Ch 20 lower GI pt 2

what is short bowel syndrome?

occurs when bowel is surgically shortened to extent that the remaining bowel is unable to absorb levels of nutrients to meet individuals needs

most common reasons of resection: Crohn’s traumatic abdominal injuries, malignant tumors, mesenteric infarction

what affects nutrition of people with short bowel syndrome?

the amount and location of resected remaining bowel

pts who have 150cm or more w/o colon or 60-90 cm of small bowel with colon may need PN and progress to oral diet over 1-2 year period

factors influencing adaptation: length present, pt’s age, whether ileocecal valve remains, health of remaining bowel, health of stomach, liver, and pancreas

describe nutrition therapy for short bowel syndrome

in early months, PN is major source of nutrition and hydration

consuming intact nutrients promotes bowel adaptation b/c they stem bowel to flow to intestine and secretion of pancreatic enzymes and bile acids

six to eight small meals per day

if pt’s colon intact, fat intake is restricted to avoid steatorrhea and increased fluid loss

what is IBS?

most frequently diagnosed digestive disorder in US

many factors in etiology

symptoms that can not be explained: lower abd pain, constipation, diarrhea, alternating periods of constipation and diarrhea, bloating, mucus in stools

can significantly impair QOL

rule out other diagnosis

what is nutrition therapy for IBS?

inconclusive evidence of current treatment used

pharm treatment options

complementary therapies

elimination diet

probiotics

grade a level evidence for 5g of guar gum daily (soluble, nongelling fiber)

low FODMAP diet: restriction of fermentable oligosaccharides, disaccharides, monosaccharides, and pyols

avoid large meals, reduce lactose, reduce fat, reduce sugar alcohols, reduce fructose, reduce gas producing foods

describe the low roadmap diet

total elimination of high roadmap for 2-6 weeks

6 week re-introduction phase: each week introduce one of the types of sugars back into diet and see how tolerated

what is diverticular disease?

caused by increase pressure within the intestinal lumen

diverticulosis is usually asymptomatic

diverticulitis occurs when diverticula become inflamed

symptoms of diverticulitis: cramping, alternating diarrhea and constipation, flatus, abd distention, low grad fever

what are complications of diverticular disease?

occult blood loss and acute rectal bleeding leading to iron deficiency anemia

accesses and bowel perforation lead to peritonitis

fistula formation causing bowel obstruction

bacterial overgrowth that leads to malabsorption of fat and vitamin B12

what is nutrition therapy like for diverticular disease?

high-fiber intake may prevent and improve symptoms and prevent diverticulosis

avoid nuts, seeds, and popcorn

during acute phase of diverticulitis: NPO until bleeding and diarrhea subside, oral intake resumes w/ clear liquids and progresses to low-fiber diet until inflammation and bleeding no longer risk

what are ileostomies/colostomies?

performed after part or all of colon, anus, and rectum are removed

potential nutritional problems, smaller length of colon = greater potential for complications

ileostomies cause a decrease in fat, bile acids dn vitamin B12 absorption

describe nutrition therapy for ostomies

goal: minimize symptoms and replenish losses

initially clear liquids low in simple sugars, advance slowly based on tolerance, low residue 6-8 week post op

avoid swallowing air and gas formation

take small bites and chew throroughly

add foods that may decrease odor: buttermilk, parsley, yogurt, cranberry juice

add foods that may thicken stool: pectin, past, potatoes, cheese, banana, applesauce

regular diet resumes abt 6-8 weeks after surgery

obtains adequate fluids and lytes is main concern

define liver disease

after absorption, almost all nutrients are transported to liver

vital for detoxifying drugs, alcohol, ammonias and other poisonous substances

liver damage can have profound and devastating effects on metabolism

failure can occur from chronic liver disease or secondary to critical illnesses

what is fatty liver disease?

abnormal fat deposition in liver, occurs in clients w/ alcoholic liver disease

what is non alcoholic fatty liver disease (NAFLD)?

simple hepatic steatosis, often aysmptomatic

benign to nonalcoholic steatohepatitis characterized by inflammation and liver cell damage

complications such as advanced fibrosis, cirrhosis, and heptocellular carcinoma may result

what is cirrhosis?

irreversible liver disease that occurs when damage liver cells are replace by functionless scar tissue, impairs function and disrupt circulation

strongly associated with obesity and metabolic syndrome

twice as likely to die of cardiovascular disease than liver disease

describe nutrition therapy for NAFLD

reduce calories to promote gradual weight loss: target is 7-10%

mediterranean diet is most recommended

avoid fructose, limit alcohol

coffee actually has protective effect, so no liver related restrictions

aerobic and resistance training reduce liver fat

describe hepatitis

inflammation of liver caused by virus, bacteria, toxins, obstruction, parasites, or chemicals

early symptoms: anorexia, nausea, vomiting, fever, fatigue, weight loss, headache

later: dark colored urine, jaundice, liver tenderness, and possible liver enlargement

cell damage is reversible

nutrition therapy: adequate energy, protein, and micronutrients

what is alcoholic hepatitis?

toxic liver injury associated with chronic ethanol consumption

presents with fever, jaundiced and hepatomegaly

advanced signs of ascites, portal hypertensive bleeding, and hepatic encephalopathy

increase susceptibility to infections

what are the goals of nutrition therapy for liver disease?

avoid/minimize permanent damage, promote cell regeneration, restore optimal nutritional status, alleviate symptoms, and avoid complications

regeneration may not be possible

malnutrition common among pts with cirrhosis

calories: 35-40kcal/kg/day

up to 1.6 g/kg/day protein depending on degree of malnutrition and other complications

ascites: 2000 mg Na and fluid restriction

describe nutrition therapy for liver transplant

moderate to severe malnutrition increase risk of complications and death after transplant

small, frequent meals and commercial supplements help maximize intake

recommendations based on nutritional status, weight, tolerance, and lab values

food safety due to immunosuppressants

what is pancreatitis?

inflammation of pancreas

may develop hyperglycemia related to insufficient insulin secretion

alcohol abuse and gallstones account for more than 70% of cases of acute pancreatitis

characterized by intermittent pain made worse by eating

malabsorption does not occur until enzyme secretion is less than 10% of normal

describe acute pancreatitis

symptoms: upper abd pain radiating to back, worsening w/ food ingestion, n/v, abd distentions, steatorrhea

diagnosis based on symptoms and abnormal serum amylase and/or lipase

mild: IV hydration and pain meds

severe: many complications may develop within hours or days such as shock, pulmonary failure, renal failure, GIB, MSOF. treat with fluid and electrolytes, antibiotics, neutron support, and possible surgery

what is chronic pancreatitis?

chronic irreversible inflammation that leads to fibrosis w/ tissue calcification

manifestations: chronic abd pain, normal or mildly elevated pancreatic enzymes

what is nutrition therapy for acute pancreatitis?

clear liquids and advance as tolerated.

if severe then j tube feedings of hydrolyzed/elemental formula, small peptide formulas w/ 70% fat, TPN if unable to tolerate j tube

describe nutrition therapy for chronic pancreatitis

goal: maintain weight, reduce steatorrhea, minimize pain, avoid acute attacks while meeting nutrient needs

frequent small meals

moderate: low fat diet

pancreatic enzymes to be taken with each meal/snack

water soluble forms of fat soluble vitamins may be needed

impaired insulin secretion

what is nutrition like for the gallbladder?

gallstones: cholelithiasis, low fat diet

cholecystitis: inflammation of gallbladder

dietary limitations: consume low fat, increase soluble fiber intake, consider prebiotics/probiotcs especially if diarrhea, consume small meals if reflux, avoid foods not tolerated, consider micronutrient supplements