4.2.2 Nutrition and Common GI Disorders: Ileus and Nutrient Absorption Flashcards
What drug does not interfere with the centrally mediated effects of opioids - including analgesia?
Alvimopan
What are some of the management methods for a patient following GI surgery to reduce risk of ileus?
Minimize usage of NG tube
Utilize multi-modality pain management (reduce opioids)
Careful use of IV fluids
Maintain electrolyte balance
Early oral intake (4-24 hrs)
What class of pharmacologics reduce the propulsive activities of the GI tract?
Opioids
What are some common GI problems and diet?
Reflux, heartburn
Nausea
Bloating, cramping, gas
IBS, diarrhea, constipation, diveritcular dz
IBD
Short bowel syndrome
Rapid gastric emptying/dumping
What is ileus?
A syndrome characterized by an impairment of intestinal propulsion mimicking a clinical picture of mechanical obstruction in the absence of any lesion occluding the lumen of the gut
(Gut going to sleep after surgery)
Describe the inflammatory etiology of ileus?
Bowel manipulation activates macrophages, macrophages induce NO prod and inflammatory cytokines, leukocytes migrate to bowel and suppress bowel muscle function
How often does ileus lasting greater than 5 days occur after GI surgeries?
40% of all GI surgeries
What are some of the supportive care measures in the management of patients
Early ambulation
Early oral intake
What are some important web pages in staying current with ileus?
www. erassociety.org (lecturer loves ERAS - enhanced recovery after surgery)
www. becertain.org/strong_for_surgery/hospitals
What is the most significant cause of postoperative ileus?
Narcotic use for analgesia
What are some dietary factors that can affect GI function
What are some of the important nutrients digested at various points along the digestive tract
Location of nutrient absorption
What are two ways to reduce the hormonal etiology of ileus?
Epidural anesthesia (blocking sympathetic nerves)
Early nutrition
What conditions are associated with obesity?
Esophageal reflux, upper/lower GI symptoms, GB dz, steatosis/steatohepatitis/cirrosis, GI cancers, GI consequences
What are some of the sites of actions of opioids?
