Nutrition and GI Disease Flashcards
What is required for protein absorption and where does most of the absorption occur?
digestion requires acidity and peptidases to digestion proteins which are absorbed in the proximal ilium
Where are bile acids reabsorbed?
digestion begins in the small intestine and bile acids are reabsorbed in the ileum
if ileum is removed, fat absorption and bile acid reabsorption can be severely impaired
What is the max amount of fat that is excreted in a normal day for patients?
7g/ 24hr which can be quantized with a 72hr stool sample
fat malabsorption can lead to calcium malabsorption
What are some of the consequences of malabsorption of fat soluble vitamins?
Vit A: night blindness, hypkeratosis
Vit D: hypocalcemia, osteoporosis, osteomalacia
Vit K: prolonged PT, easy brushing
Vit E: hemolytic anemia, axonal degeneration
Salivary enzymes are inhibited by ____ enzymes.
gastric
What are the causes and consequences of carbohydrate malabsorption?
lack of particular brush boarder enzymes can lead to undigested, unabsorbed oligosaccharides in the colon leading to diarrhea, bloating, flatulence
these molecules are fermentable (produce gas) and are osmotically active (cause diarrhea)
Name some poorly absorbed carbohydrates.
fructose
fructans (polymers of fructose): ie. inulin
sugar alcohols or polyols: monitor, sorbitol, erythritol, xylitol
galactans: i.e.. in legumes
lactose
What does FODMAP stand for?
Fermentable Oligo-saccharides (fructans, galactans) Di saccharides (lactose) Mono saccharides (fructose) and Polls (sugar alcohols)
Describe the strategy for treatment of carbohydrate intolerance.
elimination used to test toleration
re-introduce foods one at a time and monitor symptoms
use lease restrictive diet possible
ensure overall good diet quality and monitor for fear of eating
What are causes of malnutrition in patients with liver disease?
poor dietary intake due to increased alcohol
mal-digestion and malabsorption
abnormalities in the metabolism and storage of major and micronutrients
goals in tx are to correct malnutrition, provide adequate calories and prevent enceophalopathy
Thiamine deficiency in alcoholism can cause what syndrome?
Wernicke-Korsakoff syndrome
T/F Albumin is a single lab test that be used to dx malnutrition.
false, no single lab can dx malnutrition
What are there recommendation for protein, fat and carbohydrates in those with liver disease
protein 1.0-1.5 g/kg except with severe encephalopathy
avoid fasting if possible to spare protein and prevent hypoglycemia (small frequent meals)
moderation in fat, fat storage may increase in the liver due to impaired release of VLDL
formulas need to be concentrated and high calorie in order to minimize fluid intake
Patients with IBD have (increase/decrease) in nutrient requirement during active disease.
increased due to inflammation, necrosis and regeneration of epithelium, fever, sepsis and surgery
**take care for referring syndrome
Why are patients at risk for the following nutrient deficiencies in IBD? Calcium vitamin D iron potassium zinc, magnesium folate B12
Calcium: avoidance of dairy, steroids interfere
vitamin D: fat soluble
iron: blood loss in stool, decreased intake
potassium: diarrhea and prednisone therapy
zinc, magnesium: diarrhea, surgery
folate: avoiding leafy greens, sulfasalazine
B12: absorption requires functioning small bowel
