Lecture 12 Flashcards
Lower GIT and IBD
common nutrient deficiencies seen in adult IBD
energy, protein, fluid/lytes, iron, mg, zn, ca, vit D, B12, folate, water sol vits, fat sol vits
ab pain or discomfort occurs in association with altered bowel habits for at least 3 months, fxnal disorder, cause unknown
IBS
common symptoms of IBS
gas, bloating, diarrhea, constipation, increased GI distress associated with psychosocial distress
what is functional disorder?
tests show no diagnostic abnormalities so diagnosis depends on symptoms
the ____ criteria for IBS and its subtypes are used to define diagnosis based on presence of GI symptoms and exclusion of other disease
Rome 3
factors that play a role in etiology of IBS:
nervous sys alterations(abnormal motility, visceral hypersensitivity), gut flora alterations, genes, psychosocial stress
low serotonin associated with ____ IBS, high serotonin with ___ IBS
constipation/sluggish gut; diarrhea/increased peristalsis
what are the Rome 3 criteria for IBS?
recent ab pain/discomfort for at least 3 days/month in last 3 months with onset at least 6 months before diagnosis, plus 2+ of following: 1) pain improvement with defecation 2) change in stool frequency at onset 3) change in stool form or appearance at onset
initial steps for nutrition counseling for IBS should include:
1) review current meds 2) review GI symptoms 3) assess nutr status and food intake 4) review supplements 5) review mind-body therapies
what are FODMAPs?
short chain cho (poorly absorbed, highly osmotic, rapidly fermented by bacteria of large intestine)
low FODMAP diet phases:
elimination 6-8 wks, challenge
nutr deficiencies common in low FODMAP
folate, thiamin, vitamin B6 (cereals/breads), Ca, Vit D (dairy)
what does FODMAPs stand for?
fermentable oligosaccharides disaccharids monosaccharides and polyols
autoimmune, chronic inflammatory condition of GIT
IBD
2 branches of IBD?
crohn’s, ulcerative colitis
diff between ulcerative colitis and crohn’s?
ulcerative: limited to colon, always extends from rectum, continuous, young to middle aged, steatorrhea, loss of haustra; crohn’s: can involve any part of GIT from mouth to anus, disease often skips areas of intestine, young, slowly progressive, fistulas and abscesses, inflammatory mass, thickened wall and fissures, cobble-stoning, fat-wrapping
enviro factors for pathogenesis of IBD:
diet, infections, antibiotics, smoking, geography, socioeconomic, development, sanitation
these factors interact in the pathogenesis of IBD
enviro, genetic, epigenetic, gut microbiota dysbiosis, altered innate and adaptive immunity
extraintestinal manifestations of IBD
osteopenia, osteoporosis, dermatitis, ocular symptoms, hepatobiliary complications
similarities between crohn’s and colitis?
diarrhea, fever, wt loss, anemia, food intolerances, malnutrition, growth failure, arthritic, dematologic, hepatic, associated with malignancy
lab markers of IBD:
inflammatory markers, antiglycan antibodies, wbc, albumin decreased; stool (calprotectin, lactoferrin, PMN)
montreal classification of disease activity in ulcerative colitis
stools/day, blood, pulse, temp, hemoglobin, ESR
IBD treatment pharm:
aminosalicylates, corticosteroids, immunomodulators, biologics
what is step up vs top down approach?
mild to stronger vs early aggressive therapies
common nutr diagnosis in IBD
chronic disease or condition related malnutrition, underweight/unintended wt loss, inadequate energy intake, inadequate vit/min intake, impaired nutr utilization, altered GI function, food med interaction, altered nutr related lab values
nutrition therapy:
maintain fluid/lyte balace, low residue, lactose free, small frequent meals, assess for micronutr deficiencies, v fat if steatorrhea (maybe MCT oil benefit?)
nutrition therapy in exacerbations:
maintain fluid/lyte balace, low residue, lactose free, small frequent meals, assess for micronutr deficiencies, v fat if steatorrhea (maybe MCT oil benefit?)
nutr therapy in rehab:
primary goal to maximize protein and energy intake to promote rehab
no IBD diet, but consider:
^ omega 3, antioxidants, MVT/mineral, lactose free as needed
UC and Crohn’s characterized by ___ interspersed with ____
exacerbations; periods of remission
significant nutr implications of corticosteroids:
wt gain, loss of BMD, sodium and fluid retention, become hyperphagic, increased breakdown/losses, decrease in ca absorption, increased cholesterol/lipids, increased BG
3 nutr goals of care for IBD:
prevent malnutrition and restore nutr status, prevent/minimize GI symptoms, normalize bowel function
Crohn’s has increased ___ but normal ____
REE; TEE
why is PEM less common in UC?
only colon affected and small bowel is where absorption happens
why would crohn’s pro needs be increased?
losses related to intestinal inflammation/fistulas
EN may temper ___ and be __ sparing
inflammatory process; steroidal
for EN, is polymetric or elemental more effective?
polymetric
