Gastrointestinal Disorders and Surgeries Flashcards
(163 cards)
1
Q
Gastric outlet obstruction is also known as ____ ___
A
Pyloric obstruction
2
Q
Gastric outlet obstruction is caused by mechanical obstruction impeding ____ ____
A
Gastric emptying
3
Q
Gastric outlet obstruction can be caused by…
A
-Cancer
-Peptic ulcer disease
-Inflammation
-Congenital disorders
-Bezoar
4
Q
Clinical manifestations of gastric outlet obstruction:
A
-Fullness, more distressing after eating
-Epigastric pain
-Nausea/vomiting
-Dehydration
-Anorexia
-Weight loss
-Malnutrition
-Electrolyte imbalances
-Metabolic alkalosis
5
Q
Medical management of gastric outlet obstruction:
A
-Nasogastric suction
-Surgery may be necessary: pyloroplasty
6
Q
MNT for gastric outlet obstruction:
A
-PO diet if tolerated: chew foods thoroughly, avoid tough fibrous foods; may only be able to tolerate liquids
-For severe obstruction: NPO with IVF and electrolytes
-May require JT feeding if chronic or unresectable
7
Q
Upper GI bleeding is bleeding from the…
A
-Esophagus
-Stomach
-Duodenum
8
Q
Upper GI bleeding can be caused by:
A
-Esophageal varices
-Peptic ulcers
-Gastritis
-Gastric cancer
-Erosive esophagitis
-Mallory-Weiss tears
-NSAIDs and aspirin
9
Q
Lower GI bleeding is bleeding from the…
A
-Jejunum
-Ileum
-Colon
-Rectum
10
Q
Lower GI bleeding can be caused by…
A
-Inflammatory bowel disease
-Cancer
-Diverticular disease
-Enteritis; colitis
-Polyps
-Hemorrhoids
11
Q
Symptoms of acute blood loss from a GI bleed:
A
-Hematemesis (blood vomit)
-Melena (black, tarry stool)
-Hematochezia (bright red blood from rectum)
12
Q
____ bleeding can result from chronic blood loss and is explained as small amounts of blood in the stool
A
Occult
13
Q
Symptoms of a GI bleed:
A
-Decreased Hemoglobin and hematocrit
-Increased BUN
-Weakness
-Diarrhea
-Decreased BP and increased HR
-Chronic GI bleed: iron deficiency anemia
14
Q
MNT for GI bleed:
A
-Initially NPO with IV fluids, then liquid diet, then low fiber diet, then regular diet
15
Q
For someone with a GI bleed, we should provide adequate ___, ___, and ____ for healing…
A
-Fluid
-Protein
-Kcal
16
Q
Someone with a chronic GI bleed may need supplemental iron; they should be given ____-____ mg of elemental iron per day
A
150-200
17
Q
If someone has severe bleeding from the small intestine, they may need ____ ____
A
Parenteral nutrition
18
Q
An ____ is a temporary lack of peristalsis
A
Ileus
19
Q
An Ileus can be caused by…
A
-Abdominal surgery
-Medications (opioids, sedatives)
-Abdominal infections (peritonitis)
-Hypokalemia
20
Q
Symptoms of an Ileus:
A
-Abdominal distention and pain
-N/V
21
Q
Typically, after abdominal surgery, the small bowel resumes motility in less than or equal to ____ hours
A
24
22
Q
Typically, after abdominal surgery, gastric motility resumes in ___-___ hours
A
24-48
23
Q
Typically, after abdominal surgery, colonic motility resumes in ___-___ hours
A
48-72
24
Q
Prolonged postoperative ileus occurs when symptoms persist for > ____-____ days
A
3-5
25
MNT for Ileus:
-NPO with IV fluids until resolves
26
When an ileus is resolved, someone's diet should progress from ___ to ___ to ___
Clear liquids, low fiber, regular
27
Someone with an ileus may require parenteral nutrition if NPO for > ___ days (begin at 5 days if malnourished)
7
28
If someone has a prolonged gastric ileus, we can provide ______ tube feedings
Nasojejunal
29
Intestinal obstruction can be caused by...
-Post-surgical adhesions (scar tissue)
-Tumors
-Severe inflammation (strictures)
-Hernias
-Volvulus
-Fecal impaction
-Congenital disorders (intestinal atresia)
30
Clinical manifestations of intestinal obstruction:
-Severe, crampy abdominal pain that comes and goes
-Abdominal distention and bloating
-N/V
31
Possible complications of intestinal obstruction:
-Decreased intake
-Dehydration
-Hypokalemia
-Metabolic alkalosis
-Hypovolemic shock
-Intestinal perforation
-Peritonitis
32
MNT for intestinal obstruction:
-NPO with IV fluids and electrolytes
-May require parenteral nutrition
-When oral diet is appropriate, low fiber diet and then regular diet
33
If someone has chronic duodenal obstriction, ___ ___ feeding is indicated
Jejunal tube
34
Purposes of the low fiber diet:
-Reduces fecal bulk and output
-Slows intestinal transit
35
Guidelines for the low-fiber diet are to consume less than or equal to ___-___ grams of fiber per day
10-15
36
Someone on the low-fiber diet should avoid...
-All whole grains, seeds, nuts, legumes, and popcorn
-Raw fruits and vegetables, cooked corn, potato skins
37
Possible reasons for intestinal resection:
-Cancer
-Inflammatory bowel disease
-Obstruction
-Congenital anomalies
-Mesenteric infarct
-Diverticulitis
-Fistula
-Volvulus
-Rectal disorders
38
Nutritional considerations for intestinal resections:
-Site of nutrient digestion and absorption
-Digestive enzymes and secretions
-Motility
-Amount of intestine removed
-Adaptation
39
____ ____ and ____ enter the duodenum
Pancreatic secretions and bile
40
The duodenum is the preferred site of absorption for...
-Iron
-Zinc
-Copper
-Folate
41
A duodenal resection can cause _____ ____
Dumping syndrome
42
The ____ is a major site of nutrient absorption
Jejunum
43
If someone has had a jejunal resection, monitor for ____
Malnutrition
44
After jejunal resections, the ____ typically adapts to perform the functions of the jejunum
Ileum
45
If someone has had an ileal resection, they are at higher risk of ____ deficiency
B12
46
The ileum is the site of bile salt reabsorption, so resections may cause ____ ____
Fat malabsorption
47
Someone who has had an ileal resection may have deficiencies of what vitamins?
-Calcium
-Magnesium
-Zinc
-Fat-soluble vitamins (A, D, E, K)
48
Ileal resection results in rapid ____ ____, resulting in diarrhea
Intestinal transit
49
Ileal resections can also increase risk for _____ and _____
-Cholelithiasis (gallstones)
-Nephrolithiasis (oxalate kidney stones)
50
Removal of the ileocecal valve increase the emptying rate of the small intestinal contents into the colon, leading to ____
Diarrhea
51
Removal of the ileocecal valve increases migration of colonic bacteria into the ileum, which leads to ___ ___ ___ ____
Small intestinal bacterial overgrowth
52
A colonic resection decreases absorption of ____ and ____
Fluid and electrolytes
53
A colonic resection can cause rapid intestinal transit times, leading to ____
Diarrhea
54
The preoperative nutrition guidelines determined by the enhanced recovery after surgery guidelines are...
-No solid food for 6 hours before surgery
-May have clear liquids up until 2 hours before surgery
-NPO for 2 hours before surgery
55
Preoperative ERAS guidelines:
-Preadmission counseling
-Fluid and carbohydrate loading
-No prolonged fasting
-No/selective bowel preparation
-Antibiotic prophylaxis
-Thromboprophylaxis
-No premedication
56
Intraoperative ERAS guidelines:
-Short-acting anesthetic agents
-Mid-thoracic epidural anesthesia/analgesia
-No drains
-Avoidance of salt and water overload
-Maintainance of normothermia
57
Postoperative ERA guidelines:
-Mid-thoracic epidural anesthesia/analgesia
-No NG tubes
-Prevention of nausea and vomiting
-Avoidance of salt and water overload
-Early removal of catheter
-Early oral nutrition
-Non-opioid oral analgesia/NSAIDs
-Early mobilization
-Stimulation of gut motility
-Audit of compliance and outcomes
58
The MNT for intestinal resection is the traditional post-op diet advancement which is...
-Clear liquids
-Full liquids
-Low fiber
-Regular diet
59
No physiologic reason exists for solid foods not to be introduced as soon as the ___ ___ is functioning and a few liquids can be tolerated
Gastrointestinal tract
60
Therefore, after intestinal resectioning, begin with a ___ ____ diet and advance diet as tolerated to regular diet
Low fiber
61
Kcal recommendations for those after intestinal resection:
25-30 kcal/kg
62
Protein recommendations for those after intestinal resection:
1.2-2 g/kg
63
After intestinal resection, patients should receive high ___ and high ____ oral nutrition supplements
Protein, kcal
64
After intestinal resection, patients should receive ____ supplementation as needed
Micronutrient
65
If extensive resection or a prolonged, post-operative ileus, ____ nutrition may be indicated
Parenteral
66
An intestinal ____ is a surgically created opening between the intestinal tract and the skin to permit defecation from the intact portion of the intestine
Ostomy
67
A ____ is created when part of the colon or rectum are removed or must be bypassed
Colostomy
68
An ____ is created when the entire colon is removed or must be bypassed
Ileostomy
69
Indications for creation of intestinal ostomies:
-Colorectal cancer
-Diverticulitis
-IBD
-Bowel perforation
-Bowel ischemia
-Enterocutaneous or colocutaneous fistulae
70
Nutritional concerns with intestinal ostomies:
-Excessive losses of fluid and sodium (especially ileostomies)
-Obstruction of the stoma
-Gas production
-Malodorous stool
71
After an ostomy is placed, someone should follow a ___ ___ diet and advance diet as tolerated to regular diet after 6 weeks
Low fiber
72
Someone with an ostomy should receive adequate fluid, around ___-___ cups of fluid per day
8-10
73
Those with ostomies should get adequate ____ and ____, especially for those with ileostomies
Sodium and potassium
74
Someone who has had a resection of a terminal ileum should receive vitamin ___ supplementation
B12
75
What can be done to minimize the risk of ostomy obstruction?
-Chew food thoroughly
-Avoid foods that are incompletely digested (corn, popcorn, raw cabbage, vegetable and fruit peels, and dried fruit)
76
For those with ostomies, we should educate on foods that may cause odor, like...
-Cruciferous vegetables
-Beans
-Asparagus
-Garlic
-Onions
-Eggs
-Fish
77
What can be done if someone has excessive ostomy output?
-Provide oral rehydration solutions sipped throughout the day
-Reduce insoluble fiber and increase soluble fiber
-Avoid foods that can increase output: spicy food, high-fat foods, prunes, caffeine, alcohol, fruit juice, food high in added sugars, sorbitol
-6-8 small meals/day
78
____ is a clinical condition in which the normal digestion and/or absorption of nutrients is impaired
Malabsorption
79
Malabsorption may affect a single ____ or many of them
Nutrient
80
Malabsorption can lead to _____
Malnutrition
81
Fat malabsorption may be due to abnormalities in...
-Pancreatic secretion
-Bile salt availability
-Enterocyte function
82
What conditions may lead to pancreatic insufficiency?
-Chronic pancreatitis
-Cystic fibrosis
83
What conditions may lead to decreased bile availability?
-Cholestatic liver disease
-Biliary obstruction
-End-stage liver disease
84
____ disease/resection may lead to a decrease in reabsorption of bile salts
Ileal
85
What conditions may lead to small bowel mucosal disease/damage (and therefore fat malabsorption)?
-Celiac disease
-Crohn's disease
-Radiation enteritis
-AIDS
86
Gastric resection can lead to ____ syndrome
Dumping
87
Bacterial overgrowth can be caused by...
-Deconjugation of bile salts
-Intestinal mucosal damage
88
Signs and symptoms of fat malabsorption:
-Steatorrhea
-Weight loss despite adequate intake
89
Excessive fat content in stool causes ____
Diarrhea
90
Characteristics of steatorrhea:
-Pale, greasy stools
-Oily film in toilet water
-Foul odor
91
Steatorrhea is diagnosed with a ___ ___ ____
Fecal fat test
92
Procedure of the fecal fat test:
-72 hour stool collection
-Consume 100 g fat diet
93
Normally, there is ___-___ grams of fat in the stool per day
2-6
94
Steatorrhea is diagnosed if someone has more than ___ grams of fat per day in the stool
7
95
Nutritional consequences of steatorrhea:
-Dehydration
-Electrolyte losses
-Weight loss and malnutrition
-Fat-soluble vitamin deficiencies
-Decreased absorption of calcium, magnesium, and zinc
-Hyperoxaluria-> nephrolithiasis
96
Treatment goals for steatorrhea:
-Determine and treat underlying cause
-Alleviate steatorrhea
-Correct nutritional deficiencies
97
MNT for fat for malabsorption is a fat-restricted diet of _____ g/day
40
98
The purpose of a fat-restricted diet is to decrease ____
Steatorrhea
99
With a fat-restricted diet, all types of fat are restricted, except ____
MCT
100
MNT for fat malabsorption also includes treating the _____ disease
Underlying
101
If fat malabsorption is due to pancreatic insufficiency, recommend ____ ____ supplements
Pancreatic enzyme
102
Medium-chain triglyceride oil does not require ____ ____, ____ ____, or ____ for digestion and absorption
-Pancreatic lipase
-Bile salts
-Chylomicrons
103
We can consider the use of MCT oil as a fat and kcal source; it provides ___kcal/g and ___ kcal/Tbsp
8.3 kcal/g; 116 kcal/tbsp
104
MCT oil has a low smoke point so it shouldn't be used in ____
Cooking
105
MCT oil is often used in ___-____ oral supplements or enteral fomulas
Semi-elemental
106
MCT oil does not contain ___ ___ ___
Essential fatty acids
107
For someone with fat malabsorption, we should monitor for micronutrient _____ and supplement as needed
Deficiencies
108
For someone with fat malabsorption, they should get...
-MVI with minerals
-Water-soluble form of fat-soluble vitamins
109
What type of oral nutrition supplements are given to those with fat malabsorption?
-Partially hydrolyzed, peptide-based with MCT oil
110
What are two examples of oral nutrition supplements that would be given to someone with fat malabsorption?
-Peptamen with Prebio
-Vital Peptide 1.5 Cal
111
Carbohydrate malabsorption may be due to abnormalities in...
-Levels of brush border enzymes (disaccharide deficiency-> lactase deficiency)
-Pancreatic secretion (pancreatic insufficiency)
-Damaged mucosa (Celiac disease)
112
Carbohydrate malabsorption may also be caused by significant resections of the ___ ____
Small bowel
113
Signs and symptoms of carbohydrate malabsorption:
-Abdominal bloating/distention
-Flatulence
-Watery, osmotic diarrhea
-Borborygmi
-Nausea
114
MNT for carbohydrate malabsorption is to limit/avoid the offending ____
Carbohydrate
115
For someone with a lactase deficiency, someone should follow a ____-restricted diet and limit to the amount tolerated
Lactose
116
For someone with a lactase deficiency, we should provide alternate ____ and vitamin ____ sources
Calcium and D
117
Possible etiologies of protein malabsorption:
-Pancreatic insufficiency
-Small bowel mucosal damage: inflammation, Celiac disease
-Significant small bowel resections (Short bowel syndrome)
118
Signs and symptoms of protein malabsorption:
-Muscle wasting
-Edema
-Decrease serum albumin and prealbumin
119
For someone with protein malabsorption, we should recommend an high protein diet of ____ g/kg
1.5
120
If someone has protein malabsorption due to pancreatic insufficiency, recommend ___ ___ ___
Pancreatic enzyme supplements
121
Those with protein malabsorption might have a need for ____, ___-___ protein sources (enteral nutrition)
Hydrolyzed, semi-elemental
122
How should we monitor for symptoms of malnutrition?
-GI symptoms and stool output
-Nutrient intake
-Weight
-NFPE
-Hydration status
123
What labs can be used to monitor for malabsorption?
-Fecal fat test
-Serum electrolyte levels
-Serum vitamin and mineral levels
-Prothrombin time
-Serum cholesterol and triglycerides
124
A ____ is an abnormal connection from one organ to another organ, skin, or wound
Fistula
125
Fistulas can originate from anywhere in the ____ ____
Gastrointestinal tract
126
Fistulas can be caused by...
-Surgery
-Inflammatory bowel disease
-Radiation enteritis
-Bowel ischemia
127
A high output enteric fistula has over ____ mL of enteric output per day
500
128
A low output enteric fistula has less than ____ mL of enteric output per day
500
129
Complications of fistulas:
-Excessive fluid and electrolyte losses
-Micronutrient deficiencies (zinc)
-Infection, sepsis
-Malnutrition
-Mortality
130
Malnutrition can develop quickly and contributes to morbidity and mortality; it can also adversely affect spontaneous fistula ____
Closure
131
Malnutrition with a fistula can be caused by...
-Inadequate intake
-Underlying disease
-Loss of protein-rich secretion from the fistula
-Increase kcal and protein requirements due to inflammation and infection
132
What are the objectives for treatment of a fistula?
-Control/minimize fistula output
-Replace fluid and electrolyte losses
-Promote healing
133
Conservative management of a fistula includes...
-TPN
-Octreotide
134
____ can also be done to repair a fistula
Surgery
135
Someone with a fistula has high ____ needs
Energy
136
Someone with a fistula also has high protein needs; they should get ___-___ g of protein/kg and may even need up to ___ g/kg if high fistula output
1.5-2; 2.5
137
Someone with a fistula should also get ___ and ___ replacement
Fluid and electrolyte
138
We should monitor for losses of ____ with someone who has a fistula
Zinc
139
The mode of nutrition therapy is based on the ____ of the fistula and whether it is high or low output
Location
140
Frequently, those with a fistula are ____ with TPN
NPO
141
When is TPN indicated for someone with a fistula?
-High output, small bowel fistulas
142
How can TPN help someone with a fistula?
-Reduced GI secretions and output
-Improves nutritional status prior to surgery
143
Enteral nutrition for someone with a fistula may be indicated if the fistula is...
-Esophageal, stomach, or duodenal (feed distal to fistula)
-Low output
144
What type of tube feed formula should be used for those with fistulas?
Polymeric, high nitrogen
145
Oral nutrition may be indicated if someone has a _____ fistula
Colocutaneous
146
What type of oral diet should someone with a colocutaneous fistula receive?
Low fiber and low residue
147
After a fistula has healed, an oral diet should be...
-Low fiber and low residue
-Advance diet as tolerated to regular diet
148
The purpose of the low residue diet is to reduce ____ ____
Fecal output
149
Guidelines for a low residue diet:
-Low fiber: <13 grams of fiber/day
-Avoid excessive amounts of sugar alcohols, fructose, and sucrose
-Avoid alcohol and caffeine
-If lactose intolerance, limit dairy products
150
____-___ ____ is a rare condition that causes shedding of large amounts of protein from the gastrointestinal tract
Protein-losing enteropathy
151
Protein-losing enteropathy is characterized by progressive, moderate to severe _____ (<3.0 g/dL) and often ____ ____
Hypoalbuminemia and peripheral edema
152
Causes of protein-losing enteropathy:
-AIDS gastroenteropathy
-Inflammatory bowel disease
-Celiac disease
-Radiation enteritis
-Bacterial overgrowth
-Eosinophilic gastroenteritis
153
MNT for protein-losing enteropathy is the MNT for the ____ disease
Primary
154
Those with protein-losing enteropathy need a high protein diet and should get ___-___ g of protein/kg to achieve positive nitrogen balance
2-3
155
If the underlying condition is also causing fat malabsorption, we should also prescribe a ____-____ diet with MCT oil
Low-fat
156
For those with protein-losing enteropathy, we should monitor for and treat ____ and or deficiencies
Malnutrition
157
What are three things that can cause small intestine bacterial overgrowth?
-Disorders leading to impaired intestinal motility, resulting in stasis of intestinal contents
-Decreased gastric acid secretion
-Removal of the ileocecal valve
158
What disorders lead to impaired intestinal motility, resulting in stasis of intestinal contents?
-Intestinal obstruction
-Strictures-> Crohn's Disease
-Surgical blind loops
-Multiple diverticula
-Scleroderma
159
What can lead to decreased gastric acid secretion?
-Gastric resection
-Atrophic gastritis
-Chronic use of H2-receptor blockers or protein pump inhibitors
160
Symptoms and consequences of small intestine bacterial overgrowth include...
-Gas cramps, abdominal bloating, and pain
-Diarrhea
-Bacterial deconjugate bile salts-> fat malabsorption
-Mucosal damage (decreased levels of brush border enzymes, malabsorption, protein-losing enteropathy)
-Metabolism of vitamin B12 and carbohydrates by bacteria
-Malnutrition
161
How is small intestine bacterial overgrowth diagnosed?
-Hydrogen breath test
-Small bowel aspirate and culture for bacterial count
162
Treatment for small intestine bacterial overgrowth:
Broad spectrum antibiotics
163
MNT for small intestine bacterial overgrowth:
-Adequate hydration
-Reduce highly fermentable carbohydrates (low FODMAPs diet)
-If steatorrhea, 40 g low fat diet
-Micronutrient supplementation as needed (IM vitamin B12, fat-soluble vitamins in water-soluble form)
