Lecture 11 Flashcards
common nutr diagnoses with PUD
inadequate oral intake, inadequate energy intake, altered GI fxn, unintended wt loss, food and nutrition related knowledge deficit
management of PUD pharmacotherapy:
antacids, PPI, prostaglandin analogs, mucosal barrier fortifiers, H2 receptor agonists
this med causes black stool
peptobismal
what is h pylori triple therapy?
7-14 day course 2 antibiotics + PPI (cause nausea, vomiting, ab pain)
management of PUD nutrition:
prevent wt loss and restore nutrient interactions, support med therapies and v symptoms, trial restriction of foods increasing acid secretion, avoid foods not tolerated, avoid lying down after eating, avoid larger meals close to bedtime, small/frequent meals, omega 3 and 6 f.a.?
historical diet treatment of PUD:
milk and cream (but now know that they increase gastrin and pepsin secretion so don’t recommend)
one of major diffs between GERD and PUD nutrition management:
don’t restrict acid foods/juices for PUD
acute symptomology of PUD:
sharp, sudden, persistent, severe pain; melena (bloody/black stools), hematemesis (vomiting blood, coffee ground emesis)
acute symptomology of PUD indicative of serious complications like:
acute/chronic GI bleed, perforation, obstruction (big drops in Hb)
when use surgery for PUD?
when severe, refractory to treatment, complications
types of surgery for PUD:
vagotomy, gastroenterostomy
what is vagotomy?
interruption of impulses carried by vagus nerve to parietal cells (v acid production, v response to gastrin)
preferred vagotomy for treating PUD
highly selective vagotomy (preserves antral motility)
what is truncal vagotomy with pyloroplasty?
vagus nerve cut at distal esophagus to decrease antral contraction, delay emptying of solids, v pylorus relaxation; pyloroplasty is surgical revision to widen pyloric canal that creates leaky pylorus to enhance emptying (can cause dumping, less control of food flow)
what is a gastrectomy?
resection of stomach (partial or total) –>used in gastric CA, more aggressive
alternative to pyloroplasty:
gastric remnant of partial gastrectomy anastomosed to small intestine
primary gastric surgeries for PUD:
gastroduodenostomy (billroth 1), gastrojejunostomy (Billroth 2) , roux-en-Y anastomosis
what is billroth 1?
removal of pylorus and/or antrum of stomach, anastomosis of proximal end of duodenum to distal end of remnant stomach
what is billroth 2?
removal of antrum, anastomosis of remnant stomach to side of jejunum, blind duodenal loop (stapled) to allow for bile and pancreatic secretions to flow into intestine (aid in digest and absorb) –>it is more distal and lower down than billroth 1
what is roux-en-Y
close to total gastrectomy, jejunum pulled up and anastamosed at distal end of esophagus or gastric remant, duodenum then connected to small bowel to allow bile and pancreatic secretions to flow into intestine
potential complications of vagotomy:
impaired motor fxn of stomach
potential complications of total gastric and truncal vagotomy
gastric stasis and poor emptying
potential complications of subtotal gastrectomy with vagotomy
early satiety, delayed gastric emptying, rapid emptying of hypertonic fluids
potential complications of total gastrectomy
early satiety, nausea, vomiting, wt loss, poor availability bile acids and pancreatic enzymes cuz anastomotic changes, malabsorption, PEM, anemia, dumping, B12 deficiency
what is dumping syndrome?
physio response to presence of larger than normal amts of food/liquid in small intestine
healthy individual digestion:
food partially digests in 1-3 hr, enters duodenum slowly via pyloric sphincter, acidic chyme is neutralized by pancreatic bicarbonate
why are refined/simple sugars particularly problematic for dumping syndrome?
highly osmotic so rapidly absorb water from body
post-gastrectomy nutr goals of care
Adequate cals and nutr (promote healing, attenuate wt loss, correct micronutrient deficiencies), symptom management (reflux, early satiety, dumping syndrome)
nutr interventions post-gastrectomy:
dependent on goals of care, reason for surgery (PUD with acute complication, gastric carcinoma, neoadjuvant treatment pre-op, bariatric surgery), post op considerations (anastomosis, EN, PN
98% of digestion and absorption occurs in ___
lower GIT
3 parts of small intestine:
duodenum, jejunum, ileum
autoimmune disease caused by immunological rxn to gluten
celiac disease
peptide fractions (storage proteins) found in wheat, barley, rye to give shape and elasticity
gluten
this type of gluten appears to be particularly problematic
gliadin
exposure to gliadin cause:
inappropriate T cell mediated inflamm response
etiology of celiac?
unknown, but strong gene component, several other disorders associated with it
pathophysio of celiac?
absorptive surface of small intestine damaged by inflamm response/rxn to gluten proteins–>damage to enterocytes (less absorptive SA, loss of digestive enzymes), villi have ht reduced and are flattened
GI symptoms of celiac
diarrhea, ab pain, cramping, bloating , gas production
extraintestinal symptoms of celiac:
bone and joint pain, muscle cramping, fatigue, peripheral neuropathy, seizures, skin rash, mouth ulcers, depression, infertility
other clincal features encountered in celiac?
vit and min deficiencies (iron, B12, fat sol vits, Zn, Mg, Folate), secondary lactase deficiency, metabolic bone disease
treatment of celiac:
lifelong elimination of gluten (improve symptoms after 2 wks in most pt, histological improvement not seen for years)
considerations for gluten free diets:
beware cross contamination (ie. oats)
what does CELIAC stand for?
consultation with dietitian skilled in celiac, education, lifelong adherence to GED, identification and treatment of nutr deficiencies, access to advocacy group, continuous long term follow up by multidisciplinary team
what is non-celiac gluten sensitivity
clinical state in which pt develop symptoms related to celiac disease when consume gluten and feel better on GFD but do NOT have celiac (no biomarkers, autoantibodies absent, no villous atrophy)
packaged GF foods are higher in __ and lower in __
fat, CHO; protein, Fe, folate
