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Advanced Medical Nutrition Therapy II > MNT for Inflammatory Bowel Disease > Flashcards

MNT for Inflammatory Bowel Disease Flashcards

1
Q

____ ____ ____ is a collective term for chronic inflammatory diseases of the intestine

A

Inflammatory Bowel Disease

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2
Q

What two diseases are under the inflammatory bowel disease umbrella?

A

-Crohn’s Disease
-Ulcerative Colitis

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3
Q

Inflammatory Bowel Disease is characterized by periods of ____ and ____

A

Remission and exacerbations

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4
Q

The impact of Inflammatory Bowel Disease depends on the site and extent of _____

A

Inflammation

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5
Q

Inflammatory Bowel Disease often develops between ___-___

A

15-30

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6
Q

Inflammatory Bowel Disease is often confused with ____ ____ ____

A

Irritable Bowel Syndrome

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7
Q

Risk factors for Inflammatory Bowel Disease:

A

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

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8
Q

Possible dietary risk factors for Inflammatory Bowel Disease:

A

-Vitamin D deficiency
-High intake of sucrose
-Low intake of fruits and vegetables and dietary fiber
-Increased consumption of red meat and alcohol
-High intake of omega-6 fatty acids and low intake of omega-3 fatty acids

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9
Q

Crohn’s Disease results in chronic inflammation to the ____, resulting in ulcerations

A

Mucosa

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10
Q

With Crohn’s Disease, inflammation progresses to involve all ____ of the intestinal wall

A

Layers

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11
Q

Crohn’s disease usually occurs in the ___ and ___ ____ but can occur anywhere in the GIT

A

Large and small intestine

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12
Q

The most common site of Crohn’s disease is the ____ ____

A

Terminal ileum

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13
Q

The terminal ileum is where we absorb vitamin ____

A

B12

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14
Q

Crohn’s Disease is segmental with spared areas called “____ ____”

A

Skip lesions

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15
Q

Clinical manifestations of Crohn’s disease:

A

-Abdominal pain
-Diarrhea
-Anorexia
-Weight loss

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16
Q

What are complications of Crohn’s Disease?

A

-Strictures-> obstruction
-Malabsorption
-Abscesses
-Fistulas
-Possible short bowel syndrome
-Increased risk of intestinal cancer

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17
Q

Ulcerative colitis is a chronic inflammatory disease that causes ulceration of the ____ ____

A

Colonic mucosa

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18
Q

Ulcerative colitis begins in the _____ area and may extend proximally to affect the entire colon

A

Rectosigmoid

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19
Q

With Ulcerative colitis, the ____ is almost always involved

A

Rectum

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20
Q

Unlike Crohn’s, Ulcerative colitis usually only involves the ____ layer of the intestines

A

Mucosa

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21
Q

Ulcerative colitis causes deep ____ that bleed

A

Ulcers

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22
Q

The mucosal inflammation/destruction caused by ulcerative colitis leads to…

A

-Loss of absorptive surface area
-Large volumes of watery diarrhea
-Bleeding
-Cramping pain
-Tenesmus (constant feeling that you have to have a bowel movement)

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23
Q

Clinical manifestations of ulcerative colitis:

A

-Crampy abdominal pain
-Frequent bloody diarrhea
-Dehydration
-Anorexia and weight loss
-Anemia

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24
Q

Possible complications of ulcerative colitis:

A

-Severe bleeding
-Perirectal abscess
-Toxic megacolon
-Increased risk for colon cancer

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25
Is malnutrition more common in Crohn's disease or Ulcerative colitis?
Crohn's Disease
26
Malnutrition with Inflammatory Bowel Disease is caused by...
-Decreased nutrient intake -Malabsorption -Increased enteric losses
27
Malnutrition further compromises ____ and _____ functions and may increase the permeability of the GIT to potential inflammatory agents
Digestive and absorptive
28
Decreased nutrient intake in someone with Inflammatory Bowel Disease may be due to...
-Avoidance behavior -Disease-related anorexia -Iatrogenic (restrictive diets recommended by healthcare professional)
29
Malabsorption of macro- and micronutrients is due to...
-Decreased functional absorptive surface area -Medications -Bacterial overgrowth
30
People with Inflammatory Bowel Disease may have secondary ____ _____
Lactose intolerance
31
Fat malabsorption with Crohn's Disease may be due to ____ or ____ disease
Ileal or Jejunal
32
Ileal disease can cause fat malabsorption by causing a decreased ___ ___ pool due to malabsorption or deconjugation by bacteria
Bile salt
33
Jejnual disease can cause fat malabsorption by decreasing _____ surface area due to inflammation/disease
Absorptive
34
During periods of inflammation, people with Inflammatory Bowel Disease will have enteric leakage of...
-Fluid and electrolytes -Blood -Protein (protein-losing enteropathy)
35
Micronutrient deficiencies are caused by...
-Decreased intake -Malabsorption -Food-medication interactions
36
Fat-soluble vitamin deficiencies are due to...
-Ileal or jejunal resection or disease -Meds: cholestyramine
37
Vitamin ____ deficiency is most common in those with Inflammatory Bowel Disease
D
38
What are two water-soluble vitamins that are commonly deficient in those with Inflammatory Bowel Disease?
-Vitamin B12 -Folate
39
People are commonly deficient in vitamin B12 due to ____ disease
Ileal
40
People are commonly deficient in folate due to...
-Decrease intake -Sulfasalazine
41
Minerals like zinc, potassium, magnesium, and copper are commonly deficiency due to ____ and ____
Diarrhea and steatorrhea
42
People are commonly deficient in iron due to ___ ____
GI bleeding
43
People are commonly deficient in calcium due to...
-Avoidance of dairy -Corticosteroids -Fat malabsorption
44
Some additional nutritional consequences of Inflammatory Bowel Disease include...
-Nutritional anemia -Osteoporosis and osteomalacia -Growth impairment in children
45
In general, energy requirements in those with Inflammatory Bowel Disease are similar to those of the ____ population
Healthy
46
There is no evidence of ____ in those with inactive Inflammatory Bowel Disease
Hypermetabolism
47
There may be an increase in metabolic activity at times of acute severe disease activity, however, the increase in REE is likely offset by reduction in ____ ____
Physical activity
48
Energy needs for those with Inflammatory Bowel Disease should be _____
Individualized
49
In general, those with Inflammatory Bowel Disease should get between ___-___ kcal/kg
25-35
50
Protein requirements for those in remission from Inflammatory Bowel Disease:
1 g/kg
51
Protein requirements for those with active Inflammatory Bowel Disease:
1.2-1.5 g.kg
52
What are factors that would increase protein needs in someone with Inflammatory Bowel Disease?
-Active inflammation -Malnutrition -Post-operative healing -Infection -Corticosteroids -Enteric losses: blood, protein-losing enteropathy -Malabsorption -Fistulas
53
We should provide fluid as per age recommendations and additional fluid to replace ____
Losses
54
What are some factors which increase fluid needs?
-Enteric losses (diarrhea, high ostomy output, fistulas) -Fever -Sulfasalazine
55
Dietary recommendations during an Inflammatory Bowel Disease flare-up:
-Small frequent meals -Chew foods thoroughly -Adequate fluids to replace losses -Limit/avoid caffeine, prune juice, alcohol, sorbitol -Limit specific foods, if needed, based on individual tolerance
56
What are some additional dietary interventions that may be used as needed?
-Lactose restriction -Restriction of fructose -Low fiber diet -Confirmed steatorrhea
57
A low-fiber diet is only used for...
-Strictures (to avoid obstruction) -S/p intestinal resection -Increase fiber as tolerated during remission
58
If someone has confirmed steatorrhea, we should recommend...
-40 gram low fat diet
59
Those with Inflammatory Bowel Disease should be given a _____ with minerals
Multivitamin
60
If someone is deficient or at high risk of deficiency in vitamin B12, they should receive ____mcg/month IM
1000
61
If someone is deficient or at high risk of deficiency in calcium (usually due to corticosteroids or poor intake), they should get ___-___ g/day
1000-1200
62
If someone is deficient or at high risk of deficiency in vitamin D, they should get ___-___ IU daily for maintenance, as well as ____ IU weekly for 12 weeks for the treatment of deficiency
2000-4000; 50,000
63
If someone is deficient or at high risk of deficiency in folate (if on sulfasalazine), they should receive ___ mg/day
1
64
If someone has fat malabsorption, they should be given fat-soluble vitamins in ___-___ form
Water-soluble
65
If someone is deficient or at high risk of deficiency in zinc, they should be given ___ mg of zinc sulfate 1-2 times per day
220
66
People should be given oral nutrition ____ if needed
Supplements
67
If someone has fat malabsorption, we should recommend what type of oral nutrition supplement?
-Partially hydrolyzed, peptide-based with MCT oil -Ex: Petamen with Prebio
68
More research is needed for the use of ____ supplements like probiotics, prebiotics, and omega-3 fatty acids
Nutraceutical
69
What are some indications of enteral nutrition for those with inflammatory bowel disease?
-Poor appetite -Malnutrition -Induction of remission of Crohn's disease in children and adolescents
70
Enteral nutrition is preferred over parenteral nutrition due to...
-Lesser complications -Ability to maintain GIT integrity and function -Provide trophic nutrients -Lower cost
71
If someone is on enteral nutrition, they should get ____ formula
Polymeric
72
If someone has confirmed fat malabsorption, we should recommend a ____-____ formula
Semi-elemental
73
Semi-elemental formulas contain ____ oil and the protein is hydrolyzed to peptides
MCT
74
Indications of parenteral nutrition:
-Complications (SBO, fistulas, SBS) -Prolonged small bowel ileus after surgical resection
75
What are two examples of anti-inflammatory agents (aminosalicylates) used for those with inflammatory bowel disease?
-Sulfasalazine -Masalamine
76
What are food-drug interactions with sulfasalazine?
-Inhibits folate absorption -Can cause anorexia, N/V/D -Drink 8-10 glasses of fluid/day to prevent kidney stones
77
Food-drug interactions with Mesalamine:
-Nausea -Dyspepsia -Diarrhea -Anorexia
78
____ are also used for those with inflammatory bowel disease for anti-inflammatory and immunosuppressive properties
Corticosteroids
79
Food-drug interactions with corticosteroids:
-Decrease calcium absorption: osteoporosis -Increase protein catabolism -Increase blood glucose levels
80
An example of an immunosuppressive agent is ____
Azothioprine (Imuran)
81
What are food-drug interactions with Azathioprine (Imuran)?
-Anorexia -N/V/D -Steatorrhea -Esophagitis
82
An example of an anti-tumor necrosis factor medication is _____
Infliximab (Remicade)
83
Infliximab is used in more severe cases of ____ ____
Crohn's Disease
84
Side effects of anti-tumor necrosis factor medications like Infliximab:
-Abdominal pain -N/V -Serious infections
85
Some people may have _____ resections of diseased areas
Surgical
86
People with inflammatory bowel disease may require an ___ or ___
Ileostomy or colostomy
87
What surgery is curative for ulcerative colitis?
Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis (IPAA)
88
After the IPAA surgery, someone's diet should progress from a ___ ___ diet to a regular diet
Low-fiber
89
People who have had the IPAA surgery should follow the MNT for ____
Ileostomy
90
Those with IPAA may require vitamin ____ injections and need diet education
B12

Advanced Medical Nutrition Therapy II (19 decks)

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