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Advanced Medical Nutrition Therapy II > MNT for Short Bowel Syndrome > Flashcards

MNT for Short Bowel Syndrome Flashcards

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USMLE® Step 1 flashcards
1
Q

____ ____ ____ is explained as the metabolic and nutritional consequences which result from inadequate bowel mucosal absorptive surface area

A

Short bowel syndrome

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2
Q

Having inadequate bowel mucosal absorptive surface area means that someone is unable to support their ____ and ____ requirements

A

Nutritional and fluid

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3
Q

Short Bowel Syndrome is caused by a deficiency in bowel length due to extensive ____ resection

A

Surgical

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4
Q

Short bowel syndrome is characterized by…

A

-Severe, chronic diarrhea and steatorrhea
-Malabsorption of macro- and micro-nutrients
-Dehydration
-Electrolyte imbalances
-Progressive weight loss and malnutrition

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5
Q

Diarrhea with small bowel syndrome is due to…

A

-Malabsorption
-Altered motility
-Increased secretion

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6
Q

It is difficult to diagnose small bowel syndrome on ____ alone; we need to consider symptoms as well

A

Length

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7
Q

Diagnosing short bowel syndrome on length has what requirements?

A

-Loss of 70-75% of small bowel
-<200 cm of remaining small bowel length

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8
Q

If someone has >75% of bowel removed or less than 100 cm remaining, they will have severe malabsorption and will likely need ___ ____ for survival

A

Parenteral nutrition

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9
Q

Etiology of small bowel syndrome in adults:

A

-Crohn’s disease
-Mesenteric infarct
-Small bowel volvulus
-Radiation enteritis
-Cancer

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10
Q

Etiology of small bowel syndrome in children:

A

-Necrotizing enterocolitis
-Small bowel volvulus
-Intestinal atresia
-Crohn’s disease

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11
Q

What factors influence the severity of small bowel syndrome?

A

-Remaining bowel length and condition of the remaining bowel
-Location of resection
-Presence of the ileocecal valve
-Presence of the colon
-Degree of adaptation of the remaining bowel

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12
Q

____ increases with increased amount of small bowel removed or non-functional

A

Malabsorption

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13
Q

The minimal small intestine length necessary for adequate absorption of oral/enteral nutrition is…

A

-100 cm of small bowel if no colon
-60 cm of small bowel with an intact colon

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14
Q

We need to consider nutrients absorbed and the functions of the segments of intestine _____

A

Removed

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15
Q

If someone has a duodenal resection, ___ ___ may occur

A

Dumping syndrome

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16
Q

If someone has a jejunal resection, they may experience ___ intolerance

A

Lactose

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17
Q

Someone may have adequate absorption unless >___% of their jejunum has been removed

A

75

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18
Q

The ____ can assume the absorptive functions of the jejunum

A

Ileum

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19
Q

The ileum is the only site for absorption of what two things?

A

-Bile salt
-Vitamin B12

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20
Q

A resection of > 100 cm of the ileum results in a net loss of bile salts, leading to ____ and ____ ____

A

-Steatorrhea
-Cholerrheic diarrhea

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21
Q

Large resections of the ileum can result in severe malabsorption of…

A

-Fat
-Fat-soluble vitamins
-Calcium
-Magnesium
-Zinc
-Selenium
-B12

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22
Q

Ileal resections can result in loss of the ___ ___

A

Ileal break

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23
Q

End-jejunostomies can result in…

A

-Dehydration
-Electrolyte deficiencies

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24
Q

Loss of the ileocecal valve can result in ____ ____

A

Bacterial overgrowth

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25
Q

With a partial or total colon resection, there is an increased risk of ____ and ___ ___

A

-Dehydration
-Electrolyte losses

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26
Q

Intestinal transit time will be ____ with the presence of a colon

A

Prolonged

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27
Q

The ___ ___ slows gastric emptying

A

Colonic break

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28
Q

Having an intact colon means that you can metabolize ____ ___ ___ ___, which provides a source of calories

A

Short-chain fatty acids

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29
Q

Whatever small bowel is remaining undergoes structural and functional changes to increase ____ ____

A

Nutrient absorption

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30
Q

What types of changes occur in the remaining small bowel?

A

-Hyperplasia
-Elongation
-Increase height of the villi
-Increases in brush border enzymes

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31
Q

Intestinal adaptation occurs over ___-__ years after surgery

A

1-2

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32
Q

What factors influence adaptation?

A

-Oral/enteral nutrition
-Complex luminal nutrients vs simple
-Glutamine
-Short-chain fatty acids
-Hormones (enteroglucagon, glucagon-like peptide 1, peptide YY, growth hormone)

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33
Q

Those with small bowel syndrome have an increased rate of gastric emptying due to…

A

-Loss of intestinal hormones and feedback control
-Loss of the pyloric sphincter

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34
Q

If someone has an ileal resection, they would have ____ transit in remaining bowel

A

Rapid

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35
Q

Someone with short bowel syndrome would have impaired absorption of…

A

-Fluid and electrolytes
-Bile salts->cholerrheic diarrhea
-Fat->steatorrhea
-Fat-soluble vitamins
-Vitamin B12
-Minerals: Zinc, calcium, magnesium, manganese, copper, selenium, and chromium
-Lactose

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36
Q

Gastric _____ can occur after significant small bowel resections

A

Hypersecretion

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37
Q

A decrease in ____ and ____ secretion leads to increased serum gastrin levels and increased gastric acid secretion

A

Cholecystokinin and secretin

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38
Q

What are the clinical manifestations of having increased gastric acid secretion?

A

-Increases volume of secretions entering the small bowel and promotes diarrhea
-Acid damage to the intestinal mucosa
-Denatures pancreatic enzymes
-Precipitates bile salts - disrupts micelle formation
-Stimulates peristalsis

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39
Q

Small bowel bacterial overgrowth is caused by…

A

-Removal of the ileocecal valve
-Blind loops
-Antimotility medications
-Acid-suppression medications

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40
Q

Small bowel bacterial overgrowth results in…

A

-Deconjugated bile salts
-Inflammatory mucosal damage
-Gas
-Abdominal bloating and pain
-Steatorrhea
-Fat-soluble vitamin and B12 deficiencies

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41
Q

With steatorrhea, ____ is preferentially bound to unabsorbed fatty acids instead of _____

A

Calcium; oxalate

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42
Q

Increased absorption of free oxalate leads to ____

A

Nephrolithiasis

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43
Q

Hyperoxaluria and nephrolithiasis occur only if the _____ is present

A

Colon

44
Q

The risk of hyperoxaluria is increased with ____ ____

A

Volume depletion

45
Q

Vitamin B12 or folate deficiency can lead to _____ _____

A

Macrocytic anemia

46
Q

People with short bowel syndrome may develop metabolic bone disease due to…

A

-Malabsorption of vitamin D and calcium
-Metabolic acidosis

47
Q

What should be included in a nutrition assessment for someone with short bowel syndrome?

A

-Thorough knowledge of current medical status
-Current GI symptoms/complications
-Remaining small bowel anatomy
-Weight history
-Diet history: analysis of home diet/nutrition support, supplement use
-NFPE
-Input/output records
-Lab assessment: electrolytes, malabsorption workup, vitamin and mineral levels
-Food-medication interactions

48
Q

Energy requirements for someone with short bowel syndrome should be ____

A

Individualized

49
Q

On overage, people with short bowel syndrome should get ___-____ kcal/kg, but some people may need up to ___ kcal/kg

A

35-45; 60

50
Q

For people with short bowel syndrome on parenteral nutrition, they should receive ____ kcal/kg

A

32

51
Q

Someone with short bowel syndrome who eats orally or is on enteral nutrition should get ___-___ g/kg of protein per day

A

1.5-2

52
Q

For someone with short bowel syndrome on parenteral nutrition, they should receive ___-___ g/kg of protein

A

1.0-1.5

53
Q

What things might increase protein needs for someone with short bowel syndrome?

A

-Malnutrition
-Recent surgery
-Presence of other diseases or conditions
-Malabsorption

54
Q

Those with short bowel syndrome have ____ fluid needs due to diarrhea/ostomy output

A

Increased

55
Q

For ostomy patients, oral consumption of fluid should be ____ than ostomy output

A

Greater

56
Q

We should monitor fluid intake/output closely and ____ losses

A

Replace

57
Q

___ ___ ____ should be sipped slowly throughout the day

A

Oral rehydration solution

58
Q

If someone has over ___ ____ of ostomy output per day, they should receive IV fluids with electrolytes

A

2 liters

59
Q

Phase I of post-operative short bowel syndrome lasts the initial ___-___ weeks post surgery

A

1-3

60
Q

What may happen during phase 1 of post-operative short bowel syndrome?

A

-Severe malabsorption
-Hypersecretion of gastric secretions
-Massive diarrhea/ostomy output
-Rigorous IV repletion of fluid and electrolyte losses

61
Q

Someone in phase I post-op short bowel syndrome should be ____ and receive ____ for nutrition support

A

NPO, TPN

62
Q

Phase II post-op short bowel syndrome lasts ___-___ months

A

1-3

63
Q

During phase II, ____ malabsorption occurs with deficiencies in fat-soluble vitamins, calcium, magnesium, and zinc

A

Fat

64
Q

Phase II is the period of greatest intestinal _____

A

Adaptation

65
Q

Someone in phase II post of short bowel syndrome should be on _____, with the initiation of enteral nutrition when/if diarrhea or ostomy output decreases to less than 2 liters per day

A

TPN

66
Q

Phase III post op short bowel syndrome lasts ___-___ months or longer

A

3-12

67
Q

The goal during phase III is adaptation and transition to ____ diet

A

Oral

68
Q

In phase III post-op, ____ should be well-controlled

A

Diarrhea

69
Q

In phase III of the post-op diet, patients should discontinue TPN and increase to full ____/____ feedings

A

Enteral/oral

70
Q

Not all patients attain phase III of the post-op short bowel syndrome diet; some may be on home ____

A

TPN

71
Q

Enteral nutrition fosters intestinal ____

A

Adaptation

72
Q

Usually, enteral nutrition can be implemented within ____ ____ after surgery

A

1 month

73
Q

Enteral nutrition should be infused into the most ____ area (i.e., stomach) to maximize the absorptive surface area

A

Proximal

74
Q

Those with short bowel syndrome who are getting enteral nutrition should get ____ infusion

A

Continuous

75
Q

Patients may need home tube feedings if unable to meet needs with ____ diet alone

A

Oral

76
Q

Research supports using ____, ____ tube feeding formulas due to increased stimulation of intestinal adaptation and decreased osmotic load

A

Isotonic, polymeric

77
Q

If the colon is intact, we should use a ____ ____ containing formula (short-chain fatty acids)

A

Soluble fiber

78
Q

If tube feeding is unsuccessful, try a ____-____/____-____ formula with MCT

A

Semi-elemental/peptide-based

79
Q

_____ formulas are no longer recommended for those with short bowel syndrome

A

Elemental

80
Q

When determining macronutrient distribution, we need to consider ____

A

Anatomy

81
Q

If the colon is in continuity, we should recommend a higher ___, lower ____ diet

A

Carbohydrate, fat

82
Q

What is the macronutrient distribution we should recommend to a patient with small bowel syndrome who has their colon in continuity?

A

-50-60% kcal from carbohydrates
-20-30% kcal from fat
-20% kcal from protein

83
Q

If someone does not have a colon, we should recommend a diet that is ____ is carbohydrates and fat

A

Moderate

84
Q

What is the macronutrient distribution we should recommend to a patient with small bowel syndrome who does not have a colon?

A

-40-50% of kcal from carbohydrates
-30-40% kcal from fat
-20% kcal from protein

85
Q

For anyone with small bowel syndrome, we should promote ____ carbohydrates and ____ fiber (SCFA)

A

Complex; soluble

86
Q

What are some recommendations for those with short bowel syndrome on oral nutrition?

A

-Avoid concentrated sweets
-5-6 small meals
-Chew food thoroughly
-Emphasize complex carbohydrates
-Limit fluids with meals (sip fluids between meals)
-Drink isotonic beverages (oral rehydration supplements(
-Liberal use of salt (if no colon)
-Avoid caffeine and alcohol

87
Q

We should ____ restrictions for those on oral nutrition

A

Limit

88
Q

If someone has an intact colon, we should restrict ____ intake

A

Oxalate

89
Q

What are sources of oxalates?

A

-Berries
-Nuts
-Chocolate
-Green beans
-Celery
-Spinach
-Beets
-Beer
-Sweet potatoes
-Soy

90
Q

We can recommend a low ____ diet if needed

A

Lactose

91
Q

We should also provide diet education with sample ____

A

Menus

92
Q

Those on oral or enteral nutrition should receive a ____ with minerals

A

Multivitamin

93
Q

We should assess those on oral or enteral nutrition individually for additional _____ of vitamins and minerals

A

Supplementation

94
Q

If those on oral or enteral nutrition are having steatorrhea, we should provide them with fat-soluble vitamin supplements in a ____-____ form

A

Water-soluble

95
Q

In the absence of the ileum/large resection, someone on oral or enteral nutrition should receive _____ mcg of vitamin B12 IM injection monthly

A

1000

96
Q

For someone on oral or enteral nutrition, they should receive a calcium citrate supplementation of ____-____ mg, 1-2 tablets three times per day

A

500-600

97
Q

For someone on oral or enteral nutrition, they should receive magnesium lactate in ____ mg 1-2 tablets three times per day OR magnesium gluconate ____ mg tablet or liquid, 1-3 tablets three times per day

A

84; 1000

98
Q

People lose ____ mg of zinc per liter of output

A

12

99
Q

We should provide ____ mg of zinc sulfate, 1-3 tablets daily

A

220

100
Q

What would be replenished by oral rehydration supplements?

A

-Potassium
-Sodium
-Chloride
-Bicarbonate

101
Q

What are examples of pharmacologic management of short bowel syndrome?

A

-Antimotility/antidiarrheals (ex: loperamide)
-Proton pump inhibits and H2-receptor antagonists
-Bile acid binders (cholestyramine)
-Octreotide (somatostatin analogue)

102
Q

What are food-drug interactions with bile acid binders like cholestyramine?

A

-Decreased absorption of fat-soluble vitamins, calcium, iron, zinc, magnesium, and folate

103
Q

What can Octerotide (somatostatin analogue) help with?

A

-Antisecretory action
-Antimotility
-Reduces stomal output and diarrhea

104
Q

What are food-drug interactions with Octerotide (somatostatin analogue)?

A

-N/V
-Hyperglycemia

105
Q

The FDA has approved trophic factors for management of short bowel syndrome because they enhance intestinal ___ and ____

A

Adaptation and absorption

106
Q

What are two examples of trophic factors that may be prescribed for the management of short bowel syndrome?

A

-Growth hormone (Ex: somatotropin)
-Glucagon-like peptide 2 analogue (Ex: teduglutide)

107
Q

What are three examples of surgical management of short bowel syndrome?

A

-Longitudinal intestinal lengthening and tapering
-Serial transverse enteroplasy
-Small bowel transplantation

Advanced Medical Nutrition Therapy II (19 decks)

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