Ch 26: Gastrointestinal Disease

Question 1

What method should be used to deliver jejunal feedings?

Answer 1

J feeds may be administered via cycled pump or gravity infusion, typically for 8-14 hours. The flow rate can be increased form 125 mL to 160 mL/hour as tolerated; intolerance of jejunal EN is variable in patients with gastroparesis

Question 2

What is the recommended supplement regimen for calcium/vit D for patients with IBD who take steroids’?

Answer 2

1500 mg Calcium; 800-1000 IU of Vitamin D

Question 3

In a newly diagnosed patient with Celiac, what labs should be ordered?

Answer 3

folate, ferritin, 25 OHD, vitamin A, vitamin B12; zinc and Mg deficiency may also be present

Question 4

What deficiency is high in UC?

Answer 4

Iron deficiency anemia

Question 5

What type of cancer is associated with long withstanding UC?

Answer 5

Colon CA; folate supplementation may have a role in prevention

Question 6

What is common dietary management for patients diagnosed with Eosinophilic Esophagitis?

Answer 6

Empiric elimination of 6 common triggers: wheat, dairy, soy, eggs, fish/shellfish, and nuts; shown to be effective in up to 70% of patients

Question 7

How should Cystic Fibrosis Related Diabetes be treated?

Answer 7

Insulin coverage w/ minimal diet restriction to promote growth or weight maintenance

Question 8

What is Crohn’s disease?

Answer 8

Transmural inflammation of the digestive tract anywhere from mouth to anus; • No single test is absolute for diagnosis of IBD; diagnosis is based on a combo of symptoms, endoscopic findings and biopsy results

Question 9

What is Ulcerative Colitis?

Answer 9

Inflammatory disease of the colon

Question 10

Between 85-90% of patients with CF have what?

Answer 10

Exocrine pancreatic insufficiency; of buildup of mucus in pancreatic ducts with prevents enzymes from being adequately released during food digestion; this leads to malabsorption w/ steatorrhea and need for additional exogenous pancreatic enzyme replacement therapy (PERT)

Question 11

What is Celiac disease?

Answer 11

T lymphocyte immune disorder causing small intestinal inflammation and villous flattening. Intestinal injury causes malabsorption trigged by ingestion of gluten and other protein antigen in wheat, barley, and rye. Not the same was wheat allergy, which is IgE mediated

Question 12

What are the dietary modifications for treating gastroparesis?

Answer 12

Multiple small meals low in fat/fiber or liquid diet in severe cases, maximize glucose control, lifting diet restrictions, scheduling antiemetics/prokinetics regularly, trying liquid fats, treating SIBO, monitoring for nutritional deficiencies

Question 13

What are the estimated energy needs for patient with CF?

Answer 13

110-200% of estimated energy needs w/ adjustments as needed; they are encouraged to increase fat in their diets to 35-40% of daily energy intake and restrictions are discouraged

Question 14

What type of EN formula should be selected for the gastroparesis patient?

Answer 14

Most patients with motility disorders tolerate standard polymetric formulas. Because stomach is bypassed, a formula that contains fiber may be tolerated; however, indigestible fiber may aggravate symptoms if SIBO is a chronic problem

Question 15

What is the best diagnostic test to confirm gastroparesis?

Answer 15

A motility test, such as a gastric emptying study;● Diagnostic testing to confirm gastroparesis in patients with consistent symptoms involves a motility test, such as a gastric emptying study

Question 16

What is CIPO

Answer 16

) refers to intestinal motility disorders that demonstrate signs of mechanical obstruction on radiographic imaging in the absence of an overt mechanical obstruction as the cause; treated like gastroparesis

Question 17

What provides the most consistent symptoms control in setting of active symptoms of N/V?

Answer 17

Scheduled vs. PRN doses and liquid/suppository preps of antiemetics and prokinetics

Question 18

What are common causes of SIBO?

Answer 18

surgical blind loops, small bowel diverticula, or small bowel motility; diarrhea predominant IBS, end stage liver disease, exocrine pancreatic insufficiency and ESRF

Question 19

How should fiber, lactose, and fish oil be approached for patient with Crohn’s disease?

Answer 19

Low fiber diet should NOT be routinely recommended if no stricture present. No need to eliminate lactose unless it is not tolerated. No evidence to take fish oil supplements

Question 20

What type of resection increases risk for B12 deficiency?

Answer 20

Ileal resection

Question 21

What accumulates in CF?

Answer 21

of mucus in several organs including lungs, GI tract, pancreas and reproductive system

Question 22

How is SIBO diagnosed?

Answer 22

Noninvasive hydrogen breath test is the most common way to assay SIBO; Gold standard is small bowel aspirate and culture, though it is invasive and technically challenging

Question 23

What are the most common nutrient deficiencies seen in Celiac disease?

Answer 23

Iron; osteoporosis is another consequence of untreated celiac, affecting up to 75% of patients

Question 24

What annual surveillance tests should be ordered for patient with CF?

Answer 24

• Vit A: serum vit A level
• Vit D: 25-OHD level
• Vit E: alpha tocopherol/cholesterol ratio or a tocopherol/total serum lipid ratio
• Vit K: INR or protein induced by vit K antagonist II level

Question 25

Which type of GI patient should be considered to receive supplemental zinc?

Answer 25

High output fistulas, frequent diarrhea, excessive GI fluid losses

Question 26

What is the dietary management for a patient with protein losing enteropathy?

Answer 26

A low fat diet. This may relieve pressure in lymphatic system and decrease protein losses; alternatively, EN formulas high in MCTs may be used

Question 27

What is dermatitis herpetiformis, and who does it affect?

Answer 27

A bullous skin rash pathognomonic for celiac affecting 10-20% of patients. Only a GF diet will clear intestinal and skin lesions

Question 28

Which micronutrient deficiencies are common in gastroparesis?

Answer 28

Iron (may limit meats due to GI intolerance), acid reflux may be treated w/ PPIs reducing gastric acidity

Question 29

Which side effect may octreotide cause?

Answer 29

Hyperglycemima

Question 30

A patient with Crohn’s disease that involves the distal ileum should be closely monitored for malabsorption of what?

Answer 30

B12

Crohn’s disease can appear anywhere from the mouth to the most distal bowel. As a result, patients with Crohn’s disease can become deficient in a whole host of nutrients. Iron and calcium are absorbed in the duodenum. Folic acid is absorbed in the proximal jejunum. Vitamin B12 is absorbed in the distal ileum.

Question 31

Which of the following types of fistulas will result in the greatest degree of nutritional loss?

Answer 31

Proximal high output; the higher the fistula occurs in the gastrointestinal tract, the greater the output and the higher the risk of metabolic derangements, as seen with proximal high output fistulas.

Question 32

What is the approximate normal length of small intestine in adults?

Answer 32

300-600 cm

Question 33

Ascending colostomies have more ____ stool, whereas descending colostomies have more ____ stool

Answer 33

liquid; solid

Question 34

What is the difference between early and late “dumping”

Answer 34

Early: Occurs w/in 30-60 minutes of eating
Late: Occurs w/in 2-3 hours after eating and usually limited to vasomotor symptoms (sweating, weakness, dizziness, flushing, palpitations)

Question 35

The highly proliferative lining of the small bowel turns over every ___ days

Answer 35

2-5; the loss of sloughed cells translates into loss of about 30 g protein/day