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Additional CSO Cards > Chapter 19: GI cancers > Flashcards

Chapter 19: GI cancers Flashcards

1
Q

________ is also known as the “second brain and functions as an essential component of the immune system

A

Small bowel (small intestine)

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2
Q

Cirrhosis of the liver is associated with hepatocellular carcinoma and is often associated with (3)

A

Hepatitis C
Alcohol Abuse
Nonalcoholic fatty liver

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3
Q

Function of the bile duct

A

Carries bile from the liver and gallbladder to the small intestine

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4
Q

There are similar presenting symptoms for bile duct cancer and pancreatic cancer which include

A

Jaundice, acholic stools, wt loss

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5
Q

This is a slow growing tumor of the small bowel

A

neuroendocrine

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6
Q

Most patients with _______ cancer experience bleeding which may be mistaken for hemorrhoids

A

anal

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7
Q

This is the main subtype of colorectal cancer

A

adenocarcinoma

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8
Q

This is the most common (and deadliest) GI cancer after colorectal

A

Hepatocellular

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9
Q

These are the 4 cancer sites associated with HPV

A
  1. anal
  2. oral
  3. cervical
  4. esophageal
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10
Q

This type of GI cancer is associated w/ capsicum + other peppers and sweetened beverages

A

Gallbladder

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11
Q

These 4 types of GI cancer are more prevalent in women than men

A

Small bowel PET, gallbladder, anal, colorectal

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12
Q

Of the GI cancers, this one has the strongest relation with nutrition & lifestyle factors

A

colorectal

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13
Q

This is the greatest risk factor for anal cancer

A

HPV

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14
Q

True/false: ERAS include carb-loading

A

True

ERAS is aka “fast track surgery”

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15
Q

______ related to gastroparesis & ileus are common post-op issues that is a major cause for readmission post GI surgery

A

Dehydration

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16
Q

3 tips to reduce gas pains

A

Walking
Chewing gum
Heating pad

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17
Q

T/F: Small intestinal bacterial overgrowth may be a side effect of small bowel resection

A

True

*Probiotics may help to reduce the risk

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18
Q

What is the length requirement to define “short bowel?”

A

<150 cm

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19
Q

3 nutritional considerations with terminal ileum resection

A
  1. Monitor and replace B12
  2. Keep vitamin D > 30 mg/dL and supplement as needed
  3. Anal burning may mean bile acid malabsorption - consider bile acid sequestrant
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20
Q

Define enterocutaneous fistula and what is the MNT?

A

Abnormal connection between the intestine & skin

Promote wound healing
Replace fluids/electrolytes
EN below the fisula or PN for bowel rest to support closure

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21
Q

Medical management of enterocutaneous fistula

A

PPI (IV form) + anti-diarrheals

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22
Q

What is the Bristol scale?

A

A way to describe stool, 1-7

1= impacted
7= fully liquid

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23
Q

Is it better to titrate or hold medications to help gain control of BMs?

A

Titrate. Helps to prevent overcorrection and extreme swings in BMs

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24
Q

What is considered a low level of Vitamin B12 in the blood

A

<300 pg/mL

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25
Q

_____ disease limits B12 reserves

A

Liver

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26
Q

_______ and _______ are the only curative options for heaptocelluar carcinoma, however they only improve survival rate by 50%

A

Surgical resection
Transplant

*very few are resectable either d/t location or the pt being a poor candidate

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27
Q

2 liver-directed therapies (not surgery are) called

A

Ablation & embolization

Ablation - energy to destroy the tissue
Emobilization - blocks or reduced blood flow

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28
Q

T/F: Embolization should be avoided prior to hepatic resection

A

True because it reduces blood flow

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29
Q

What is TACE

A

Transarterial chemoemobilization often used for treatment of liver cancer

30
Q

Why is chemotherapy rarely used with liver cancer?

A

Poorly tolerated since the liver is what processes the drugs

*targeted therapies or immunotherapies used instead

31
Q

What are the 3 components of the bile duct?

A
  1. Intrahepatic - within the liver
  2. Perihilar - outside the liver
  3. Distal - closest to intestine
32
Q

Whipple is the sole curative intention for ______ or ______ choliangiocarcinoma

A

Perihilar
Distal

33
Q

Palliative intervention for choliangiocarcinoma (2)

A
  1. Bile duct stenting (improves survival, plastic < metal)
  2. External biliary drain placement
34
Q

Bile salts recycle in the ________

A

illeum

35
Q

If an external billary drain is used, the bile salt acid pool will be reduced. This may cause malabsorption. This can be overcome by reinfusion of biliary secretions of ________- ________ mL every ______ - _______ hours via the y-port to coincide with enteral feedings (may need semielemental)

A

100-200
4-6

36
Q

Is glutamine supplementation recommended for acute encephalopathy?

A

No - glutamine turns into ammoina and will worsen it

37
Q

Vitamin/mineral supplementation for cirrhosis

A

Thiamin, 1-2 mg/day

38
Q

Hepatocellular caricnoma is linked to low levels of this micronutrient

A

Selenium

39
Q

Sodium restriction for ascites related to liver compromise

A

2-3 g/day

40
Q

3 strategized to maximize nutrition status with hepatic compromise

A
  1. 6 small meals/snacks with CHO rich snack at bedtime
  2. Minimize time without nutrition d/t decreased glycogen stores (may need dextrose containing IV)
  3. Frequently need ONS
41
Q

T/F: There is increased risk for osteoporosis with hepatic compomise

A

True

42
Q

Calculations to adjust dry wt with ascites

A

Mild: 3-5 kg
Moderate: 7-9 kcal
Severe: 14-15 kg

43
Q

How does the gallbladder help the pancreas with digestion?

A

Secretes alkaline bile acids which neutralize stomach acid and allow the pancreatic enzymes to work in the SI

44
Q

Small intestine neuroendocrine tumors can either be functional or non-functional. Functional produce an excess of _____________ and other hormones

A

Serotonin

45
Q

__________________ is used as a tumor marker for GI neuroendocrine tumors and is elevated in 90% of patients

A

Chromogranin A

46
Q

_____________ receptors are found on neuroendocrine cells

A

Somatostatin

47
Q

What is Somatostatin Analogue Therapy?

A

Drug that is similar to the hormone somatostatin. Somatostatin is responsible for the release of other hormones. Somatostatin analogues reduce the amount of hormones secreted from functional NET and help to stabilize tumor growth. Side effect is malabsorption d/t limiting pancreatic and gallbladder function.

48
Q

In addition to somatostatin analogue therapy, peptide receptor radionuclide therapy is a ____________________ that delivers cytoxic compounds to the tumor

A

Radiopharmaceutical

49
Q

What is carcinoid syndrome?

A

Flushing, abdominal cramps, diarrhea, valvular heart disease which often occurs with metastatic GI NET. It’s due to serotonin secreted by the tumor.

50
Q

What types of food should be limited w/ NET since they stimulate excess serotonin Y& lead to carcinoid symptoms of diarrhea & flushing?

A

Sources of tyramine & dopamine

Tyramine: Aged cheese, alcohol, smoked/salted meats, fava beans, soybeans, fermented foods

Dopamine: dairy, unprocessed meats, omega-3 rich fish, bananas, eggs, nuts

51
Q

What is the maintain symptom of carcinoid syndrome? What are the 5 Es?

A

Dry flushing of the upper body without persperation.

Eating
Epinephrine
Emotion
Ethanol
Exercise

*may also need to limit spicy foods

52
Q

Secretory diarrhea is a differentiating feature of ___________ tumors

A

serotonin-secreting

53
Q

What is secretory diarrhea?

A

D/t serotonin secreting tumors as a result of extremely rapid GI transit time that does not slow nocturnally or with fasting and only has a limited response to anti-diarrheals

Ondansetron may help since it’s a serotonin receptor antagonist

54
Q

Enterade may possibly be beneficial for management of ____________

A

Secretory diarrhea

55
Q

________ deficiency can occur when synthesis is limited by tryptophan diversion to serotonin production

A

Niacin

**recommend a high protein diet and niacinamide supplementation
(20-50 mg 2x/day)

56
Q

When colorectal cancer recurs, it’s typically within _____ years and most often in the ______ or ______

A

3
liver or lung

57
Q

Cytoreductive surgery and HIPEC are typically used for treatment of _______________

A

metastatic colorectal cancer with peritoneal carcinomatosis

**often requires 2 weeks of EN or PN

58
Q

What is the sigmoid colon?

A

The end, between the descending colon and the anus

59
Q

What is the goal for number of BMs post-colorectal surgery

A

Firm, formed stool with fewer than 4 BMs per day

60
Q

3 tips to slow transit time post colorectal surgery

A
  1. 1 teaspoon psyllium twice daily with (morning and evening meals). Mix with oatmeal, pudding, yogurt (not water) and don’t drink fluid for 1 hour before and after meals.

Increase by 1 teaspoon every 3-5 days to a max of 1T twice daily

  1. Avoid hot beverages
  2. Use foods to thicken stools (like marshmellow)
61
Q

What is the max recommendation for psyllium?

A

1T twice daily (6 teaspoons total)

62
Q

Ostomies are more common when involving the _________

A

Rectum

63
Q

What is normal colostomy & illeostomy output considered?

A

Colostomy: 200-600 mL
Illeostomy: 500-1000 mL

64
Q

Are fluid & electrolyte losses more of a concern with illestomy or colostomy?

A

Illeostomy
**replace fluids and electrolytes
**aim for 1L more than output

65
Q

What does lower anterior resection involve

A

Removal of the sigmoid colon and rectum. Still has the anus thus do not need an ostomy

66
Q

How is lower anterior resection syndrome characterized

A

increased frequency and clustering of BMs, urgency & incontinence OR constipation and feelings of incomplete emptying

Very common with this procedure

67
Q

Medical and nutritional recommendations for lower anterior resection syndrome

A
  1. low fiber diet for 2 weeks post-op
  2. largest meal earlier in the day
  3. psyllium
  4. imodium
  5. serotonin receptor antagonists or bile acid sequestrants
  6. Tap water enema (insitlled and help for 30 second) if OK by surgeon
  7. Sacral nerve simulation if persisting > 1 year
  8. Pelvic floor rehab
68
Q

What is a neorectal reservoir?

A

Either a 1 or 2 step process used to create an internal resoirvoir using the ileum. Temporary ileostomy is reversed at 8-12 weeks post-op.

69
Q

What to expect with BMs for neorectal resoivoir

A

5-7 loose BMs with urgency for up to 6 weeks post-op. They will become less frequent and thicken as the pouch stretches over 6 months

*may need anti-diarrheals before meals

70
Q

3 vitamins/minerals that may become deficient in response to rapid transit time through the GI tract

A

Vitamin D, calcium, B12

71
Q

What is the standard of care for anal cancer?

A

ChemoRT. Surgery is for persistent disease

Additional CSO Cards (26 decks)

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