Lower GI Flashcards
Which foods should be avoided after ileostomy?
For the first 6-8 weeks:
V&F: bean sprouts, coconut, dried fruit, mushrooms, snow peas, vegetable skins, popcorn
Protein: legumes such as beans, meat casings, tough or stringy meat, whole nuts and seeds
After 6 to 8 weeks, once your stoma has healed, you can introduce the foods listed above into your diet. Do this one type of food at a time. This will help you see the effects of each food on your ileostomy output.
WHat are good fluid choices after ileostomy?
- water
- milk or milk alternatives
- 100% fruit juices, diluted
- herbal or weak tea.
Try limiting these foods to help decrease odour with ileostomy
- asparagus
- broccoli
- eggs
- fish
- garlic
- onion
- spiced foods.
Try adding these foods to help decrease odour with ileostomy
- buttermilk
- fresh parsley
- yogurt.
Which diet/habit adjustments can you undertake with gas after ileostomy
Try limiting these foods to reduce gas: • cruciferous vegetables such as broccoli, Brussels sprouts, cabbage, cauliflower • legumes (beans, peas and lentils) • onions • sprouts • beer • carbonated beverages • coffee • dairy products. Try the following suggestions to reduce swallowing air and producing gas: • Eat slowly. • Chew your food well. • Don't skip meals. • Eat small meals throughout the day. • Avoid talking while eating. • Don't smoke. • Avoid chewing gum. • Avoid drinking with a straw. • Avoid carbonated beverages.
what is considered high output ileostomy
> 1Litre
what should u do when u have high output ileostomy?
Add 1-2 extra litres (4-8 cups) of fluid each day. Good choices are: water, milk or milk alternatives, diluted 100% fruit juices, herbal or weak tea
Add 5 mL (1 tsp) of salt throughout the day. You can do this by sprinkling salt on your food and choosing saltier items such as canned soups or crackers.
Include potassium rich foods such as bananas, diluted orange juice, potatoes, tomato juice, milk and milk alternatives.
Do not restrict your fluids to control a high ostomy output. This could lead to dehydration or worsen existing dehydration.
Speak to your doctor or dietitian if you continue to have a high stool output. They may recommend an oral rehydration drink or have other dietary suggestions.
what is POSTOPERATIVE ILEUS
temporary problems with bowel movement after surgical intervention, which prevents effective transit of intestinal contents or tolerance of oral intake
Primary versus secondary POI
“primary” POI occurs without being caused by postoperative complications. A “secondary” POI occurs due to a postoperative complication such as infection, anastomotic leak, obstruction, etc
what is considered as prolonged POI?
A POI is considered prolonged if it lasts >5 days
ESPEN has recently defined diagnostic criteria for malnutrition according to two options
option 1: BMI <18.5 kg/m2
option 2: combined: weight loss >10% or >5% over 3 months and
reduced BMI or a low fat free mass index (FFMI).
How is surgical stress response clinically manifested
- as salt and water retention to maintain plasma volume;
- increased cardiac output and oxygen consumption to maintain systemic delivery of nutrient and oxygen-rich blood;
- and mobilisation of energy reserves (glycogen, adipose, lean body mass) to maintain energy processes, repair tissues and synthesise proteins involved in the immune response
what Causes hyperglycaemia in surgical response
peripheral and central insulin resistance
Peripheral insulin resistance refers to impaired insulin-mediated glucose uptake, whereas central insulin resistance refers to the inability of insulin to suppress glucose production from the liver
What can be done to meet protein needs and support protein anabolism before surgery?
Dietary protein consumption and resistance exercise- training
what is prehabilitation?
A process in the continuum of care that occurs between the time of diagnosis and the beginning of acute treatment (surgery, chemotherapy, radiotherapy) and includes physical, nutritional and psychological assessments that establish a baseline functional level, identify impairments, and provide interventions that promote physical and psychological health to reduce the incidence and/or severity of future impairments
Preoperative nutrition recommendations
Preoperative routine nutritional assessment offers the opportunity to correct malnutrition and should be offered. Preoperatively, patients at risk of malnutrition should receive nutritional treatment preferably using the oral route for a period of at least 7–10 days.
anemia recommendations in colorectal surgery
Anaemia is common in patients presenting for colorectal surgery and increases all cause morbidity. Attempts to correct it should be made prior to surgery.
Preoperative fasting and carbohydrate loading recommendation
Patients undergoing elective colorectal surgery should be allowed to eat up until 6h and take clear fluids including CHO drinks, up until 2 h before initiation of anaesthesia. Patients with delayed gastric emptying and emergency patients should remain fasted overnight or 6 h before surgery. No recommendation can be given for the use of CHO in patients with diabetes.
what does IBD result from?
IBD is caused by inappropriate inflammatory response that results in a chronic intestinal damage
what are the 2 types of IBD?
Crohn’s Disease
Ulcerative Colitis.
is there a good single test to diagnose IBD?
no
localization of Crohn’s vs UC
Crohn’s Disease the lesions are discontinuous and they can occur anywhere from the mouth to the anus. However, the most common locations are the terminal ileum, the large intestine which is also known as the colon, as well as then other areas in the small intestine.
- BOTH SI ad LI are affected
UC:
Lesions are continuous
Typically begin in the rectum and then move backwards through the large intestine. - ONLY large intestine is affected
Presentations of Crohn’s
Terminal illium
The last section of SI before it enters into the colon-> Right lower quadrant is affected
Right lower quadrant abdominal pain
Also may result in diarrhea that may or may not be bloody
If a large part of small intestine is involved
Risk of malabsorption-> poor nutrition-> weight loss and fatigue
Large intestine/colon
Colon is mainly responsible for absorbing water from the stool->
Inflammation of the colon will result in water being poorly absorbed-> diarrhoea (may or may not be bloody)
Presentations of UC
Most common presentation is diarrhoea with some diffuse cramps abdominal pain
Diarrhea is more commonly bloody in UC than in Crohn’s disease
Extra intestinal symptoms and how can they be “helpful”
Symptoms of Crohn’s disease and UC that are not associated with the location of inflammation
Skin disease - Eythema Nodosum - red tender nodules
Joint pain that often seems to migrate between different joints such as the shoulders, elbows, hips, and knees
Redness of the eyes
Liver disease.
There are not many diseases that will cause these abdominal symptom that can be associated with IBD in association with some of these extra-intestinal symptoms.
So, if they’re happening together that’s actually a fairly specific sign that someone might have Inflammatory Bowel Disease
are lab studies for IBD specific/sensitive?
Laboratory findings of Crohn’s disease and ulcerative colitis are fairly non-specific, but they’re very sensitive for IBD if this findings are not present-> no IBD
Name lab studies in IBD
Markers of inflammation
Anemia
Malabsorption
Describe markers of inflammation lab test for IBD
Increased white blood cell count
Non-specific markers of inflammation that include an increased sedimentation rate and an increased C-reactive protein.
Very non-specific, as many inflammatory condition in the body can cause these findings.
However, they’re very sensitive for Inflammatory Bowel Disease, as if someone doesn’t have
an increased sedimentation rate or an increased C-reactive protein the process that’s going on is likely not Crohn’s Disease or Ulcerative Colitis.
Describe anemia as a lab test for IBD
May occur due to terminal illeum being affected in the case of Crohn’s Disease. Thus the body is not able to properly absorb vitamin B12 which is necessary to produce red blood cells
Both Crohn’s Disease and Ulcerative Colitis can have bloody diarrhea. If this bloody diarrhea is occurring frequently and over long periods-> can result in anemia.
Describe malnutrition as a lab test for IBD
If small intestine and even parts of the large intestine are inflamed and not working properly this can lead to malabsorption b
Blood test can be marker of malabsorption
Low albumin level is the main marker of malabsorption
what are the steps of IDB diagnosis?
lab studies
diagnostic work up
biopsy
describe diagnostic workup for IBD
If lab findings, especially the markers of inflammation are present the next step would be diagnostic work up which is obtaining imaging studies
CT and MRI can be done
Barium Enema is a contrast dye that is inserted through the rectum into the intestine as it fills up and intestinal lumen x-ray is taken to look at the abdominal cavity
In Chron’s disease the results will display inflammation happening in both small intestine and large intestine which will be intermixed was normal looking intestines. This discontinuity it is characteristic of Crohn’s
In Ulcerative Colitis you’ll see a continuous lesion that only involves the large intestine with no gaps of inflammation. Small intestine will look OK
biopsy for IBD
Type of procedure is largely based on the location of biopsy
The procedure is always two-fold: there is visualization of the lesion and the biopsy of microscopic pathology
For example Crohn’s disease is suspected and the lesion is in the first part of the small intestine-> use an endoscope down the oesophagus through the stomach to see the first part of small intestine
-Visualization: Cobblestone appearance
- Biopsy of microscopic pathology: transmural inflammation where the inflammation caused by the disease goes through all three layers of the intestinal wall: the mucosa, the submucosa, and the muscularis externa as well as these noncaseating granulomas
These granulomas are a sign of chronic infection.
Ulcerative colitis where the inflammation is only in the colon-> sigmoidoscopy or colonoscopy where a camera is inserted through the anus and rectum to obtain a biopsy
- Visualization: frable appearance (looks like it would easily bleed or parts of it would just slough off)
- Biopsy of microscopic pathology: inflammation contained only in the mucosal and submucosal layers
primary functions of LI
reabsorption of water, electrolytes, some vitamins
• ~1500 species of bacteria live within
colon
• Fibre fermented = short-chain fatty acids
• Formation and storage of feces (entire process can take 12-72hrs)
• Vitamin K, biotin, and folate produced endogenously
Normal anatomy and physiology of the small intestine
- GALT- gut associated lymphoid tissue
- Enzymatic digestion
- Carbs, protein, fat
- Secretions
- Hormones
- Digestive enzymes, bicarb and bile from ancillary digestive organs: liver, gallbladder and pancreas
- 1.5L of digestive juices
- 3-day turnover of enterocytes
IBD is __, __ inflammatory condition of the GI tract.
Autoimmune, chronic inflammatory condition of the GI tract.
which part of the world experiences IBD more commonly? what does that suggest?
More common in Western world, which suggests a strong environmental/lifestyle influence
which layers of gut are affected: Crohn’s vs UC
Crohn’s: all 3
UC: only inflames the innermost lining of bowel tissue.
• Ulcerations can lead to __ colon and toxic __
• Ulcerations can lead to thin ulcerated colon and toxic megacolon
What is toxic megacolon?
toxic meagacolon happens when inflammation causes it to distend and when that happens, the gas with feces is trapped
if not fixed, it can rupture -> risk of death
there is a lot of bacteria in the gut-> if this rupture becomes systemic it is very dangerous
