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Advanced MNT 2 > Intestinal Bowel Disease > Flashcards

Intestinal Bowel Disease Flashcards

1
Q

What does the term IBD refer to?

A

Collective term for chronic inflammatory diseases of the intestine
including Crohn’s disease & Ulcerative Colitis

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2
Q

IBD is Characterized by ___________
Impact of IBD depends on the _______ and ______
Often develops at age _____
Often confused with __________

A

periods of remissions & exacerbations
site & extent of inflammation
15-30
Irritable Bowel Syndrome (IBS)

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3
Q

risk factors for IBD

A

Positive family history
Jewish ancestry
Caucasian
Smoking increases risk for Crohn’s Disease
Antibiotic use

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4
Q

Possible Dietary Risk Factors for IBD

_________ deficiency
High intake of ________
Low intake of _______________
Increased consumption of _______ and __________

High intake of ______ and low intake of __________
High intake of ______________

A

Vitamin D
sucrose
fruits & veg, dietary fiber
red meat and alcohol

omega-6 fatty acids
omega-3 fatty acids
ultra-processed food

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5
Q

What is Crohn’s Disease ?

A

Chronic inflammation of the mucosa resulting in ulcerations

Inflammation progresses to involve all layers of the intestinal wall

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6
Q

where does Crohn’s disease usually occur?

A

small & large intestine but can occur anywhere in the GIT
- Terminal ileum is the most common site

Disease is segmental with spared areas=> “skip lesions”

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7
Q

Clinical Manifestations of Crohn’s Disease

A

Abdominal pain
Diarrhea
Anorexia
Weight loss

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8
Q

Complications of Crohn’s Disease

A

Strictures=> obstruction
Malabsorption
Abscesses
Perianal disease
Fistulas
Possible short bowel syndrome
Increased risk of intestinal cancer

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9
Q

What is Ulcerative Colitis (UC) ?
Where?

A

Chronic inflammatory disease that causes ulceration of the colonic mucosa

Begins in the rectosigmoid area & may extend proximally to affect the entire colon (rectum almost always involved)
- usually only involves the mucosa

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10
Q

UC contains Deep ulcers that _____

Mucosal inflammation/destruction=> loss of _______ surface area, large volumes of ________, bleeding, cramping pain, and ______(need to empty bowel)

A

bleed

absorptive
watery diarrhea
tenesmus

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11
Q

Clinical Manifestations of UC

A

Crampy abdominal pain
Frequent bloody diarrhea
Dehydration
Anorexia & weight loss
Anemia

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12
Q

Complications of UC

A

Severe bleeding
Perirectal abscess
Toxic megacolon
Increased risk for colon cancer

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13
Q

Malnutrition in IBD is more common with _____

Malnutrition is caused by ______, _______, and _______

A

CD

decreased nutrient intake
malabsorption
increased enteric losses

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14
Q

Malnutrition further compromises digestive & absorptive function and may increase permeability of the GIT to potential ________

A

inflammatory agents

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15
Q

factors that lead to Decreased nutrient intake leading to malnutrition

A

Avoidance behavior
Disease-related anorexia
Iatrogenic—restrictive diets

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16
Q

Malabsorption of macro- & micronutrients due to:

Decreased__________
_________
____________

Secondary ________

A

functional absorptive surface area
Medications
Bacterial overgrowth

lactose intolerance

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17
Q

What can cause fat malabsorption in IBD?

A

Crohn’s disease
- Ileal disease
- Jejunal disease

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18
Q

explanation of fat malabsorption from ileal disease

A

decreased bile salt pool due to malabsorption or deconjugation by bacteria

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19
Q

explanation of fat malabsorption from jejunal disease

A

decreased absorptive surface area due to inflammation/disease

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20
Q

During periods of inflammation, there is enteric leakage of:
_____, _____, and _____

A

Fluid & electrolytes
Blood
Protein (protein-losing enteropathy)

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21
Q

micronutrient deficiencies are caused by ____, ____, and ____

A

decreased intake
malabsorption
food-medication interactions

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22
Q

fat soluble vitamin deficiency can be due to ___________ and also _________

Which vit def is most common ?

A

ill or jejunal resection or disease
meds - cholestyramine

vit D

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23
Q

Water-Soluble Vitamin Deficiencies from IBD

A

Vitamin B12=> malabsorption due to ileal disease

Folate=> decreased intake, sulfasalazine

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24
Q

Minerals & Trace Element Deficiencies and causes

A

Zn, K+, Mg, Cu=> diarrhea, steatorrhea

Iron=> GI bleeding

Calcium=> avoidance of dairy, corticosteroids, fat malabsorption

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25
Q

Additional Nutritional Consequences of IBD

A

Nutritional anemia
Osteoporosis & osteomalacia
Growth impairment in children

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26
Q

In general, energy requirements in IBD are similar to those of the healthy population

No evidence of ____________ in inactive IBD

There may be an ________ in metabolic activity at times of acute severe disease activity; however, the ______ in REE is likely offset by _______ of physical activity

Individualized—consider current nutrition status, & disease condition
_____ kcal/kg

A

hypermetabolism

increase
increase
reduction

30-35

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27
Q

FOR IBD
_____ kcal/kg

____ g/kg protein for remission
______ g/kg protein for active IBD

A

30-35

1
1.2-1.5

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28
Q

Factors that increase protein needs for IBD:

A

Active inflammation
Malnutrition
Post-operative healing
Infection
Corticosteroids
Enteric losses: blood, protein-losing enteropathy
Malabsorption
Fistulas

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29
Q

Provide fluid as per age recommendations and additional fluid to replace losses

Factors which increase fluid needs:

A

Enteric losses: diarrhea, high ostomy output, fistulas

Fever

Sulfasalazine

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30
Q

Dietary Interventions for Complications of IBD

restriction of _______ and ______

Low fiber used only for _______ to ______,
___________

If confirmed steatorrhea=> _____________

A

Lactose and fructose

Strictures=> to avoid obstruction
s/p intestinal resection

40-gram Low Fat Diet

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31
Q

Supplementation for IBD ?

If deficiencies or high risk, additional supplementation ?

A

MVI w/ minerals

Vitamin B12=> 1000 mcg/month IM
Calcium (if on corticosteroids or poor intake)=> 1000-1200 g/d
Vitamin D: 2000-4000 IU daily for maintenance; 50,000 IU weekly for 12 weeks for treatment of deficiency
Folate (if on sulfasalazine) => 1 mg/d
If fat malabsorption=> fat-soluble vitamins in water-soluble form
Zinc=> 220 mg zinc sulfate 1-2 times/day

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32
Q

For IBD If person has fat malabsorption=> recommend ____________ (e.g., Peptamen with Prebio)

More research is needed on use of ___________ (e.g., probiotics, prebiotics, omega-3 fatty acids)

A

partially-hydrolyzed, peptide-based with MCT oil

nutraceutical supplements

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33
Q

Indications if enteral nutrition need

A

poor appetite
malnutrition
induction of remission of Crohn’s disease in children & adolescents

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34
Q

EN is preferred over PN due to ______, ______, _______, and _____

A

lesser complications
ability to maintain GIT integrity & function
provide trophic nutrients
lower cost

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35
Q

Formula Choice for enteral nutrition for IBD ?

if fat malabsorption ?

A

Polymeric formulas

use semi-elemental formulas
- contain MCT oil and protein is hydrolyzed to peptides

36
Q

Parenteral Nutrition Indications

A

complications (SBO, fistulas, SBS)

prolonged small bowel ileus after surgical resection

37
Q

Medications used for IBD

A

Anti-inflammatory agents
corticosteroids
immunosuppressive agents
anti-TNF medications

38
Q

Anti-inflammatory agents are _______

examples ?

A

aminosalicylates

sulfasalazine
mesalamine

39
Q

corticosteroids are _________ and ______ drugs

A

anti-inflammatory
immunosuppressive

40
Q

immunosuppressive agents example?

A

azathioprine (Imuran)

41
Q

anti-TNF medications example ?

A

infliximab (Remicade)

42
Q

sulfasalazine FDI and interventions

A

Inhibits folate absorption
Can cause anorexia; N/V/D

Drink 8-10 glasses of fluid/d to prevent kidney stones

43
Q

mesalamine FDI

A

nausea
dyspepsia
diarrhea
anorexia

44
Q

Corticosteroids FDI

A

Decrease calcium absorption=> osteoporosis

Increase protein catabolism

Increase blood glucose levels

45
Q

azathioprine (Imuran) FDI

A

anorexia
N/V/D
steatorrhea
esophagitis

46
Q

infliximab (Remicade) use ?
FDI ?

A

Use=> More severe cases of Crohn’s disease

Abdominal pain
N/V
serious infections

47
Q

Surgery for IBD involves surgical ____________ and patient may require ____________ or ____________

_________________ is curative for UC

A

resection of diseased areas
ileostomy or colostomy

Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis (IPAA)

48
Q

Post-Operative Diet Therapy

Diet progression: ______ diet => advance to _______
MNT for _______
Need to provide diet education

A

low fiber
regular diet
ileostomy

49
Q

This is the start of the guest speaker notes

A

YOU GOT THIS

50
Q

etiology of IBD ?
potential factors being explored?

A

unclear etiology

effects on microbiome
stress
use of antibiotics/NSAIDS
use of food additives, emulsifiers, processing

51
Q

what is the role of diet in the development of IBD?

A

gut microbiome
processed food/food additives
inflammatory properties

52
Q

diet for prevention of IBD

A

diet rich in fruit and veggies
rich in n-3 fatty acids
low in n-6 fatty acids

breastfeeding for infants

53
Q

microbiome in the GI tract includes _____, ______, and ______

A

bacteria
viruses
fungi

54
Q

_______ microbiota is potential for involvement in the pathogenesis of IBD

A

dysbiotic

55
Q

nutritional interventions that have shown potential anti-inflammatory properties

A

specific carbohydrate diet
mediterranean diet
anti-inflammatory diet
crohn’s disease exclusion diet

56
Q

medical history to collect

A

Remission vs. Active disease
Crohn’s Disease vs. Ulcerative Colitis
Location in GI tract, severity, strictures
Surgical history
Food-Drug Interactions
- Corticosteroids, methotrexate, sulfasalazine

57
Q

social history assessment involves

A

Employed/ability to buy food
Home/access to kitchen
Social/Family support/eating with others Cultural or religious eating preferences

58
Q

what labs to review ?

If increased fluid loss (diarrhea, ostomy output) ______.

Other vitamins and minerals to consider:

A

Vitamin D, B12
CBC, CMP
Iron

zinc, urine sodium

Thiamine, folate, B6, B12, Vitamin C (scurvy)
Selenium, magnesium

59
Q

what to look for in their diet recall

A

time of meals
supplement use

60
Q

malnutrition risks in IBD include decreased oral intake due to _______.

metabolic needs are _____

A

food fear, intolerances, elimination diets

increased

61
Q

sarcopenia occurs 52% from ________ and 37% from ________.

19% of patients with sarcopenia have a BMI above ______ and 41% have a BMI of ______

A

Crohn’s disease
ulcerative colitis

25
normal

62
Q

two questions to ask for malnutrition screening

A

how much weight have you lost recently

has your eating decreases

63
Q

identification of food intolerances or restrictions is important. You should include ______, ______, and _______

Also include assessment of ______

A

time
GI symptoms
Stress symptoms

food fear (AFRID)

64
Q

Foods and flare ups

A

foods do not cause flare ups, but symptoms when flare ups are happening

65
Q

if no stricture or obstructive disease, encourage _______

A

fiber (may need to adapt texture)

66
Q

should have ____ calorie and ____ protein with ____ meals, _____ per day

A

high
increases
small
4-6

67
Q

for fiber increase ______ and decrease ______, and make it ______

A

soluble
insoluble
soft

68
Q

ACTIVE IBD
____ g/kg protein
if anemia ______

A

1.2-1.5
IV iron

69
Q

INACTIVE IBD
______ g/kg protein
if anemia _____

A

1
oral iron

70
Q

Vitamin D Deficiency: _____ ng/ml
Reccommendation ?

Vitamin D Insufficiency: between ___ ng/ml. Reccommendation?

Maintenance: >____ ng/ml
Recommendation?

Toxicity occurs with levels of ____ ng/ml or more

A

<20
50,000 IU Vitamin D2 weekly x 12 weeks recheck levels in 3 months

20-30
4000 IU Vitamin D3 daily
recheck levels in 3 months

30
2000-4000 IU D3 daily (depends on weight, race, and pregnancy)

100

71
Q

_____ levels can be very high when replaced

A

vitamin B12

72
Q

VITAMIN B12

Goal: _____ pg/ml

A

> 400

73
Q

Vitamin B12 formulas available

A

Intramuscular/deep subcutaneous injection

Oral

Sublingual

*Oral and Sublingual forms are just as effective as replacement with injection

74
Q

Oral Replacement:
________ mcg _____
Repeat level in _______

Injection Replacement:
______ mcg/ml ________
Repeat level in ______

Vitamin B12 is water soluble – tolerated at high doses

A

1000-2000
daily
3 months

1000
weekly x 4 weeks, then monthly
3 months

75
Q

does probiotic use in IBD help?

example

A

some evidence for moderate UC
ineffective in CD

VSL#3 (Visbiome)

76
Q

For eating behaviors make sure patient is ______

A

chewing thoroughly
spacing and sizing meals correctly
sitting up straight
eating slowly
limiting distractions

77
Q

for introducing new foods ?

A

smooth
increase texture
combining textures

78
Q

therapeutic diets for Crohn’s disease?

A

Mediterranean Diet
Specific Carbohydrate Diet (SCD)
Anti-Inflammatory Diet for IBD (IBD-AID)
Crohn’s Disease Exclusion Diet
Exclusive Enteral Nutrition* (pediatrics)

79
Q

what has larger focus on avoiding red and processed meat

A

UC

80
Q

Main idea od Mediterranean diet

A

↑ whole foods (fruit, veg, beans/legumes), fish, lean protein (chicken/dairy), healthy fats

↓ ultra-processed foods, desserts, and red meats

81
Q

Specific Carbohydrate Diet (SCD)

Low in _______________

Aims for diversity of __________

Risk of insufficient intake:
___________

A

starchy vegetables, grains, processed/added sugars, lactose,
artificial ingredients

produce, nuts, animal proteins, yogurt, aged cheeses

calcium, vitamin D, vit A, potassium, thiamine, folate, pyridoxine, vitamin E

82
Q

IBD Anti-Inflammatory Diet (IBD-AID)

Modified from _____
More _____ and _____ foods and _____

Low in _______ carbohydrates (refined sugars, grains with ____)

Restricts _____, _____, ______, and ______

____ phases – slow progression of textures, depends on disease status

A

SCD
prebiotic and probiotic
omega 3 fats

complex
gluten

emulsifiers, maltodextrins, milk (unless fermented), sweeteners

3

83
Q

In IBD Anti-Inflammatory Diet (IBD-AID)

focuses on Soluble fibers such as ______

can have _____________ for omega 3 fats

Probiotic foods such as ______

Prebiotic foods such as _______

A

ground flax, lentils, or oats

Beans, nuts, avocado, fish

kefir, miso, yogurt, or sauerkraut

leeks or artichokes

84
Q

Crohn’s Disease Exclusion Diet (CDED)

Decrease foods that may harm the _______ or ________

______ + _______ : ___ phases, slow ________ as they transition through the phases

Avoids: ___________

Encourages: ________

A

microbiome or intestinal barrier

PEN + whole food diet
3
decrease of PEN

Emulsifiers, coffee, alcohol, canned foods, dairy, soy, gluten, processed foods

Fruits & vegetables, Chicken, Fish

85
Q
A

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