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Clinical Nutrition 2 > IBD - Crohn's Disease > Flashcards

IBD - Crohn's Disease Flashcards

1
Q

What is the aetiology of IBD and Crohns?

A
  • Largely unknown

- An interaction between luminal microbial antigens, genetic susceptibility, immune response and environmental triggers

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2
Q

What is Crohn’s disease characterized by?

A
  • Dysfunctional regulatory T-cells which normally control pro-inflammatory cytokine releases.
  • If activated antigen presenting cells and lymphocytes are allowed to secrete these pro-inflammatory cytokines, then tissue damage may result from prolonged inflammation
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3
Q

What is a key player in crohn’s disease?

A

TNF alpha

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4
Q

What is the prevalence of IBD? Is CD and UC more common?

A
  • 0.67%

- CD slightly more common (129,000) compared to UC (104,000)

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5
Q

Whats the difference between IBS and IBD?

A

IBD has presence of ulcerations

-May share similar symptoms

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6
Q

What is the prevalence of crohn’s disease in Canada?

A

319 per 100,000

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7
Q

In CD there are more females (T/F)

A

T

In UC, there are slightly more males, however we don’t know why

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8
Q

What are the common characteristics of IBD? (3)

A
  • Affects all levels of the GIT
  • Often onset in youth
  • 30-50% of people have the colon affected
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9
Q

Which parts of the colon are often affected in IBD?

A
  • Ileocolonic (50-60%)

- Crohn’s colitis (10-30%)

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10
Q

(T/F) Crohn’s disease affects only the large intestine

A

F

Can be the small or large intestine, often “patches” throughout

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11
Q

What is the difference between ileocolic and colon originates crohn’s disease?

A
  • ileocolic will present with affected arears in the terminal ileum, and patches throughout the colon
  • Colon means the patches are distributed throughout the colon only
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12
Q

Where is the affected area in recto-sigmoid crohns?

A
  • In the terminal sigmoid colon and rectum

- Continuous and not patchy

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13
Q

When may UC be misdiagnosed for chron’s?

A

If it’s initial presentation is in the colon, and is patchy

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14
Q

When may crohn’s be a misdiagnosis of UC?

A

When it is present in the colon and not yet pathcy

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15
Q

What is the presentation of UC?

A

-Continuous, not patchy throughout the colon to anus

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16
Q

What is the Montreal Disease Activity Score?

A

Allows us to define UC by the extent of affected area. Considers 3 subgroups.

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17
Q

What does E1 represents in the MDAS?

A
  • Ulcerative proctitis

- Involvement limited to the rectum (i.e, proximal extend of inflammation is distal to the rectosigmoid junction)

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18
Q

What does E2 represent in the MDAS?

A
  • Left sided UC, or distal UC

- Involvement limited to the portion of the colorectum distal to the splenic flexure

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19
Q

What does E3 represent in the MDAS?

A
  • Extensive US, or pan-colitis

- Involvement extents proximal to the splenic flexure

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20
Q

What is the significance of tool required to diagnose IBD?

A

-There is often lengthly preparation to undergo these diagnoses, such as fasting, and often patients with IBD are malnourished at baseline

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21
Q

Preparation for endoscopy?

A
  • 8 hr NPO

- May exacerbate malnutrition

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22
Q

Discuss the 2-3 day preparation in order to undergo a colonoscopy

A

1) Obtain bowel preparation solution at least 2 days before the test
2) 1 day before test; clear liquids all dat, Then, from 6-8pm drink 2L of any PEG-based solution
3) Dat of test, no solid food , and 4 hour before appointment, drink remaining 2L of PEG based solution
4) Stop drinking all liquids including water 2 h before the test

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23
Q

What is the PEG solution?

A
  • PIC-SALAX

- Contents are not absorbed, and will function to “clean the bowel” so that we can observe ulcerations upon colonoscopy

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24
Q

Overall preparation guielines for colonoscopy on Pico-Salax?

A
  • No fibre 3 days prior

- Day prior can have breakfast and then clear fluid only plus lavage

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25
Q

When assessing a patient with potential IBD, what do we need to investigate?

A
  • Is it UC or Crohn’s? Where is the inflammation? (Recall that Crohn’s can go from anus to mouth
  • Are there stricture, ulcers? How deep are the strictures?
  • What is the patient currently able to eat?
  • Has there been weight-loss?
  • What medication is she on?
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26
Q

A1?

A

16 years or younger

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27
Q

A2?

A

17-40 years

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28
Q

A3?

A

Over 40 years

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29
Q

L1?

A

Terminal ileum

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30
Q

L2?

A

Colon

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31
Q

L3?

A

Ileocolon

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32
Q

L4?

A

Upper GI

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33
Q

B1?

A

Non-stricturing, non-penetrating

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34
Q

B2?

A

Stricturing

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35
Q

B3?

A

Penetrating

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36
Q

B1 or 2 or 3 with p?

A

+ perianal

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37
Q

In UC, what do the ulcerations on the colon lead to?

A
  • Toxic megacolin
  • A thin, ulcerated colon which has complete lack of the strong-muscular walls
  • People can due for this as the thin walls can perforate and cause sepsis
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38
Q

What is the solution for toxic megacolon?

A
  • Take out the large intestine

- Likely have an ostomy

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39
Q

What does Crohn’s disease primarily present with?

A
  • Ulcers, fistulas, strictures and obstructions

- Makes the lumen and peristalsis less functional and flexible

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40
Q

What is transmural?

A
  • All the way through
  • Through the mucosa, submucosa and musculature into the peritoneal cavity (high risk of sepsis)
  • Can transverse both circular an longitudinal muscle
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41
Q

What is the mesentery?

A

A set of tissues that attaches the intestines to the posterior abdominal wall in humans and is formed by the double fold of peritoneum.
-Helps lead nutrients to the surrounding vascular system

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42
Q

What happens when the mesentery is thickened?

A

-Will have difficulties in supplying nutrients from the villi, and will also not transport nutrients to the liver (bidirectional) may not have enough oxygen

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43
Q

What is commonly observed in the affected area during IBD?

A

-Enlarged lymph nodes

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44
Q

What is an aphthoid ulcer?

A

-Ulcer over payer’s path’
-Ulcer over immune spots
and similar to canker sores

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45
Q

What are skip lesions?

A
  • Patchy distribution of inflammation

- Recall the inflammation is normally continuous and contained to the colon in UC

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46
Q

What is a fissure?

A

-Deep cleft, slit or linear ulcers

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47
Q

What is a fistula?

A

An abnormal passage from a hollow organ to surface of another organ stricture; narrowing of hollow organ can ensure, causing scaring and fibrosis

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48
Q

What are abscesses?

A

a swollen area within body tissue, containing an accumulation of pus.

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49
Q

What are granuloma?

A

When tissue in an organ becomes inflamed — often in response to an infection — groups of cells called histiocytes cluster to form little nodules. May become calcified and hardened over time.

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50
Q

What type of IBD is at higher risk of fistula development?

A

Crohn’s

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51
Q

What else is consistent with IBD pathology?

A
  • Perianal disease (when complication occur in the anus/rectum)
  • Inflamed mucosa with adjacent normal tissue (recall skip lesions)
  • Perianal skin tags
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52
Q

What are common clinical presentations of crohns?

A
  • “Cobble-stoning” of intestinal lumen
  • Marked thickening of bowel wall
  • fat wrapping around outside of GI tract (due to high inflammatory state)
  • Deep fissures
  • -> MAJOR impacts on absorption
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53
Q

What are common clinical presentations of ulcerative colitis?

A

-Extremely thin, ulcerated wall
-“surviving” mucosa is known as pseudopolyps
-Loss of haustra
(the sacs)
—> MAJOR impact on absorption

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54
Q

What are the general clinical features of IBD?

A
  • Skip lesions
  • Thickened bowel wall
  • Stricture formation
  • Decreased brush-border lactase
  • Diminished serum folate
  • Reduce dietary intake (to avoid symptoms)
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55
Q

Which clinical features are conducive to malabsorption?

A
  • Skip lesions

- Decreased brush border lactase

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56
Q

Which clinical features are conducive to obstruction?

A
  • Thickening of bowel wall

- Stricture formation

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57
Q

(T/F) Due to decreased brush-border lactase, IBD patients must eliminate milk intake

A
  • Not necessarily
  • If tolerated, include in diet
  • Important source of energy and protein
  • Recall that patient likely malnourished at baseline, and if on corticosteroids even more so
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58
Q

If we must eliminate lactose from diet, what could be a compromise?

A
  • Consider lactase enzyme supplement or lactose-free products to avoid omission of high protein high energy foods
  • People with IBD are often already at increased risk of osteoporosis
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59
Q

What are the general clinical manifestations of IBD?

A
  • Abdominal pain, bloody diarrhea, tenesmus
  • Febrile, tachycardia
  • CRP and WBC elevated
  • Weight loss
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60
Q

What is tenesmus? What may it be caused by?

A
  • The feeling of needing to pass stools even if there are none
  • May be caused by strictures
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61
Q

What happens when people are tachychardic?

A

They often don’t sleep well

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62
Q

What is common in IBD?

A
  • Anemia is very common

- Must determine whether IDA or AOCD (as both are likely)

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63
Q

What may indicate IDA?

A
  • High CRP
  • Low/normal Serum Ferritin
  • Low HmG, low HcT
  • Normal hydration status
  • Historical low PO intake
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64
Q

What may indicated AOCD?

A
  • High CRP
  • HIGH serum ferritin (+APP)
  • Low HmG, low Hct
  • Normal Hydration status
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65
Q

What may low or normal WBC and CRP indicate?

A

That “inflammation” is still occurring, but managed by corticosteroids
-Consider when interpreting AOCD and IDA

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66
Q

Why do we need to make sure we interpret AOCD and IDA appropriately

A
  • As we don’t want to unnecessarily provide an iron supplement as they can be irritating and cause constipation
  • On the other hand, if they are really IDA this must be addressed as there is recurring blood loss and we want to avoid further decline in nutritional state
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67
Q

Common characteristics of small intestine crohn’s in the adult?

A
  • Obstructive in nature (require Sx)
  • Pain when eating
  • Palpitation causes pain in LRQ
  • Anorexia/diarrhea
  • Malabsorption, including lactose intolerance
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68
Q

Which type of IBS has a high incidence of fistula formation?

A

-Ileocolonic disease

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69
Q

What is located in the LRQ?

A

Ileocolonic area, likely ileocolonic disease

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70
Q

How do many people manage diarrhea?

A

Will often just not eat –> anorexia and weight-loss

71
Q

Colonic Crohn’s can be similar to UC, What are 5 clinical presentations which may differentiate CC from UC?

A
  • Hematochezia
  • Pain prior to defecation
  • Perianal skin tags
  • Deep anal fissures
  • Perianal fistula
72
Q

What is hematochezia?

A

Diarrhea which often contains blood

73
Q

What are systematic and extra-intestinal manifestations of crohn’s?

A
  • Fever
  • Weight loss
  • Arthritis
  • Oral ulcers, skin lesions
  • UTI
  • Enhanced oxalate absorption (kidney stones)
  • Altered body composition
74
Q

What are the 4 stages of Crohn’s disease? Important

A
  • Mild-moderate
  • Moderate-severe
  • Severe-fulminant
  • Remission
75
Q

Mild-moderate score?

A

CDAI 15-220

76
Q

Moderate-Severe Disease?

A

CDAI 220-450

77
Q

Severe-Fulminant Disease?

A

CDAI >450

78
Q

Mild-moderate crohn’s?

A
  • Ambulatory
  • Able to tolerate oral intake without dehydration
  • Toxicity (fevers)
  • Abdo tenderness
  • Painful mass, obstruction
  • -> OR 10% weight-loss
79
Q

Moderate-severe crohn’s?

A
  • Failure to respond to treatment for mild-moderate disease OR
  • Those with major fevers
  • Significant weight-loss
  • Abdo pain/tenderness
  • Intermittent nausea/vomiting (w/o obstruction)
  • Significant aneamia
80
Q

What does fulminant mean?

A

When it cannot be under-control

81
Q

Severe-fulminant Crohn’s?

A
  • Persisting symptoms in spite of steroid Rx OR
  • Those with high fever, persistent vomiting
  • Intestinal obstruction
  • Rebound tenderness
  • Cachexia OTR
  • EvidenceIn of abscess
82
Q

Remission crohns?

A
  • Asymptomatic
  • Without inflammatory sequela AND
  • includes those who have responded to acute medical intervention or surgical resection w/o gross evidence or residual disease
83
Q

(T/F) Remission includes those who have receive steroids and are asymptomatic F

A

F

84
Q

What does the crohns activity index consider?

A

Numerical score based on:

  • # of diarrheal stools
  • abdo pain
  • general well-being
  • systemic manifestations
  • use of anti-diarrheal agents
  • presence of abdo mass
  • body weight
85
Q

Index values of ___ and below are associated with quiescent disease. Values above ___ are seen with extremely sever disease

A

150

450

86
Q

Lowering of ___ points id indicative of positive change in the crohn’s activity index

A

70

87
Q

Whats another use of the crohn’s activity index?

A

These parameters could be turned into questions to ask patients or consider in the chart

88
Q

In the CAI, which parameter has the largest weighting factor? Which factor is weighted more than # liquid stool, abdo pain, or hct level?

A
  • Anti-diarrheal use

- General well-being

89
Q

In CDAI, how are # of stools calculated?

A

Total/week x 2

90
Q

In CDAI, how is pain calculated?

A
  • Scale of 0-3 (non to severe)

- Sum score/wk x 5

91
Q

In CDAI, how is well being calculated?

A

0-4 (well to terrible)

92
Q

How is weight calculated in CDAI?

A

100 x [(std wt - actual wt/std wt]

93
Q

What does the Truelove and Witts Criteria assess?

A

–Disease activity for US

94
Q

TWC daily BM for mild and severe activity?

A
  • =5

- >5

95
Q

TWC hematochezia for mild and severe activity?

A
  • Small amounts

- Large amounts

96
Q

TWC temperature for mild and severe activity?

A
  • <37.5

- >/=37.5

97
Q

TWC pulse for mild and severe activity?

A
  • <90/minn

- >/= 90/min

98
Q

TWC erythrocyte sedimentation rate for mild and severe activity?

A
  • <30 mm/h

- >/= 30 mm/h

99
Q

TWC hmg mild and severe activity?

A
  • > 10 g/dl

- = 10 g/dl

100
Q

At what score are those with UC suggested to have moderately active disease?

A

-When less than all 6 of the criteria for severe disease activity has been met

101
Q

Prior to planning, what should we know about the patient Hx?

A
  • Their appetite and activity
  • Type and duration of IBD, relapse
  • Severity and extent of current symptoms
  • Meds
  • 3 day food record to assess for insufficiencies
102
Q

Prior to planning, what should we observe for in our physical exam?

A
  • Height and weight
  • loss of subcutaneous fat
  • muscle wasting, edema, skin rash
  • hepatomegaly
103
Q

What is stool guaiac?

A

blood in stool

104
Q

Prior to planning, which special tests may be ordered?

A
  • Tests of absorption
  • xylose
  • 73 hr fecal fat
  • lactose breath test (uncomfortable and must consume a lot of lot of lactose(
  • Schillings test
105
Q

What is the xylose absorption test?

A

-Dose of d-xylose provided, which is normally absorbed
-Urine is collected and if xylose low = malabsorption (not absorbed into the bloodstream,
lost in stool)

106
Q

A 72 hr fecal fat tests requires prep for 2 days prior and during the test, what kind of diet needs to be adhered to? Which result indicates malabsorption? When may it indicate crohns’s?

A
  • Regular diet containing 100 g fat or max tolerated
  • Constant amount of fat = best
  • Daily fat intake calculates
  • MCT oil NOT used
  • Then stool fat measured and subtracted
  • -> 6 indicates malabsorption, which is usually very high in Crohn’s
107
Q

What is the lactose breath test/hydrogen breath test?

A
  • 50 g of lactose ( a LOT)
  • If undigested, bacteria in colon will break down
  • H2 absorbed and measured in breath
108
Q

What is the schilling’s test?

A
  • Intravenous B12 is given first, then radioactive B12
  • Look for normal excretion of radioactive B12 in urine
  • -> Lower excretion indicates deficiency (3%(, normal is 8%
109
Q

What does ADA suggest for active IBD nutrition prescription?

A
  • If NS, caution for RF

- If oral; progress to low-fat, low-fibre, high-protein high kcal, SFM and then progress to normal diet as tolerated

110
Q

Which vitamin and minerals are recommended for active IBD?

A
  • Vit , zinc, calcium and magnesium’

- Folate, vit B12,iron

111
Q

Which vit/mins are exceptions to the DRI?

A

-All previously mentioned plus vit E, K, C and copper

112
Q

When should fibre be restricted?

A
  • CI
  • Active IBD
  • Acute flare-ups with exacerbations o strictures
113
Q

Nutrition prescription of IBD in remission?

A
  • Maximize E and P intake for maintenance of weight
  • Avoid foods high in oxalate (FFA)
  • Increase antioxidant intake
  • Consider omega-3 FA and glutamine supplementation
  • Use of pro and prebiotics
114
Q

What is oxalate normally bound to?

A

FFA, but in Crohn’s there is an increase in FFA in lumen due to malabsorption which will bind calcium instead. Oxalate is consequently absorbed, and can form oxalate kidney stones

115
Q

What is a major reason for sub-optimal calcium and vitamin D status?

A

Long term steroid use

116
Q

What is a major reason for sub-optimal folate status? (And subsequent anemia)

A

-Medications, such as methotrexate

117
Q

Province of PEM in CD? UC?

A
  • 50-70%

- 18-62%

118
Q

% of CD underweight at presentation?

A

65-75%

119
Q

Is hypoalbuminemia more common in CD or UC hospitalized patients?

A

CD

120
Q

How does hypoalbuminemia develop in CD compared to UC?

A
  • Develop chronically in CD and more acutely in UC, depending on severity of disease
  • Basis is multi-factorial, pro-inflammatory cytokines, malabsorption, maldigestion, GI losses and reduced intakes
121
Q

What is the general high nutrient density diet in IBD?-

A
  • Fluid of 1ml/kcal
  • E of 25-30 kcal/kg
  • Protein of 1-1.5 g/kg/day
  • High minerals and vitamins
122
Q

Is there as SF consistent for IBD?

A

No, based on symptoms

123
Q

Which key vitamin/minerals to consider in UC?

A
  • Iron
  • Ca (1500 mg)
  • Vitamin D (800-1000 IU)
  • Increase fibre as long as not an acute exacerbated state
124
Q

Other macronutrient considerations of nutritional management with IBD?

A
  • Fibre should be normal (high fibre may prevent relapse)
  • Complex CHO
  • Lactose OK
  • Fat as tolerated, but sometimes low in the event of steatorrhea
125
Q

Why should complex CHO be used?

A

-Keep osmolality low if malabsorption and diarrhea (larger, less quick breakdown)

126
Q

Why should lactose still be included?

A

-Even if we suspect intolerance, we should not entirely exclude milk products –> w e should gradually adapt

127
Q

What are the beneficial effects of dietary fibre intake?

A
  • Decrease gut transit time
  • Increase stool bulking
  • Decreased diarrhea
  • Decreased constipation
128
Q

Which type of fibre will decrease diarrhea?

A

-Soluble

129
Q

Which type of fibre will decease constipation?

A

Insoluble

130
Q

What are the effects of fibre in the gut microbiota?

A

-Changes in microbe composition, facilitating SCFA production, regulating gut motility and maintaining functional imunne homeostasis

131
Q

What else does fibre effect on the gut?

A
  • Decrease inflammation
  • Increase permeability
  • Increase tissue healing
  • –> We want to prioritize keeping the gut mucosa healthy
132
Q

You are following two patients. One patient c/o of frequent oily stools and another one has frequent watery stools , which one would benefit from a low oxalate diet?

A
  • Oily stool sis indicative of fat malabsorption

- Therefore, would benefit from low oxalate diet

133
Q

What is the problem with low oxalate intake?

A

We are not 100% sure of the oxalate content in foods

134
Q

What could be an alternative to the low oxalate diet?

A

-Combine with water intake and low fat diet

135
Q

What would be the low-oxalate diet prescription?

A
  • 3-4 L/day water and low fat if steatorrhea
  • Avoid Vitamin C supplements (DRI OK)
  • Urinary oxalate measurements (should be low0
  • One choice/day of high oxalate foods (125 ml)
136
Q

Examples of high oxalate foods?

A
  • Chocolate
  • Tea
  • rhubarb
  • Beets
137
Q

In the high oxalate diet, how should be limit our fruits and vegetables? Whole grains?

A
  • No more than 4-5 servings AND avoid high-oxalate

- Whole grains, breads and cereals nor more the 3/day

138
Q

Examples of appropriate choices for low oxalate diet?

A
  • Apples
  • Pears
  • Bananas
  • Yellow corn
  • Red pepper
  • Onions
  • Mushrooms
  • Peas
139
Q

What are FODMAPs?

A

-Fermentable oligo-di-monosaccharies

and polyols

140
Q

What are examples of disaccharides that are excluded in the low FODMAP diet?

A
  • Fructose, including honey and fruit

- Lactose, including milk, yogurt, cottage cheese and ice-cream

141
Q

What are oligosaccharides excluded in the low FODMAP diet?

A

-Wheat, rye, onions, garlic,legumess

142
Q

What polyols are excluded in the low FODMAP diet?

A

-Plums, avocado, mushrooms, sugar-free gum,tomatoes

143
Q

(T/F) The low FODMAP diet has been should to help manage symptoms in IBD

A

T

But does NOT improve IBD disease activity

144
Q

Is there a validated protocol to reintroduce FODMAPs?

A

No

145
Q

What may be a disadvantage of the low FODMAP diet?

A

-Elimination can be a disadvantage to energy intakes, as fermentable SCFA contribute energy

146
Q

Which CAM is on the rise for IBD treatment?

A

Probiotics

147
Q

What was CAM use associated with?

A
  • Less favourable adherence to conventional therapy
  • Those who only used CAM specifically for IBD has this lower adherence
  • Inquiring why a patient uses CAM is important
148
Q

What have trials of probiotics show in Crohn’s disease?

A

-No effects

149
Q

What did trials of probiotics show in UC?

A

-Significant effects with the combination of pre and probiotics

150
Q

Reasons of use of medicinal cannabis?

A
  • Stimulate appetite

- Cannabinoid receptors in GIT and immune system; promise for immune modulating effects

151
Q

What can cannabis be used to alleviate?

A
  • Diarrhea
  • Abdo pain
  • Loss of appetite
152
Q

What is the current evidence to date about cannabis?

A
  • May be helpful for certain symptom of IBD, but lack clear guidelines
  • Cannot recommend as standard tx as of today
153
Q

-RINE and Methotrexate?

A

Immunosuppressive drugs

154
Q

-AZIDE, -AMINE, -AINE?

A
  • Aminosalicylate

- Enteric coated or bacterial cleavage of 5-ADA

155
Q

-IDE/ONE?

A
  • Glucocorticoid

- Oral or IV

156
Q

Ciprofloxacin?

A

-Flouroquinolone antibiotic

157
Q

Infliximab?

A

Anti-TNF monoclonal antibody

158
Q

Metronidazole?

A

Antibiotic

159
Q

Cylocsporine?

A

Immunosuppressive

160
Q

What can cyclosporine elevate?

A

-Elevate serum cholesterol, and grapefruit will increase absorption and increase elimination of the oral form of the drug

161
Q

What are the top nutrient deficiencies in IBD?

A
  • Folate
  • Calcium
  • Vitamin D
162
Q

Which drugs can cause folate deficiency?

A
  • Sulfasalazine (Aminsalicylates)
  • Competes with folate in the intestinal lumen, causes reduced availability of folate
  • Methotrexate –> antagonist to folic acid
163
Q

% deficiency of folate in IBD patients?

A

20-60%

164
Q

What happens if there is a folate deficiency? how can we avoid?

A
  • Megoblastic anemia
  • Reduce medications or ad supplemental folate if feasible
  • Consider that DFE is higher for supplements (more bioavailable)
165
Q

Which drugs will impair absorption and retention of calcium

A

Glucocorticoids

166
Q

Why do glucocorticoids impair absorption and retention of calcium?

A

-They alter the action of 1-alpha hydroxylase, an therefore the conversion of 12-OH-D to 1,25 OH-D is altered, implication of bone deminieralization

167
Q

What may glucorticoids increase?

A

Protein needs, cause Na retention

168
Q

____ improved the health-related quality of life in Crohn’s disease patients with long-term disease duration

A

EN

169
Q

What should be recommended for one of the options for maintenance therapy for Crohns?

A

EN

170
Q

What needs to be considered about TPN with EN?

A

HIGH risk of infections because of corticosteroids, and the GI tract is an important modulation of the immune symptoms
–> Last resort

171
Q

Contraindications to EN in IBD?

A
  • Oral intake adequate, or can use supplements
  • Fistula
  • SBS (Start with PN)
172
Q

When do fistulas occur? When is PN required?

A
  • Most after Sx, where may take 4-6 weeks to close

- PN needed if high output >500 ml/day

173
Q

When is EN possible with fistula?

A
  • if low output <500 mol/day
  • possible if proximal duodenal or jejunal or lower distal ileal or colonic
  • use low or no fibre
  • feed as distal or proximal to the fistula as possible

Clinical Nutrition 2 (21 decks)

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