Exam # 2 MNT Review GI-Liver

Question 1

MNT for hematomacrosis

Answer 1

Control iron intake to maintain serum ferritin level below 50 mg/dL in order to prevent damage
to various organs including the liver
< No alcohol
< No iron supplements, fortified cereal products
< Moderate intake of iron containing foods

Question 2

MNT for Liver disease

Answer 2

Prevent/correct weight loss
Monitor carbohydrate intake based on whether patient is hyperglycemic or hypoglycemic
Control ascites (edema)
Vitamin/mineral deficiencies

< Increase in branched chain amino acids (BCAA) and decrease in Aromatic amino acids if signs of hepatic encephalopathy
< Calories to prevent/correct weight loss
< Carbohydrates adjusted based on glucose levels
< Fluid/sodium restriction if ascites present
< Vitamin/mineral supplements (especially thiamin and B-complex vitamins)
< Avoid NPO status for longer than 6-8 hours (prevent hypoglycemia)

Question 3

MNT Short Bowel Syndrome

Answer 3

Goal is to transition patient from TPN or tube feeding to food if possible

< 4-6 meals per day
< Soluble Fiber Supplements
< Oral Rehydration Drinks
< Mineral supplements ( Ca, Mg, Zn) in chewable or liquid forms

Question 4

MNT for Diverticulitis

Answer 4

Diverticulosis-want to prevent diverticulitis
Diverticulitis- want to minimize pain and discomfort

< Diverticulosis- high fiber, minimum of 10 cups of fluids/day, may want to avoid seeds, nuts, skins if cause problems
< Diverticulitis- low fiber, avoid nuts, seeds, and fibrous vegetables, elemental or PN in severe cases

Question 5

MNT IBS syndrome

Answer 5

Reduce colon spasms/normalize bowel movements

< Avoid foods causing individual discomfort
< FODMAP Diet
Phase 1 Eliminate all FODMAP’s Foods from diet for a trial period of 2 weeks
Phase 2 Challenge-add foods from one FODMAP class using a small then larger load and observe for symptoms
Phase 3 Maintenance
< FODMAP Foods
• Fructose (fruits, honey, HFCS, etc.)
• Lactose (dairy)
• Fructans (wheat, garlic, onion, inulin, etc.)
• Galactans (legumes such as beans, lentils, soybeans, etc.)
• Polyols (sweeteners containing isomalt, mannitol, sorbitol, sylitol, stone fruits such as avocado, apricots, cherries, nectarines, peaches, plums, et.)

Question 6

MNT for IBD

Answer 6

Alleviating symptoms/Correcting nutritional deficiencies
MNT treatment depends on disease process:

Exacerbation
< Low fiber
< Small, frequent feedings
< Liquid oral supplements
< MCT if steatorrhea
< Lactose restriction if secondary lactose intolerance
< Acute attacks may require elemental tube feeding or PN to allow complete bowel rest
< TF with MCT oil and glutamine may also be beneficial

Remission
<	Increase diet as tolerated
<	Maximize energy and protein intake
<	Consumption of foods high in antioxidants and omega-3 fatty acids may protect against inflammation
<	Prebiotics/Probiotics

Question 7

MNT Fructose malabsorption

Answer 7

Avoid or at least minimize symptoms. Does not cause damage to the GI tract

< Elimination Diet and record keeping to confirm problematic foods and amounts
< Start by avoiding all sources of fructose and then slowly adding in different foods to identify problematic foods
< Limit servings of fruits and vegetables choosing those lower in fructose or with a more favorable ratio of glucose to fructose
< Avoid honey
< MAY need to limit consumption of HFCS beverages like soda (12 ounce can is generally tolerated)

Question 8

MNT Lactose Intolerance

Answer 8

Avoid or at least minimize symptoms. Does not cause damage to the GI tract.

< Consume small amounts of lactose with food as tolerated
< Whole milk and chocolate milk better tolerated (fat slows down ` digestion/absorption)
< Most aged cheeses are low in lactose
< Unpasteurized yogurt
< Lactaid added to products

Question 9

MNT Celiac Disease

Answer 9

Address the primary cause/Support regeneration of villi
< Gluten free diet (eliminate wheat, rye, oats, and barley). Some research has suggested that oats may be tolerated if not contaminated with other grains for some individuals.
< Secondary lactose intolerance common (will often resolve itself as villi return to normal)

Question 10

Malabsorption/Steatorrhea

Answer 10

Correct nutritional deficiency

<	Fat Restricted (25-50 grams)
<	Use of Medium Chain Triglycerides (MCT)
<	Vitamin/Mineral Supplementation
		Fat soluble Vitamins
		Calcium/Zinc/Magnesium
<	Pancreatic lipase
<	Minimize weight loss

Question 11

MNT Diarrhea

Answer 11

Replace fluids and electrolytes (Na and K)
< Do not rest gut-needs to be fed to repair
< Introduce starches first-non-sugared cold cereals, potatoes, breads, rice, pasta
< Fruits-bananas, applesauce
< Use of banana flakes, apple power, or other pectin sources
< Choose low-fiber foods
< Usually need to limit lactose, fructose, and sucrose until diarrhea resolved

Question 12

MNT Constipation

Answer 12

Minimum of 14 g of fiber/1000 kcal/day for adults (insoluble and soluble fiber)
< Minimum of 2 quarts per day of fluid
< Physical movement

Question 13

MNT Dumping Syndrome

Answer 13

Minimize symptoms of abdominal fullness and nausea, diarrhea, and hypoglycemia

< Small meals
< High protein/complex carbohydrates
< Lie down after eating
< Liquids 30-45 minutes before or after meals and not with meals
< Limit lactose
< MCT may be necessary
< Fiber supplements reduce upper GI transit time and decrease rate of glucose absorption

Question 14

MNT Gastritis and peptic ulcer disease

Answer 14

Minimize pain and discomfort/decrease acidity of gastric secretion
• Decrease consumption of alcohol, coffee (including decaffeinated), caffeine, black and red pepper (individualized)
• Avoid cigarette smoking
• Avoid foods that are not tolerated

Question 15

MNT GERD/ Hiatial Hernia

Answer 15

Minimize pain and discomfort/decrease acidity of gastric secretion
• Decrease consumption of alcohol, coffee (including decaffeinated), caffeine, black and red pepper (individualized)
• Avoid cigarette smoking
• Avoid foods that are not tolerated