remainder Flashcards
fatty foods and alcohol
decrease LES pressure
gastric ulcers develop even with low acid output
false
duodenal ulcers develop with high gastric acid secretions
H2 Blocking agents
decrease gastric acid
lack of if cause macrocytic anemia
low residue diet is fiber
les than 20 grams of insoluble fiber
in a illeal resection
inssuficient bile salts to emulsify the lipids
diverticulosis is treated with
high fiber diet
normal amount of fat excreted n diter
2-6 grams
ascites fluid resctriction
if they are on low sodium with hypnatremia
amino acids that decrease
BCAA v l i
valine leucine isoleucine
spider nevi
portal pressure
hepatic encephalopathy meds
lactulose rifaximin
minerals malabsorbed in steatorrhea
ca mg zn
POST lver trasnplant 6 onths foward
mod pro intake
wt mntc
mod fat 30%
pancreatitis 2 main causes
low albumin and soap formation by ca and fatty acids
severe acute pancatitis
not using GI tract worsen symptoms use jejunal lower feeding to minimize pancreatic stimulations
this lab indicated impaired liver funtion
ammonia
chonric alcoohol abuse can beneifit from supplementation of
thiamine
encelophathy encourage veggie proteins
true
post liver transplant should follow
moderate protein low fat
bile salts and low fat are MNT for
gallstone
pancretitis patients should limiti
fatty foods and alcolhol
this kind of nutrition suppport maybe needed for acute severe pancreatitis patients
tpn
check which lab before starin TPN in hepatic patients
tg
ranks severity of pancreatitis
ranson
ebb phase
hypovelemic shock
hrmone response in metabolic stress
cortisol mobilizes amino acids from skeleton muscles
glucose levels metabolic stress
140-180
burns
replace fluids and elecyrolyctes
first step in controling fat malabsoprtion
enzymes
CF pulmonary
Na , salt losses sweat losses
post operative metabolic and pulmonary tpm can be given if
pt cant oral 5-7 days or moere
albumin can be low
negatve acute phase protein and multiple fluid
tisseu hypozia with COPD causes
anorexia, bloating and early satiety, constipation
weight loss in COPD is common bc
work of breatign and low energy intake
overhydration vs deydration in pulmonary pts
we will see more =overhydration in these pts
lab data expected to see decreased electrolys low protein - diluted effec
rq is respiratory quotient and is highest wen
a lot of cals are consumed
if rq is 2 or 3
we are feeding too much
if rq >1
decrease total caloric intake
adjust cho to lipid rato
decrease especially cho
if rq is < .8
increase calories
** IN CF WE RECOMMEND
LOW SALT DIET, PANCRATIC ENZYMES, WATER SOLUBLE VITAMINS
SEVERELY MALNOURISHED PTS IN MET/PULM STRESS
TPN
WANT TO DO A CLEAR LIQUID DIET - JUICE OR JELLO
IF OPTION DO TUBE FEEDING NG EVEN IF WELL NOURISHED
FUEL SOURCE FOR ENTEROCYTES N CRITICAL ILLNESS
GLUTAMINE
.261
MNT for oxalate kidney stones includes
High Ca diet and low oxalate foods
Bacterial hydrolysis of blood from bleeding varices can lead to
Increased NH3
NutraHep TF product is
high in BCAA
Rapid ingestion/digestion of simple CHO causing increased insulin secretion is
Dumping syndrome
Guaiac and Melena are medical terms for
Blood in stool
The Hippocratic writings encourage physicians to recognize when medicine has reached its limit of usefulness. So it is ethically defensibe to … hydration and nutrition support for some patients who
have advanced dementia
are in a persistent vegetative state
are terminally ill
ALLLLLLL THE ANSWERS ARE CORRRECT!!!!
General energy requirements for cancer pts
30-35 kcal /kg
Cancer cachexia
Progressive wt loss anorexia wasting weakened increased lipolysis
Cytokines produced by tumor . Causes proteolysis - amino acids. n excretion
Lipid mobilizing factor
Inhibits lipase no fat stores
Therefore bold goes back to liver and they are broken down into TG
Medication for cancer cachexia
Magestrol/ megaCe
Used for anorexia cachexia and unplanned wt loss
Make sure pt doesn’t have a hx of clotting or on blood thinning
When calcium level is high in cancer
We don’t put them on low calcium
We treat with hydration
Make sure they are not getting calcium supllmentestion and Vit d
MNT for chemotherapy side effects
Diarrhea
MAINTAIN HYDRATION STATUS
replace electrolytes
Low fat low fiber possibly low
Bulking agents BRAT diet
FOOD AND DEUG INTERACTION cancer Tx
Alimta
Requires b12 and folic acid to avoid anemia
MNT FOR CHEMOTHERAPY SIDE EFFECT ORAL CHANGES
Hydration tart foods
Bitterness in meat
Meat aversions
MNT for chemotherapy for oral mucositis
Soft diet and liquids
Tamoxifen and a astrodome side effects
Hormonal
Hot flashes
Radiation induced enteritis
Supplement b 12 fat soluble and calcium to prevent deficiency
CANCER pancreatic surgery , Whipple procedure MNT
Enzyme replacement, small frequent low fat meals and snacks, avoid simples CHO
Enzymes allow them to eat
Resection of terminal ileum
MNT
Bile salts losses steatorrhea
B12 malabsorption
Diet low in fat osmolality lactose and oxalates
When can you start using the GI tract cancer
if diarrhea ia less than 500 ml/day
Minimal amount of fluid needed to eliminate daily fixed solute load of around 600 mOsm
500 mL
Osteodystrophy in kidney disease
High serum phosphorus stimulates PTH o help with resorption of calcium from the blood - a way to help the blood calcium normal
GFR calculator kidney disease, uses
serum creatinine, age, race, gender
Lab tests renal disease
high BUN
excessice body protein catabolism
GI bleeding
high BUN doesn’t always mean renal
Biggest risk factor for kidney stone
not drinking enough water
nephritic syndrome MNT
restrict sodium to control BP
Edema in nephrotic syndrome causes
`Proteinuria- GI permeability lower albumin in blood more oncotic pressure more edema
Glomerular injury leads to decrease in GFR then kidney kicks in rening angio tensin - retention of water and sodium
Nephrotic syndrome nutrition
.8 PRO
35KCAL/KG/DAY
3G SODIUM
low sodium low protein helps control edema
high biological value protein
contains all essencial amino acids
juice used to treat bacterial infection in kidney - pyelonephritis
cranberry and blueberry
Acute kidney disease oliguria amount
< 500 mL per day
Kidney transplant medication can cause increase in serum
potassium
name of kidney transplant medications
cyclosporine tacrolimus
causes high potassium htn hlp
dialysis diet
low K, low sodium, postassium exchanges
veggies ad fruites broken broken down in - renal diet
potassium content
**MNT for constipation
Adequate mix of soluble and insoluble fiber
Adequate fluid intake
Exercise
Soluble fiber
fruits veggies oats
forms a gel and slows down digestion
o good for watery diarrhea
insoluble fiber
bran wheat brans
absorbs water increases stool wegiht so speeds up time in small intestine - stumlats bowel mocement
**EXUDATIVE DIARRHEA characteristics
Mucosal damage - outpouring, mucous, fluid, blood
**EXUDATIVE DIARRHEA associated with
chrons disease
Ulcerative colitis
radiation enteritis
****osmotic diarrhea related to
solute that cant be absorbed
dumping syndrome
lactose intoleracne
releived by fasting
***secretory diarrhea
from bacterial exotoxin
c diff
viruses
increases intestinal hormone secrestions
***malabsorptive diarrhea
steatorrhea - excess fat
inflammatory bowel disease or bowel resection
not enough bile and pancreatic enzymes to digest
not getting the breakdown needed
**steatorrhea
excess fat n stool
60 g normal is 2-6 g
steatorrhea related to*****
lver disease
disease involvng distal ileum
BLIND LOOP SYNDROME
MNT for steatorrhea*****
MCT - synthetic fats
products absorbed witout bile salts
*****MNT for diarrhea
manage fluid and electrolyte - be careufl with dehydration
**minimal residue diet
insoluble fiber >20 g
*****MNT for diarrhea in chldren
replace Na and K losses
*** celiac disease gluten
specific peptide fraction of proteins - resistant to complete digestion by GI enzymes
Inflammatory bowel disease - CRONS DISEASE vs UC
Crons can eba naywhere along the GI TRACT
uc limited to large intestine and rectum
** inflamatory bowel disease etiology
inappropriate inflammatory response and ablity to suppress it
damage to the cells of the small / large intestine
malabsorption, ulceration, stricture
*****Energy requirements for IBD
energy requirements are constant unless weight gain desired
1.3-1.5 protein
bc of steroid use and protein losses from mucosa
divertculitis
bowel rest
short bowel syndrome - resection
b12 - intrinsic factor
*****!!! see nutrition for short bowel syndrome CHO FAT AND OXALATE
*** SMALL INTESTINE BACTERIAL OVERGROWTH SIVBO OR BLIND LOOP SYNDROME
overgrowth of bacteria
*** SMALL INTESTINE BACTERIAL OVERGROWTH SIVBO OR BLIND LOOP SYNDROME
consequences
B12 DEFICIENCY
