LG is a 24-year-old woman who presents with irritable bowel syndrome that began about 6 months previously following an episode of food poisoning

LG is a 24-year-old woman who presents with irritable bowel syndrome that began about 6 months previously following an episode of food poisoning.

Medical Diagnosis by MD: postinfectious irritable bowel syndrome (PI-IBS)

Initial Assessment of LG:

B/P: 115/70

Height: 5’3”

Weight: 112.8 lbs

BMI: 20.0

History:

LG was attending veterinary school in Grenada and had lived there for about 4 months. At the beginning of her second semester, she experienced a severe case of food poisoning. She is not certain of the cause, but suspected that it was jerk chicken purchased from a road-side food stall. She was very sick for about 1 week, and gradually began to feel somewhat better. However, since this acute illness, her GI function has not returned to normal. She complains of alternating diarrhea and constipation, intermittent severe abdominal cramps, and has no appetite. As a result of her symptoms, LG has lost about 7 lbs in the past 6 months. Due to these chronic symptoms, LG was forced to leave school and return home for better treatment.

Before this episode of food poisoning, she reports her GI function was normal. Her overall health before going to Grenada was fairly good. However, she notes that she has always been somewhat anxious and believes she has hypoglycemia, although it has never been diagnosed. Symptoms that make her believe she is hypoglycemic are periods of extreme fatigue and/or shakiness. She has passed out on a couple of occasions within the past two years. Lately she has noted increasing frequency of these symptoms, especially shakiness and feeling like she is going to pass out.

Her intake info is featured in the picture-

Medication and Supplements:

hyoscyamine- .375 mg capsule 30-60 minutes before meals

IBgard 3 x’s daily for cramps

Multi-vitamin

Caltrate

Align probiotic

Metamucil as needed

Laboratory Data:

LG had blood work done in Grenada, but results are not available. Blood work since she came home was normal except for mildly elevated liver enzymes and borderline anemia.

Dietary Intake:

LG has been following an elimination diet which is featured in the pictures given to her by her gastroenterologist.

Questions:

1. What is the major complaint to be addressed with LG?

2. What further information would you elicit? Keep in mind the four types of nutritional assessment- clinical, anthropometric, dietary, and biochemical. Explain your rationale for the assessments you suggest.

3. What is your assessment of the dietary plan LG is following? Do you have any suggested modifications? Explain your rationale for any suggestions you make.