NUTRITION IN SPECIFIC GI DISEASE STATES (AB) Flashcards
What is intestinal failure (IF)?
State of insufficient intestinal capacity to fulfill nutritional demands, resulting in dependency on parenteral nutrition (PN)
What is the primary site of digestion and absorption in the gastrointestinal tract?
Small intestine
What happens when diseases affect the small intestine?
They can lead to intestinal failure
What is the ESPEN definition of intestinal failure?
Decreased absorption of macronutrients, water, and electrolytes due to loss of gut function, requiring parenteral support
What are the three types of intestinal failure?
Type I, Type II, Type III
What is Type I intestinal failure?
Acute, short-term failure due to self-limiting conditions like paralytic ileus, may require brief nutritional support
What is Type II intestinal failure?
Prolonged acute condition in metabolically unstable patients requiring IV supplementation for weeks to months, may be reversible or progress to Type III
What is Type III intestinal failure?
Chronic intestinal failure requiring long-term nutritional support, typically home parenteral nutrition (PN)
What are common etiologies of Type III intestinal failure?
Crohn’s disease, radiation enteritis, intestinal obstruction, dysmotility, intestinal trauma, congenital disorders, intestinal fistulae, vascular complications (e.g., ischemia)
What is short bowel syndrome (SBS)?
Intestinal malabsorption associated with functional intestine length <200 cm
What happens during Stage I of short bowel syndrome?
Occurs in the first few weeks after surgery; significant fluid and electrolyte shifts require IV fluids to prevent dehydration
What happens during Stage II of short bowel syndrome?
May last up to 2 years; structural and functional adaptation occur
What is structural adaptation in SBS?
Increase in size and absorptive surface due to cellular hyperplasia
What is functional adaptation in SBS?
Slowing of bowel transit to increase time for absorption
What happens during Stage III of short bowel syndrome?
Maintenance or stable phase; no further improvement or adaptation
What does nutritional management of SBS depend on?
Amount and location of small intestine removed
What is the role of proton pump inhibitors (PPIs) in SBS?
Decrease gastric acid hypersecretion
What medications are used to slow intestinal transit in SBS?
Anticholinergics and opioids
What are the 3 stages of post-resection nutritional management in SBS?
Stage I - Parenteral nutrition, Stage II - Gradual introduction of oral feeding with PN reduction, Stage III - Maintenance phase
What dietary strategies are recommended during Stage II of SBS?
Small frequent meals, avoid simple sugars, fiber, and nutrient-poor foods, separate fluid and solid intake
How does feeding liquids only affect gastric emptying time?
Liquids empty faster than solids
Which macronutrient empties from the stomach fastest?
Carbohydrates
What is the order of gastric emptying speed by macronutrient?
Carbohydrates > Protein > Fats
When is lactose usually well-tolerated in SBS?
Unless the proximal jejunum is resected
How much should dietary intake be increased in SBS patients?
At least 50% (only half of macronutrients are absorbed)
How is enteral nutrition (EN) advanced in SBS patients?
Slowly advanced while PN is isocalorically decreased over months
What symptoms should be monitored to assess tolerance in SBS patients?
Diarrhea, food/fluid intake, stool/urine output, body weight, hydration, macronutrient levels
What are the 3 clinical types of short bowel syndrome?
Type I, Type II, Type III
What characterizes Type I short bowel syndrome?
Only jejunum remains with end jejunostomy and no colon, with massive fluid shifts and poor adaptation
What characterizes Type II short bowel syndrome?
Variable jejunum length connected to some colon, with slow nutritional deterioration without parenteral support
What characterizes Type III short bowel syndrome?
Best adaptation potential with preserved colon and ileocecal valve, production of GLP-1 stimulates adaptation
What is the role of GLP-1 in intestinal rehabilitation?
Trophic effect and stimulates small bowel adaptation
What clinical factors predict success of intestinal rehabilitation?
Residual disease, bowel length, degree of adaptation, duration on PN
What bowel length allows intestinal autonomy if the colon is intact?
70-90 cm small intestine with intact colon
What bowel length allows intestinal autonomy if the colon is absent?
130-150 cm small intestine with no colon
How much small bowel remaining is classified as severe inflammatory bowel syndrome?
<200 cm
What type of oral rehydration solution (ORS) is recommended in severe inflammatory bowel syndrome?
ORS with sodium concentration of at least 90 mmol/L
How much ORS is recommended daily to prevent dehydration in severe inflammatory bowel syndrome?
2-3 liters per day
What types of fluids should be avoided in severe inflammatory bowel syndrome?
Hypo-osmolar and hyperosmolar fluids
How does osmolarity affect gastric emptying time?
It influences gastric emptying time
What is the management for partial ileal resection with intact colon?
Cholestyramine
Should fat restriction be used for SBS Type I patients without a colon?
No
When are Vitamin B12 injections needed in SBS?
If >50-60 cm of terminal ileum is resected
What is the role of GLP-2 analogs in SBS?
Stimulates small intestinal mucosa, improving absorption
What is the recommended timing for early feeding in acute pancreatitis?
Within 24-36 hours of admission
What are the benefits of early feeding in acute pancreatitis?
Lower risk of multiple organ failure (MOF), operative interventions, systemic infections, septic complications, and mortality
What is the key issue in nutritional therapy for acute pancreatitis?
Severity of Systemic Inflammatory Response Syndrome (SIRS)
In severe SIRS requiring ICU admission, what feeding method is recommended and when?
NG/NJ tube with enteral nutrition within 24-36 hours
What is the recommended nutritional approach for minimal SIRS in acute pancreatitis?
Oral diet as tolerated, enteral nutrition only if oral diet fails after 4 days
How does enteral nutrition (EN) impact severe acute pancreatitis outcomes?
Reduces total and pancreatic infectious complications, and reduces risk of death
What are common factors contributing to weight loss in chronic pancreatitis?
Hypermetabolism, abdominal pain, malabsorption, and diabetes
What type of feeding is offered in chronic pancreatitis patients?
Jejunal feeding
What antioxidant supplements are recommended in chronic pancreatitis?
Selenium, ascorbic acid, beta-carotene, alpha-tocopherol, and methionine
What dietary pattern is recommended for chronic pancreatitis?
Small frequent meals, avoiding difficult-to-digest foods (e.g., legumes)
Is fat restriction recommended in chronic pancreatitis?
No, fat restriction is no longer recommended
What type of fat can be used for extra calories in chronic pancreatitis patients with weight loss?
Medium-chain triglycerides (MCTs)
What are the common side effects of MCTs in chronic pancreatitis?
Foul taste, cramps, nausea, diarrhea
What vitamins and minerals should be replaced in chronic pancreatitis?
Fat-soluble vitamins (A, D, E, K), vitamin B12, and calcium
What micronutrient deficiencies are common in Crohn’s disease?
Magnesium, selenium, potassium, zinc, iron, vitamin B12
What percentage of Crohn’s disease patients have vitamin D deficiency?
0.5
What is the preferred initial nutrition therapy in Crohn’s disease?
Enteral Nutrition (EN)
When is Parenteral Nutrition (PN) used in Crohn’s disease?
Only if EN fails or cannot be delivered
What percentage of cirrhotic patients suffer from malnutrition?
50-90%
What factors contribute to malnutrition in liver disease?
Malabsorption, altered metabolism, decreased storage, increased requirements, decreased intake
What deficiency causes dysguesia in cirrhosis?
Magnesium deficiency
What is the recommended supplementation for dysguesia in liver disease?
Multivitamins with magnesium
What dietary restrictions further aggravate malnutrition in cirrhotic patients?
Sodium and protein restriction
Why do cirrhotic patients have fat intolerance and fat-soluble vitamin malabsorption?
Decreased bile salt production
How does hypoalbuminemia contribute to malnutrition in liver disease?
Causes small intestinal edema, reducing nutrient absorption
What is the role of portosystemic shunting in liver disease?
Nutrients bypass the liver, preventing metabolism
What metabolic changes occur in cirrhotic patients?
Upregulation of gluconeogenesis and protein catabolism, downregulation of glycogenolysis
What is the impact of cirrhosis on muscle mass and protein requirements?
Muscle wasting increases protein needs
Why are BCAAs preferred for cirrhotic patients?
They prevent hepatic encephalopathy by avoiding excess aromatic amino acids
What micronutrient deficiencies are common in alcohol-associated and non-alcoholic liver disease?
Water-soluble vitamins (B and C)
What deficiency can lead to Wernicke encephalopathy and Korsakoff dementia in cirrhosis?
Thiamine deficiency
What vitamin deficiencies are linked to HCV infection?
Folate and vitamin B6
What type of liver disease is associated with more frequent fat-soluble vitamin deficiencies?
Cholestatic liver disease
What deficiency is a risk factor for hepatocellular carcinoma (HCC)?
Vitamin A deficiency
How do vitamin D levels change in liver disease?
Decrease as liver disease progresses
What role does vitamin E play in liver disease?
Deficiency may facilitate progression of fatty liver to steatohepatitis
What micronutrient deficiency is especially common in alcohol-associated liver disease?
Zinc deficiency
What are symptoms of zinc deficiency in liver disease?
Anorexia, altered taste, immune dysfunction, protein metabolism issues, hepatic encephalopathy, impaired glucose tolerance
Why is zinc often coupled with vitamin C in supplementation?
Zinc enhances immune response
What micronutrients may be reduced or omitted in parenteral nutrition for liver disease?
Copper and manganese
What type of nutrition is preferred for cirrhotic patients?
Enteral nutrition (EN)
What is the recommended maximum fasting time for cirrhotic patients?
No more than 3 hours
What bedtime snack is recommended for cirrhotic patients?
BCAA peptide snack
What are common complications in malnourished cirrhotic patients after surgery or liver transplant?
More infections, longer ICU stays, longer hospitalizations
What lifestyle recommendations are given to cirrhotic patients with low resistance?
Vaccination and face mask use
What is another name for diverticular disease?
Colonic diverticulosis
What is the recommended daily fiber intake for diverticular disease?
At least 25 g/day of insoluble fiber
What role do probiotics play in diverticular disease?
Potential benefit in treatment and prevention of diverticulitis
What lifestyle factors increase the risk of diverticular disease?
Obesity and physical inactivity
What diet and activity recommendations are given to patients with diverticular disease?
Weight loss and regular exercise
What is dumping syndrome?
Rapid passage of food into the small intestine after gastric surgery
What are symptoms of early dumping syndrome?
Abdominal pain, diarrhea, borborygmi, bloating, nausea, flushing, sweating, tachycardia, hypotension, syncope
What causes early dumping syndrome?
Fluid shifts into duodenal lumen and GI hormone release after carbohydrate load
What are symptoms of late dumping syndrome?
Hypoglycemia, sweating, hunger, fatigue, syncope
What causes late dumping syndrome?
Excessive insulin release from rapid glucose absorption
What is the dietary strategy for post-gastrectomy dumping syndrome?
Small, frequent meals high in protein and fat, avoid simple sugars
What is the recommended fluid intake strategy for dumping syndrome?
Separate fluids from meals
What types of foods help slow gastric output in dumping syndrome?
High pectin foods like bananas and oranges
