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NUTR 442 > Lecture 14: SBS > Flashcards

Lecture 14: SBS Flashcards

1
Q

what are potential complications from fistula?

A

sepsis, fluid/electrolyte imbalances, malnutrition, hemorrhage, pain, anxiety, death

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2
Q

most low-output ECFs will close within 4 wks of presentation, this is called _______

A

spontaneous closure

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3
Q

what are cornerstones of ECF (enterocutaneous fistula) management?

A

SOWATS: sepsis control, optimization of nutr status, wound care, assessment of fistula anatomy, timing of surgery, surgical strategy

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4
Q

when fistula first diagnosed, go-to nutrition therapy:

A

PN

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5
Q

PN is indicated for fistula when:

A

originating from pancreas, high output from jejunum/ileum, proximal fistula where distal EN access not feasible, output can’t be collected in way that protects skin

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6
Q

when is EN / PO indicated?

A

low output fistula, esophageal/gastric/duodensl fistula, proximal jejunal fistula with distal enteral access, distal ileal or colonic fistulas

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7
Q

temporary loss of GI motility is called:

A

ileus

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8
Q

most common complication of abdominal surgery:

A

post operative ileus

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9
Q

post op ileus usually resolve after __ h

A

24-72

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10
Q

other causes of ileus?

A

inflammation/SIRS, infection, certain drugs

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11
Q

symptoms of ileus:

A

nausea, vomiting, ab distention, delayed passage of flatus and stool

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12
Q

treatments for ileus:

A

NG suction, IV fluids/electrolytes, minimal sedative use

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13
Q

For ileus, PO diets and early EN can be intiated within ____ h after surgery; if EN not possible for longer period (__ days), then PN warranted

A

6; 7

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14
Q

what is SBS?

A

condition resulting from surgical resection, congenital defect, or disease associated loss of absorption, characterized by inability to maintain protein-energy, fluid, electrolyte balances when on normal diet

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15
Q

how big is bowel?

A

half a badminton court

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16
Q

what is intestinal failure?

A

reduction of gut function below minimum necessary for absorption of macros and/or water and electrolytes, such that IV supplementation is needed

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17
Q

prognosis for SBS depend on:

A

how much of bowel length reduced, types of bowel segments involved in SBS

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18
Q

__ jejunum is primary site of ____absorption

A

proximal; water sol vit, CHO, pro

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19
Q

intercellular junctions of jejunal epithelia are ____ while ileum has ____ intercellular junctions

A

porous; tighter

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20
Q

ileum is primary site of ____ absorption and _____ recirculation

A

b12; enterohepatic (bile)

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21
Q

PN dependence in SBS likely when:

A

end jejunostomy (<100cm small bowel left), jejunocolonic anastomosis (<60cm small bowel with colon intact)

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22
Q

common cause SBS in kids:

A

congenital malformation, severe infection, small bowel resection

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23
Q

common cause SBS in adults?

A

2ndary to serial/massive small bowel resections, condition related (crohn’s, mesenteric vascular insufficiency), post surgery complications, malignancy, trauma

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24
Q

what is gastroschisis?

A

part of bowel is outside of body

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25
Q

what is intussusception?

A

tube going inside a tube

26
Q

necrotizing entercolitis found in:

A

premature babies

27
Q

clinical manifestations of SBS include malabsorption of ______ which leads to malnutrition characterized by _____

A

macronutrients, vitamins, fluid, electrolytes, trace elements; hypovolemia, hypoalbuminemia, metabolic acidosis, diarrhea, steatorrhea, wt loss, dehydration

28
Q

factors that affect clinical/metabolic status of pt with SBS

A

extent and site of resection, presence/absence of ileocecal valve, function and health of remaining GI tract, active and course of underlying disease, patient age, presence or absence of colon in continuity with small bowel

29
Q

mechanisms of malabsorption:

A

acid hypersecretion, loss of SA, rapid intestinal transit, impaired residual bowel, bacterial overgrowth, bile acid wasting

30
Q

why gastric acid hypersecretion?

A

loss of small bowel segments–>decreased gut hormones–>continued acid secretion/accelerated gastric emptying (dumping)

31
Q

what does gastric acid hypersecretion cause?

A

damage to mucosa, interfere with pancreas enzyme activity

32
Q

if ____ cm terminal ileum resected, bile synthesis is upregulated to compensate losses and bile entering colon interferes with fluid absorption so _____ occurs

A

<100; water diarrhea

33
Q

if ____ cm terminal ileum resected, amt unrecycled bile lost > max rate hepatic synth, causing ______

A

> 100; bile insufficiency, fat malabsorption, steatorrhea

34
Q

what is SIBO?

A

presence of excess bacteria in small intestine (>10^5-10^6 organisms/mL)

35
Q

what is normal concentration of bacteria in gut?

A

<10^3 organisms/mL

36
Q

gram ____ coliforms produce mucosa damaging toxins impacting absorption

A

negative

37
Q

microorgs that prefer metabolize _______ produce bloating

A

CHO to SCFAs and gas

38
Q

processes predisposing to SIBO:

A

diminished gastric acid secretion, small intestine dysmotility, disturbances in gut immune function, anatomical abnormalities of GIT

39
Q

resection of ____ may promote retrograde transit of clonic bacteria into small bowel , causing SIBO

A

ileocecal valve

40
Q

SIBO can result in:

A

microscopic mucosal injury, alteration in bile salt absorption, intestinal malabsorption

41
Q

symptoms associated with SIBO:

A

ab pain/discomfort, bloating, distension, diarrhea, gas, weakness (non specific)

42
Q

clinical manifestations of SIBO:

A

wt loss, steatorrhea, vit/mineral deficiency, excess folate, hypoproteinemia, decreased xylose absorption

43
Q

goals in SBS:

A

maintain adequate nutrition

44
Q

what you need to know to determine nutr therapy for SBS:

A

site of resection, how much left, health of bowel, presence of colon/ileocecal valve/ostomy/bowel complications/strictures/chronic obstruction/fistula

45
Q

PN indicated for SBS if:

A

end jejunostomy w/ <100cm jejunum left; functional colon intact w/ <60cm of jejunum left

46
Q

patients with < __% of colon may benefit from ___

A

50; ORS (iso-osmolar) like milk, diluted juice, some EN formulas, commercial or homemade ORS

47
Q

hyperosmolar should be ____ and hypoosmolar should be restricted to ____oz/d

A

avoided; 4-6

48
Q

structural changes that occur in intestinal adaptation

A

hyperplasia, angiogenesis, bowel dilation, bowel elongation

49
Q

functional changes that occur in intestinal adaptation (1-2 yrs):

A

^ transporters/cell, accelerated crypt cell diferentiation, slower transit time, ^ nutr/fluid absorption

50
Q

hydration factors to consider before weaning from PN:

A

reduce only if pt achieve daily fluid intake goal consistently, U/O exceeds 1L/d and at least 0.5 mL/kg/h on nights w/o PN

51
Q

if U/O can’t be measured, look at _____

A

surrogate lab markers of hydration (BUN, creatinine, urine sodium and osmolarity)

52
Q

meeting at least ___% of energy goal without symptoms that limit oral intake before weaning from PN?

A

80

53
Q

no more than ___ kg loss of BW between PN reductions

A

1.5 (remember edema)

54
Q

what is enteral balance?

A

oral fluid intake minus stool and u/o

55
Q

before weaning from PN, what should enteral balance be?

A

positive (>500mL/d)

56
Q

factors to consider before weaning off PN ?

A

hydration, energy goal, body weight, lab values, enteral balance

57
Q

meds commonly used in SBS?

A

acid suppression agents (H2 receptor antagonists, PPIs), antimotility/antidiarrheal agents (loperamide), antisecretory agents (octreotide)

58
Q

examples of bowel related complications?

A

malabsorptive diarrhea, malnutrition, fluid/electroyte disturbances, micronutrient deficiency, EFA deficiency, SIBO, D lactic acidosis, oxalate nephropathy, renal dysfunction, metabolic bone disease, acid peptic disease, anastomotic ulceration/stricture, bowel obstruction

59
Q

what is prioritization matrix?

A

prioritize pt for screening/assessment by RD (ensure right pt receive right care at right time and serve better manage allocation of time and resources, support safe provision of pt care and clinical cross-coverage, facilitate transfer of accountability

60
Q

what are the goals in SBS?

A

maintain adequate nutrition, maintain adequate hydration, maintain electrolyte balance, support bodily functioning

NUTR 442 (34 decks)

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