Di Week 1 Mnt Terms

Front 1

Anorexia

Back 1

lack or loss of appetite. extreme weight loss (eating disorder-dieting) or with disease

Front 2

Anuria

Back 2

failure of the kidneys to produce urine; lack of urine formation by the kidney

Front 3

Aphasia

Back 3

loss ability to speak, process words, language due to brain damage; absence or impairment of communication through speech

Front 4

Ascites

Back 4

accumulation of fluid, serum proteins and electrolytes w/in the peritoneal cavity (p 653) occurs when blood cannot leave the liver in ascites, a dilution factor can cause low serum albumin; abnormal collection of fluid in the abdomen. A serious consequence of liver disease.

Front 5

Aspiration

Back 5

the action of drawing breath, withdrawal of fluid from a cavity or sac. In breast aspiration, a needle is used to remove fluid from cystic lesions in the breast. The fluid is analyzed for the presence of malignant cells. (Terminology p.236)

Front 6

Cachexia

Back 6

wasting syndrome is loss of weight, muscle atrophy, fatigue, weakness

Front 7

Decubitus Ulcers

Back 7

(pressure sore/ bedsore.) chronic ulcer of skin and underlying tissues caused by prolonged pressure on the body surface of bedridden patients

Front 8

Diuresis

Back 8

excretion of a large volume of urine

Front 9

Dysphagia

Back 9

difficulty swallowing

Front 10

Dyspnea

Back 10

difficult/ labored/ painful breathing

Front 11

Edema

Back 11

abnormal swelling/fluid collection in spaces between the cells of the body

Front 12

Encephalopathy

Back 12

disease of the brain may be brought about by multiple causes including drugs, liver toxicity, injury or genetics.

Front 13

Extubation

Back 13

removing a tube from the body

Front 14

Fistula

Back 14

abnormal channel between organs

Front 15

Guaiac

Back 15

chemical used to determine blood in fecal occult blood test

Front 16

Hepatomegaly

Back 16

abnormal enlargement condition of the liver

Front 17

Hyperemesis

Back 17

excessive vomiting and nausea

Front 18

Idiopathic

Back 18

condition of unknown origin

Front 19

Ileus

Back 19

Severe reduction in peristalsis, but not due to mechanical or obstructive reasons. Typically caused by pain killers, GI surgery, reduced blood flow to the intestines, injury/ trauma, or abdominal infections.

Front 20

Intubation

Back 20

placing tubes inside the body

Front 21

Melena

Back 21

refers to black, tarry stools that are common in peptic ulcer disease especially in older adults. Melena may suggest either acute or chronic upper GI bleeding.

Front 22

Neutropenic

Back 22

related to reduced white blood cells or neutrophils

Front 23

Oliguria

Back 23

urine volume of less than 500mL/day.

Front 24

Palliative

Back 24

the alleviation of physical symptoms, anxiety, and fear while attempting to maintain the patient’s ability to function independently.

Front 25

Paracentesis

Back 25

surgical puncture of the membrane surrounding the abdomen (peritoneum) to remove fluid from the abdominal cavity. Fluid is drained for analysis and to prevent its accumulation in the abdomen. Also known as abdominocentesis.

Front 26

Paraplegic

Back 26

related to paralysis of the lower half of the body

Front 27

Pneumothorax

Back 27

air leaks into the space between your lung and chest wall. This air pushes on the outside of your lung and makes it collapse.

Front 28

Refeeding Syndrome

Back 28

patients who eat poorly previously and are on enteral or PN therapies may experience this if aggressive administration if nutrition, especially via the intravenous route, are administered. Symptoms in the syndrome include: severe, potentially lethal electrolyte fluctuations involving metabolic, hemodynamic, and neuromuscular problems.

Front 29

Tracheostomy

Back 29

creation of an opening into the trachea through the neck and the insertion of a tube to create an airway.

Front 30

Varices

Back 30

plural form of varix, enlarged, swollen veins

Front 31

Xerostomia

Back 31

dry mouth caused by inadequate saliva production.

Front 32

Nutrients absorbed in the DUODENUM

Back 32

Riboflavin (B2), Iron, Calcium, Magnesium, Zinc, phosphorus, copper, selenium, Manganese, thiamin (B1), niacin (B3), biotin, folate, vitamins C, A, D, E and K.

Front 33

Nutrients absorbed in the JEJUNUM

Back 33

Most of the protein the body absorbs. Glucose, galactose, fructose, Amino acids, dipeptides and tripeptides. Water-soluble vitamins (Thiamin (B1), vitamin B6, pantothenic acid, biotin, folic acid, pyridoxine (B6), vitamin C, riboflavin (B2)), vitamin A,D,E,K, Fat, cholesterol, niacin (B3), pantothenate (B5), biotin, folate, vitamins A, D, E and K, calcium, phosphorus, magnesium, iron, zinc, chromium, magnesium, molybdenum, selenium. Lipids.

Front 34

Nutrients absorbed in the ILEUM

Back 34

B12, intrinsic factor, bile salts, and a major portion of fluid are absorbed in this part of the intestine, thiamine, biotin, vitamin C, folate,vitamin D, vitamin K, magnesium, selenium, manganese, and others depending on transit time

Front 35

Principal absorption tasks of the large intestine

Back 35

Water and electrolyte reabsorption (main function of the large intestine); Vitamins K and B are reabsorded as well.

Front 36

Other roles of the large intestine

Back 36

Formation and temporary storage of feces; Maintains population of over 500 species of bacteria & bacterial fermentation of indigestible materials.; Produce gases methane, hydrogen, CO2, hydrogen sulfide used by bacteria in colon

Front 37

Liver metabolic functions:

Back 37

Processing of CHO, PRO, FAT; Storage activation of vitamins and minerals; formation & excretion of bile; conversion of amonia to urea; metabolism of steroids; blood filter and flood chamber.

Front 38

LIVER metabolism of carbohydrate

Back 38

1.) galactose and fructose, products of CHO digestion, are converted into glucose; 2.) galactose and fructose, products of CHO digestion, are converted into glucosestores glucose as glycogen (glycogenesis) and returns it to the blood when glucose levels become low (glycogenolysis)produces “new” glucose (gluconeogenesis) from precursors such as lactic acid, glycogenic amino acids, and intermediates of the tricarboxylic acid cycle; 3.) galactose and fructose, products of CHO digestion, are converted into glucosestores glucose as glycogen (glycogenesis) and returns it to the blood when glucose levels become low (glycogenolysis)produces “new” glucose (gluconeogenesis) from precursors such as lactic acid, glycogenic amino acids, and intermediates of the tricarboxylic acid cycle

Front 39

LIVER metabolism of PRO

Back 39

1.) transamination and oxidative deamination: convert amino acids to substrates that are used in energy, glucose production, and nonessential amino acids; and 2.) transamination and oxidative deamination: convert amino acids to substrates that are used in energy, glucose production, and nonessential amino acidsfunctional protein formation: blood-clotting factors (fibrinogen), prothrombin; serum proteins (albumin, alpha-globulin, beta-globulin, transferrin, ceruloplasmin, and lipoprotein)

Front 40

LIVER metabolism of FATTY ACIDS

Back 40

1.) fatty acids→ acetyl-CoA in beta-oxidation to produce energy; 2.) Ketone production; 3.)Synthesizes and hydrolyzes triglycerides, phospholipids, cholesterol, and lipoproteins.

Front 41

LIVER storage and activation of vitamins and minerals

Back 41

1.) stores all the fat-soluble vitamins + Vit B12+ Zn, Fe, Cu, Mg; 2.) synthesizes proteins to transport VitA, Fe, Zn, Cu; 3.) activation: Carotene→ Vit A; folate→ 5-methyl tetrahydrofolic acid; Vit D→ 25-H Vit D

Front 42

How LIVER metabolizes ammonia

Back 42

detoxify ammonia by converting it into urea, 75% of which is excreted by the kidneys, the remaining urea finds its way back to the gastrointestinal tract

Front 43

How LIVER metabolizes steroids

Back 43

inactives and excretes aldosterone, glucocorticoids, estrogen, progesterone, and testosterone

Front 44

How does the LIVER acts as a filter and flood chamber

Back 44

1.) Filter: removes bacteria and debris from blood through phagocytic action of Kupffer cells; 2.) Flood chamber: Stores blood backed up from the vena cava as in right heart failure

Front 45

What is the function of the gallbladder?

Back 45

Gallbladder acts as a storage and concentration site for bile which are produced by the LIVER.

Front 46

Why is bile needed?

Back 46

Bile is needed to help the body digest fats/fat soluble vitamins, help to excrete bilirubin and acts as a detergent to help clear the body of cholesterol and toxic compounds, including drugs.

Front 47

Describe the three (3) major causes of jaundice

Back 47

ALL three mean that bilirubin does not get properly processed and cleared from the body. The first two involve the liver's processing of bile acids. 1.) Inflammatory hepatitis (viral hepatitis, autoimmune hepatitis, toxic hepatic injury); 2.) Alcoholic liver disease (fatty liver, alcoholic hepatitis, cirrhosis, hepatocellular carcinoma); 3.) Biliary obstruction

Front 48

What is the cause of hepatic coma?

Back 48

Deterioration of brain function with serious liver disease (Hepatic encephalopathy). Liver is not removing toxins from the blood, results in a buildup of toxins in the bloodstream that cause brain damage. This condition can be acute or chronic. In some cases, a person with hepatic encephalopathy may become unresponsive and slip into a coma. Theories: 1). Liver fails, so it is unable to detoxify ammonia to urea, and ammonia is a direct cerebral toxin. 2). Drugs such as lactulose and rifaximin are given, causing retaining ammonia as the ammonium ion. 3). GABA receptor complex in contributing to neuronal inhibition. 4). Altered neurotransmitter, imbalanced plasma amino acids cause branched-chain amino acids decreases. Can also be from toxic hepatitis, which may be caused by exposure to alcohol, chemicals, drugs, or supplements. Reye’s syndrome, a rare, serious condition primarily seen in children that results in sudden swelling and inflammation of the liver and brain (CLF).

Front 49

Type A Hepatitis

Back 49

transmitted through fecal-oral route through contaminated drinking water, food, and swage. Anorexia is the most frequent symptom, and it can be severe. Other common symptoms include nausea, vomiting, right upper quadrant abdominal pain, dark urine, and jaundice (icterus). Recovery is usually complete, and long-term consequences are rare. Serious complications may occur in high-risk patients; subsequently, great attention must be given to adquent nutritional intake.

Front 50

Type B Hepatitis

Back 50

transmitted via blood, blood products, semem, and saliva. For example, it can be spread from contaminated needles, blood transfusions, open cuts or wounds, splashes of blood into the mouth or eyes, or sexual contact. HBV leads to chronic and carrier states. Chronic active hepatitis can also develop, leading to cirrhosis and liver failure.

Front 51

Type C Hepatitis

Back 51

HCV: like HBV

Front 52

Type D Hepatitis

Back 52

HDV: rare in US. depends on HBV for survival and propagation. usually chronic

Front 53

Type E Hepatitis

Back 53

HEV: oral-fecal route. rare in US. contaminated water the main source of infection and for people in crowded and unsanitary conditions. usually acute

Front 54

Type G Hepatitis

Back 54

HGV: transmitted through blood transfusion, but it does not appear to cause liver disease.

Front 55

three causes of nutritional deficiencies in alcoholics

Back 55

Alcohol replaces real food; Compromised digestion and absorption due to pancreatic insufficiency and morphological & functional alteration of intestinal mucosa; use of lipids and CHO compromised.

Front 56

Symptoms of nutritional deficiencies in alcoholics

Back 56

steatorrhea resulting from bile acid deficiency; night blindness due to Vitamin A deficiency; Wernicke encephalopathy due to thiamin deficiency (most common); hypocalcemia; hypomagnesemia; hypophosphatemia; folate deficiency; Vit B6 deficiency. Deficiency of all B vitamins and vitamins C,D, E, and K.

Front 57

Five good sources of Vitamin A

Back 57

organ meat, egg, carrots, sweet potato; pumpkin

Front 58

Five good sources of Vitamin D

Back 58

sunlight exposure; fatty fish; fortified milk; eggs; Swiss cheese

Front 59

Five good sources of Vitamin E

Back 59

vegetable oil; seeds; nuts; kiwi, mango

Front 60

Five good sources of Vitamin K

Back 60

kale, collard greens, spinach; broccoli; canola oil;

Front 61

Five good sources of Thiamin

Back 61

brown rice; legumes; potato; milk; organ meat

Front 62

Five good sources of Riboflavin

Back 62

liver; milk; broccoli; kale, collard greens, spinach

Front 63

Five good sources of Niacin

Back 63

meat; egg; white rice; peanut butter; tomato products

Front 64

Five good sources of Vitamin B6 (Pyridoxine)

Back 64

meat; baked potato; banana; sunflower seeds; soybeans

Front 65

Five good sources of Folic Acid

Back 65

kale, collard greens, spinach; broccoli; OJ

Front 66

Five good sources of Vitamin B12

Back 66

oyster; crab; meat (esp. pork and beef), milk; yogurt; egg

Front 67

Five good sources of Vitamin C

Back 67

citrus fruits; kiwi; kale; broccoli; mango

Front 68

Ascites Definition

Back 68

Def: Accumulation of fluid in the abdominal cavity

Front 69

Ascites MNT

Back 69

MNT: Sodium restriction and diuretic therapy.

Front 70

Cirrhosis Definition

Back 70

Def: Liver disease that may cause numerous morbidities: muscle wasting, increased fat stores, ascites or edema, malnutrition, hyponutremia, hepatic encephalopathy, glucose malabsorption, hepatorenal syndrome and osteopenia. (Krause 656-658)

Front 71

Cirrhosis MNT

Back 71

MNT: Dependent on results of examination/physical condition. May need to increase energy intake via small, frequent meals. for malnutrition; restrict sodium intake for fluid retention; restrict fluid intake for hyponatremia; control CHO intake for hyperglycemia; provide MVM supplementation; Provide oral liquid supplements or enteral feeding.

Front 72

Cholecystitis Defined

Back 72

Def: Inflammation of the gallbladder, usually caused by bile duct obstruction.

Front 73

Cholecystitis MNT

Back 73

MNT: During an acute attack, oral feeding is discontinued. Parental nutrition may be started if the pt is malnurished. Upon resumption of the regular diet, a low-fat diet is recommended to decrease pancreatic activity. It may be continued depending on the reason for the illness.A hydrolyzed low-fat formula or an oral low fat diet (40-45 g of fat per day) can be given.

Front 74

Hepatic Coma Defined

Back 74

Def: Hepatic Coma is the fourth stage of Hepatic Encephalopathy, HE, a condition where there is a clinical complication due to portosystemic venous shunting, where underlying liver disease may or may not be present. HE can be caused by GI bleeding, abnormal electrolytes, renal failure, infection, diuretic therapy, use of sedatives or medications that affect the nervous system, and constipation. Signs of HE include mental status changes from the subtle, like confusion or irritability, to the extreme, level 4, resulting in coma. Diagnosis should determine if alternate causes of mental state can be ruled out.

Front 75

Hepatic Coma MNT

Back 75

MNT: Use care to prevent refeeding. Use tube feeding with .5-.6 g of protein per kilogram body weight; advance to 1 to 1.5g/kg euvolemic weight. Higher intakes of BCAAs and glutamine enriched products are not usually beneficial. Glucose is needed to reduce likelihood or presence of hypoglycemia. Start feeding slowly to prevent refeeding syndrome; then to progress to desired levels of intake in malnourished pt. Best to start with 15-20 kcal/kg and progress as tolerated over several days. Consider Lactulose, a nonabsorbable disaccharide, and rifaximin, a nonabsorbable antibiotic. Oral branched chain amino acids may be used in those who are non-responsive to typical treatment. IV L-ornithin, L-aspartate or neomycin may also be used. Probiotics and multivitamin mineral supplements may also be used.

Front 76

Acute Pancreatitis DEF

Back 76

Def: Inflammation of the pancreas. Typically associated with the secretory mechanisms of pancreatic enzymes and bile.

Front 77

Acute Pancreatitis MNT

Back 77

Withhold oral and PN feeding; Support with IV liquids; Start TF if feeding hasn't resumed in 5-7 days; if PN, provide easily digestible foods; low fat diet; 6 small meals spaced evenly throughout the day; Ensure adequate PRO and kcal, increase kcal if necessary.

Front 78

Chronic Pancreatitis Def

Back 78

Def: Inflammation of the pancreas with major damage along the intestinal track.

Front 79

Chronic Pancreatitis MNT

Back 79

Provide oral diet in acute phase; Use TF to support diet and reduce pain; pancreatic enzymes; supplemental fat soluble vitamins and minerals in water miscible form

Front 80

CHF defined

Back 80

Def: congestive Heart Failure, the heart cannot provide adequate blood flow to the rest of the body, causing symptoms of fatigue, shortness of breath, and fluid retention. The progress of CHF is similar to that of atherosclerosis, there is an asymptomatic phase when damage is silently occurring.

Front 81

CHF MNT

Back 81

Diet low in sat fat, trans fat, cholesterol; restricted sodium diet <2gm/day; increased use of whole grains, fruits, vegetables; limit fluid to 2L per day; lose to or maintain appropriate weight; magnesium supplementation; thiamin supplementation; increase physical activity as tolerated; avoid tobacco; avoid alcohol. determine body weight first (dry weight), daily weights should be recorded. Restricting sodium and fluids along with diuretic therapy to restore fluid balance and prevent full-blown HF. Malnutrition usually related to the cardiac cachexia, negative N balance can be noted. In overweight patients caloric reduction must be carefully monitored to avoid excessive and rapid body protein catabolism. Nutrition education to promote behavior change. For dyslipidemia or atherosclerosis, heart-healthy diet: low in SFAs, trans-fatty acids, and cholesterol, high in fiber, whole grains, fruits, and vegetables is recommended. For patients w/ hypertension, DASH diet is recommended. Both of these dietary patterns emphasize lower-sodium foods and higher intake of potassium. Total energy expenditure is higher in HF patients because of the catabolic state, adequate protein and energy should be provided.

Front 82

COPD def

Back 82

Def: slow, progressive obstruction of the airways. Goal is to assess and monitor diseas, reduce risk factors, maintain stable COPD, and manage any exacerbations.

Front 83

COPD MNT

Back 83

Sufficient protein (1.2-1.7 g/kg) to maintain and restore lung/muscle growth. Balanced ratio protein 15-20% of kcal, fat 30-45%, CHO 40-55%. primary goal is to facilitate nutritional well being, maintain appropriate ratio of lean body mass to adipose tissue, correct fluid imbalance, manage drug-nutrient interactions, and prevent osteoporosis. Supplemental vitamin C may be necessary for smokers and for bone mineral density, vitamin D and K.Accurately evaluate energy intake vs expenditure to combat the disease. Decreased food intake is common and energy expenditure is generally elevated. Nutritional depletion evidenced by low body weight for height and reduced triceps fatfold measurement. So weight maintain or weight gain, body composition is important.

Front 84

HTN Def

Back 84

Systolic >120 (pre:120-139, stage 1: 140-159, Stage 2: 160+) , Diastolic > 80 (pre 80-89, stage 1: 90 - 99, stage 2: 100+)

Front 85

HTN MNT

Back 85

Recommend low-sodium DASH diet (better than DASH alone). Salt restriction, <2400 mg of sodium per day. Patients w/ HTN, blacks, and middle-age and elderly people, no more than 1500mg/day. Fish, Limit alcohol (Men < 2/d, Women < 1/d). Exercise: 30-45 min moderate exercise per day (weight loss: 300-500kcal/day or 1,000 - 2,000 kcal/wk).

Front 86

Gastrectomy Def

Back 86

partial or total resection of the stomach to remove cancer.

Front 87

Gastrectomy MNT

Back 87

Start with liquids, then easily digested solid foods, and progress to a regular diet. Dumping, diarrhea, and abdominal discomfort are common. Iron deficiency may occur, due to malabsorption, or loss of acid secretion. B12 deficiency may also occur and supplementation may be necessary. Rationale: patient with advanced, inoperable cancer should receive a diet that is adjusted to his or her tolerances, preferences, and comfort. Anorexia is almost always present from the early stages. In later stages, patients may tolerate only a liquid diet. If no tolerance to oral feeding, consider gastric or intestinal feeding tube, or if inability to feed eternally, PN.

Front 88

Diverticulosis Def

Back 88

condition of having saclike herniations in the colonic wall.

Front 89

Diverticulosis MNT

Back 89

high-fiber diet, in combination with adequate hydration, promotes soft, bulky stools that pass more swiftly and require less straining with defecation. High fiber + exercise prevent constipation. Fiber intake should be increased gradually. Recommended intakes of dietary fiber, preferably from foods, are 25g/day for adult women and 38g/day for men. If cannot from foods, fiber supplements can be used. Adequate fluid intake (2-3L daily) should accompany the high-fiber diet.

Front 90

Diverticulitis Def

Back 90

Complications of diverticular disease range from painless, mild bleeding and altered bowel habits to diverticulitis. Spectrum of inflammation, abscess formation, acute perforation, acute bleeding, obstruction, and sepsis. Treatment includes antibiotics and oral intake as tolerated. Modified diet or bowel rest based on degree of illness, desire to eat, and likelihood of imminent surgery.

Front 91

Diverticulitis MNT

Back 91

low-residue diet or PN may be required initially, followed by a gradual return to a high-fiber diet.

Front 92

Ulcerative Colitis (UC) Def

Back 92

DEF: One of two major forms of inflammatory bowel disease (IBD), share common clinical characteristics, including diarrhea, fever, weight loss, anemia, food intolerances, malnutrition, growth failure, and extraintestinal manifestations (arthritic, dermatologic, and hepatic). Malnutrition can occur in both forms, but it is more of a lifelong concern in Crohn’s disease. Segments of inflamed bowel (the disease process) is continuous; the disease is limited to the mucosa; bleeding is more common. ational: genetic predisposition + unknown stimulate à abnormal activation of the mucosal immune response, secondary systemic response à inflammatory response à damage to the cells of the small and/or large intestine with malabsorption, ulceration, or stricture à weight loss, diarrhea, poor growth, hyperhomocysteinemia, partial GI obstructions

Front 93

Ulcerative Colitis (UC) MNT

Back 93

oral enteral formula (tube-feed if necessary); use of foods that are well tolerated; parenteral nutrition in patients with severe disease or obstruction; multivitamin supplement containing folic acid, B12, and B6; omega-3 fatty acid supplementation; consider use of prebiotics and probiotics; modify fiber intake as necessary; tests for food intolerances. Energy needs are not greatly increased. Protein requirements may be increased, depending on the severity and stage of the disease.

Front 94

Crohn's Disease

Back 94

Def:One of two major forms of inflammatory bowel disease (IBD), share common clinical characteristics, including diarrhea, fever, weight loss, anemia, food intolerances, malnutrition, growth failure, and extraintestinal manifestations (arthritic, dermatologic, and hepatic). Malnutrition can occur in both forms, but it is more of a lifelong concern in Crohn’s disease. Segments of inflamed bowel may be separated by healthy segments; it affects all layers of the mucosa; it is characterized by abscesses, fistula, fibrosis, submucosal thickening, localized strictures, narrowed segments of bowel, and partial or complete obstruction of the intestinal lumen.Rational: less functioning bowel for nutrient absorption, malnutrition and narrowed segments of bowel may occur

Front 95

Crohn's Disease

Back 95

MNT: oral enteral formula (tube-feed if necessary) in addition to normal food to improve nutrition status; Correct specific vitamin/trace elements deficit by supplementation. Use continuous tube feeding rather than bolus delivery because of the lower complication rate. MNT: oral enteral formula (tube-feed if necessary) in addition to normal food to improve nutrition status; Correct specific vitamin/trace elements deficit by supplementation. Use continuous tube feeding rather than bolus delivery because of the lower complication rate. Using oral nutritional supplements, a supplementary intake of up to 600 kcal/day can be achieved in addition to normal food. Use tube feeding if a higher intake is necessary. Tube feeding can be safely delivered by nasogastric tube or percutaneous endoscopic gastrostomy.There are no significant differences in the effect of free amino acid, peptide-based and whole protein formulae for tube feeding. Modified enteral formulae (fat modified, omega-3 fatty acids, glutamine, TGF-b-enriched) are not recommended because no clear benefits have been shown.

Front 96

Celiac Disease DEF

Back 96

Def: characterized by a combination of four factors: 1) genetic susceptibility; 2) exposure to gluten; 3) an environment “trigger”; 4) an autoimmune response (whereas gluten sensitivity refers to persons with nonspecific symptoms, without the immune responses). Symptoms are usually: nausea, abdominal cramps, or diarrhea after ingesting gluten.

Front 97

Celiac Disease MNT

Back 97

MNT: following a gluten-free (GF) diet--avoid foods contains wheat, rye, or barley. 1.) At initial phase, assess for nutrient deficiency before supplementation, such as Fe, folate and Vit D. If patients present more severe symptoms, such as diarrhea, wt loss, malabsorption, or signs of nutrient deficiency (night-blindness, neuropathy, prolonged prothrombin time, etc.), other vitamins such as fat-soluble vitamins (A, E, K) and minerals (zinc) should be checked. Usually, patients who eat well-balanced GF diet don’t need nutritional supplementation. 2.) Patients with malabsorption may benefit from bone density scan to assess for osteopenia or osteoporosis. Electrolytes and fluid replacement is essential for those dehydrated from severe diarrhea.

Front 98

Colostomy Def

Back 98

Only the rectum and anus are removed. Surgical opening made in the abdominal wall to empty bowl contents into an ostomy bag. The consistency of the stool is fairly well formed.

Front 99

Ileostomy Def

Back 99

The entire colon, rectum, and anus are removed. Surgical opening made in the abdominal wall to empty bowl contents into an ostomy bag. The consistency of the stool is liquid.

Front 100

Ostomy MNT

Back 100

MNT: 1) Learn by observing which food to eliminate. For colostomy: avoid legumes, onions, garlic, cabbage, eggs, fish, some medications, as well as some vitamin and mineral supplements. 2) For ileostomy, to compensate for excessive losses in stool, increase salt intake by eating normal diet and increase water intake by drink at least 1L more than their ostomy output daily. 3) no greater energy intake. but for those who undergo terminal ileum resection need Vit B12 supplement or intravenous injections. Patients with an ileostomy may need Vit C and folate supplements due to low fresh vegetable and fruits intake. 4) Prepared cooked, shredded, or pureed fruits and vegetables. Avoid very fibrous vegetables and chew all food well. Rational: 1) Malodorous stools may be caused by steatorrhea, or partial digestion or bacterial fermentation of foodstuff. SCFAs, sulfur-containing compounds, ammonia, methane, and other end products may produce odors. 2) loss of liquid and minerals that are supposed to be reabsorbed in colon. 3) usually do not become nutrient depleted. 4) The empty time and fermented time period are shorter. it is possible for a food bolus being caught at the point where the ileum narrows.

Front 101

Small Bowel Obstruction Def

Back 101

partially or completely obstruction of the small bowel due to intestinal tumor, GI surgery scars, IBD, peptic ulcer, or radiation enteritis. Symptoms include bloating, abdominal distension, and pain, and sometimes nausea and vomiting.

Front 102

Small Bowel Obstruction MNT

Back 102

Prone to obstruct: chew food well and avoid excessive fiber intake. for edentulous patients, avoid potato skin, citrus fruits, persimmons. Partial obstruction: A proximal blockage may require a semisolid or liquid diet. however, for distal blockage, altering the consistency of the diet is less likely to help. Complete obstruction: in some cases, enteral feeding beyond the point of obstruction may be feasible, but if not possible for a prolonged period, PN may be needed.

Front 103

Kidney Stones Rationale

Back 103

Rational: the risk of kidney stone rises with increasing urine calcium and oxalate, decreases with increasing citrate and urine volume. the goal for MNT is to prevent new stones from forming and preexisting stones from growing. High animal protein intake is associated with incidence of kidney stones.

Front 104

Kidney Stones MNT

Back 104

DRINK much more water. cranberry juice acidifies urine may help with struvite stone. tea, coffee, beer, and wine have been associated with reduced risk of stone formation. Add milk to tea may help decrease oxalate content. Avoid soft drinks due to phosphoric acid which can acidify the urine. EATING an adequate-calcium, low animal-protein, low-salt diet (less than 4 g) which can reduces oxalate excretion. EAT high calcium foods (dairy products) and high magnesium food to combine oxalate in the food. ENCOURAGE stone former to choose low oxalate fruits and vegetables many times throughout the day to increase potassium intake. DASH diet to lower sodium intake because Na and Ca are reabsorbed at common sites. the more Na reabsorbed, the more Ca reabsorbed.

Front 105

Tuberculosis Def

Back 105

Def: infection of tuberculosis. Symptoms are undernutrition, wt loss, night sweat,fatigue, dyspnea, and hemoptysis.

Front 106

Tuberculosis MNT

Back 106

MNT: provide high-calorie and high-protein meal by food and supplement. Increasing fluids intake. May need assistant for grocery shopping and meal preparation. Isoniazid absorption is reduced by food, it should be administered 1 hour before or 2 hour after meals. It depletes pyridoxine and interferes with Vit D metabolism, which in turn can decrease absorption of Ca and P. Patients thus require increase Vit B6 and D, and minerals from meals and supplements.

Front 107

Pernicious Anemia Def

Back 107

Def: a megaloblastic, macrocytic anemia caused by deficiency of Vit B12, most commonly from a lack of IF. Rarely found in strict vegetarian diets that contains no Vit B12. Other causes include antibody to IF, small intestinal disorder such as celiac disease, idiopathic steatorrhea, tropical sprue, small intestinal cancers, drugs (paraaminosalicylic acid, colchicine, neomycin, metformin, antiretrovirals); and long-term ingestion of alcohol or calcum-chelating agents.

Front 108

Pernicious Anemia MNT

Back 108

MNT: a high-protein diet (1.5g/kg) for liver function and blood regeneration. Increase green leafy vegetables in diet due to its high content in folate and iron. Increase food rich in Vit B12 such as meat (esp. beef and pork), egg, milk and yogurt. FOR DM patients who take metformin, 10%-30% of the drug interfere the absorption through calcium-dependent membrane and the B12-IF complex receptor on the ileal surface. Increased intake of Ca reverses the vitamin B12 malabsorption. FOR people older than 50 y/o should take B12 in its crystalline form (i.e. fortified cereal, supplements) to overcome the effects of atrophic gastritis.

Front 109

Iron Deficiency Anemia Def

Back 109

Serum iron low. Charaterized by low RBC's, Hgb, and HCT's.

Front 110

Iron Deficiency Anemia MNT

Back 110

MNT: in addition to iron supplement, absorbable dietary iron should be advised, such as liver, kidney, beef, dried fruits, dried peas and beans, nuts, green leafy vegetables, iron-fortified foods. HEME iron (15% absorption) is found in meat, poultry, and fish. non-heme iron (3%-8% absorption) can also be found in meat, poultry and fish, as well as eggs, grains, vegetables, and fruit. Enhancer: ascorbic acid is helpful for iron absorption as a powerful reducing agent as well as a binding factor for absorption. Inhibitor: things that chelate iron, such as carbonates, oxalates, phosphates, and phytates (unleavened bread, unrefined cereals, and soybeans). vegetable fiber; tannin inside tea and coffee (may reduce up to 50% of the absorption). Iron in yolk is poorly absorbed due to the presence of phosvitin.