necrosis[\/pb_glossary] of the pancreas or <\/span><span role=\"presentation\" dir=\"ltr\">surrounding tissues (increased risk of death by 36-50%)<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<span role=\"presentation\" dir=\"ltr\">Initial <strong>treatment<\/strong> in the hospital for acute pancreatitis involves various management strategies.\u00a0<\/span>\r\n\r\n<span role=\"presentation\" dir=\"ltr\"><strong>Fasting <\/strong>\u00a0is indicated t<\/span><span role=\"presentation\" dir=\"ltr\">o allow the pancreas to recover. Once the inflammation in the pancreas is controlled, the <\/span><span role=\"presentation\" dir=\"ltr\">patient will typically be switched to clear fluids and eating bland foods. With time, they can go back to a <\/span><span role=\"presentation\" dir=\"ltr\">normal diet.<\/span><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\">\u00a0<\/span><\/span>\r\n\r\n<span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\">As p<\/span><\/span><span role=\"presentation\" dir=\"ltr\">ancreatitis can cause severe pain, <strong>pain medications<\/strong> are often used. The health care team will give the patient <\/span><span role=\"presentation\" dir=\"ltr\">medications to help control the pain. Dehydration is also likely. For this reason, individuals typically receive extra <strong>fluids through intravenous route (IV).<\/strong><\/span><span role=\"presentation\" dir=\"ltr\"><\/span><span role=\"presentation\" dir=\"ltr\"><\/span>\r\n\r\n<strong><span role=\"presentation\" dir=\"ltr\">Treatment of the underlying cause <\/span><\/strong><span role=\"presentation\" dir=\"ltr\">wil<\/span><span role=\"presentation\" dir=\"ltr\">l range based on the patient's circumstances and needs. This could include surgery, <\/span><span role=\"presentation\" dir=\"ltr\">medications, or education (dietary, alcohol dependence, etc).<\/span>\r\n<h2>Chronic Pancreatitis<\/h2>\r\n<div class=\"page\" data-page-number=\"27\" role=\"region\" aria-label=\"Page 27\" data-loaded=\"true\">\r\n<div class=\"textLayer\">\r\n<div class=\"page\" data-page-number=\"31\" role=\"region\" aria-label=\"Page 31\" data-loaded=\"true\">\r\n<div class=\"annotationLayer\"><span role=\"presentation\" dir=\"ltr\">Chronic pancreatitis is an inflammation of the pancreas that doesn\u2019t improve over time. There are <\/span><span role=\"presentation\" dir=\"ltr\">numerous causes of chronic pancreatitis. The most common cause is long-term alcohol abuse. <\/span><span role=\"presentation\" dir=\"ltr\">Approximately 70% of cases are linked to alcohol consumption. <\/span><span role=\"presentation\" dir=\"ltr\">Chronic pancreatitis is associated with unique <\/span><strong><span role=\"presentation\" dir=\"ltr\">complications<\/span><\/strong><span role=\"presentation\" dir=\"ltr\"> relevant to nutrition, some of which may be more common than others. <\/span><\/div>\r\n<strong><span role=\"presentation\" dir=\"ltr\">Nutrient <\/span><span role=\"presentation\" dir=\"ltr\">malabsorption <\/span><\/strong><span role=\"presentation\" dir=\"ltr\">is o<\/span><span role=\"presentation\" dir=\"ltr\">ne of the most common complications, related to pancreatic digestive enzymes. Specifically, v<\/span><span role=\"presentation\" dir=\"ltr\">itamin B12 deficiency and fat-soluble vitamin deficiency can occur. <\/span><span role=\"presentation\" dir=\"ltr\">The development of <\/span><span role=\"presentation\" dir=\"ltr\"><strong>diabetes<\/strong> is also common, as p<\/span><span role=\"presentation\" dir=\"ltr\">ancreatitis damages the cells that produce insulin and glucagon. <\/span><span role=\"presentation\" dir=\"ltr\">About <\/span><span role=\"presentation\" dir=\"ltr\">45% of people with chronic pancreatitis will develop diabetes.<\/span>\r\n\r\n<span role=\"presentation\" dir=\"ltr\"><strong>Pseudocysts <\/strong>are another complication of chronic pancreatitis. These \"cysts\" are a <\/span><span role=\"presentation\" dir=\"ltr\">collection of pancreatic fluid caused by direct leakage from the inflamed gland or the pancreatic <\/span><span role=\"presentation\" dir=\"ltr\">duct. About 50% of pseudocysts resolve on their own. Treatment may be necessary when they become symptomatic, infected, or are increasing <\/span><span role=\"presentation\" dir=\"ltr\">in size.<\/span>\r\n\r\n<\/div>\r\n<strong>Treatments<\/strong> of chronic pancreatitis may have similarities to that of acute pancreatitis, such as with\u00a0<strong>pain medications,\u00a0<\/strong>and dietary\u00a0<strong>education.<\/strong> Unique treatment approaches are also used, such as <strong>e<\/strong><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\"><strong>nzymes to improve digestion<\/strong>. <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">Pancreatic enzyme supplements help the body break down and absorb the <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">nutrients in food, and are taken with each meal.<\/span><span style=\"text-align: initial;font-size: 1em\">\u00a0If the patient has autoimmune pancreatitis, <\/span><strong style=\"text-align: initial;font-size: 1em\">steroids<\/strong><span style=\"text-align: initial;font-size: 1em\"> may be used. <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\"><strong>Surgery <\/strong><\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">is not necessary for most people, but remains an option.<\/span>\r\n\r\n&nbsp;\r\n\r\n<\/div>\r\n<\/div>\r\n<div class=\"textbox shaded\">Background complete!<span> Feel free to review any resources and move to the next section \u201cAssess\u201d when you are ready.<\/span><\/div>","rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Page Contents<\/p>\n<label for=\"ez-toc-cssicon-toggle-item-69d5b75476f48\" class=\"ez-toc-cssicon-toggle-label\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/label><input type=\"checkbox\"  id=\"ez-toc-cssicon-toggle-item-69d5b75476f48\" checked aria-label=\"Toggle\" \/><nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/gi_in-background\/#Conditions_Covered_in_this_Section\" >Conditions Covered in this Section<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/gi_in-background\/#Inflammatory_Bowel_Disease_IBD\" >Inflammatory Bowel Disease (IBD)<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/gi_in-background\/#Comparing_Crohns_Disease_and_Ulcerative_Colitis\" >Comparing Crohn&#8217;s Disease and Ulcerative Colitis<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/gi_in-background\/#Shared_Complications_of_Crohns_Disease_and_Ulcerative_Colitis\" >Shared Complications of Crohn&#8217;s Disease and Ulcerative Colitis\u00a0<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/gi_in-background\/#Complications_of_Crohns_Disease\" >Complications of Crohn\u2019s Disease<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/gi_in-background\/#Complications_of_Ulcerative_Colitis\" >Complications of Ulcerative Colitis<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/gi_in-background\/#Factors_Altering_Nutritional_Status\" >Factors Altering Nutritional Status<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/gi_in-background\/#Treatment_Options\" >Treatment Options<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/gi_in-background\/#Medications\" >Medications<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/gi_in-background\/#Surgery\" >Surgery<\/a><\/li><\/ul><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/gi_in-background\/#Ostomies\" >Ostomies<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/gi_in-background\/#Pancreatitis\" >Pancreatitis<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/gi_in-background\/#Acute_Pancreatitis\" >Acute Pancreatitis<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-14\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/gi_in-background\/#Chronic_Pancreatitis\" >Chronic Pancreatitis<\/a><\/li><\/ul><\/li><\/ul><\/nav><\/div>\n<h1><span class=\"ez-toc-section\" id=\"Conditions_Covered_in_this_Section\"><\/span>Conditions Covered in this Section<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>This &#8220;Background&#8221; section of the Inpatient GI module addresses three main conditions:<\/p>\n<ol>\n<li>Inflammatory Bowel Disease (IBD)<\/li>\n<li>Ostomies<\/li>\n<li>Pancreatitis<\/li>\n<\/ol>\n<p>After reviewing background information, you will be led through the Nutrition Care Process along with a relevant case study to apply your knowledge. The case study will be a complex case focused on IBD and ostomies. A summary of evidence, education, and recommendations will be provided for all topics.<\/p>\n<p>It may also be useful to review the first section of the <a href=\"https:\/\/pressbooks.library.ryerson.ca\/dietmods\/chapter\/gi_out-background\/#The_Gastrointestinal_GI_Tract\">Background for Outpatient GI<\/a>, which provides a general overview of GI system components, digestion, and nutrient absorption.<\/p>\n<h1><span class=\"ez-toc-section\" id=\"Inflammatory_Bowel_Disease_IBD\"><\/span>Inflammatory Bowel Disease (IBD)<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<div class=\"page\" data-page-number=\"13\" role=\"region\" aria-label=\"Page 13\" data-loaded=\"true\">\n<div class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Inflammatory Bowel Disease (IBD) is an inflammatory condition of the digestive tract, and consists of two main types: <strong>Crohn\u2019s Disease and Ulcerative Colitis<\/strong><\/span><span role=\"presentation\" dir=\"ltr\">. Their similarities and differences will be explored in this section. <\/span><span role=\"presentation\" dir=\"ltr\">Although the specific cause of IBD remains unknown, the main h<\/span><span role=\"presentation\" dir=\"ltr\">ypothesis relates to i<\/span><span role=\"presentation\" dir=\"ltr\">mmune system malfunction and heredity factors. <\/span><\/div>\n<div class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\"><strong><br \/>\nSymptoms<\/strong> may include: <\/span><\/div>\n<ul>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Severe diarrhea (with blood and mucus)<\/span><\/li>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Abdominal pain, fatigue<\/span><\/li>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Malabsorption of nutrients<\/span><\/li>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Anemia<\/span><\/li>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Weight loss<\/span><\/li>\n<\/ul>\n<p><span role=\"presentation\" dir=\"ltr\">As a result, IBD disrupts the body\u2019s ability to digest food, absorb nutrients and eliminate waste. It is e<\/span><span role=\"presentation\" dir=\"ltr\">stimated that up to <\/span><span role=\"presentation\" dir=\"ltr\">85% of hospitalized IBD patients <\/span><span role=\"presentation\" dir=\"ltr\">have protein energy malnutrition, based on <\/span><span role=\"presentation\" dir=\"ltr\">abnormal anthropometric and biochemical parameters.<\/span><\/p>\n<div class=\"textLayer\"><span style=\"text-align: initial;font-size: 1em\"><br \/>\nAlthough specific causes of IBD are yet to be discovered, there are <strong>risk factors<\/strong> associated with IBD:<\/span><\/div>\n<\/div>\n<div>\n<ul>\n<li class=\"textLayer\"><strong><span role=\"presentation\" dir=\"ltr\">Age: <\/span><\/strong><span role=\"presentation\" dir=\"ltr\">Most people who develop IBD are diagnosed before they&#8217;re 30 years old. Some people don&#8217;t develop <\/span><span role=\"presentation\" dir=\"ltr\">the disease until their 50s or 60s.<\/span><\/li>\n<li class=\"textLayer\"><strong><span role=\"presentation\" dir=\"ltr\">Ethnicity: <\/span><\/strong><span role=\"presentation\" dir=\"ltr\">Caucasian\u2019s have the highest risk of the disease; but it can occur in any race. <\/span><\/li>\n<li class=\"textLayer\"><strong><span role=\"presentation\" dir=\"ltr\">Family history: <\/span><\/strong><span role=\"presentation\" dir=\"ltr\">You&#8217;re at higher risk if you have a close relative, such as a parent, sibling or child with the <\/span><span role=\"presentation\" dir=\"ltr\">disease.<\/span><\/li>\n<li class=\"textLayer\"><strong><span role=\"presentation\" dir=\"ltr\">Cigarette smoking: <\/span><\/strong><span role=\"presentation\" dir=\"ltr\">Cigarette smoking is the most important controllable risk factor for developing Crohn&#8217;s <\/span><span role=\"presentation\" dir=\"ltr\">disease. Although smoking may provide some protection against ulcerative colitis, the overall health benefits <\/span><span role=\"presentation\" dir=\"ltr\">of not smoking make it important to try to quit.<\/span><\/li>\n<li class=\"textLayer\"><strong><span role=\"presentation\" dir=\"ltr\">Non-Steroidal anti-inflammatory medications (NSAIDs): <\/span><\/strong><span role=\"presentation\" dir=\"ltr\">These include ibuprofen (Advil, Motrin), naproxen sodium <\/span><span role=\"presentation\" dir=\"ltr\">(Aleve), diclofenac sodium (Voltaren) and others. These medications may increase the risk of developing <\/span><span role=\"presentation\" dir=\"ltr\">IBD or worsen disease in people who have IBD.<\/span><\/li>\n<li class=\"textLayer\"><strong><span role=\"presentation\" dir=\"ltr\">Where you live: <\/span><\/strong><span role=\"presentation\" dir=\"ltr\">If you live in an industrialized country, you&#8217;re more likely to develop IBD. Therefore, it may <\/span><span role=\"presentation\" dir=\"ltr\">be that environmental factors, including a diet high in fat or refined foods, play a role. People living in <\/span><span role=\"presentation\" dir=\"ltr\">northern climates also seem to be at greater risk.<\/span><\/li>\n<\/ul>\n<p>Some of these are modifiable risk factors (such as cigarette smoking), while other factors are fixed (such as family history and ethnicity). <span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\"> It is important to note that diet and stress do not <em>cause<\/em> IBD, but still play a role in aggravating symptoms for those diagnosed.<\/span><\/p>\n<\/div>\n<div class=\"page\" data-page-number=\"14\" role=\"region\" aria-label=\"Page 14\" data-loaded=\"true\">\n<h2><span class=\"ez-toc-section\" id=\"Comparing_Crohns_Disease_and_Ulcerative_Colitis\"><\/span>Comparing Crohn&#8217;s Disease and Ulcerative Colitis<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span role=\"presentation\" dir=\"ltr\"><strong>Crohn&#8217;s Disease<\/strong> is a chronic inflammatory <\/span><span role=\"presentation\" dir=\"ltr\">disease that may involve any area throughout <\/span><span role=\"presentation\" dir=\"ltr\">the entire digestive tract <span>\u2014 <\/span>anywhere from the mouth to the anus. However, it often affects the <\/span><span role=\"presentation\" dir=\"ltr\">terminal ileum within the small intestine. Inflammation can extend <\/span><span role=\"presentation\" dir=\"ltr\">through the entire thickness of the bowel wall, <\/span><span role=\"presentation\" dir=\"ltr\">resulting in diarrhea, <button class=\"glossary-term\" aria-describedby=\"380-2444\">strictures<\/button>, <button class=\"glossary-term\" aria-describedby=\"380-2445\">anal fissures<\/button>, <\/span><span role=\"presentation\" dir=\"ltr\">abscesses, and <button class=\"glossary-term\" aria-describedby=\"380-2446\">fistulas<\/button>.<\/span><\/p>\n<p><span role=\"presentation\" dir=\"ltr\"><strong>Ulcerative Colitis<\/strong> is an inflammatory disease that <\/span><span role=\"presentation\" dir=\"ltr\">begins at the anus and involves the inner <\/span><span role=\"presentation\" dir=\"ltr\">mucosa of the colon.\u00a0 The inflammation does not result in fistulas, although e<\/span><span role=\"presentation\" dir=\"ltr\">xtensive inflammation may require surgery to <\/span><span role=\"presentation\" dir=\"ltr\">remove affected area. Ulcerative proctitis, a <\/span><span role=\"presentation\" dir=\"ltr\">milder form of UC, occurs at a maximum of <\/span><span role=\"presentation\" dir=\"ltr\">20 cm proximal to the anus.<\/span><\/p>\n<h3><span class=\"ez-toc-section\" id=\"Shared_Complications_of_Crohns_Disease_and_Ulcerative_Colitis\"><\/span><strong>Shared Complications of Crohn&#8217;s Disease and Ulcerative Colitis\u00a0<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em;text-align: initial\">Ulcerative colitis and Crohn&#8217;s disease have some complications in common and others that are specific to <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em;text-align: initial\">each condition.<\/span><\/p>\n<p><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em;text-align: initial\">Complications found in both conditions may include<\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em;text-align: initial\">:<\/span><\/p>\n<\/div>\n<ul>\n<li><strong><span role=\"presentation\" dir=\"ltr\">Colon cancer:<\/span><\/strong><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\"> <\/span><\/span><span role=\"presentation\" dir=\"ltr\">having IBD increases your risk of colon cancer. General colon cancer screening <\/span><span role=\"presentation\" dir=\"ltr\">guidelines for people without IBD call for a colonoscopy every 10 years beginning at age 50. For those <\/span><span role=\"presentation\" dir=\"ltr\">with IBD, this test may need to be done sooner and more frequently.<\/span><br role=\"presentation\" \/><span role=\"presentation\" dir=\"ltr\"><\/span><\/li>\n<li><strong><span role=\"presentation\" dir=\"ltr\">Skin, eye and joint inflammation:<\/span><\/strong><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\"> <\/span><\/span><span role=\"presentation\" dir=\"ltr\">Certain disorders, including arthritis, skin lesions and eye <\/span><br role=\"presentation\" \/><span role=\"presentation\" dir=\"ltr\">inflammation (uveitis), may occur during IBD flare-ups.<\/span><br role=\"presentation\" \/><span role=\"presentation\" dir=\"ltr\"><\/span><\/li>\n<li><strong><span role=\"presentation\" dir=\"ltr\">Medication side effects:<\/span><\/strong><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\"> <\/span><\/span><span role=\"presentation\" dir=\"ltr\">Certain medications for IBD are associated with a small risk of developing <\/span><span role=\"presentation\" dir=\"ltr\">certain cancers. Corticosteroids can be associated with a risk of osteoporosis, high blood pressure and <\/span><span role=\"presentation\" dir=\"ltr\">other conditions.<\/span><br role=\"presentation\" \/><span role=\"presentation\" dir=\"ltr\"><\/span><\/li>\n<li><strong><span role=\"presentation\" dir=\"ltr\">Primary sclerosing cholangitis:<\/span><\/strong><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\"> <\/span><\/span><span role=\"presentation\" dir=\"ltr\">In this condition, inflammation causes scars within the bile ducts, <\/span><span role=\"presentation\" dir=\"ltr\">eventually making them narrow and gradually causing liver damage.<\/span><br role=\"presentation\" \/><span role=\"presentation\" dir=\"ltr\"><\/span><\/li>\n<li><span role=\"presentation\" dir=\"ltr\"><strong>Blood clots<\/strong>:<\/span><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\"> <\/span><\/span><span role=\"presentation\" dir=\"ltr\">IBD increases the risk of blood clots in veins and arteries.<\/span><\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"Complications_of_Crohns_Disease\"><\/span><span role=\"presentation\" dir=\"ltr\">Complications of Crohn\u2019s Disease<\/span><span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>The complications specific to Crohn&#8217;s disease are related to the deeply-penetrating nature of the inflammation, as well as its ability to affect any spot along the digestive tract. The severity and recurrence of complications is variable.<\/p>\n<ul>\n<li><strong><span role=\"presentation\" dir=\"ltr\">Bowel obstruction:<\/span><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\"> <\/span><\/span><\/strong><span role=\"presentation\" dir=\"ltr\">Crohn&#8217;s disease affects the full thickness of the intestinal wall. Over time, parts of the <\/span><span role=\"presentation\" dir=\"ltr\">bowel can thicken and narrow, which may block the flow of digestive contents. Patient\u2019s may require surgery <\/span><span role=\"presentation\" dir=\"ltr\">to remove the diseased portion of the bowel.<\/span><\/li>\n<li><strong><span role=\"presentation\" dir=\"ltr\">Malnutrition:<\/span><\/strong><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\"> <\/span><\/span><span role=\"presentation\" dir=\"ltr\">Diarrhea, abdominal pain and cramping may make it difficult to eat or for the intestine to absorb <\/span><span role=\"presentation\" dir=\"ltr\">enough nutrients to keep the patient nourished. It&#8217;s also common to develop anemia due to low iron or <\/span><span role=\"presentation\" dir=\"ltr\">vitamin B12 caused by the disease.<\/span><\/li>\n<li><strong><span role=\"presentation\" dir=\"ltr\">Ulcers:<\/span><\/strong><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\"> <\/span><\/span><span role=\"presentation\" dir=\"ltr\">Chronic inflammation can lead to open sores (ulcers) anywhere in the digestive tract, including the <\/span><span role=\"presentation\" dir=\"ltr\">mouth and anus, and in the genital area (perineum).<\/span><\/li>\n<li><strong><span role=\"presentation\" dir=\"ltr\">Fistulas:<\/span><\/strong><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\"> <\/span><\/span><span role=\"presentation\" dir=\"ltr\">Sometimes ulcers can extend completely through the intestinal wall, creating a fistula \u2014 an <\/span><span role=\"presentation\" dir=\"ltr\">abnormal connection between different body parts. Fistulas near or around the anal area (perianal) are the <\/span><span role=\"presentation\" dir=\"ltr\">most common kind. In some cases, a fistula may become infected and form an abscess.<\/span><\/li>\n<li><strong><span role=\"presentation\" dir=\"ltr\">Anal fissure:<\/span><\/strong><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\"> <\/span><\/span><span role=\"presentation\" dir=\"ltr\">This is a small tear in the tissue that lines the anus or in the skin around the anus where <\/span><span role=\"presentation\" dir=\"ltr\">infections can occur. It&#8217;s often associated with painful bowel movements and may lead to a perianal fistula.<\/span><\/li>\n<\/ul>\n<figure id=\"attachment_1824\" aria-describedby=\"caption-attachment-1824\" style=\"width: 362px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/art13_f1-300x168.jpeg\" alt=\"Two ulcers on the labial mucosa of the upper lip\" width=\"362\" height=\"203\" class=\"wp-image-1824\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/art13_f1-300x168.jpeg 300w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/art13_f1-65x36.jpeg 65w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/art13_f1-225x126.jpeg 225w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/art13_f1-350x196.jpeg 350w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/art13_f1.jpeg 580w\" sizes=\"auto, (max-width: 362px) 100vw, 362px\" \/><figcaption id=\"caption-attachment-1824\" class=\"wp-caption-text\">Two ulcers on the labial mucosa of the upper lip. Photo by <a href=\"https:\/\/www.scielo.cl\/scielo.php?script=sci_arttext&amp;pid=S0718-381X2016000300013\">Universidad de La Frontera<\/a> , <a href=\"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/deed.en\">CC BY-NC 4.0<\/a><\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Complications_of_Ulcerative_Colitis\"><\/span>Complications of Ulcerative Colitis<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Ulcerative Colitis may appear to have fewer complications than Crohn&#8217;s, but it is important to remember that the inflammation may still require surgery, ultimately affecting nutrient absorption and increasing malnutrition risk. These complications can be life-threatening if not addressed.<\/p>\n<div class=\"page\" data-page-number=\"19\" role=\"region\" aria-label=\"Page 19\" data-loaded=\"true\">\n<ul>\n<li><strong><span role=\"presentation\" dir=\"ltr\">Toxic megacolon:<\/span><\/strong><span role=\"presentation\" dir=\"ltr\">Ulcerative colitis may cause the colon to rapidly widen and swell, a serious condition <\/span><span role=\"presentation\" dir=\"ltr\">known as toxic megacolon.<\/span><\/li>\n<li><strong><span role=\"presentation\" dir=\"ltr\">Severe dehydration:<\/span><\/strong><span role=\"presentation\" dir=\"ltr\">Excessive diarrhea can result in dehydration<\/span><\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<p><strong>Complications Summary Table\u00a0<\/strong><\/p>\n<table class=\"grid\" style=\"border-collapse: collapse;width: 100%;height: 221px\">\n<tbody>\n<tr style=\"height: 17px\">\n<td style=\"width: 33.3333%;height: 17px;text-align: left\"><strong>Complication\u00a0<\/strong><\/td>\n<td style=\"width: 33.3333%;height: 17px;text-align: left\"><strong>Crohn&#8217;s Disease<\/strong><\/td>\n<td style=\"width: 33.3333%;height: 17px;text-align: left\"><strong>Ulcerative Colitis\u00a0<\/strong><\/td>\n<\/tr>\n<tr style=\"height: 17px\">\n<td style=\"width: 33.3333%;height: 17px\">Colon cancer<\/td>\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\n<\/tr>\n<tr style=\"height: 17px\">\n<td style=\"width: 33.3333%;height: 17px\">Skin, eye, and joint inflammation<\/td>\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\n<\/tr>\n<tr style=\"height: 17px\">\n<td style=\"width: 33.3333%;height: 17px\">Medication side effects<\/td>\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\n<\/tr>\n<tr style=\"height: 17px\">\n<td style=\"width: 33.3333%;height: 17px\">Primary sclerosing cholangitis<\/td>\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\n<\/tr>\n<tr style=\"height: 17px\">\n<td style=\"width: 33.3333%;height: 17px\">Blood clots<\/td>\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\n<\/tr>\n<tr style=\"height: 17px\">\n<td style=\"width: 33.3333%;height: 17px\">Bowel obstruction<\/td>\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\n<td style=\"width: 33.3333%;height: 17px\"><\/td>\n<\/tr>\n<tr style=\"height: 17px\">\n<td style=\"width: 33.3333%;height: 17px\">Malnutrition<\/td>\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\n<td style=\"width: 33.3333%;height: 17px\"><\/td>\n<\/tr>\n<tr style=\"height: 17px\">\n<td style=\"width: 33.3333%;height: 17px\">Ulcers<\/td>\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\n<td style=\"width: 33.3333%;height: 17px\"><\/td>\n<\/tr>\n<tr style=\"height: 17px\">\n<td style=\"width: 33.3333%;height: 17px\">Fistulas<\/td>\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\n<td style=\"width: 33.3333%;height: 17px\"><\/td>\n<\/tr>\n<tr style=\"height: 17px\">\n<td style=\"width: 33.3333%;height: 17px\">Anal fissures<\/td>\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\n<td style=\"width: 33.3333%;height: 17px\"><\/td>\n<\/tr>\n<tr style=\"height: 17px\">\n<td style=\"width: 33.3333%;height: 17px\">Toxic megacolon<\/td>\n<td style=\"width: 33.3333%;height: 17px\"><\/td>\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\n<\/tr>\n<tr style=\"height: 17px\">\n<td style=\"width: 33.3333%;height: 17px\">Severe Dehydration<\/td>\n<td style=\"width: 33.3333%;height: 17px\"><\/td>\n<td style=\"width: 33.3333%;height: 17px\">X<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"page\" data-page-number=\"20\" role=\"region\" aria-label=\"Page 20\" data-loaded=\"true\">\n<h2 class=\"textLayer\"><span class=\"ez-toc-section\" id=\"Factors_Altering_Nutritional_Status\"><\/span>Factors Altering Nutritional Status<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>There are many factors that can impact an individual&#8217;s nutrition status in IBD. They may increase someone&#8217;s risk of malnutrition, affect their ability to access or prepare food, and change their anthropometric data.<\/p>\n<p>Review the following factors and identify which are more closely related to Crohn&#8217;s, Ulcerative Colitis, or both.<\/p>\n<div class=\"page\" data-page-number=\"20\" role=\"region\" aria-label=\"Page 20\" data-loaded=\"true\">\n<ul>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Decreased nutrient intake <\/span><\/li>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Severe diarrhea <\/span><\/li>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Blood in stool <\/span><\/li>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Abdominal pain and cramping <\/span><\/li>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Fatigue<\/span><\/li>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Weight loss <\/span><\/li>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Nausea and vomiting <\/span><\/li>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Restrictive diets <\/span><\/li>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Side effects of medications (appetite suppression, taste alterations)<\/span><\/li>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Mouth sores <\/span><\/li>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Increased needs for healing (protein, vitamins and minerals)<\/span><\/li>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Malabsorption <\/span><\/li>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">Surgical resections<\/span><\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Treatment_Options\"><\/span>Treatment Options<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Treatment for IBD falls into two main categories: medications and surgery. Drugs are primarily used to manage symptoms of IBD and reduce inflammation, the most common of which are explored in the &#8220;Medications&#8221; section below. Crohn&#8217;s disease is more likely to require surgical treatment, with around 70% of individuals affected undergoing ileostomy or bowel resection (removal of parts of the intestine that are damaged from inflammation). The complications of each GI surgery are listed in the &#8220;Surgery&#8221; section below.<\/p>\n<\/div>\n<\/div>\n<h3><span class=\"ez-toc-section\" id=\"Medications\"><\/span>Medications<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>The tables below provide an overview of medications used to reduce inflammation and manage symptoms of patients with IBD.<\/p>\n<table class=\"grid\" style=\"border-collapse: collapse;width: 100%;height: 606px\">\n<caption>Medications used for reducing inflammation in patients with IBD<\/caption>\n<tbody>\n<tr style=\"height: 17px\">\n<th style=\"width: 16.8186%;height: 17px\" scope=\"col\">Medications<\/th>\n<th style=\"width: 49.848%;height: 17px\" scope=\"col\">General Explanation<\/th>\n<th style=\"width: 33.3333%;height: 17px\" scope=\"col\">Examples<\/th>\n<\/tr>\n<tr style=\"height: 123px\">\n<th style=\"width: 16.8186%;height: 123px\" scope=\"row\">Sulfasalazine and 5-Aminosalicylates (5-ASA)<\/th>\n<td style=\"width: 49.848%;height: 123px\">These drugs limit the production of certain chemicals that trigger inflammation. This medicine is generally prescribed to help combat\u00a0<strong>milder attacks<\/strong> of Crohn&#8217;s or UC.<\/td>\n<td style=\"width: 33.3333%;height: 123px\">Mesalamines, Sulfazine<\/td>\n<\/tr>\n<tr style=\"height: 87px\">\n<th style=\"width: 16.8186%;height: 87px\" scope=\"row\">Steroids<\/th>\n<td style=\"width: 49.848%;height: 87px\">Steroids aim to reduce inflammation. These drugs are used by patients who have <strong>moderate to severe\u00a0<\/strong>attacks.<\/td>\n<td style=\"width: 33.3333%;height: 87px\">Prednisone, Hydrocortisone<\/td>\n<\/tr>\n<tr style=\"height: 158px\">\n<th style=\"width: 16.8186%;height: 158px\" scope=\"row\">Immunomodulators<\/th>\n<td style=\"width: 49.848%;height: 158px\">This type of medicine alters how the body mounts an inflammatory response. Immunomodulators do supress the ability to fight infections in general. These drugs are used by patients who have\u00a0<strong>moderate to severe\u00a0<\/strong>attacks.<\/td>\n<td style=\"width: 33.3333%;height: 158px\">Methotrexate<\/td>\n<\/tr>\n<tr style=\"height: 151px\">\n<th style=\"width: 16.8186%;height: 151px\" scope=\"row\">Biologics<\/th>\n<td style=\"width: 49.848%;height: 151px\">These drugs target and block molecules involved in inflammation. These drugs are used to combat\u00a0<strong>moderate to severe\u00a0<\/strong>attacks.<\/td>\n<td style=\"width: 33.3333%;height: 151px\">Adalimumab (Humira)<\/p>\n<p>Infliximab (Remicase, Inflectra)<\/p>\n<p>Vedolizumab (Entyvio)<\/p>\n<p>Ustekinumab (Sterlara)<\/td>\n<\/tr>\n<tr style=\"height: 70px\">\n<th style=\"width: 16.8186%;height: 70px\" scope=\"row\">Antibiotics<\/th>\n<td style=\"width: 49.848%;height: 70px\">Antibiotics do not counteract inflammation directly but decrease infection that can cause severe inflammation.<\/td>\n<td style=\"width: 33.3333%;height: 70px\">Ciprofloxacin, Metronidazole<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<table class=\"grid\" style=\"border-collapse: collapse;width: 100%;height: 329px\">\n<caption>Medications used for managing symptoms in patients with IBD<\/caption>\n<tbody>\n<tr style=\"height: 15px\">\n<th style=\"width: 15.8055%;height: 15px\" scope=\"col\">Medications<\/th>\n<th style=\"width: 50.8611%;height: 15px\" scope=\"col\">General Explanation<\/th>\n<th style=\"width: 33.3333%;height: 15px\" scope=\"col\">Examples<\/th>\n<\/tr>\n<tr style=\"height: 70px\">\n<th style=\"width: 15.8055%;height: 70px\" scope=\"row\">Antidiarrheals<\/th>\n<td style=\"width: 50.8611%;height: 70px\">Used to treat diarrhea and works by slowing down the movement of the gut. Relieves symptoms of increased frequency and urgency.<\/td>\n<td style=\"width: 33.3333%;height: 70px\">Loperamide, Diphenoxylate, Cholestyramine<\/td>\n<\/tr>\n<tr style=\"height: 35px\">\n<th style=\"width: 15.8055%;height: 35px\" scope=\"row\">Antispasmodics<\/th>\n<td style=\"width: 50.8611%;height: 35px\">Relieves, prevents or lowers the incidence of muscle spasms.<\/td>\n<td style=\"width: 33.3333%;height: 35px\">Hyoscyamine, Dicyclomine<\/td>\n<\/tr>\n<tr style=\"height: 35px\">\n<th style=\"width: 15.8055%;height: 35px\" scope=\"row\">Bulk formers<\/th>\n<td style=\"width: 50.8611%;height: 35px\">Soak up water in the stool, thereby firming it up as well as reducing frequency.<\/td>\n<td style=\"width: 33.3333%;height: 35px\">Fybogel, Normacol<\/td>\n<\/tr>\n<tr style=\"height: 35px\">\n<th style=\"width: 15.8055%;height: 35px\" scope=\"row\">Bile salt binders<\/th>\n<td style=\"width: 50.8611%;height: 35px\">Prevent irritation of the gut by capturing bile salts.<\/td>\n<td style=\"width: 33.3333%;height: 35px\">Cholestyramine, Colestipol<\/td>\n<\/tr>\n<tr style=\"height: 35px\">\n<th style=\"width: 15.8055%;height: 35px\" scope=\"row\">Stool softeners<\/th>\n<td style=\"width: 50.8611%;height: 35px\">For softening feces to ease bowel movements.<\/td>\n<td style=\"width: 33.3333%;height: 35px\">Docusate<\/td>\n<\/tr>\n<tr style=\"height: 35px\">\n<th style=\"width: 15.8055%;height: 35px\" scope=\"row\">Analgesics<\/th>\n<td style=\"width: 50.8611%;height: 35px\">For pain reduction<\/td>\n<td style=\"width: 33.3333%;height: 35px\">Acetaminophen, Morphine, Hydrocodone, Oxycodone<\/td>\n<\/tr>\n<tr style=\"height: 52px\">\n<th style=\"width: 15.8055%;height: 52px\" scope=\"row\">Non-steroidal anti-inflammatory drugs (NSAIDs)<\/th>\n<td style=\"width: 50.8611%;height: 52px\">For pain control in joints (Note: some people find these drugs aggravate their abdominal pain and diarrhea).<\/td>\n<td style=\"width: 33.3333%;height: 52px\">Aspirin, Ibuprofen, Naproxen<\/td>\n<\/tr>\n<tr style=\"height: 17px\">\n<th style=\"width: 15.8055%;height: 17px\" scope=\"row\">Acid reducing drugs<\/th>\n<td style=\"width: 50.8611%;height: 17px\">For &#8220;heartburn&#8221;<\/td>\n<td style=\"width: 33.3333%;height: 17px\">Cimetidine, Famotidine, Nizatidine<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3><span class=\"ez-toc-section\" id=\"Surgery\"><\/span>Surgery<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p><span role=\"presentation\" dir=\"ltr\">Approximately 70% of people with Crohn\u2019s and 40% of those with Ulcerative Colitis will require surgery at some point <\/span><span role=\"presentation\" dir=\"ltr\">in their lives. <\/span><span role=\"presentation\" dir=\"ltr\">Surgery should not be regarded as a last resort, it is simply another treatment option. The m<\/span><span role=\"presentation\" dir=\"ltr\">ost common types of surgeries for people with IBS are <\/span><span role=\"presentation\" dir=\"ltr\">ileostomies or primary resection.<\/span><\/p>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_1960\" aria-describedby=\"caption-attachment-1960\" style=\"width: 257px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Ileostomy_with_bag-257x300.jpeg\" alt=\"An ileostomy bag lies flat covering a stoma on the right side of a woman's abdomen.\" width=\"257\" height=\"300\" class=\"wp-image-1960 size-medium\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Ileostomy_with_bag-257x300.jpeg 257w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Ileostomy_with_bag-878x1024.jpeg 878w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Ileostomy_with_bag-768x895.jpeg 768w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Ileostomy_with_bag-65x76.jpeg 65w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Ileostomy_with_bag-225x262.jpeg 225w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Ileostomy_with_bag-350x408.jpeg 350w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Ileostomy_with_bag.jpeg 1195w\" sizes=\"auto, (max-width: 257px) 100vw, 257px\" \/><figcaption id=\"caption-attachment-1960\" class=\"wp-caption-text\">An ileostomy bag is placed over the stoma to collect waste matter. Photo by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Ileostomy_with_bag.jpg\">Remedios44<\/a>, <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\">CC BY-SA 4.0<\/a>, via Wikimedia Commons<\/figcaption><\/figure>\n<p>The table below summarizes nutrition complications after GI surgery, depending on the type of resection.<\/p>\n<table class=\"grid\">\n<caption>Nutrition complications after GI surgery, by type of resection<\/caption>\n<tbody>\n<tr style=\"height: 17px\">\n<th style=\"height: 57px;width: 93.4375px\" rowspan=\"2\">Type of Resection<\/th>\n<th style=\"height: 10px;width: 38.1597px\" rowspan=\"2\" scope=\"col\">\u2191TG<\/th>\n<th style=\"width: 40.1389px;height: 10px\" rowspan=\"2\" scope=\"col\">\u2191BG<\/th>\n<th style=\"width: 91.1979px;height: 10px\" rowspan=\"2\" scope=\"col\">Fluid\/ electrolyte balance<\/th>\n<th style=\"width: 315.365px;height: 10px;text-align: center\" colspan=\"4\" scope=\"colgroup\">GI Function<\/th>\n<th style=\"width: 150.208px;height: 10px;text-align: center\" colspan=\"3\" scope=\"colgroup\">Malabsorption<\/th>\n<\/tr>\n<tr style=\"height: 35px\">\n<th style=\"width: 89.2708px;height: 47px\" scope=\"col\">Gastroparesis<\/th>\n<th style=\"width: 81.3195px;height: 47px\" scope=\"col\">Anastomotic Leak<\/th>\n<th style=\"width: 37.2917px;height: 47px\" scope=\"col\">Chyle Leak<\/th>\n<th style=\"width: 65.2951px;height: 47px\" scope=\"col\">Dumping Syndrome<\/th>\n<th style=\"width: 21.3542px;height: 47px\" scope=\"col\">Fat<\/th>\n<th style=\"width: 50.3299px;height: 47px\" scope=\"col\">Vitamin<\/th>\n<th style=\"width: 50.3993px;height: 47px\" scope=\"col\">Mineral<\/th>\n<\/tr>\n<tr style=\"height: 17px\">\n<th style=\"width: 93.4375px;height: 17px\" scope=\"row\">Esophagastric<\/th>\n<td style=\"width: 36.7361px;height: 17px\"><\/td>\n<td style=\"width: 38.7153px;height: 17px\"><\/td>\n<td style=\"width: 89.7743px;height: 17px\">X<\/td>\n<td style=\"width: 87.8472px;height: 17px\"><\/td>\n<td style=\"width: 79.8958px;height: 17px\">X<\/td>\n<td style=\"width: 35.8681px;height: 17px\">X<\/td>\n<td style=\"width: 63.8715px;height: 17px\">X<\/td>\n<td style=\"width: 19.9306px;height: 17px\"><\/td>\n<td style=\"width: 48.9062px;height: 17px\"><\/td>\n<td style=\"width: 48.9757px;height: 17px\"><\/td>\n<\/tr>\n<tr style=\"height: 17px\">\n<th style=\"width: 93.4375px;height: 17px\" scope=\"row\">Gastric<\/th>\n<td style=\"width: 36.7361px;height: 17px\">X<\/td>\n<td style=\"width: 38.7153px;height: 17px\"><\/td>\n<td style=\"width: 89.7743px;height: 17px\"><\/td>\n<td style=\"width: 87.8472px;height: 17px\">X<\/td>\n<td style=\"width: 79.8958px;height: 17px\"><\/td>\n<td style=\"width: 35.8681px;height: 17px\"><\/td>\n<td style=\"width: 63.8715px;height: 17px\">X<\/td>\n<td style=\"width: 19.9306px;height: 17px\">X<\/td>\n<td style=\"width: 48.9062px;height: 17px\">B12, D<\/td>\n<td style=\"width: 48.9757px;height: 17px\">Fe, Ca<\/td>\n<\/tr>\n<tr style=\"height: 17px\">\n<th style=\"width: 93.4375px;height: 17px\" scope=\"row\">Pancreas<\/th>\n<td style=\"width: 36.7361px;height: 17px\">X<\/td>\n<td style=\"width: 38.7153px;height: 17px\"><\/td>\n<td style=\"width: 89.7743px;height: 17px\">X<\/td>\n<td style=\"width: 87.8472px;height: 17px\">X<\/td>\n<td style=\"width: 79.8958px;height: 17px\">X<\/td>\n<td style=\"width: 35.8681px;height: 17px\">X<\/td>\n<td style=\"width: 63.8715px;height: 17px\">X<\/td>\n<td style=\"width: 19.9306px;height: 17px\">X<\/td>\n<td style=\"width: 48.9062px;height: 17px\">A, D, E, K, B12<\/td>\n<td style=\"width: 48.9757px;height: 17px\">Fe, Ca, Zn<\/td>\n<\/tr>\n<tr style=\"height: 17px\">\n<th style=\"width: 93.4375px;height: 17px\" scope=\"row\">Hepatocellular<\/th>\n<td style=\"width: 36.7361px;height: 17px\">X<\/td>\n<td style=\"width: 38.7153px;height: 17px\">X<\/td>\n<td style=\"width: 89.7743px;height: 17px\">X<\/td>\n<td style=\"width: 87.8472px;height: 17px\"><\/td>\n<td style=\"width: 79.8958px;height: 17px\"><\/td>\n<td style=\"width: 35.8681px;height: 17px\">X<\/td>\n<td style=\"width: 63.8715px;height: 17px\"><\/td>\n<td style=\"width: 19.9306px;height: 17px\"><\/td>\n<td style=\"width: 48.9062px;height: 17px\">A, D, E, K, B12, Folic acid<\/td>\n<td style=\"width: 48.9757px;height: 17px\">Mg, Zn<\/td>\n<\/tr>\n<tr style=\"height: 17px\">\n<th style=\"width: 93.4375px;height: 17px\" scope=\"row\">Gall Bladder<\/th>\n<td style=\"width: 36.7361px;height: 17px\">X<\/td>\n<td style=\"width: 38.7153px;height: 17px\"><\/td>\n<td style=\"width: 89.7743px;height: 17px\">X<\/td>\n<td style=\"width: 87.8472px;height: 17px\">X<\/td>\n<td style=\"width: 79.8958px;height: 17px\"><\/td>\n<td style=\"width: 35.8681px;height: 17px\">X<\/td>\n<td style=\"width: 63.8715px;height: 17px\"><\/td>\n<td style=\"width: 19.9306px;height: 17px\">X<\/td>\n<td style=\"width: 48.9062px;height: 17px\">A, D, E, K, B12<\/td>\n<td style=\"width: 48.9757px;height: 17px\">Fe, Ca, Zn<\/td>\n<\/tr>\n<tr style=\"height: 17px\">\n<th style=\"width: 93.4375px;height: 17px\" scope=\"row\">Bile Duct<\/th>\n<td style=\"width: 36.7361px;height: 17px\">X<\/td>\n<td style=\"width: 38.7153px;height: 17px\"><\/td>\n<td style=\"width: 89.7743px;height: 17px\">X<\/td>\n<td style=\"width: 87.8472px;height: 17px\"><\/td>\n<td style=\"width: 79.8958px;height: 17px\"><\/td>\n<td style=\"width: 35.8681px;height: 17px\">X<\/td>\n<td style=\"width: 63.8715px;height: 17px\"><\/td>\n<td style=\"width: 19.9306px;height: 17px\">X<\/td>\n<td style=\"width: 48.9062px;height: 17px\">A, D, E, K, B12<\/td>\n<td style=\"width: 48.9757px;height: 17px\">Fe, Ca, Zn<\/td>\n<\/tr>\n<tr style=\"height: 17px\">\n<th style=\"width: 93.4375px;height: 17px\" scope=\"row\">Small Bowel<\/th>\n<td style=\"width: 36.7361px;height: 17px\">X<\/td>\n<td style=\"width: 38.7153px;height: 17px\"><\/td>\n<td style=\"width: 89.7743px;height: 17px\">X<\/td>\n<td style=\"width: 87.8472px;height: 17px\">X<\/td>\n<td style=\"width: 79.8958px;height: 17px\"><\/td>\n<td style=\"width: 35.8681px;height: 17px\">X<\/td>\n<td style=\"width: 63.8715px;height: 17px\"><\/td>\n<td style=\"width: 19.9306px;height: 17px\">X<\/td>\n<td style=\"width: 48.9062px;height: 17px\">A, D, E, K, B12<\/td>\n<td style=\"width: 48.9757px;height: 17px\">Fe, Ca, Zn<\/td>\n<\/tr>\n<tr style=\"height: 17px\">\n<th style=\"width: 93.4375px;height: 17px\" scope=\"row\">Colon or Rectum<\/th>\n<td style=\"width: 36.7361px;height: 17px\"><\/td>\n<td style=\"width: 38.7153px;height: 17px\"><\/td>\n<td style=\"width: 89.7743px;height: 17px\">X<\/td>\n<td style=\"width: 87.8472px;height: 17px\"><\/td>\n<td style=\"width: 79.8958px;height: 17px\"><\/td>\n<td style=\"width: 35.8681px;height: 17px\">X<\/td>\n<td style=\"width: 63.8715px;height: 17px\"><\/td>\n<td style=\"width: 19.9306px;height: 17px\"><\/td>\n<td style=\"width: 48.9062px;height: 17px\">B12<\/td>\n<td style=\"width: 48.9757px;height: 17px\">Na, K, Mg, Ca<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h1><span class=\"ez-toc-section\" id=\"Ostomies\"><\/span>Ostomies<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>A<span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">n <strong>ostomy <\/strong><\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">is<\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\"> a change in the way urine or stool exits the body as <\/span><span style=\"font-size: 1em\">a result of a surgical procedure. Bodily waste is rerouted from its <\/span><span style=\"font-size: 1em\">usual path because of malfunctioning parts of the urinary or <\/span><span style=\"font-size: 1em\">digestive system. An ostomy can be temporary or permanent. <\/span><\/p>\n<p><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">A<strong> stoma <\/strong><\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">is the opening created by the ostomy surgery. It is <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">located on the abdomen and is dark pink in color. For most <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">ostomies, a pouch is worn over the stoma to collect stool or urine. <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">For some people it is possible to have a continent diversion, <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">an <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">alternative to a conventional ostomy that eliminates the necessity <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">for a pouch.<\/span><\/p>\n<p>The three most common forms of ostomies are ileostomies, colostomies, and urosomies.<\/p>\n<p><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\"><strong>Ileostomy<\/strong>: <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">A surgically created <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">opening from the ileum, the lowest <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">part of the small intestine. The <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">intestine is brought through the <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">abdominal wall to form a stoma. <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">Ileostomies may be temporary or <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">permanent, and may involve <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\"><span role=\"presentation\" dir=\"ltr\">removal of all or part of the colon.<\/span><\/span><\/p>\n<p><strong>Colostomy<\/strong>: <span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">The surgically created <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">opening of the colon (large intestine) <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">which results in a stoma. A colostomy <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">is created when a portion of the colon <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">or the rectum is removed, and the <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">remaining colon is brought to the <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">abdominal wall. It may further be <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">defined by the portion of the colon <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">involved and\/or its permanence.<\/span><\/p>\n<p><strong>Urostomy<\/strong>: <span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">This is a general term for a <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">surgical procedure which diverts urine away <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">from a diseased or defective bladder. The <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">ileal or cecal conduit procedures are the most <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">common urostomies. Either a section at the <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">end of the small bowel (ileum) or at the <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">beginning of the large intestine (cecum) is <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">surgically removed and relocated as a <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">passageway for urine to pass from the <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">kidneys to the outside of the body through a <\/span><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\">stoma.<\/span><\/p>\n<div class=\"page\" data-page-number=\"27\" role=\"region\" aria-label=\"Page 27\" data-loaded=\"true\">\n<figure id=\"attachment_1962\" aria-describedby=\"caption-attachment-1962\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.40.58-AM-300x243.png\" alt=\"An ileostomy bag covers the stoma on the right side of a person's abdomen.\" width=\"300\" height=\"243\" class=\"wp-image-1962 size-medium\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.40.58-AM-300x243.png 300w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.40.58-AM-768x622.png 768w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.40.58-AM-65x53.png 65w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.40.58-AM-225x182.png 225w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.40.58-AM-350x283.png 350w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.40.58-AM.png 892w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-1962\" class=\"wp-caption-text\">Placement of an ileostomy bag. Photo by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Diagram_of_an_ileostomy_with_a_bag_CRUK_030.svg\">Cancer Research UK<\/a>, <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\">CC BY-SA 4.0<\/a>, via Wikimedia Commons<\/figcaption><\/figure>\n<figure id=\"attachment_1965\" aria-describedby=\"caption-attachment-1965\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.23.40-PM-300x257.png\" alt=\"A colostomy bag attaches to a stoma on the left side of the abdomen, leaving a rectal stump.\" width=\"300\" height=\"257\" class=\"wp-image-1965\" style=\"color: #373d3f;font-weight: bold;font-size: 1em\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.23.40-PM-300x257.png 300w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.23.40-PM-768x659.png 768w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.23.40-PM-65x56.png 65w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.23.40-PM-225x193.png 225w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.23.40-PM-350x300.png 350w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.23.40-PM.png 858w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-1965\" class=\"wp-caption-text\">Placement of a colostomy bag. Photo by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Diagram_showing_a_colostomy_with_a_bag_CRUK_061.svg\">Cancer Research UK<\/a>, <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\">CC BY-SA 4.0<\/a>, via Wikimedia Commons<\/figcaption><\/figure>\n<figure id=\"attachment_1964\" aria-describedby=\"caption-attachment-1964\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.21.57-PM-300x288.png\" alt=\"The ureter is attached to a small piece of bowel called an ileal conduit. The ileal conduit carries urine out of the body through an opening called a stoma in the abdomen.\" width=\"300\" height=\"288\" class=\"wp-image-1964\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.21.57-PM-300x288.png 300w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.21.57-PM-768x736.png 768w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.21.57-PM-65x62.png 65w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.21.57-PM-225x216.png 225w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.21.57-PM-350x336.png 350w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Screen-Shot-2022-02-27-at-9.21.57-PM.png 920w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-1964\" class=\"wp-caption-text\">The creation of a urostomy by way of an ileal conduit. <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Diagram_showing_how_a_urostomy_is_made_(ileal_conduit)_CRUK_124.svg\">Cancer Research UK<\/a>, <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\">CC BY-SA 4.0<\/a>, via Wikimedia Commons<\/figcaption><\/figure>\n<h1><span class=\"ez-toc-section\" id=\"Pancreatitis\"><\/span><span style=\"text-align: initial;font-size: 1em\">Pancreatitis<\/span><span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>The pancreas is an important gland in the digestive system, located behind the stomach in the upper abdomen.<\/p>\n<\/div>\n<p>There are two <strong>main functions of the pancreas<\/strong>:<\/p>\n<ol>\n<li><strong>Exocrine<\/strong>, which makes digestive enzymes\n<ul>\n<li>Enzymes such as amylase, lipase and gastric juices help to digest food<\/li>\n<li>The pancreas releases enzymes into progressively larger ducts towards the main pancreatic duct<\/li>\n<li>The enzymes then drain into the duodenum<\/li>\n<\/ul>\n<\/li>\n<li><strong>Endocrine<\/strong>, which makes hormones\n<ul>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">The Islets of Langerhans make insulin and glucagon<\/span><\/li>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\">These hormones are released into the blood stream to c<\/span><span role=\"presentation\" dir=\"ltr\">ontrol blood sugar (glucose) levels<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<figure id=\"attachment_1961\" aria-describedby=\"caption-attachment-1961\" style=\"width: 526px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Pancreas-300x151.jpeg\" alt=\"The pancreas is tucked between the duodenum of the small intestine, the spleen and splenic artery. Acinar cells in the pancreas secrete digestive enzymes that are carried through the pancreatic duct to the duodenum. Pancreatic islets throughout the organ make the hormones insulin and glucagon.\" width=\"526\" height=\"265\" class=\"wp-image-1961\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Pancreas-300x151.jpeg 300w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Pancreas-1024x517.jpeg 1024w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Pancreas-768x388.jpeg 768w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Pancreas-65x33.jpeg 65w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Pancreas-225x114.jpeg 225w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Pancreas-350x177.jpeg 350w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/Pancreas.jpeg 1092w\" sizes=\"auto, (max-width: 526px) 100vw, 526px\" \/><figcaption id=\"caption-attachment-1961\" class=\"wp-caption-text\">An overview of the functions of the pancreas. Diagram by<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:1820_The_Pancreas.jpg\"> OpenStax College<\/a> , <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\">CC BY 3.0<\/a>, via Wikimedia Commons<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<p><span role=\"presentation\" dir=\"ltr\" style=\"font-size: 1em\"><strong>Pancreatitis<\/strong> is inflammation in the pancreas. <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">It occurs when digestive enzymes become activated while still in the pancreas, irritating the cells of <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">your pancreas and causing inflammation. It can occur as <strong>acute pancreatitis<\/strong>, meaning it appears suddenly and lasts for days; or as <strong>chronic pancreatitis<\/strong>, which occurs over many years.<\/p>\n<p><\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">With repeated bouts of acute pancreatitis, damage to the pancreas <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">can occur and lead to chronic pancreatitis. <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">Mild cases of pancreatitis may go away without treatment, but severe cases can cause life-threatening <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">complications. <\/span><\/p>\n<p><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">Risk factors for pancreatitis: <\/span><\/p>\n<ul>\n<li><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">Excessive alcohol consumption<\/span><\/li>\n<li><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">Cigarette smoking<\/span><\/li>\n<li><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">Obesity <\/span><\/li>\n<li><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">Family history<\/span><\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Acute_Pancreatitis\"><\/span>Acute Pancreatitis<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<div class=\"page\" data-page-number=\"27\" role=\"region\" aria-label=\"Page 27\" data-loaded=\"true\">\n<div class=\"page\" data-page-number=\"30\" role=\"region\" aria-label=\"Page 30\" data-loaded=\"true\">\n<p><span role=\"presentation\" dir=\"ltr\"><strong>Signs and symptoms <\/strong>of acute pancreatitis\u00a0include <\/span><span role=\"presentation\" dir=\"ltr\">upper abdominal pain, fever, rapid pulse, nausea, and vomiting.<\/span><\/p>\n<p><span role=\"presentation\" dir=\"ltr\">Many causes of acute pancreatitis exist, with b<\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">iliary stones and <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">alcohol overuse causing around <\/span>70-80% <span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">of cases. Obstructive causes like gallstones and tumours may also occur. <\/span>Gallstones can get stuck in the common bile duct and press on the pancreatic duct, which blocks normal flow and leads to pancreatic injury. Other causes can include: t<span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">oxins such as scorpion bites, certain drugs (ex. azathioprine), trauma from surgical procedures or blunt trauma, and infections (viruses, bacteria, parasites). Metabolic causes for acute pancreatitis include <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">hypertriglyceridemia and hypercalcemia.<\/span><\/p>\n<\/div>\n<\/div>\n<div><\/div>\n<div>There are several <strong>classifications<\/strong> of acute pancreatitis that are defined differently:<\/div>\n<div class=\"page\" data-page-number=\"27\" role=\"region\" aria-label=\"Page 27\" data-loaded=\"true\">\n<div class=\"textLayer\">\n<div class=\"page\" data-page-number=\"31\" role=\"region\" aria-label=\"Page 31\" data-loaded=\"true\">\n<ul>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\"><strong>Mild<\/strong> acute pancreatitis<strong>: <\/strong><\/span>No organ failure, local or systemic complications<\/li>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\"><strong>Moderately severe <\/strong>acute pancreatitis: <\/span><span role=\"presentation\" dir=\"ltr\">Transient organ failure &gt; 48 hours, l<\/span><span role=\"presentation\" dir=\"ltr\">ocal complications<\/span><\/li>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\"><strong>Severe<\/strong> acute pancreatitis: <\/span><span role=\"presentation\" dir=\"ltr\">Persistent organ failure &gt; 48 hours, <\/span><span role=\"presentation\" dir=\"ltr\">local complications<\/span>\n<ul>\n<li class=\"textLayer\"><span role=\"presentation\" dir=\"ltr\"><strong>Necrotizing<\/strong> acute pancreatitis:<\/span><span role=\"presentation\" dir=\"ltr\"> Inflammation associated with <button class=\"glossary-term\" aria-describedby=\"380-2447\">necrosis<\/button> of the pancreas or <\/span><span role=\"presentation\" dir=\"ltr\">surrounding tissues (increased risk of death by 36-50%)<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<p><span role=\"presentation\" dir=\"ltr\">Initial <strong>treatment<\/strong> in the hospital for acute pancreatitis involves various management strategies.\u00a0<\/span><\/p>\n<p><span role=\"presentation\" dir=\"ltr\"><strong>Fasting <\/strong>\u00a0is indicated t<\/span><span role=\"presentation\" dir=\"ltr\">o allow the pancreas to recover. Once the inflammation in the pancreas is controlled, the <\/span><span role=\"presentation\" dir=\"ltr\">patient will typically be switched to clear fluids and eating bland foods. With time, they can go back to a <\/span><span role=\"presentation\" dir=\"ltr\">normal diet.<\/span><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\">\u00a0<\/span><\/span><\/p>\n<p><span class=\"markedContent\"><span role=\"presentation\" dir=\"ltr\">As p<\/span><\/span><span role=\"presentation\" dir=\"ltr\">ancreatitis can cause severe pain, <strong>pain medications<\/strong> are often used. The health care team will give the patient <\/span><span role=\"presentation\" dir=\"ltr\">medications to help control the pain. Dehydration is also likely. For this reason, individuals typically receive extra <strong>fluids through intravenous route (IV).<\/strong><\/span><span role=\"presentation\" dir=\"ltr\"><\/span><span role=\"presentation\" dir=\"ltr\"><\/span><\/p>\n<p><strong><span role=\"presentation\" dir=\"ltr\">Treatment of the underlying cause <\/span><\/strong><span role=\"presentation\" dir=\"ltr\">wil<\/span><span role=\"presentation\" dir=\"ltr\">l range based on the patient&#8217;s circumstances and needs. This could include surgery, <\/span><span role=\"presentation\" dir=\"ltr\">medications, or education (dietary, alcohol dependence, etc).<\/span><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Chronic_Pancreatitis\"><\/span>Chronic Pancreatitis<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<div class=\"page\" data-page-number=\"27\" role=\"region\" aria-label=\"Page 27\" data-loaded=\"true\">\n<div class=\"textLayer\">\n<div class=\"page\" data-page-number=\"31\" role=\"region\" aria-label=\"Page 31\" data-loaded=\"true\">\n<div class=\"annotationLayer\"><span role=\"presentation\" dir=\"ltr\">Chronic pancreatitis is an inflammation of the pancreas that doesn\u2019t improve over time. There are <\/span><span role=\"presentation\" dir=\"ltr\">numerous causes of chronic pancreatitis. The most common cause is long-term alcohol abuse. <\/span><span role=\"presentation\" dir=\"ltr\">Approximately 70% of cases are linked to alcohol consumption. <\/span><span role=\"presentation\" dir=\"ltr\">Chronic pancreatitis is associated with unique <\/span><strong><span role=\"presentation\" dir=\"ltr\">complications<\/span><\/strong><span role=\"presentation\" dir=\"ltr\"> relevant to nutrition, some of which may be more common than others. <\/span><\/div>\n<p><strong><span role=\"presentation\" dir=\"ltr\">Nutrient <\/span><span role=\"presentation\" dir=\"ltr\">malabsorption <\/span><\/strong><span role=\"presentation\" dir=\"ltr\">is o<\/span><span role=\"presentation\" dir=\"ltr\">ne of the most common complications, related to pancreatic digestive enzymes. Specifically, v<\/span><span role=\"presentation\" dir=\"ltr\">itamin B12 deficiency and fat-soluble vitamin deficiency can occur. <\/span><span role=\"presentation\" dir=\"ltr\">The development of <\/span><span role=\"presentation\" dir=\"ltr\"><strong>diabetes<\/strong> is also common, as p<\/span><span role=\"presentation\" dir=\"ltr\">ancreatitis damages the cells that produce insulin and glucagon. <\/span><span role=\"presentation\" dir=\"ltr\">About <\/span><span role=\"presentation\" dir=\"ltr\">45% of people with chronic pancreatitis will develop diabetes.<\/span><\/p>\n<p><span role=\"presentation\" dir=\"ltr\"><strong>Pseudocysts <\/strong>are another complication of chronic pancreatitis. These &#8220;cysts&#8221; are a <\/span><span role=\"presentation\" dir=\"ltr\">collection of pancreatic fluid caused by direct leakage from the inflamed gland or the pancreatic <\/span><span role=\"presentation\" dir=\"ltr\">duct. About 50% of pseudocysts resolve on their own. Treatment may be necessary when they become symptomatic, infected, or are increasing <\/span><span role=\"presentation\" dir=\"ltr\">in size.<\/span><\/p>\n<\/div>\n<p><strong>Treatments<\/strong> of chronic pancreatitis may have similarities to that of acute pancreatitis, such as with\u00a0<strong>pain medications,\u00a0<\/strong>and dietary\u00a0<strong>education.<\/strong> Unique treatment approaches are also used, such as <strong>e<\/strong><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\"><strong>nzymes to improve digestion<\/strong>. <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">Pancreatic enzyme supplements help the body break down and absorb the <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">nutrients in food, and are taken with each meal.<\/span><span style=\"text-align: initial;font-size: 1em\">\u00a0If the patient has autoimmune pancreatitis, <\/span><strong style=\"text-align: initial;font-size: 1em\">steroids<\/strong><span style=\"text-align: initial;font-size: 1em\"> may be used. <\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\"><strong>Surgery <\/strong><\/span><span role=\"presentation\" dir=\"ltr\" style=\"text-align: initial;font-size: 1em\">is not necessary for most people, but remains an option.<\/span><\/p>\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<div class=\"textbox shaded\">Background complete!<span> Feel free to review any resources and move to the next section \u201cAssess\u201d when you are ready.<\/span><\/div>\n<div class=\"glossary\"><div class=\"glossary__tooltip\" id=\"380-2444\" hidden><p>Abnormal narrowings of the intestine caused by scar tissue<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"380-2445\" hidden><p>Small tears or sores in the lining of the anus<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"380-2446\" hidden><p>Abnormal connections\/ tunnels between different parts of the intestine<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"380-2447\" hidden><p>Cell death <\/p>\n<\/div><\/div>","protected":false},"author":315,"menu_order":1,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-380","chapter","type-chapter","status-publish","hentry"],"part":112,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapters\/380","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/wp\/v2\/users\/315"}],"version-history":[{"count":47,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapters\/380\/revisions"}],"predecessor-version":[{"id":2448,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapters\/380\/revisions\/2448"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/parts\/112"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapters\/380\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/wp\/v2\/media?parent=380"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapter-type?post=380"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/wp\/v2\/contributor?post=380"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/wp\/v2\/license?post=380"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}