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

MNT for Inflammatory Bowel Disease Flashcards

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USMLE® Step 1 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
Q

Is malnutrition more common in Crohn’s disease or Ulcerative colitis?

A

Crohn’s Disease

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26
Q

Malnutrition with Inflammatory Bowel Disease is caused by…

A

-Decreased nutrient intake
-Malabsorption
-Increased enteric losses

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27
Q

Malnutrition further compromises ____ and _____ functions and may increase the permeability of the GIT to potential inflammatory agents

A

Digestive and absorptive

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28
Q

Decreased nutrient intake in someone with Inflammatory Bowel Disease may be due to…

A

-Avoidance behavior
-Disease-related anorexia
-Iatrogenic (restrictive diets recommended by healthcare professional)

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29
Q

Malabsorption of macro- and micronutrients is due to…

A

-Decreased functional absorptive surface area
-Medications
-Bacterial overgrowth

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30
Q

People with Inflammatory Bowel Disease may have secondary ____ _____

A

Lactose intolerance

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31
Q

Fat malabsorption with Crohn’s Disease may be due to ____ or ____ disease

A

Ileal or Jejunal

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32
Q

Ileal disease can cause fat malabsorption by causing a decreased ___ ___ pool due to malabsorption or deconjugation by bacteria

A

Bile salt

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33
Q

Jejnual disease can cause fat malabsorption by decreasing _____ surface area due to inflammation/disease

A

Absorptive

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34
Q

During periods of inflammation, people with Inflammatory Bowel Disease will have enteric leakage of…

A

-Fluid and electrolytes
-Blood
-Protein (protein-losing enteropathy)

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35
Q

Micronutrient deficiencies are caused by…

A

-Decreased intake
-Malabsorption
-Food-medication interactions

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36
Q

Fat-soluble vitamin deficiencies are due to…

A

-Ileal or jejunal resection or disease
-Meds: cholestyramine

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37
Q

Vitamin ____ deficiency is most common in those with Inflammatory Bowel Disease

A

D

38
Q

What are two water-soluble vitamins that are commonly deficient in those with Inflammatory Bowel Disease?

A

-Vitamin B12
-Folate

39
Q

People are commonly deficient in vitamin B12 due to ____ disease

A

Ileal

40
Q

People are commonly deficient in folate due to…

A

-Decrease intake
-Sulfasalazine

41
Q

Minerals like zinc, potassium, magnesium, and copper are commonly deficiency due to ____ and ____

A

Diarrhea and steatorrhea

42
Q

People are commonly deficient in iron due to ___ ____

A

GI bleeding

43
Q

People are commonly deficient in calcium due to…

A

-Avoidance of dairy
-Corticosteroids
-Fat malabsorption

44
Q

Some additional nutritional consequences of Inflammatory Bowel Disease include…

A

-Nutritional anemia
-Osteoporosis and osteomalacia
-Growth impairment in children

45
Q

In general, energy requirements in those with Inflammatory Bowel Disease are similar to those of the ____ population

A

Healthy

46
Q

There is no evidence of ____ in those with inactive Inflammatory Bowel Disease

A

Hypermetabolism

47
Q

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 ____ ____

A

Physical activity

48
Q

Energy needs for those with Inflammatory Bowel Disease should be _____

A

Individualized

49
Q

In general, those with Inflammatory Bowel Disease should get between ___-___ kcal/kg

A

25-35

50
Q

Protein requirements for those in remission from Inflammatory Bowel Disease:

A

1 g/kg

51
Q

Protein requirements for those with active Inflammatory Bowel Disease:

A

1.2-1.5 g.kg

52
Q

What are factors that would increase protein needs in someone with Inflammatory Bowel Disease?

A

-Active inflammation
-Malnutrition
-Post-operative healing
-Infection
-Corticosteroids
-Enteric losses: blood, protein-losing enteropathy
-Malabsorption
-Fistulas

53
Q

We should provide fluid as per age recommendations and additional fluid to replace ____

A

Losses

54
Q

What are some factors which increase fluid needs?

A

-Enteric losses (diarrhea, high ostomy output, fistulas)
-Fever
-Sulfasalazine

55
Q

Dietary recommendations during an Inflammatory Bowel Disease flare-up:

A

-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
Q

What are some additional dietary interventions that may be used as needed?

A

-Lactose restriction
-Restriction of fructose
-Low fiber diet
-Confirmed steatorrhea

57
Q

A low-fiber diet is only used for…

A

-Strictures (to avoid obstruction)
-S/p intestinal resection
-Increase fiber as tolerated during remission

58
Q

If someone has confirmed steatorrhea, we should recommend…

A

-40 gram low fat diet

59
Q

Those with Inflammatory Bowel Disease should be given a _____ with minerals

A

Multivitamin

60
Q

If someone is deficient or at high risk of deficiency in vitamin B12, they should receive ____mcg/month IM

A

1000

61
Q

If someone is deficient or at high risk of deficiency in calcium (usually due to corticosteroids or poor intake), they should get ___-___ g/day

A

1000-1200

62
Q

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

A

2000-4000; 50,000

63
Q

If someone is deficient or at high risk of deficiency in folate (if on sulfasalazine), they should receive ___ mg/day

A

1

64
Q

If someone has fat malabsorption, they should be given fat-soluble vitamins in ___-___ form

A

Water-soluble

65
Q

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

A

220

66
Q

People should be given oral nutrition ____ if needed

A

Supplements

67
Q

If someone has fat malabsorption, we should recommend what type of oral nutrition supplement?

A

-Partially hydrolyzed, peptide-based with MCT oil
-Ex: Petamen with Prebio

68
Q

More research is needed for the use of ____ supplements like probiotics, prebiotics, and omega-3 fatty acids

A

Nutraceutical

69
Q

What are some indications of enteral nutrition for those with inflammatory bowel disease?

A

-Poor appetite
-Malnutrition
-Induction of remission of Crohn’s disease in children and adolescents

70
Q

Enteral nutrition is preferred over parenteral nutrition due to…

A

-Lesser complications
-Ability to maintain GIT integrity and function
-Provide trophic nutrients
-Lower cost

71
Q

If someone is on enteral nutrition, they should get ____ formula

A

Polymeric

72
Q

If someone has confirmed fat malabsorption, we should recommend a ____-____ formula

A

Semi-elemental

73
Q

Semi-elemental formulas contain ____ oil and the protein is hydrolyzed to peptides

A

MCT

74
Q

Indications of parenteral nutrition:

A

-Complications (SBO, fistulas, SBS)
-Prolonged small bowel ileus after surgical resection

75
Q

What are two examples of anti-inflammatory agents (aminosalicylates) used for those with inflammatory bowel disease?

A

-Sulfasalazine
-Masalamine

76
Q

What are food-drug interactions with sulfasalazine?

A

-Inhibits folate absorption
-Can cause anorexia, N/V/D
-Drink 8-10 glasses of fluid/day to prevent kidney stones

77
Q

Food-drug interactions with Mesalamine:

A

-Nausea
-Dyspepsia
-Diarrhea
-Anorexia

78
Q

____ are also used for those with inflammatory bowel disease for anti-inflammatory and immunosuppressive properties

A

Corticosteroids

79
Q

Food-drug interactions with corticosteroids:

A

-Decrease calcium absorption: osteoporosis
-Increase protein catabolism
-Increase blood glucose levels

80
Q

An example of an immunosuppressive agent is ____

A

Azothioprine (Imuran)

81
Q

What are food-drug interactions with Azathioprine (Imuran)?

A

-Anorexia
-N/V/D
-Steatorrhea
-Esophagitis

82
Q

An example of an anti-tumor necrosis factor medication is _____

A

Infliximab (Remicade)

83
Q

Infliximab is used in more severe cases of ____ ____

A

Crohn’s Disease

84
Q

Side effects of anti-tumor necrosis factor medications like Infliximab:

A

-Abdominal pain
-N/V
-Serious infections

85
Q

Some people may have _____ resections of diseased areas

A

Surgical

86
Q

People with inflammatory bowel disease may require an ___ or ___

A

Ileostomy or colostomy

87
Q

What surgery is curative for ulcerative colitis?

A

Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis (IPAA)

88
Q

After the IPAA surgery, someone’s diet should progress from a ___ ___ diet to a regular diet

A

Low-fiber

89
Q

People who have had the IPAA surgery should follow the MNT for ____

A

Ileostomy

90
Q

Those with IPAA may require vitamin ____ injections and need diet education

A

B12

Advanced Medical Nutrition Therapy II (19 decks)

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