MNT for Short Bowel Syndrome Flashcards by perjunke fibers

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

Short bowel syndrome

How well did you know this?

Not at all

Perfectly

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

Nutritional and fluid

How well did you know this?

Not at all

Perfectly

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

Surgical

How well did you know this?

Not at all

Perfectly

Short bowel syndrome is characterized by…

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

How well did you know this?

Not at all

Perfectly

Diarrhea with small bowel syndrome is due to…

-Malabsorption
-Altered motility
-Increased secretion

How well did you know this?

Not at all

Perfectly

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

Length

How well did you know this?

Not at all

Perfectly

Diagnosing short bowel syndrome on length has what requirements?

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

How well did you know this?

Not at all

Perfectly

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

Parenteral nutrition

How well did you know this?

Not at all

Perfectly

Etiology of small bowel syndrome in adults:

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

How well did you know this?

Not at all

Perfectly

Etiology of small bowel syndrome in children:

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

How well did you know this?

Not at all

Perfectly

What factors influence the severity of small bowel syndrome?

-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

How well did you know this?

Not at all

Perfectly

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

Malabsorption

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

Removed

How well did you know this?

Not at all

Perfectly

If someone has a duodenal resection, ___ ___ may occur

Dumping syndrome

How well did you know this?

Not at all

Perfectly

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

Lactose

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

The ____ can assume the absorptive functions of the jejunum

Ileum

How well did you know this?

Not at all

Perfectly

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

-Bile salt
-Vitamin B12

How well did you know this?

Not at all

Perfectly

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

-Steatorrhea
-Cholerrheic diarrhea

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

Ileal resections can result in loss of the ___ ___

Ileal break

How well did you know this?

Not at all

Perfectly

End-jejunostomies can result in…

-Dehydration
-Electrolyte deficiencies

How well did you know this?

Not at all

Perfectly

Loss of the ileocecal valve can result in ____ ____

Bacterial overgrowth

How well did you know this?

Not at all

Perfectly

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

-Dehydration -Electrolyte losses

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

Prolonged

The ___ ___ slows gastric emptying

Colonic break

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

Short-chain fatty acids

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

Nutrient absorption

What types of changes occur in the remaining small bowel?

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

Intestinal adaptation occurs over ___-__ years after surgery

1-2

What factors influence adaptation?

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

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

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

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

Rapid

Someone with short bowel syndrome would have impaired absorption of...

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

Gastric _____ can occur after significant small bowel resections

Hypersecretion

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

Cholecystokinin and secretin

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

-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

Small bowel bacterial overgrowth is caused by...

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

Small bowel bacterial overgrowth results in...

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

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

Calcium; oxalate

Increased absorption of free oxalate leads to ____

Nephrolithiasis

Hyperoxaluria and nephrolithiasis occur only if the _____ is present

Colon

The risk of hyperoxaluria is increased with ____ ____

Volume depletion

Vitamin B12 or folate deficiency can lead to _____ _____

Macrocytic anemia

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

-Malabsorption of vitamin D and calcium -Metabolic acidosis

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

-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

Energy requirements for someone with short bowel syndrome should be ____

Individualized

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

35-45; 60

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

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

1.5-2

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

1.0-1.5

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

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

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

Increased

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

Greater

We should monitor fluid intake/output closely and ____ losses

Replace

___ ___ ____ should be sipped slowly throughout the day

Oral rehydration solution

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

2 liters

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

1-3

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

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

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

NPO, TPN

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

1-3

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

Fat

Phase II is the period of greatest intestinal _____

Adaptation

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

TPN

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

3-12

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

Oral

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

Diarrhea

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

Enteral/oral

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

TPN

Enteral nutrition fosters intestinal ____

Adaptation

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

1 month

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

Proximal

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

Continuous

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

Oral

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

Isotonic, polymeric

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

Soluble fiber

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

Semi-elemental/peptide-based

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

Elemental

When determining macronutrient distribution, we need to consider ____

Anatomy

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

Carbohydrate, fat

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

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

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

Moderate

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

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

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

Complex; soluble

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

-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

We should ____ restrictions for those on oral nutrition

Limit

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

Oxalate

What are sources of oxalates?

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

We can recommend a low ____ diet if needed

Lactose

We should also provide diet education with sample ____

Menus

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

Multivitamin

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

Supplementation

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

Water-soluble

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

1000

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

500-600

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

84; 1000

People lose ____ mg of zinc per liter of output

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

220

What would be replenished by oral rehydration supplements?

-Potassium -Sodium -Chloride -Bicarbonate

What are examples of pharmacologic management of short bowel syndrome?

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

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

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

What can Octerotide (somatostatin analogue) help with?

-Antisecretory action -Antimotility -Reduces stomal output and diarrhea

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

-N/V -Hyperglycemia

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

Adaptation and absorption

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

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

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

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