Nutrition and Diseases of GI Flashcards
What are the two parts to dysphagia?
- oropharyngeal dysphagia= transfer dysphagia (initiating a swallow).
- esophageal dysphagia= after swallowing, food getting stuck (intrinsic; webs…, or extrinsic; mediastinal mass).
Why is dysphagia important?
- weight loss (an energy INTAKE problem).
What important questions should you ask in regard to dysphagia?
- Do you have problems swallowing liquids, solids, or both?
- Do you have loss of appetite, weight loss, nausea, vomiting, or heartburn
What are some examples of esophageal dysphagia motility disorders?
- achalasia
- scerloderma (systemic sclerosis)
- sjogren’s syndrome
What are some stomach disorders that can cause gastric outlet obstruction?
- malignancy (adenocarcinoma, lymphoma, stromal tumors).
- infections (TB)
- infiltartive (amyloidosis, sceroderma)
- stricture (peptic, post-radiation, pancreatic pseudocyst)
- pyloric stenosis
What is atrophic gastritis?
- chronic inflammation of the stomach mucosa, leading to loss of gastric glandular cells (impairing secretion of HCl, pepsin, and intrinsic factor).
- B12 deficiency occurs leading to megaloblastic anemia.
- may also see iron deficiency anemia (microcytic)
What is gastroparesis?
delayed gastric emptying, usually associated with T2DM, but can be due to Parkinson’s, MS, brainstem tumor, chemo, or paraneoplastic syndromes. Signs and symptoms:
- nausea, vomiting, abdominal pain, a feeling of fullness after eating just a few bites.
What nutritional interventions do we do for gastroparesis?
stage approach:
- stage 1= introduce liquid
- stage 2= low residue/low fat
- stage 3= maintenance
- if that fails we go to enteral or parenteral nutrition.
How does enteral vs parenteral nutrition differ?
- enteral= provision of protein, calories, electrolytes, trace elements, and fluids via INTESTINAL ROUTE (tube through nose into stomach or small bowel).
- parenteral= an INTRAVENOUS solution that contains dextrose, lipids, amino acids, vitamins, and trace elements.
Is enteral nutrition preferred?
YES via temporary nasojejunal tube or permanent surgically placed jejunal feeding tube.
When do we use parenteral nutrition?
reserved for those who are enterally intolerant (malignancy or diabetic gastroparesis).
What nutritional implications will we see with Roux-en-Y gastric bypass?
malabsorption of Vitamin B12, B1 (thiamin), D, K, folate, iron, and calcium
What nutritional implications will we see with laproscopic adjustable gastric banding?
folic acid deficiency
What nutritional implications will we see with BPD and BPD/DS?
- vitamin A, D, E, and K deficiency, protein-calorie malnutrition, malabsorption of calcium, zinc, selenium, potassium, chloride, phosphorus, and magnesium.
What are general recommended supplements for pts with bariatric surgery?
- multivitamin with iron
- calcium with vitamin D
- oral vitamin B12
- iron with vitamin C (to increase absorption of iron)
- thiamin
What is the nutritional problem with IBD?
- malabsorption (iron, vitamin D, folate, vitamin A, and vitamin B12).
What are the consequences of malnutrition?
- growth failure (common in children with Crohn’s)
- weight loss and reduced muscle mass
- metabolic bone disease
- anemia
What percentage of lean body mass loss is the threshold for increased morbidity?
greater than 5 - 10%
** What can cause metabolic bone disease?
- glucocorticoid use
- puberty delay
- deficiencies of calcium, vit D, and vit K
What is celiac disease?
- autoimmune disorder of the small intestine with a reaction to gluten or various proteins found in wheat, barley, and rye.
What is the human microbiome project?
- NIH initiative to identify and characterize the microorganisms in health and disease. Goal is to develop a reference set of microbial genome sequences and to perform preliminary characterization of the human microbiome.
By how much, does the total number of microbial cells in humans exceed the total number of human cells?
- by a factor of 10!
What is a nutritional problem in pts with cirrhosis?
they can take in nitrogen from proteins, but can’t synthesize ALBUMIN from it in the liver.
How do we do a nutritional assessment?
History:
- unintentional weight loss greater than 10% over 6 months.
- GI symptoms
- severity of liver disease (child-pugh score, MELD score).
- micronutrient deficiency
Is nutrition more relevant in acute or chronic pancreatitis?
CHRONIC
How do you treat chronic pancreatitis from a nutritional standpoint?
- alcohol cessation and low fat diet
* antioxidants seem to help
*** Should we feed through the vein or the gut with acute pancreatitis?
enteral (through the gut)
What is short bowel syndrome?
- a malabsorptive state following massive resection of small intestine (less than 2 meters of bowel left). Usually results from resection for Crohn’s disease, radiation, or bowel infarction.
Is malnutrition evident in up to 50% of hospitalized pts?
YES (hypermetabolism is the most common reason for admission to SICU)
What do we need to distinguish in starvation?
stressed (hospitalized) from unstressed (healthy) models
*** What happens to pts in an unstressed (healthy) starvation state?
- conserve lean body mass (protein) and energy.
- increased epinephrine and glucagon with lipolysis and glycogenolysis early.
- next is acceleration of gluconeogenesis. If this continues, then 1/3 of body PROTEIN would lost in just a few weeks.
- prolonged starvation= brain adapts to use ketone for energy so muscle protein losses are diminished (KETO-ADAPTATION).
** Does keto-adaptation in STRESSED starvation occur? (TEST QUESTION)
NO!!
What do we see in pts with stressed (hospitalized) pts?
- increase in catabolic hormones (cortisol, glucagon, epinephrine).
- increased cytokine response (IL-1, TNF)
- most losses are NON-VISCERAL, rather they are lean tissue.
Is hypercatabolism disconnected from hyper-metabolism?
- YES catabolism is breakdown of lean tissue (proteins).
- Metabolism is calories and energy expenditure.
Why is protein not viewed as an energy source?
bc it does not exist in storage form. It is either utilized or sacrificed. Protein takes energy to be used as energy.
What are our body stores and how long do they last?
- carbohydrate in the form of glycogen= lasts 36 hrs.
- fat= could last up to 60 days.
