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Advanced Medical Nutrition Therapy II > Gastrointestinal Disorders and Surgeries > Flashcards

Gastrointestinal Disorders and Surgeries Flashcards

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USMLE® Step 1 flashcards
1
Q

Gastric outlet obstruction is also known as ____ ___

A

Pyloric obstruction

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2
Q

Gastric outlet obstruction is caused by mechanical obstruction impeding ____ ____

A

Gastric emptying

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3
Q

Gastric outlet obstruction can be caused by…

A

-Cancer
-Peptic ulcer disease
-Inflammation
-Congenital disorders
-Bezoar

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4
Q

Clinical manifestations of gastric outlet obstruction:

A

-Fullness, more distressing after eating
-Epigastric pain
-Nausea/vomiting
-Dehydration
-Anorexia
-Weight loss
-Malnutrition
-Electrolyte imbalances
-Metabolic alkalosis

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5
Q

Medical management of gastric outlet obstruction:

A

-Nasogastric suction
-Surgery may be necessary: pyloroplasty

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6
Q

MNT for gastric outlet obstruction:

A

-PO diet if tolerated: chew foods thoroughly, avoid tough fibrous foods; may only be able to tolerate liquids
-For severe obstruction: NPO with IVF and electrolytes
-May require JT feeding if chronic or unresectable

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7
Q

Upper GI bleeding is bleeding from the…

A

-Esophagus
-Stomach
-Duodenum

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8
Q

Upper GI bleeding can be caused by:

A

-Esophageal varices
-Peptic ulcers
-Gastritis
-Gastric cancer
-Erosive esophagitis
-Mallory-Weiss tears
-NSAIDs and aspirin

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9
Q

Lower GI bleeding is bleeding from the…

A

-Jejunum
-Ileum
-Colon
-Rectum

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10
Q

Lower GI bleeding can be caused by…

A

-Inflammatory bowel disease
-Cancer
-Diverticular disease
-Enteritis; colitis
-Polyps
-Hemorrhoids

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11
Q

Symptoms of acute blood loss from a GI bleed:

A

-Hematemesis (blood vomit)
-Melena (black, tarry stool)
-Hematochezia (bright red blood from rectum)

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12
Q

____ bleeding can result from chronic blood loss and is explained as small amounts of blood in the stool

A

Occult

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13
Q

Symptoms of a GI bleed:

A

-Decreased Hemoglobin and hematocrit
-Increased BUN
-Weakness
-Diarrhea
-Decreased BP and increased HR
-Chronic GI bleed: iron deficiency anemia

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14
Q

MNT for GI bleed:

A

-Initially NPO with IV fluids, then liquid diet, then low fiber diet, then regular diet

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15
Q

For someone with a GI bleed, we should provide adequate ___, ___, and ____ for healing…

A

-Fluid
-Protein
-Kcal

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16
Q

Someone with a chronic GI bleed may need supplemental iron; they should be given ____-____ mg of elemental iron per day

A

150-200

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17
Q

If someone has severe bleeding from the small intestine, they may need ____ ____

A

Parenteral nutrition

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18
Q

An ____ is a temporary lack of peristalsis

A

Ileus

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19
Q

An Ileus can be caused by…

A

-Abdominal surgery
-Medications (opioids, sedatives)
-Abdominal infections (peritonitis)
-Hypokalemia

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20
Q

Symptoms of an Ileus:

A

-Abdominal distention and pain
-N/V

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21
Q

Typically, after abdominal surgery, the small bowel resumes motility in less than or equal to ____ hours

A

24

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22
Q

Typically, after abdominal surgery, gastric motility resumes in ___-___ hours

A

24-48

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23
Q

Typically, after abdominal surgery, colonic motility resumes in ___-___ hours

A

48-72

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24
Q

Prolonged postoperative ileus occurs when symptoms persist for > ____-____ days

A

3-5

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25
Q

MNT for Ileus:

A

-NPO with IV fluids until resolves

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26
Q

When an ileus is resolved, someone’s diet should progress from ___ to ___ to ___

A

Clear liquids, low fiber, regular

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27
Q

Someone with an ileus may require parenteral nutrition if NPO for > ___ days (begin at 5 days if malnourished)

A

7

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28
Q

If someone has a prolonged gastric ileus, we can provide ______ tube feedings

A

Nasojejunal

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29
Q

Intestinal obstruction can be caused by…

A

-Post-surgical adhesions (scar tissue)
-Tumors
-Severe inflammation (strictures)
-Hernias
-Volvulus
-Fecal impaction
-Congenital disorders (intestinal atresia)

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30
Q

Clinical manifestations of intestinal obstruction:

A

-Severe, crampy abdominal pain that comes and goes
-Abdominal distention and bloating
-N/V

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31
Q

Possible complications of intestinal obstruction:

A

-Decreased intake
-Dehydration
-Hypokalemia
-Metabolic alkalosis
-Hypovolemic shock
-Intestinal perforation
-Peritonitis

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32
Q

MNT for intestinal obstruction:

A

-NPO with IV fluids and electrolytes
-May require parenteral nutrition
-When oral diet is appropriate, low fiber diet and then regular diet

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33
Q

If someone has chronic duodenal obstriction, ___ ___ feeding is indicated

A

Jejunal tube

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34
Q

Purposes of the low fiber diet:

A

-Reduces fecal bulk and output
-Slows intestinal transit

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35
Q

Guidelines for the low-fiber diet are to consume less than or equal to ___-___ grams of fiber per day

A

10-15

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36
Q

Someone on the low-fiber diet should avoid…

A

-All whole grains, seeds, nuts, legumes, and popcorn
-Raw fruits and vegetables, cooked corn, potato skins

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37
Q

Possible reasons for intestinal resection:

A

-Cancer
-Inflammatory bowel disease
-Obstruction
-Congenital anomalies
-Mesenteric infarct
-Diverticulitis
-Fistula
-Volvulus
-Rectal disorders

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38
Q

Nutritional considerations for intestinal resections:

A

-Site of nutrient digestion and absorption
-Digestive enzymes and secretions
-Motility
-Amount of intestine removed
-Adaptation

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39
Q

____ ____ and ____ enter the duodenum

A

Pancreatic secretions and bile

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40
Q

The duodenum is the preferred site of absorption for…

A

-Iron
-Zinc
-Copper
-Folate

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41
Q

A duodenal resection can cause _____ ____

A

Dumping syndrome

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42
Q

The ____ is a major site of nutrient absorption

A

Jejunum

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43
Q

If someone has had a jejunal resection, monitor for ____

A

Malnutrition

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44
Q

After jejunal resections, the ____ typically adapts to perform the functions of the jejunum

A

Ileum

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45
Q

If someone has had an ileal resection, they are at higher risk of ____ deficiency

A

B12

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46
Q

The ileum is the site of bile salt reabsorption, so resections may cause ____ ____

A

Fat malabsorption

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47
Q

Someone who has had an ileal resection may have deficiencies of what vitamins?

A

-Calcium
-Magnesium
-Zinc
-Fat-soluble vitamins (A, D, E, K)

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48
Q

Ileal resection results in rapid ____ ____, resulting in diarrhea

A

Intestinal transit

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49
Q

Ileal resections can also increase risk for _____ and _____

A

-Cholelithiasis (gallstones)
-Nephrolithiasis (oxalate kidney stones)

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50
Q

Removal of the ileocecal valve increase the emptying rate of the small intestinal contents into the colon, leading to ____

A

Diarrhea

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51
Q

Removal of the ileocecal valve increases migration of colonic bacteria into the ileum, which leads to ___ ___ ___ ____

A

Small intestinal bacterial overgrowth

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52
Q

A colonic resection decreases absorption of ____ and ____

A

Fluid and electrolytes

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53
Q

A colonic resection can cause rapid intestinal transit times, leading to ____

A

Diarrhea

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54
Q

The preoperative nutrition guidelines determined by the enhanced recovery after surgery guidelines are…

A

-No solid food for 6 hours before surgery
-May have clear liquids up until 2 hours before surgery
-NPO for 2 hours before surgery

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55
Q

Preoperative ERAS guidelines:

A

-Preadmission counseling
-Fluid and carbohydrate loading
-No prolonged fasting
-No/selective bowel preparation
-Antibiotic prophylaxis
-Thromboprophylaxis
-No premedication

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56
Q

Intraoperative ERAS guidelines:

A

-Short-acting anesthetic agents
-Mid-thoracic epidural anesthesia/analgesia
-No drains
-Avoidance of salt and water overload
-Maintainance of normothermia

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57
Q

Postoperative ERA guidelines:

A

-Mid-thoracic epidural anesthesia/analgesia
-No NG tubes
-Prevention of nausea and vomiting
-Avoidance of salt and water overload
-Early removal of catheter
-Early oral nutrition
-Non-opioid oral analgesia/NSAIDs
-Early mobilization
-Stimulation of gut motility
-Audit of compliance and outcomes

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58
Q

The MNT for intestinal resection is the traditional post-op diet advancement which is…

A

-Clear liquids
-Full liquids
-Low fiber
-Regular diet

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59
Q

No physiologic reason exists for solid foods not to be introduced as soon as the ___ ___ is functioning and a few liquids can be tolerated

A

Gastrointestinal tract

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60
Q

Therefore, after intestinal resectioning, begin with a ___ ____ diet and advance diet as tolerated to regular diet

A

Low fiber

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61
Q

Kcal recommendations for those after intestinal resection:

A

25-30 kcal/kg

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62
Q

Protein recommendations for those after intestinal resection:

A

1.2-2 g/kg

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63
Q

After intestinal resection, patients should receive high ___ and high ____ oral nutrition supplements

A

Protein, kcal

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64
Q

After intestinal resection, patients should receive ____ supplementation as needed

A

Micronutrient

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65
Q

If extensive resection or a prolonged, post-operative ileus, ____ nutrition may be indicated

A

Parenteral

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66
Q

An intestinal ____ is a surgically created opening between the intestinal tract and the skin to permit defecation from the intact portion of the intestine

A

Ostomy

67
Q

A ____ is created when part of the colon or rectum are removed or must be bypassed

A

Colostomy

68
Q

An ____ is created when the entire colon is removed or must be bypassed

A

Ileostomy

69
Q

Indications for creation of intestinal ostomies:

A

-Colorectal cancer
-Diverticulitis
-IBD
-Bowel perforation
-Bowel ischemia
-Enterocutaneous or colocutaneous fistulae

70
Q

Nutritional concerns with intestinal ostomies:

A

-Excessive losses of fluid and sodium (especially ileostomies)
-Obstruction of the stoma
-Gas production
-Malodorous stool

71
Q

After an ostomy is placed, someone should follow a ___ ___ diet and advance diet as tolerated to regular diet after 6 weeks

A

Low fiber

72
Q

Someone with an ostomy should receive adequate fluid, around ___-___ cups of fluid per day

A

8-10

73
Q

Those with ostomies should get adequate ____ and ____, especially for those with ileostomies

A

Sodium and potassium

74
Q

Someone who has had a resection of a terminal ileum should receive vitamin ___ supplementation

A

B12

75
Q

What can be done to minimize the risk of ostomy obstruction?

A

-Chew food thoroughly
-Avoid foods that are incompletely digested (corn, popcorn, raw cabbage, vegetable and fruit peels, and dried fruit)

76
Q

For those with ostomies, we should educate on foods that may cause odor, like…

A

-Cruciferous vegetables
-Beans
-Asparagus
-Garlic
-Onions
-Eggs
-Fish

77
Q

What can be done if someone has excessive ostomy output?

A

-Provide oral rehydration solutions sipped throughout the day
-Reduce insoluble fiber and increase soluble fiber
-Avoid foods that can increase output: spicy food, high-fat foods, prunes, caffeine, alcohol, fruit juice, food high in added sugars, sorbitol
-6-8 small meals/day

78
Q

____ is a clinical condition in which the normal digestion and/or absorption of nutrients is impaired

A

Malabsorption

79
Q

Malabsorption may affect a single ____ or many of them

A

Nutrient

80
Q

Malabsorption can lead to _____

A

Malnutrition

81
Q

Fat malabsorption may be due to abnormalities in…

A

-Pancreatic secretion
-Bile salt availability
-Enterocyte function

82
Q

What conditions may lead to pancreatic insufficiency?

A

-Chronic pancreatitis
-Cystic fibrosis

83
Q

What conditions may lead to decreased bile availability?

A

-Cholestatic liver disease
-Biliary obstruction
-End-stage liver disease

84
Q

____ disease/resection may lead to a decrease in reabsorption of bile salts

A

Ileal

85
Q

What conditions may lead to small bowel mucosal disease/damage (and therefore fat malabsorption)?

A

-Celiac disease
-Crohn’s disease
-Radiation enteritis
-AIDS

86
Q

Gastric resection can lead to ____ syndrome

A

Dumping

87
Q

Bacterial overgrowth can be caused by…

A

-Deconjugation of bile salts
-Intestinal mucosal damage

88
Q

Signs and symptoms of fat malabsorption:

A

-Steatorrhea
-Weight loss despite adequate intake

89
Q

Excessive fat content in stool causes ____

A

Diarrhea

90
Q

Characteristics of steatorrhea:

A

-Pale, greasy stools
-Oily film in toilet water
-Foul odor

91
Q

Steatorrhea is diagnosed with a ___ ___ ____

A

Fecal fat test

92
Q

Procedure of the fecal fat test:

A

-72 hour stool collection
-Consume 100 g fat diet

93
Q

Normally, there is ___-___ grams of fat in the stool per day

A

2-6

94
Q

Steatorrhea is diagnosed if someone has more than ___ grams of fat per day in the stool

A

7

95
Q

Nutritional consequences of steatorrhea:

A

-Dehydration
-Electrolyte losses
-Weight loss and malnutrition
-Fat-soluble vitamin deficiencies
-Decreased absorption of calcium, magnesium, and zinc
-Hyperoxaluria-> nephrolithiasis

96
Q

Treatment goals for steatorrhea:

A

-Determine and treat underlying cause
-Alleviate steatorrhea
-Correct nutritional deficiencies

97
Q

MNT for fat for malabsorption is a fat-restricted diet of _____ g/day

A

40

98
Q

The purpose of a fat-restricted diet is to decrease ____

A

Steatorrhea

99
Q

With a fat-restricted diet, all types of fat are restricted, except ____

A

MCT

100
Q

MNT for fat malabsorption also includes treating the _____ disease

A

Underlying

101
Q

If fat malabsorption is due to pancreatic insufficiency, recommend ____ ____ supplements

A

Pancreatic enzyme

102
Q

Medium-chain triglyceride oil does not require ____ ____, ____ ____, or ____ for digestion and absorption

A

-Pancreatic lipase
-Bile salts
-Chylomicrons

103
Q

We can consider the use of MCT oil as a fat and kcal source; it provides ___kcal/g and ___ kcal/Tbsp

A

8.3 kcal/g; 116 kcal/tbsp

104
Q

MCT oil has a low smoke point so it shouldn’t be used in ____

A

Cooking

105
Q

MCT oil is often used in ___-____ oral supplements or enteral fomulas

A

Semi-elemental

106
Q

MCT oil does not contain ___ ___ ___

A

Essential fatty acids

107
Q

For someone with fat malabsorption, we should monitor for micronutrient _____ and supplement as needed

A

Deficiencies

108
Q

For someone with fat malabsorption, they should get…

A

-MVI with minerals
-Water-soluble form of fat-soluble vitamins

109
Q

What type of oral nutrition supplements are given to those with fat malabsorption?

A

-Partially hydrolyzed, peptide-based with MCT oil

110
Q

What are two examples of oral nutrition supplements that would be given to someone with fat malabsorption?

A

-Peptamen with Prebio
-Vital Peptide 1.5 Cal

111
Q

Carbohydrate malabsorption may be due to abnormalities in…

A

-Levels of brush border enzymes (disaccharide deficiency-> lactase deficiency)
-Pancreatic secretion (pancreatic insufficiency)
-Damaged mucosa (Celiac disease)

112
Q

Carbohydrate malabsorption may also be caused by significant resections of the ___ ____

A

Small bowel

113
Q

Signs and symptoms of carbohydrate malabsorption:

A

-Abdominal bloating/distention
-Flatulence
-Watery, osmotic diarrhea
-Borborygmi
-Nausea

114
Q

MNT for carbohydrate malabsorption is to limit/avoid the offending ____

A

Carbohydrate

115
Q

For someone with a lactase deficiency, someone should follow a ____-restricted diet and limit to the amount tolerated

A

Lactose

116
Q

For someone with a lactase deficiency, we should provide alternate ____ and vitamin ____ sources

A

Calcium and D

117
Q

Possible etiologies of protein malabsorption:

A

-Pancreatic insufficiency
-Small bowel mucosal damage: inflammation, Celiac disease
-Significant small bowel resections (Short bowel syndrome)

118
Q

Signs and symptoms of protein malabsorption:

A

-Muscle wasting
-Edema
-Decrease serum albumin and prealbumin

119
Q

For someone with protein malabsorption, we should recommend an high protein diet of ____ g/kg

A

1.5

120
Q

If someone has protein malabsorption due to pancreatic insufficiency, recommend ___ ___ ___

A

Pancreatic enzyme supplements

121
Q

Those with protein malabsorption might have a need for ____, ___-___ protein sources (enteral nutrition)

A

Hydrolyzed, semi-elemental

122
Q

How should we monitor for symptoms of malnutrition?

A

-GI symptoms and stool output
-Nutrient intake
-Weight
-NFPE
-Hydration status

123
Q

What labs can be used to monitor for malabsorption?

A

-Fecal fat test
-Serum electrolyte levels
-Serum vitamin and mineral levels
-Prothrombin time
-Serum cholesterol and triglycerides

124
Q

A ____ is an abnormal connection from one organ to another organ, skin, or wound

A

Fistula

125
Q

Fistulas can originate from anywhere in the ____ ____

A

Gastrointestinal tract

126
Q

Fistulas can be caused by…

A

-Surgery
-Inflammatory bowel disease
-Radiation enteritis
-Bowel ischemia

127
Q

A high output enteric fistula has over ____ mL of enteric output per day

A

500

128
Q

A low output enteric fistula has less than ____ mL of enteric output per day

A

500

129
Q

Complications of fistulas:

A

-Excessive fluid and electrolyte losses
-Micronutrient deficiencies (zinc)
-Infection, sepsis
-Malnutrition
-Mortality

130
Q

Malnutrition can develop quickly and contributes to morbidity and mortality; it can also adversely affect spontaneous fistula ____

A

Closure

131
Q

Malnutrition with a fistula can be caused by…

A

-Inadequate intake
-Underlying disease
-Loss of protein-rich secretion from the fistula
-Increase kcal and protein requirements due to inflammation and infection

132
Q

What are the objectives for treatment of a fistula?

A

-Control/minimize fistula output
-Replace fluid and electrolyte losses
-Promote healing

133
Q

Conservative management of a fistula includes…

A

-TPN
-Octreotide

134
Q

____ can also be done to repair a fistula

A

Surgery

135
Q

Someone with a fistula has high ____ needs

A

Energy

136
Q

Someone with a fistula also has high protein needs; they should get ___-___ g of protein/kg and may even need up to ___ g/kg if high fistula output

A

1.5-2; 2.5

137
Q

Someone with a fistula should also get ___ and ___ replacement

A

Fluid and electrolyte

138
Q

We should monitor for losses of ____ with someone who has a fistula

A

Zinc

139
Q

The mode of nutrition therapy is based on the ____ of the fistula and whether it is high or low output

A

Location

140
Q

Frequently, those with a fistula are ____ with TPN

A

NPO

141
Q

When is TPN indicated for someone with a fistula?

A

-High output, small bowel fistulas

142
Q

How can TPN help someone with a fistula?

A

-Reduced GI secretions and output
-Improves nutritional status prior to surgery

143
Q

Enteral nutrition for someone with a fistula may be indicated if the fistula is…

A

-Esophageal, stomach, or duodenal (feed distal to fistula)
-Low output

144
Q

What type of tube feed formula should be used for those with fistulas?

A

Polymeric, high nitrogen

145
Q

Oral nutrition may be indicated if someone has a _____ fistula

A

Colocutaneous

146
Q

What type of oral diet should someone with a colocutaneous fistula receive?

A

Low fiber and low residue

147
Q

After a fistula has healed, an oral diet should be…

A

-Low fiber and low residue
-Advance diet as tolerated to regular diet

148
Q

The purpose of the low residue diet is to reduce ____ ____

A

Fecal output

149
Q

Guidelines for a low residue diet:

A

-Low fiber: <13 grams of fiber/day
-Avoid excessive amounts of sugar alcohols, fructose, and sucrose
-Avoid alcohol and caffeine
-If lactose intolerance, limit dairy products

150
Q

____-___ ____ is a rare condition that causes shedding of large amounts of protein from the gastrointestinal tract

A

Protein-losing enteropathy

151
Q

Protein-losing enteropathy is characterized by progressive, moderate to severe _____ (<3.0 g/dL) and often ____ ____

A

Hypoalbuminemia and peripheral edema

152
Q

Causes of protein-losing enteropathy:

A

-AIDS gastroenteropathy
-Inflammatory bowel disease
-Celiac disease
-Radiation enteritis
-Bacterial overgrowth
-Eosinophilic gastroenteritis

153
Q

MNT for protein-losing enteropathy is the MNT for the ____ disease

A

Primary

154
Q

Those with protein-losing enteropathy need a high protein diet and should get ___-___ g of protein/kg to achieve positive nitrogen balance

A

2-3

155
Q

If the underlying condition is also causing fat malabsorption, we should also prescribe a ____-____ diet with MCT oil

A

Low-fat

156
Q

For those with protein-losing enteropathy, we should monitor for and treat ____ and or deficiencies

A

Malnutrition

157
Q

What are three things that can cause small intestine bacterial overgrowth?

A

-Disorders leading to impaired intestinal motility, resulting in stasis of intestinal contents
-Decreased gastric acid secretion
-Removal of the ileocecal valve

158
Q

What disorders lead to impaired intestinal motility, resulting in stasis of intestinal contents?

A

-Intestinal obstruction
-Strictures-> Crohn’s Disease
-Surgical blind loops
-Multiple diverticula
-Scleroderma

159
Q

What can lead to decreased gastric acid secretion?

A

-Gastric resection
-Atrophic gastritis
-Chronic use of H2-receptor blockers or protein pump inhibitors

160
Q

Symptoms and consequences of small intestine bacterial overgrowth include…

A

-Gas cramps, abdominal bloating, and pain
-Diarrhea
-Bacterial deconjugate bile salts-> fat malabsorption
-Mucosal damage (decreased levels of brush border enzymes, malabsorption, protein-losing enteropathy)
-Metabolism of vitamin B12 and carbohydrates by bacteria
-Malnutrition

161
Q

How is small intestine bacterial overgrowth diagnosed?

A

-Hydrogen breath test
-Small bowel aspirate and culture for bacterial count

162
Q

Treatment for small intestine bacterial overgrowth:

A

Broad spectrum antibiotics

163
Q

MNT for small intestine bacterial overgrowth:

A

-Adequate hydration
-Reduce highly fermentable carbohydrates (low FODMAPs diet)
-If steatorrhea, 40 g low fat diet
-Micronutrient supplementation as needed (IM vitamin B12, fat-soluble vitamins in water-soluble form)

Advanced Medical Nutrition Therapy II (19 decks)

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