Chapter 20: MNT For Cancers Of The GI Tract Flashcards
The majority of gastric cancers are ____?
Adenocarcinomas
What is the leading cause of gastric cancers?
Inflammatory changes related to H. pylori.
Gastric cancers most frequently metastize to the ____, ____, and ____?
Liver, lung, and bone
What are common symptoms of gastric cancer?
Early satiety, heartburn or indigestion, abdominal pain and discomfort, nausea, vomiting (with or without food), anorexia and unintended weight loss.
Malnutrition and weight loss occur in ____% of gastric cancers?
> 70%
What are common treatments for gastric cancers?
Chemotherapy, biotherapy, radiation therapy and surgery
Common NIS with GI cancer treatments?
Anorexia, nausea, vomiting and gastric pain (which can lead to rapid unexpected weight loss)
What are types of partial gastrectomies?
Billroth I (gastroduodenostomy), Billroth II (gastrojejunostomy), partial hastric resections, and Rouex-en -Y
Risk factors for CRC?
Over 50, adenoma polyps in the colon, african american, Ashkenazi Jews, DM2, overweight, smoking, tobacco use, heavy alcohol use, physical inactivity, hx of Crohn’s or Ulcerative Colitis, intake of PAH and HCA from grilling at high temperatures, diet high in red meat, low vitamin D and Calcium, inherited syndromes
Most common symptoms of CRC?
Change in bowel habits (diarrhea, constipation or a narrowing of the stool). Also, heme-positive stools or unexplained anemia, abdominal pain and bloating, nausea/vomiting, blood in stool, unintended weight loss and fatigue
What are the diet and lifestyle recommendations for CRC survivors?
Avoid “Western Diet”: Limit red/fatty meat, processed meat, refined carbohydrates, alcohol, Eat more plant based foods, increase fiber, limit alcohol, maintain a healthy weight, engage in regular physical activity, Calcium supplementation may be beneficial
What is HCC?
Hepatocellular Cancer
T/F: HCC accounts for a majority of liver cancers?
True
T/F: The liver is a common site of metastases from other primary cancers?
True
What are risk factors for HCC?
Gender (more common in men), Hepatitis B, heavy alcohol use, Aflatoxin, Hemocromotosis, Inherited metabolic disease, cirrhosis, obesity, DM2, anabolic steroids, environmental toxins (arsenic in water)
What are treatment options for HCC?
Surgery, Ablation (use of small probe that transmits high energy radio waves), Embolization (injection that blocks blood flow to tumor), Chemotherapy, Biotherapy, Radiation therapy
Signs and symptoms of HCC?
nausea, vomiting, an enlarged liver, abdominal pain, swollen abdomen, itching, jaundice, worsening of existing cirrhosis, loss of appetite, early satiety, fatigue, unintended weight loss.
T/F: Gallbladder cancer (GBC) is the most common of the biliary tract tumors and is the leading cause of cancer mortality in certain ethnic groups.
True
T/F: GBC affects women at two to three times the rate of men and its incidence increases with age?
True
Risk factors for GBC?
gallstones, obesity, being female, Mexican-American & Native American, Diabetes, biliary abnormalities, parasitic infection, industrial and environmental chemicals
Signs and Symptoms of GBC?
vague abdominal pain, nausea, vomiting, fever, taste changes, anorexia, and jaundice
GBC treatment regimens can result in nutrition impact symptoms such as….
mucositis, diarrhea, nausea, vomiting, fatigue, changes in appetite and unintended weight loss.
What are the two types of anal cancers?
Squamous cell (most common) which line the anal margin and most of the anal canal. and Adenocarcinoma which develops in the cells that line the upper part of the anal canal adjacent to the rectum.
Treatments for anal cancer?
chemotherapy, radiation therapy and surgery
NIS from anal cancer treatment?
oral mucositis, nausea, vomiting, and diarrhea, which can lead to loss of appetite and unintended weight loss.
Common nutrient deficiencies after partial or total gastrectomy?
B12, Folate, Iron
After gastrectomy, patients who are unable to meet ___% of their energy needs by post-op day 6 should be considered for enteral nutrition.
60%
Post-gastrectomy complications?
malnutrition, weight loss, gastric stasis, dumping syndrome, fat malabsorption, nutritional deficiencies
What are the post-gastrectomy syndromes?
small gastric remnant (early satiety) gastric stasis (Roux stasis syndrome) dumping syndrome post-vagotomy diarrhea Bile reflux gastritis
What is a small gastric remnant?
One of the post-gastrectomy syndromes. Loss of gastric capacity or vagotomy resulting in loss of receptive relaxation / accommodation.
what are the symptoms of small gastric remnant and what can you recommend for it?
early satiety, pain with eating, vomiting
–> small frequent meals, no fluid with meals
What is gastric stasis (Roux stasis)?
One of the post-gastrectomy syndromes. Hypomotility of remnant stomach and motor disturbances in the jejunal limb.
What are the symptoms of gastric stasis (Roux stasis) and what can you recommend for it?
Nausea, pain, gas/bloating, postparandial fullness, symptoms relieved by vomiting.
–> small frequent meals, liquids rather than solids, liquid calories and pureed foods, low fat, low fiber diet
What is the dumping syndrome?
One of the post-gastrectomy syndromes. Loss of pyloric sphincter causes rapid influx of hyperpsmolar contents into the small bowel and releases of hormones (epinephrine) which affect GI motility.
How soon after a meal does early dumping occur?
10-30 minutes after a meal
What are the symptoms of early dumping syndrome?
epigastric fullness, N/V, abdominal cramps, nausea, diarrhea
How soon after a meal does late dumping occur?
1-3 hours after a meal
What are the symptoms of late dumping?
hunger, perspiration, tremors, difficulty concentrating
What is postvagotomy diarrhea?
One of the post-gastrectomy syndromes. alterations in gastric emptying cause episodic explosive diarrhea unrelated to intake.
What can you recommend for postvagotomy diarrhea?
watchful waiting (symptoms may improve over several months), avoidance of instigating foods, fiber supplement may be helpful, addition of antidiarrheal agents.
MNT for dumping?
reduce concentrated sugars, test tolerance to lactose foods, eat protein rich foods with complex carbohydrates, drink 30 minutes before and after a meal (no liquid with meals), 5-6 smaller meals, chew foods well.
What is bile reflux gastritis?
One of the post-gastrectomy syndromes. Most common after Billroth II. Results from chronic exposure of the gastric remnant to biliopancreatic secretions caused by loss of the pylorus.
What are the symptoms of bile reflux gastritis?
burning epigastric pain, N/V that doesn’t relieve pain, pain only partially associated with meals, vomitus continuing bile mixed with food, possible weight loss and anemia.
What can you recommend for bile reflux gastritis?
cholestyramine, antacids, histamine receptor blockers, proton pump
T/F: Bone disease is common after gastritis?
True due to reduced intake of calcium and vitamin D-containing foods and malabsorption.
Why does fat malabsorption occur after gastritis?
Due to alterations to gastric lipase and exocrine pancreatic insufficiency, cck release and SIBO
