Short Bowel (Week 3 GI)

Question 1

What the GI diseases?

Answer 1

• Short bowel syndrome
• Gastroesophageal Reflux (D)isease
• Dysphagia: Swallowing Abnormalities
• Peptic Ulcer Disease
• Celiac disease
• Irritable Bowel Syndrome
• Inflammatory Bowel Disease
• Diverticular Disease

Question 2

When is a nutrient considered in the body?

Answer 2

Only after nutrient is absorbed into the intestinal mucosa is it considered to be “in” the body

Question 3

What is the result of GI diseases?

Answer 3

most GI diseases result in some degree of malabsorption
* General effect: can affect all nutrients
* Specific effect: individual nutrients e.g. vitamin B12

Question 4

Draw out the absorption of nutrients

Answer 4

Question 5

What nutrients are absorbed in the duodenum?

Answer 5

• iron (mainly 2+)
• Calcium (2+)
• some magnesium and chloride
• sulfate SO42-

Question 6

What nutrients are absorbed in the jejunum?

Answer 6

• Macronutrients
• Glucose & other monosaccharides
• Fatty Acids
• Cholesterol
• Amino Acids & Peptides
• Water soluble vitamins
• Electrolytes
• Minerals
• Water

Question 7

What nutrients are absorbed in the ileum?

Answer 7

• Bile Acids
• Fat & Cholesterol
• Fat Soluble Vitamins
• Vitamin B12
• Electrolytes
• Water

Question 8

What nutrients are absorbed in the colon?

Answer 8

• iron
• calcium
• magnesium
• sodium
• potassium
• SCFAs
• vitamin K formed by bacterial action

Question 9

where are electrolytes absorbed?

Answer 9

All the way through the bowel but mostly in the colon

Question 10

Where can B12 be absorbed?

Answer 10

• mostly in ileum when attached to IF
• passive infusion at duodenum with high doses
• IM injection once a month if needed

Question 11

What is included in intestinal failure?

Answer 11

• short gut
• severe dismotility of bowel
• combination of both

Question 12

What is Short Bowel (Gut) Syndrome?

Answer 12

A condition that develops when the small intestine, also called the small bowel, is shortened or damaged and cannot absorb enough nutrients from the foods you eat to maintain health.

Question 13

What determines severity of short bowel syndrome?

Answer 13

• amount of bowel resected
• site of removal
• ileocecal valve resected/in place
• condition of remaining bowel

Question 14

Where is the ileocecal valve and why is it important?

Answer 14

sphincter muscle connection between large bowel and terminal ileum
* important because if IC valve is not closing properly the bacteria from the colon can come into small bowel and spread on to undigested foods creating toxins, interfereing with absorption, creating gases and if there is damage in small bowel the bacteria can get into circulation (bacterial translocation)
* may be neuronal dysfunction

Question 15

Treatment for short bowel syndrome

Answer 15

• often requires ostomy (can be lifestyle option)
• if malnutrition is untreatable then nutrition support which may be lifelong → oral/enteral elemental diet, TPN total/supplemental

Question 16

What is an anastomosis?

Answer 16

connects two ends of a channel (a tube or passageway) together. It’s usually done after part of the channel has been removed (resected). For example, if you have surgery to remove part of your intestines (bowel resection), the two severed ends of the intestine are reconnected.

Question 17

What is end-jejunostomy?

Answer 17

Extensive intestine removal that leads to ostomy bag (end-jejunostomy) This surgery involves removal of the colon, ileum, and some of the jejunum. The remaining jejunum is then connected to a surgical opening (called an ostomy) created in the belly.

Question 18

Malabsorption with missing ileum (and colon)

Answer 18

• water
• electrolytes
• fat
• vitamins A,D,E, and K
• vitamin B12
• plus watery diarrhea

.

Question 19

Benefit of colon if missing parts of the small bowel

Answer 19

Helps to maintain nutrient balance → greater chance of not being dependant on IV nutrition and fluid
* Significantly improves with presence of colon (up to 20% of enteral CHO can be absorbed)
* Undigested CHO- converted to SCFA by colonic bacteria; buytric acid-energy substrate for colonocyte
* MCT absorption?

Question 20

Purpose of nutrition care in short gut and intestinal failure

Answer 20

• To provide adequate energy and nutrients to support nutritional status.
• To feed enterally (if safe) to support ongoing liver and gastrointestinal health.
• Meet fluid and electrolyte requirements (can be variable)

Question 21

Questions to ask about the route of nutrition support.

Answer 21

When the gut works, use it!
1. What part of the GI tract is missing and/or signficiant dysfunction. and how well do pieces left work?
2. Is it safe to feed enterally (by tube or mouth) or would this put the patient at risk of bleeding, further damage to the GI tract
3. If feed enterally is possible, how much is it safe to feed enterally (via the GI tract)

Question 22

How can nutrition support be delivered?

Answer 22

• Oral + Tube Feeding
• Oral + IV hydration
• Oral + Tube Feeding + IV hydration
• Parenteral Nutrition + IV hydration ± small amounts of oral and/or EN tube feeding

Question 23

What does significant bowel failure require?

Answer 23

50% of the GI tract is missing and/or doesn’t work
* usually results in the need for IV parenteral support and/or need for IV hydration therapy.

Question 24

Signs to look for when planning nutrition support for short bowel

Answer 24

• look at stools - how much water
• physical signs
• hydration status
• hard bellies
• blood tests