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Transcript
The Inflammatory Bowel Diseases
Crohn’s Disease
Ulcerative Colitis
Ulceration + granulomas usually in
ileum and colon.
At risk: Jewish descent; ages 20-40
Causes? Unknown
Treatments? Palliative; no cure yet.
Progressive loss of absorptive capacity due to:
build-up of fibrous tissue
narrowing of intestinal lumen
Other common complications:
Fibrous tissue causes obstruction.
Often obstruction leads to infection
(infection in peritoneal cavity= peritonitis)
Fistulas: the joining of inflammed tissue to nearby
organs or skin.
stomach:intestine
stomach:colon
intestine:skin
(high volume fistulas)
Sx:
Weight Loss 2˚ to anorexia
N/ V / D
abdominal pain
Nutritional Sequelae:
PEM
Low serum albumin
Immune fxn
Common deficiencies: Ca, Mg, Zn, B12, folate
Vitamin C, folate
Supplements often required.
After acute attacks, bowel rest recommended
Feeding route (oral, tube, or parenteral) determined by status
Enteral often chosen (usually “hydrolyzed” formulas“predigested” amino acids, monosaccharides, etc.)
Oral diets = high kcal, high protein
(fat-restricted if malabsorbing fat;
Lactose intolerance often accompanies Crohn’s)
Short bowel syndrome (SBS)
Gut “short” to due surgeries to remove
significant portion of GI tract
Surgeries? IBD, Cancer, Repair fistulas/
obstructions, diverticulitis
Sx?
“Everything but the kitchen sink”
rapid mobilization of
D, wt loss, wasting (muscle tissue for energy),
malabsorption, anemia, hypoCa, Mg emias.
Nutritional effects?
What part(s) resected?
Small Bowel Resection:
Adaptation and Feeding
On average ~50% of small bowel resection tolerable if ileum ,
ileocecal valve and colon remains.
= TREMENDOUS ADAPTIVE ABSORPTION/DIGESTION
CAPACITY
(EVEN THE COLON CAN TAKE OVER CERTAIN
NONTYPICAL ABSORPTIVE FUNCTIONS)
ILEUM RESECTED? PRO/FAT/CHO MALABSORPTION
MULTIPLE VITAMIN/MINERAL DEFICITS
Feeding Strategies
Return of bowel sounds
Start using enteral route as soon as possible to promote
adaptation!
Use enteral formulas containing preferred GI fuels:
Glutamine, Short Chain Fatty Acids
(fermentation products of WS fibers)
Type of regular diet? Fat-restricted (20% of kcal),
high CHO (60% kcal), low oxalate
No colon? Likely require long-term parenteral nutrition
Celiac Sprue, Gluten-Sensitive Enteropathy, Celiac Disease
Genetically Determined Food Sensitivity Caused by a Protein
Component of Gluten
(Gliadin; found in wheat, oats, rye, barley; often in
processed foods containing thickeners such as
salad dressing, ice creams, etc.)
READ FOOD LABELS!!
Substitutes:
soy flour, corn, potato, rice, or low-gluten
wheat starch
Presenting Sx:
steatorrhea, wt loss, diarrhea
PEM, anemia
PEM
Low serum albumin
Edema
Etiology:
Gliadin causes massive flattening/atropy
of intestinal villi
2˚ lactose intolerance may develop.
Two-three weeks gluten-free diet reverses sx
(Watch for breaded foods, Ovaltine, beer, root beer,
Postum, soups in addition to bread/cracker/
cereal products)