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Advanced MNT 2 > Gastrointestinal Disorders & Surgeries > Flashcards

Gastrointestinal Disorders & Surgeries Flashcards

1
Q

What Gastric Outlet Obstruction (GOO)

A

pyloric obstruction impeding gastric emptying

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2
Q

GOO is Caused by ?

A

cancer
PUD (peptic ulcer disease)
inflammation
congenital disorders
bezoar

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3
Q

what is a bezoar ?

A

can be hair or undigested fiber material stuck in the stomach

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4
Q

Clinical Manifestations of GOO

A

Fullness, more distress after eating
Epigastric pain

Nausea/Vomiting
Dehydration

Anorexia
Weight loss
Malnutrition
Electrolyte imbalances
Metabolic alkalosis

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5
Q

Metabolic alkalosis

A

pH too basic bc too much acid loss

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6
Q

Medical Management of GOO

A

gastric enzymes first
nasogastric suction
surgery - pyloroplasty (largen the sphincter)

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7
Q

pyloroplasty may cause

A

dumping syndrome

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8
Q

MNT for GOO

PO diet if tolerated=> _______ & ________
may only be able to tolerate liquids=> _________

For severe obstruction=> __________
May require _______ if chronic or unresectable

A

chew foods thoroughly & avoid tough fibrous foods
blenderized diet

NPO with IVF & electrolytes

JT feeding

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9
Q

Upper GI bleeding (UGIB) is bleeding from the ___________

A

esophagus, stomach, or duodenum

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10
Q

Upper GI bleeding (UGIB) can be caused by:

A

Esophageal varices

Peptic & stress ulcers
Gastritis
Gastric cancer

Erosive esophagitis
Mallory-Weiss tears
NSAIDS and aspirin (ibuprofen)

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11
Q

Lower GI Bleeding (LGIB) is bleeding from the ________

A

jejunum, ileum, colon, or rectum

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12
Q

Lower GI Bleeding (LGIB) caused by:

A

Inflammatory bowel disease
Cancer
Diverticular disease
Enteritis or colitis
Polyps
Hemorrhoids

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13
Q

Symptoms of a GI Bleed (GIB)

A

Acute blood loss
Chronic blood loss
Decreased Hgb & Hct

Increased BUN (from high pro of blood)
Weakness
Diarrhea
Decreased BP and increased HR

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14
Q

Chronic GIB=> _____________

A

iron deficiency anemia

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15
Q

Acute blood loss from GIB? (3)

A

Hematemesis=>bloody vomit

Melena=>black, tarry stools (digested)

Hematochezia=>bright red blood from rectum (BRBPR) (lower GI)

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16
Q

chronic GIB ?

A

Occult bleeding=>small amounts of blood in stool

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17
Q

MNT for GIB

If acute bleeding:
Initially ______ then=>______=>______ diet=> ______ diet

Provide adequate _____; _____ and _____ for healing

____ supplement if needed (chronic bleeding)

A

NPO with IVF
liquids
low fiber
regular

fluid
protein & kcal

Iron

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18
Q

___ mg of elemental iron daily for adults with GIB
Note: ________ contains 20% elemental iron
If severe bleeding from small intestine, may need=> _____

iron taken _______

A

120 mg
taken without food
Ferrous sulfate
parenteral nutrition (PN)
without eating food

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19
Q

what is ileus

A

temporary lack of peristalsis

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20
Q

illeus can be caused by

A

abdominal surgery
medications (opioids or sedatives)
abdominal infections
hypokalemia

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21
Q

symptoms of ileus

A

Abdominal distention, pain, N/L

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22
Q

Intestinal obstruction is caused by…?

A

Post-surgical adhesions
Tumors
Severe inflammation=>strictures
Hernias
Volvulus
Fecal impaction
Congenital disorders: intestinal atresia

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23
Q

Clinical Manifestations of Intestinal Obstruction

A

Severe, crampy abdominal pain that comes and goes

Abdominal bloating & distention

N/V

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24
Q

Possible Complications of Intestinal Obstruction

A

Decreased intake
Dehydration
Hypokalemia
Metabolic alkalosis
Hypovolemic shock
Intestinal perforation=> peritonitis

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25
Q

MNT for Intestinal Obstruction

__________________.
May require ________.

When oral diet appropriate=>____ diet=>_____ diet

If chronic duodenal obstruction=> _________

A

NPO with IVF & electrolytes
May require PN

low fiber
regular

JT feeding

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26
Q

Low fiber diet is consuming <______ grams fiber per day

Avoid?

A

10-15

whole grains, nuts, seeds, legumes, popcorn
raw fruits & veggies, cooked corn, and potato skins

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27
Q

resection ?

A

remove

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28
Q

Reasons for Intestinal Resections

A

MAINLY - Cancer
Inflammatory Bowel Disease
Obstruction
Congenital anomalies
Mesenteric Infarct
Diverticulitis
Fistula
Volvulus
Rectal disorders

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29
Q

Nutritional Considerations of intestinal resection

A

Site of nutrient digestion & absorption
Digestive enzymes & secretions
Motility
Amount of intestine removed
Adaptation

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30
Q

Pancreatic secretions & bile enter the ___________

A

duodenum

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31
Q

Duodenum is Preferred site of absorption for ____, ____, ____, and ____ however the _____ can take over some absorption

A

iron, zinc, copper, & folate

jejunum

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32
Q

Duodenal resections can cause __________

A

dumping syndrome

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33
Q

______ is the Major site of nutrient absorption, so Monitor for _____________

After resections, the______ typically adapts to perform the functions

A

Jejunum
malabsorption

ileum

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34
Q

________ slows down gastric emptying

A

cholecystickinase

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35
Q

ONLY place B12 is absorbed

A

end of ileum

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36
Q

ileum is where we reabsorb ____________

why is this important for resections?

A

bilesalts

can cause fat malabsorption which can further cause Ca, Mg, and Zn excretion

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37
Q

some side effects of ileum resection

A

malabsorption
diarrhea
cholelithiasis due to decreased bile salt pool
nephrolithiasis (oxalate stones)

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38
Q

how does cholelithiasis happen

A

low bile salts
high cholesterol doesn’t get bonded to bile

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39
Q

how does nephrolithiasis happen

A

Not enough calcium to binds to oxalates and takes them away bc the calcium is bonded to fat

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40
Q

can something take the job of ileum

A

no

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41
Q

Ilealcecal Valve (ICV):

  1. what is it?
  2. ## what does it do when removed?-
A
  1. connects ileum to ascending colon
    • Increases the emptying rate of small intestinal contents into the colon=> diarrhea
    • Migration of colonic bacteria into the ileum=> small intestinal bacterial overgrowth (SIBO)
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42
Q

Colonic resection can lead to Decreased absorption of _______
and _______

resection can lead to ________

A

fluid & electrolytes

diarrhea

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43
Q

where is fluid and electrolytes absorbed

A

colon and ileum

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44
Q

Per Enhanced Recovery After Surgery (_____) Guidelines:

No solid food for ____ before surgery
May have clear liquids up until_____ before surgery
NPO for _____ before surgery

A

ERAS

6 hrs
2 hours
2 hrs

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45
Q

high fluid in surgery can result in

A

ileus and inflamed bowel

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46
Q

MNT for Intestinal Resections

Traditional post-op diet advancement=> ?

However, there is no reason for solid foods and liquids to not be introduced as soon as the GIT is functioning. Soooo, new recommendation is _________

A

clear liquids=>full liquids=> low fiber=> regular

low fiber diet and ADAT (advance diet as tolerated) to regular diet

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47
Q

FOR INTESTINAL RESECTIONS

Provide ____ kcal/kg
Provide ________ g/kg of protein

Provide high protein, high kcal ONS
Micronutrient supplementation ?

If extensive resection or prolonged, patient can get _______=> and in this case we recommend ____________

A

25-30
1.2-2.0

as needed

post-operative ileus
parenteral nutrition

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48
Q

A surgically created opening between the intestinal tract and the skin to permit defecation from the intact portion of intestine

A

Intestinal Ostomies

49
Q

created when part of the colon or rectum are removed or must be bypassed

A

Colostomy

50
Q

created when entire colon is removed or must be bypassed

A

Ileostomy

51
Q

Indications for Creation of Intestinal Ostomies

A

Most common is Colorectal cancer & Diverticulitis

Also…
IBD
Bowel perforation
Bowel ischemia
Enterocutaneous or colocutaneous fistulae

52
Q

intestine cut and the rest is gone, ostomy type is _____

looks like ?

A

end stoma

turtleneck folded over

53
Q

ostomy type that is more a bypass situation

A

loop ostomy

54
Q

MNT for Ostomies
Post-op: ______________
Provide adequate fluid=> _________ of fluid/d
Adequate ____________________
Supplementation
Resection terminal ileum=> _____________

A

Low fiber diet=> ADAT to a Regular diet after ~6 weeks

8-10 cups

Na & K+ (especially for ileostomies)

vitamin B12 supplementation

55
Q

MNT for ostomy longterm for as long as they have the ostomies

A

Minimize risk of stoma obstruction:
Chew food thoroughly
Avoid foods that are incompletely digested=> corn, popcorn, seeds, nuts, coconut, raw cabbage, veg & fruit peels, dried fruit

56
Q

If excessive ostomy output..

Particularly a concern with _______

Provide a __________________
Avoid foods that can increase output=> foods high in ________, ____ food, high ___ foods, prunes, caffeine, alcohol, fruit juice, foods high in __________, _______

______ insoluble fiber and _____ soluble fiber
_____ small meals/day

A

ileostomies

oral rehydration solution (ORS) sipped throughout the day

insoluble fiber
spicy
fat
added sugars
sorbitol

Reduce
increase
6-8

57
Q

soluble fiber foods

A

bananas
oats
carrots

58
Q

Educate on foods that may cause odor=> _________

A

cruciferous vegetables
beans
asparagus
garlic
onions
eggs
fish

59
Q

If excessive gas, limit=> ____________

A

cruciferous vegetables, garlic, onions, fish, eggs, legumes

carbonated beverages, chewing gum, alcohol

dairy products (if lactose intolerant)

60
Q

Clinical condition in which the normal digestion and/or absorption of nutrients is impaired

A

Malabsorption

61
Q

Malabsorption May be a _______ or ____________
Can lead to _______________

A

single nutrient
multiple nutrients

malnutrition

62
Q

where is alcohol absorbed

A

stomach

63
Q

colon can make some ___

A

vitamin K

64
Q

can also absorb ____ in colon

A

oxalates and short chain fatty acids

65
Q

Fat Malabsorption can be from abnormalities in _______, __________, or _________

A

Pancreatic secretion (pancreatic lipase deficiency)
Bile salt availability
Enterocyte function (damaged spot of absorption)

66
Q

what can cause Pancreatic insufficiency

A

CF
chronic pancreatitis

67
Q

Bile salt function

A

breaks down globs of fat (emulsifying)
form around globs to transport them

68
Q

what cause decrease bile availability ?

what decreases reabsorption of bile?

A

Cholestatic liver disease
biliary obstruction
ESLD

ileal disease or resection

69
Q

what can cause small bowel mucosal disease/damage

A

Celiac disease
Crohn’s disease
radiation enteritis
AIDS

70
Q

what can cause dumping syndrome

A

gastric resection because doesn’t have time to mix

71
Q

bacterial overgrowth can cause ?

A

deconjugation of bile salts
intestinal mucosal damage

72
Q

Signs & Symptoms of Steatorrhea

A

Excessive fat content in stool causes diarrhea
Pale, greasy stools, oily film in toilet water, foul odor
Weight loss despite adequate intake

73
Q

diagnosis of fat malabsorption

A

Fecal Fat Test

74
Q

Fecal Fat Test

____ hr stool collection
Consume a _____ g fat diet
Normally _____ g fat in stool per day
>___ g/day=> malabsorption

A

72
100
2-6 g
>7 days

75
Q

Nutritional Consequences of Steatorrhea

A

Dehydration
Electrolyte losses
Weight loss and malnutrition

Fat-soluble vitamin deficiencies
Decreased absorption of Ca, Mg, & Zn

Hyperoxaluria=> nephrolithiasis

76
Q

Vitamin deficiency consequences of fat soluble vitamins

A

A - night blindness and bitots spots
D - osteoporosis and malabsorption Ca
E - peripheral neuropathy (nerve pain)
K - clotting factors so if someone is bruising

77
Q

Treatment Goals for Fat Malabsorption

A

Determine & treat underlying cause

Alleviate steatorrhea

Correct nutritional deficiencies

78
Q

Fat-Restricted Diet: ____ g/d

Purpose=> decrease _______

Note: All types of fat are restricted except _____

If due to pancreatic insufficiency=> _______

A

40

steatorrhea

MCT

pancreatic enzyme supplements

79
Q

MCT do not require _____, ____, or _____ for digestion & absorption

A

pancreatic lipase, bile salts, or chylomicrons

80
Q

Can consider MCT oil use of as a fat & kcal source
____ kcal/g; ____ kcal/Tbsp

Used for cooking?

Often used in __________ or __________

Does not contain ____

A

8.3
116

no bc it has low smoke point

semi-elemental oral supplements
enteral formulas

EFA

81
Q

For Fat-Malabsorption, Monitor for micronutrient deficiencies & supplement as needed
- __________
- ___________

Oral nutrition supplements
- ____________________

A

MVI w/minerals
Water-soluble form of fat-soluble vitamins

Partially-hydrolyzed, peptide-based with MCT oil

82
Q

examples of oral nutrition supplements for fat malabsorption

A

Peptamen with Prebio
Vital Peptide 1.5 Cal

83
Q

How can CHO malabsorption occur?

  1. abnormalities in __________ such as ________ leading to _______ deficiency
  2. abnormalities in ___________ leading to __________
  3. damaged _______ from ________
  4. significant resections of the ________
A
  1. brush border enzymes
    disaccharide deficiency
    lactase deficiency
  2. pancreatic secretions
    pancreatic insufficiency
  3. mucosa
    celiac disease
  4. small bowel
84
Q

Signs & Symptoms of CHO Malabsorption

A

Abdominal bloating/distention
Flatulence
Watery, osmotic diarrhea
Borborygmi (gurgling noise)
Nausea

85
Q

MNT for carb malabsorption

_____________

If Lactase deficiency __________ and _________
Also provide ____________

A

Limit/avoid the offending CHO

Lactose-restricted diet and Limit to amount tolerated
Provide alternate Ca & vitamin D sources

86
Q

Etiology of Protein Malabsorption

A

Pancreatic insufficiency

Small bowel mucosal damage
- inflammation, Celiac disease

Significant small bowel resections
- Short Bowel Syndrome (SBS)

87
Q

Signs & Symptoms of Protein Malabsorption

A

Muscle wasting
Hair loss
Decreased serum albumin, prealbumin
Edema

88
Q

MNT for Protein Malabsorption

Increase protein intake=> ______ g/kg

If due to pancreatic insufficiency=> _________

Possible need for _____________ sources
(oral nutrition supplements or enteral nutrition)

A

1.5

pancreatic enzyme supplements

hydrolyzed, semi-elemental protein

89
Q

Monitoring for protein Malabsorption

A

GI symptoms & stool output
Nutrient intake
Weight
Nutrition-Focused Physical Examination
Hydration status

90
Q

Lab Assessment for protein malabsorption

A

Fecal fat test
Serum electrolyte levels
Serum vitamin & minerals levels
Prothrombin time
Serum cholesterol & TG

91
Q

What is a fistula?

A

Abnormal connection from one organ to another organ, skin, or wound

92
Q

where can a fistula happen

A

from anywhere in the GIT

93
Q

fistula can be cause by

A

Surgery (mostly)
Inflammatory Bowel Disease
Radiation Enteritis
Infection (e.g., diverticulitis)
Cancer
Injury
Bowel ischemia

94
Q

Classification of Enterocutaneous Fistulas (ECF)

A

High output: >500 ml of enteric output/day
Low Output: <500 ml

95
Q

Fistula Complications

A

Excessive fluid & electrolyte losses
Micronutrient deficiencies (Zn)
Infection; sepsis
Malnutrition
Mortality

96
Q

Malnutrition from fistula Can develop quickly and contributes to morbidity & mortality
- Adversely affects spontaneous ECF closure

Caused by:
_______
________
________
________

A

Inadequate intake

Underlying disease

Loss of protein-rich secretions from the fistula

Increased kcal & protein requirements due to inflammation & infection

97
Q

objectives of medical treatment for fistula

management and treatment?

A

Control/minimize fistula output
Replace fluid & electrolyte losses
Promote healing

Conservative management: TPN, octreotide
Surgical repair

98
Q

fistula nutritional needs

kcal ?
pro ?
fluid/electrolytes/vit/min ?

A

High calorie

High protein: 1.5-2.0 g/kg
May need up to 2.5 g/kg if high fistula output

Fluid & electrolyte replacement
Monitor for Zn losses

99
Q

Mode of nutrition therapy based on location of fistula and whether it is _____ or _______

A

high or low output

100
Q

Esophageal, stomach, duodenal fistulas=> provide _________ and ________
Use a ___________ formula

A

enteral nutrition
feed distal to the fistula

polymeric, high nitrogen EN

101
Q

Colocutaneous fistula=> _______ and ______ diet

A

oral low fiber & low residue diet

102
Q

For high output, ECF…

provide _________

Reduces _________ which increases the chances of spontaneous closure

Improves nutritional status prior to surgery

A

NPO with TPN

GI secretions & output

103
Q

Low output ECF=> can try _________

A

enteral nutrition

104
Q

MNT After Fistula Has Healed

provide an ___________ diet and _________

A

oral low fiber, low residue diet

ADAT regular diet as tolerated

105
Q

Purpose of low residue diet

A

reduce fecal output

106
Q

low residue diet guidelines

fiber?
what to avoid?

A

Low fiber: <10-15 grams fiber per day

Avoid excessive amounts of sugar alcohols, fructose, sucrose
Avoid alcohol & caffeine

If lactose intolerant=> Limit dairy products

107
Q

what is Protein-Losing Enteropathy (PLE) ?

how common?

characterized by ______ and _______

A

Shedding of large amounts of protein from the GIT

Rare condition

progressive, moderate to severe hypoalbuminemia (<3.0 g/dL)
often peripheral edema

108
Q

Causes of Protein-Losing Enteropathy

A

AIDS enteropathy
Inflammatory bowel disease (IBD)
Celiac disease
Radiation enteritis
Bacterial overgrowth
Eosinophilic gastroenteritis

109
Q

MNT for Protein-Losing Enteropathy

A

High protein=> may require 2-3 g/kg to achieve positive nitrogen balance

If underlying condition is also causing fat malabsorption,
Rx a 40 g low-fat diet with MCT oil

Monitor for and treat malnutrition &/or micronutrient deficiencies

110
Q

What is (SIBO) ?

A

Small Intestine Bacterial Overgrowth

111
Q

Small Intestine Bacterial Overgrowth (SIBO) is caused by ?

A

Disorders leading to impaired intestinal motility resulting in stasis of intestinal contents

Decreased gastric acid secretion

Removal of the ileocecal valve (ICV)

112
Q

Disorders leading to impaired intestinal motility resulting in stasis of intestinal contents (causing SIBO)

A

Intestinal obstruction
Strictures - Crohn’s disease
Surgical blind loops
Multiple diverticula
Scleroderma

113
Q

Decreased gastric acid secretion (causing SIBO) can come from ?

A

Gastric resection
Atrophic gastritis
Chronic use of H2-receptor blockers or proton pump inhibitors

114
Q

Symptoms and Consequences of Small Intestine Bacterial Overgrowth (SIBO)

A

Gas cramps, abdominal bloating & pain
Diarrhea

Bacteria deconjugate bile salts=>fat malabsorption
Metabolism of vitamin B12 & CHO by bacteria

Mucosal damage:
- Decreased levels of brush border enzymes
- Malabsorption
- Protein-losing enteropathy
- Malnutrition

115
Q

SIBO Diagnosis

A

Hydrogen breath test
Small bowel aspirate & culture for bacterial count

116
Q

SIBO Treatment

A

Broad-spectrum antibiotics

117
Q

MNT for SIBO

Adequate ________

Reduce highly fermentable CHO=> _______ diet

If steatorrhea __________

Micronutrient supplementation as needed:
- _________
- _________

A

hydration

low FODMAPs

40 g Low Fat diet

  • IM vitamin B12
  • Fat-soluble vitamins in water-soluble form
118
Q
A

Advanced MNT 2 (17 decks)

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