W10 Pathophysiology of digestive disorders and the requirement of TPN Flashcards
What are some common digestive disorders? (5)
- GORD
- peptic ulcers
- celiac disease
- IBD- inflammatory bowel disease (Crohns and UC)
- Pancreatitis
What is GORD?
Definition?
Symptoms?
Gastro oesophageal reflux disease
GORD occurs when the lower oesophageal sphincter fails to prevent stomach acid from flowing back into the oesophagus
Symptoms include heartburn, regurgitation, and chest pain
Chronic reflux can cause inflammation, erosions, and complications such as oesophageal strictures and barrett’s oesophagus
What are peptic ulcers situated?
What are they caused by? (2)
Develop in the stomach or the first part of the small intestine (duodenum)
- Most ulcers are caused by infection with helicobacter pylori bacteria, or by nsaids
- Ulcers can erode through the lining of the stomach or duodenum, leading to bleeding, perforation, and obstruction
Affects nutrient absorption e.g. Vitb12
What is IBD?
Inflammatory Bowel Disease (IBD):
Crohn’s disease and ulcerative colitis
Can affect any part of the gastrointestinal tract, causing symptoms like abdominal pain, diarrhoea, and rectal bleeding.
The immune system plays a significant role in ibd pathophysiology, leading to continuous inflammation and tissue damage
What is celiac disease?
- An autoimmune disorder characterised by an immune reaction to gluten – a protein found in wheat, barley, and rye
- The immune response triggered by gluten damages the small intestine’s lining, leading to malabsorption of nutrients
- Symptoms may include abdominal pain, bloating, diarrhoea, weight loss, and fatigue.
Differences in IBD:
Symptoms?
Malnutrition?
Crohns:
* Patchy inflammation throughout small and large bowel
Malnutrition is common- bc its affecting lots of areas
symptoms- depends on location of disease. may include abdominal pain, diarrhoea, weight loss and fatigue
UC: Malnutrition is less common
symptoms-
continuous and uniform inflammation in the large bowel
SIGNS OF MALNUTRITION?
➢ Under-eating and/or severely restricting the variety and types of foods eaten
➢ Weight loss
➢ General fatigue and low energy
➢ Weakness
➢ Loss of muscle mass
➢ Vitamin and mineral deficiency
What nutrients are absorbed in the ileum?
Vitamin B12
Vitamin D, K
Magnesium
Folate
Others depending on transit time
Micronutrient deficiencies
- Most common micronutrient deficiencies are of vitamin D, zinc, iron, and vitamin B12
Vitamin B12 malabsorption occurs frequently after terminal ileum resection - Ileocecal valve damage / resection»_space;> reduces intestinal transit duration and increases the risk of bacterial mis-colonisation of the small bowel, increasing the likelihood of additional bile acid deconjugation and depletion of the vitamin B12 intrinsic factor complex»_space;>pernicious anaemia
- Deficiencies of fat-soluble vitamins arise as a direct result of disrupted fat resorption. If untreated, these deficiencies can lead to night blindness (vitamin A), coagulation disturbances (vitamin K), and, in the long term, bone metabolism disorders and even osteoporosis (vitamin D)
- Patients with intestinal failure are prone to iron deficiency as result of malabsorption, gastrointestinal blood loss, and multiple surgical procedures
- Diarrhoea»_space;> large quantities of zinc are lost, with losses of 12 mg zinc per litre stoma output not unusual
IBD in children- factors
Malabsorption, inc metabolic demands, reduced nutrient intake
= leads to malnutrition
Malnutrition, Inflammatory cytokines, Corticosteroid therapy
= leads to dec growth velocity
IBD in children :
- Growth failure and pubertal delay are common complications of paediatric IBD
- Iron deficiency is common in IBD
- Increased prevalence of vitamin D deficiency in IBD
- Low bone mineral density affects children with Crohn’s disease at diagnosis
- Screening and monitoring guidelines of bone mineral density are needed in children with IBD.
- Exclusive enteral nutrition (EEN) is the recommended first-line therapy to treat active Crohn’s disease. The formula-based (no solid foods) diet is designed to induce remission in patients
- EEN therapy may be as effective as corticosteroids for the induction of remission for children with CD
Nutritional interventions to ameliorate intestinal inflammation
What is enteral nutrition?
- Enteral nutrition is a fluid given through a tube that is inserted into the nose, down the throat, and into the stomach
- This tube is called a nasogastric, or NG, tube
- The fluid contains essential nutrients and helps supplement or replace a regular diet
- The intestines absorb nutrients from the fluid more easily than from regular food
What is Partial enteral nutrition?
Partial enteral nutrition, or PEN, means you receive between 30 and 50% of your calories from formula and the remainder from regular food
What is Total Parenteral Nutrition (TPN)?
- TPN represents a therapeutic modality that could save the life of a patient with IBD facing severe nutritional problems, by restoring the patient’s impaired nutritional status
- There is no single diet or eating plan that will work for everyone with Crohn’s disease or ulcerative colitis
- Dietary recommendations must be tailored for each patient, depending on what part of the intestines is affected and what symptoms are present
- There may be times when modifying a patient’s diet can be helpful, particularly during a flare
What is Exclusive enteral nutrition (EEN)?
Receive calories through formula patients do not eat regular food. EEN has been proven to induce remission in children with Crohn’s disease, and is a popular paediatric therapy in Western Europe
