19: Liver, Bile Duct, Gallbladder, SB, Colon/Rectum/Anus Flashcards
(29 cards)
What types of cancers are considers gastrointestinal cancers?
Hepatocellular carcinoma (HCC)
cholangiocarcinoma (CCA)
gallbladder carcinoma (GBC)
neuroendocrine tumor of small bowel (GI NET)
colorectal cancer (CRC)
anal carcinoma (AC)
What are some risk factors for: HCC
males more than females
obesity
smoking, particularly with drinking or hepatitis
alcohol —- more than 45 g/day
chronic conditions impacting the liver—hepatitis, cirrhosis, DM
What are some risk factors for: GBC
female more than males
obesity
mexicans and native americans at higher risk
salmonella or H pylori infection
sweetened beverages
What are some risk factors for: CCA
syndromes like Lynch or Metabolic
Hepatitis
cholestatis of bilary tract/bile duct cysts
parasitic infection from liver flukes in undercooked fish
What are some risk factors for: CRC
smoking and drinking
black males
multifactorial ethnic disparities due to access of care
lynch syndrome
GI conditions likes chronic and UC
family hx —1st degree relatives doubles risk
high intake of red and processed meats
What are some risk factors for: AC
HPV
HIV and immune suppression
organ transplant
STDs
name the common issues seen in GI cancers
SBS/diarrhea from resection
Enterocutaneous fistulas
changes in bowel movements
Bit B12 deficiency
what type of cancer is the 2nd leading cause of cancer related deaths worldwide?
HCC — 83% occur in developing countries. Lower in US but opioid. epidemic has resulted in doubled incidence in 20-39 year olds
what is a unique, possible treatment option for HCC?
liver transplant — has to be resectable in the first place and patient has to be a transplant candidate.
What is the sole curative treatment option for CCA?
surgery — however many are deemed unresectable via ex lap
if able to have it, it is often a whipple surgery
What are some basic nutrition recommendations for HCC pts?
kcal: 25-40 kcal/kg based on dry wt
Pro: 1.0-1.5 g/kg unless acute encephalopathy-then 1 g/kg
if cirrhosis, 1-2 mg/d of thiamin
note low selenium is linked to increased risk so check lab
may need Vit D3 and Ca
What can be an issue with GI NET? What is a unique testing option?
initial symptoms are very vague - leading delayed diagnosis, can be more than 4 years
Hormone levels like 5-HIAA can be checked along with tumor marker Chromogrania A
what are the 3 disease-specific nutrition problem/intervention for GI NET?
carcinoid syndrome - cutaneous flushing, abd cramps, diarrhea and right-sided valvular heart disease. To reduce this, need to avoid/limit foods that h increase tyramine and dopamine production.
Secretory diarrhea—due to serotonin-secreting tumors
niacin deficiency—can happen when niacin synthesis is limited by tryptophan diversion to serotonin production. treat with supplementation
What foods are high in tyramine?
aged cheeses, alcohol, smoked and salted animal proteins, yeast extracts, fava beans, soy beans and fermented foods.
moderate sources include chocolate, peanuts, coconut, brazil nuts, raspberries, avocados, bananas, and caffeine beverages
what foods are high in dopamine?
diary products
unprocessed meats like beef/chicken/turkey
omega-3 containing fish like salmon, herring and mackerel
eggs
nuts like almonds and walnuts
fruits and vegetables, but particularly bananas
dark chocolate
what is specific/special about Secretory diarrhea?
it can be a differentiating feature for serotonin-secreting tumors. Clues is that the diarrhea doesn’t slow down nocturnal or with fasting and has a limited response to anti-diarrheal medications.
may need to try Ondansetron as its a serotonin receptor antagonist
what are niacin deficiency symptoms to look for with GI NET patients?
scaly brown patches on arms/legs - though overt pellagra was rare
can do a high protein diet of 1.5 g/kg and possibly niacin supplementation
What is the transit time for the small bowel and for the colon?
SB: 1-4 hrs
Colon: up to 10x longer, diet impacts this
What are the genetic mutations to screen for with colon cancer? How many of the CRC cases are related?
APC, TP53, PI3K, KRAS, and BRAF – these are gatekeepers or growth regulatory genes and when mutated can cause cancer
80%
What bacteria can trigger genetic mutations and can cancer development for CRC?
C diff
pathogenic strains of E coli and B fragilis
What are the different surgery types you might see for CRC?
Colectomies — Left, Right, Sigmoid
Resections —- low anterior, abd perineal (results in a stoma), segmental
Can also sometimes see surgery use for mets — when CRC reoccurs, its often within 3 years and in the liver or lung. If isolated, resection could still be curative
What is CRS and HIPEC? What about side effects?
CRS - cytoreductive surgery
HIPEC - hypothermic intraperitoneal chemotherapy
used with metastatic CRC with peritoneal carcinomatosis. Because 90% of the chemo stays in the abd, acting locally, this may potentially minimize systemic side effects. Nutrition would be impacted based on the surgery component
What is the optimal goal for bowel movements after CRC surgery?
fewer than 4 movements/day - somewhat more formed to avoid leaking, decreasing urgency and allows for more complete elimination
What would be the nutritional intervention for bowel management after CRC surgery?
1 tsp psyllium with little to no added water, BID with morning/evening meals. Best mixed with oatmeal, pudding, yogurt, mashed potatoes, applesauce, or peanut butter with no additional fluid for 1 hour before/after meals. This will assist in absorbing excess fluid and slowing transit. Increase by 1 tsp every 3-5 days to a max of 1 Tbsp BID
advise to avoid hot beverages
recommend foods that thicken stools
adjust other medications
