Nutrition Final- Week 14

dumping syndrome (what is it? what causes symptoms?- due to rapid gastric emptying in some types of gastrectomy - quick emptying causes rapid increase in blood sugar, rapid insulin responsenutrition therapy for those with dumping syndrome- patient eat many small meals throughout the day - protein with every meal - avoid sugar - soluble fiber to slow gastric emptying - not recommended to drink fluids during mealNutrition problems for those who have had a gastrectomy- fat malabsorption: treat with medium chain FAs; problem due to rapid transit - bone disease: due to vitamin D deficiency and fat removing calcium from intestine, supplement calcium and vitamin D - anemia: reduced acid and intrinsic factor; decrease B12 and nonheme iron absorption **** if duodenum is removed more risk bc its absorbed there treat with B12 and iron supplementbariatric surgery is only for those with a BMI > _____.40gastric bypass (what is it? risks?)- reduce stomach size and connect to jejunum - reduced absorption, no duodenum - risk of nutrient deficiency and dumping syndromegastric sleeve- remove most of stomach leaving only a sleeve - attaches to the duodenumgastric banding- wrap upper stomach with band to decrease size - slows movement through the stomach which increases feeling of fullnessNutrition therapy for those who have had bariatric surgery- smaller meals - protein: 1.0-1.5g/kg/BW/day; use protein supplements - avoid doughy or sticky food - avoid high sugar foodsPeople who have had gastric bypass will need supplements of :- vitamin B12 *less intrinsic factor - vitamin D - calcium ** fat malabsorption - and iron * most absorbed in the duodenumFewer than three poops a week is called ____________.constipationMedical conditions that lead to constipation:- diabetes - hypothyroid - Parkinsons - multiple sclerosisMedications that can lead to constipation:- diuretics - opiates - calcium or iron supplementsNutrition therapy for those who are constipated:- GRADUALLY increase fiber to 20/25g/day - ingest 1.5-2.0 liters water - eat breakfast - increase activitychloride agonists- Linzess: increase fluid secretion into intestinesfiber supplements- Citrucel or metamucil: increase stool weight and bulkosmotic laxatives- hold water in the intestines * Poorly absorbed salts - Epsom salt, milk of magnesia (magnesium salts) * Poorly absorbed sugars - Cephulac (sorbitol, lactulose)Laxatives: stimulants- E-lax or Dulcolax: stimulate peristalsis and mucus secretion - only if severe because can cause dependenceacute diarrhea- start abruptly due to infection or medication side effectchronic diarrhea- chronic GI infection/inflammation - malabsorptive/motility disorder, radiation, following parenteral nutritionosmotic diarrhea- unabsorbed material reduces water digestion - ingested material moves very quickly *sorbitol, mannitol, lactulose, Mg laxativessecretory diarrhea- fluid secreted into the GI tract is more than can be absorbed - can be caused by foodborne illness or intestinal inflammationmotility diarrhearapid intestinal transit due to increased contractionoral rehydration therapy- for those with lots of diarrhea - IV used for extreme dehydration - oral rehydration should have glucose to increase ion absorption (sports drinks are not ideal due to low Na)nutrition therapy for those with diarrhea- low fiber - low fat - lactose free - avoid sugar, alcohol, fructose - increase fluid ingestionFat malabsorption (Cause? Symptoms?)- caused by: * inadequate enzyme and bile * decreased lipase * decreased bile * increased motility * damage to the mucosa - symptom: fatty stool (steatorrhea)pancreatitis and cystic fibrosis cause decreased ___________. This causes fat malabsorption.lipaseliver disease causes decreased _____________ which causes fat malabsorption.bileconsequences of fat malabsorption- Loss of energy - Loss of essential fatty acids - Loss of fat-soluble vitamins - Decreased absorption of calcium, magnesium, and zinc - Increased risk of oxalate kidney stonesNutrition therapy for those with fat malabsorption- fat restriction - medium chain triglycerides can replace fat energy - multivitamin and mineral supplementsbacterial overgrowthCauses: impaired intestinal motility reduced gastric acidcauses of reduced GI motility- gastrectomy - stricture - diabetic neuropathy - muscular dystrophycauses of decreased GI acid production- atrophic gastritis - proton pump inhibitorsBacterial overgrowth in the GI tract causes: and treatment- fat malabsorption - deficiency in fat soluble vitamins and associated enzymes - increased risk of bacterial translocation - treatment: fat malabsorption therapypancreatitisinflammation of the pancreasacute inflammation of the pancreas (causes and symptoms)- premature activation of digestive enzymes cause digestion of pancreas - causes: *most from gallstones or alcohol abuse *elevated amylase and lipase in the blood Symptoms: - inadequate absorption of nutrients - severe abdominal pain, distension, nausea, vomitingnutritional therapy for pancreatitis (mild/moderate vs severe)mild to moderate: - support with IV hydration - regular low fat diet severe: - require tube feeding with elemental formula - 2x protein - multivitaminsChronic pancreatitis- progressive and permanent damage to the pancreas (enzyme and HCO3 secretion impaired) - usually caused by repeated bouts of acute; mostly in those abusing alcohol - symptoms: abdominal pain that worsens after eating with nausea and vomitingFat malabsorption in chronic pancreatitis can cause _____________ and ______________ release to decrease causing diabetes mellitusinsulin and glucagonnutrition therapy for those with chronic pancreatitis- pancreatic enzyme replacement - low fat diet - 2x protein - 35 kcal/kg/day - dietary supplement to correct deficiencycystic fibrosis- multiorgan disease with decreased secretion due to Chloride channel mutationconsequences of Chloride channel mutation in cystic fibrosis- lungs: impaired ability to clear thickened mucus - pancreas: exocrine dysfunction; blocks ducts - sweat glands: excessive salt loss - children have difficulty maintaining weight and meeting growth standardsnutrition therapy for cystic fibrosis- energy and protein needs high due to increased metabolism and nutrient malabsorption - high calorie/high fat/high protein - replace pancreatic enzymes every time eat - essential FA - Ca, Fe, Zn supplement - increase salt ingestion_____________ has energy requirements 120-150% above DRI.Cystic Fibrosisceliac disease (cause, consequences, symptoms)- autoimmune response to foods with gluten - damage to SI mucosa leading to malabsorption - leads to anemia, osteoporosis, and dermatitis - symptoms: diarrhea, steatorrhea, and flatulence (haha)nutrition therapy for those with celiac disease- gluten free - avoid milk (mucosal damage impacts lactase - dietary supplements for vitamin B12, folate, vitamin D, Ca, Fe, Zn, Mg, and fiberChron's disease- inflammation of small/large intestine (can lead to nutrient malabsorption) Lesion develop in regions along intestine - extend deep into wall and require surgery Surgery required due to extent inflammation and narrowing of intestine - stricture/obstruction Malnutrition from: Poor intake, malabsorption, diarrhea, nutrient loss (protein), bleed, metabolism (inflammation) Ileum - deplete bile salt, vit B12, fat soluble vitamins, Ca, Mg & Zn (fatty acids bind divalent cations)Nutrition therapy for Chron's diseasefood avoidance common because of pain (tube feeding, oral supplements) High calorie, high protein diet recommended Vitamin & mineral supplement required - Mg, Zn Anemia (bleeding, vitamin/mineral deficiency) - B12, folate, Fe Osteoporosis - vit D, Ca Adequate fluid if diarrhea During exacerbation - low fiber, low fat in small amounts (frequently) to reduce stool outputulcerative colitis- inflammation of large intestine/rectum (less risk of malnutrition) Involve rectum and colon - frequency, urgent bowel movements (small volume, blood) Severe disease associated with anemia (blood loss), dehydration and electrolyte imbalance Protein loss can be substantial - protein-energy malnutritionulcerative colitis nutrition therapyfew adjustment required but based upon extent diarrhea and bleeding During episodes - fluid/electrolyte replacement and address blood loss (folate, B12, iron) Moderate protein diet to address loss of protein - adequate calories Low fiber diet to reduce fecal volumeshort bowel syndromeDue to resectioning of bowel (>50% reduction before malabsorption occurs) Used to treat Crohn's, intestinal cancers other intestinal conditions Malabsorption leads to kidney (urinary oxalate) and gallstones (bile malabsorption) Loss of ileocecal valve increases risk of intestinal bacterial overgrowth Malabsorption syndrome results from the remaining intestine not meeting absorption needs Fluid/electrolyte imbalance, nutrient deficiencies Duodenum - calcium and Fe absorption decreased Ileum - extensive adaptation can make up for resection of duodenum and jejunum If removed - malabsorption fat (bile recycling), vit B12, protein, fat soluble vitamins, Ca, Mg, Zn, waternutrition therapy for short bowel syndromefluid/electrolyte loss is biggest problem post surgery (IV) Total parenteral nutrition required - replaced within a week with tube and oral feeding Tube and oral feeding increases ileum adaptation Start with sugar free liquids and then transition to liquid formulas then solid food Frequent, small meals - high calorie diet recommended (compensate for malabsorption) Specific diet depends upon the segment(s) removed and addressing any issues (and allowing for adaptation) Vitamin and mineral supplements may be needed - B12 injection if ileum removedirritable bowel syndrome- Large intestine - most common GI disorder Frequent or severe abdominal pain or cramping and disturbance in GI motility Stronger contractions cause gas, bloating and diarrhea Symptoms vary in intensity Cause unclear - stress, certain foods or stronger response to GI tract hormones Intestinal transit accelerated (diarrhea) or delayed (constipation) Hypersensitivity to stretch Low grade intestinal inflammationnutrition therapy for IBS- identify foods that they are sensitive to and avoid (trial and error) Diet free of gluten and free of FODMAP are recommended High fiber have been recommended but recent work suggests no benefit (and may worsen)diverticulosisPresence of pebble sized herniations (outpockets) in large intestine mucosa Cause - unclear with many risk factors (few symptoms) Common complication is diverticulitis - inflammation develops around the herniations Lead to microperforations of colon that can become infected (and enlarge) Symptoms - abdominal pain, tenderness, fever, nausea, vomiting, diarrhea or constipationnutrition therapy for diverticulosisIf constipated - increase insoluble fibers (do so slowly to ensure tolerated) Current research has not supported avoiding nuts or seeds Mild cases - reduce oral intake until tolerated (usually not last too long) Severe cases - oral fluid and food withheld and fluids delivered IV Once symptoms resolve - start with liquid diet to low fiber (10 g/day) to high fiber (25-35 g/day)ileostomy: nutrition therapyChew food completely and reduce insoluble fiber - prevent obstruction and increase transit time (slow) Increase fluid & electrolyte ingestion (salt liberally and sports beverages) If large segment ileum removed, fat malabsorption results (see Short Bowel Syndrome)colostomy nutrition therapyshould return to normal diet If large portion removed, recommendations similar to ileostomy