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Billroth I

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an operation in which the pylorus is removed and the proximal stomach is anastomosed directly to the duodenum; less dumping

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Billroth II

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an operation in which the greater curvature of the stomach is connected to the first part of the jejunum in a side-to-side manner

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partial gastric resection

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partial removal of the stomach; treat cancer and perforations of the stomach wall

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vagotomy

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a surgical procedure that involves removing part of or resection of the vagus nerve; reduces acid secretion in stomach; treatment option for chronic duodenal ulcers

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pyloroplasty

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surgery to widen the opening in the lower part of the stomach (pylorus) so that stomach contents can empty into the small intestine (duodenum); used to treat complications in patients with peptic ulcers or other stomach problems that cause a blockage of the stomach opening

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dumping syndrome

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occurs when the undigested contents of your stomach move too rapidly into your small bowel; food and gastric juices from your stomach move to your small intestine in an uncontrolled, abnormally fast manner; most often related to changes in your stomach associated with surgery

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gastric ileus

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a condition in which normal gastric movement is stopped or slowed and normal gastric functions are disturbed; usually caused by inflammation, injury, or operation

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significant weight loss, hypoglycemia, malabsorption, anemia/osteoporosis

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other problems associated with gastric surgeries

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Barrett's esophagitis

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precancerous condition; normal cells of distal esophagus replaced by abnormal columnar epithelium, lining resembles intestine

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GERD over 5 years, white males over 50, family history or adenocarcinoma of esophagus

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risk factors for Barrett's esophagitis

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fundoplication

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surgical treatment for GERD; fundus of stomach wrapped around lower esophagus to limit reflux, reinforces sphincter pressure

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dysphagia, odynophagia, anorexia (nausea/vomiting related to chemo), dysguesia

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common problems associated with oral and esophageal cancers

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dysphagia

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difficulty swallowing

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odynophagia

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painful swallowing

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dysguesia

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altered taste acuity

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EGD (Esophagodudonostomy)

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flexible tube that is passed into esophagus with a light & camera at distal end. Can be passed to stomach or small intestine Used to diagnose inflammation, ulceration, changes in blood vessels & erosion Can also be used to cauterize ulcer sites, dilate strictures or place feeding tubes May be used long term to monitor patients with chronic esophagitis and gastritis to identify cancer Local anesthetic used during procedure

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chronic acid suppression

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caused by medications to treat GERD (proton pump inhibitors, H2 blockers); reduction in secretion of HCl; Reduces absorption of calcium, heme iron & b12; May increase risk of bone fractures & intestinal infection

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sucralfate, antibiotics, antacids, H2 blockers, proton pump inhibitors

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medications which reduce and neutralize stomach acid

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prokinetics (metoclopramide and erythromycin)

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a type of drug which enhances gastrointestinal motility by increasing the frequency of contractions in the small intestine or making them stronger, but without disrupting their rhythm; used to treat a number of gastrointestinal disorders, including irritable bowel syndrome, gastritis, acid reflux disease, gastroparesis, and functional dyspepsia

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villi and microvilli

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tiny structures that cover small intestinal wall; make surface area of small intestines bigger to maximize absorption of nutrients from food into your bloodstream

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lacteals

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drain villi and connect submucosal lymphatic network

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lyphatics

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drain intestinal muscular layer

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lymph

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Regulation of tissue fluid homeostasis Immune surveillance Transports nutrients from intestinal lumen System affected by & contributes to, disease processes within intestine

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pancreatic amylase

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breaks down complex CHO in SI to oligosaccharides and disaccharides

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brush border enzymes

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furthers digestion of oligosaccharides and disaccharides to monosaccharides

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trypsin and chymotrypsin

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digest complex proteins in SI to smaller peptides

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carboxypeptidases

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digest carboxyl end amino acids

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aminopeptidases

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catalyze the cleavage of amino acids from the amino terminus of protein (N-terminus) or peptide substrates

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dipeptidases

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enzymes secreted by enterocytes into the small intestine; hydrolyze bound pairs of amino acids; cleave dipeptides into their two component amino acids prior to absorption

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duodenum

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absorption site of: CHO, proteins calcium, magnesium, iron, chloride, sodium, zinc

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jejunum

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absorption site of: glucose, galactose, fructose vitamin C, thiamin (B1), riboflavin (B2), pyridoxine (B6), folic acid

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ileum

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absorption site of: protein, amino acids vitamins A, D, E, K (fat-soluble) fat, cholesterol bile salts and vitamin B12

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colon

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absorption site of: remaining Na, K and water

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prebiotic

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dietary substance used to promote growth of beneficial intestinal bacteria; increase growth of healthy bacteria; fruits, vegetables, legumes, seeds, nuts, inulin

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probiotic

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orally consumed sources of bacteria used to bolster the presence of beneficial intestinal flora; yogurt, kefir, raw sauerkraut, cultured bacteria supplements

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steatorrhea

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malabsorption of fat; excess fat in stool

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secondary lactose intolerance

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issue with Celiac disease; temporarily omit dairy foods

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lactose intolerance

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deficiency of lactase enzyme; causes bloating, cramping, osmotic diarrhea, gas; diagnosed via tolerance test or hydrogen breath test

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African Americans, Hispanic, Asian, South American, Native American

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groups at risk for lactose intolerance

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lactaid

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predigested lactose

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colon (functions)

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absorbs water and vitamins created (vitamin K) by gut bacteria; fat soluble vitamins, bile salts and B12 (terminal ileum); converts digested food into feces

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Crohn's disease

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inflammatory bowel disease; chronic inflammation of small intestine, lesser colonic involvement; segmented; symptoms: fatigue, anorexia, weight loss, RLQ (right lower quadrant) pain

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Ulcerative colitis

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inflammatory bowel disease; chronic inflammation of large intestine, begins at rectum; continuous; symptoms: bloody diarrhea, pain and spasm, dehydration and electrolyte imbalances

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antidiarrheal medications (sulfasalazine)

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treat IBD (ulcerative colitis); works inside the bowels by helping to reduce the inflammation and other symptoms of the disease; decrease iron and folic acid absorption; GI problems are side effects

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anti-inflammatory (prednisone)

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treat IBD; steroid; decrease Ca, K, vitamin C and D, folic acid, increases fluid retention

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antibiotics (tetracycline)

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calcium considerations

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enteral nutrition support

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MNT for IBD as sole support may be beneficial to temper some elements of inflammatory response

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40 kcal/kg IBW

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energy needs for patient experiencing weight loss associated with IBD

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1.3-1.5 g/kg IBW

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protein needs for patient with IBD

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soluble fiber

answer

may be beneficial for binding stool and for healthy bacterial growth in patient with IBD; consideration given with obstruction/acute attack, where minimal residue needed

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iron, Ca, vitamin D and B12

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vitamin and mineral supplements that may be beneficial to patients with IBD

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small bowel resection

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surgical removal of part of SI typically due to Crohn's Dz or Ulcerative Colits; potential problems depend on length and section

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ileostomy

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Surgically made opening in abdominal wall. The ileum, which is the lower end of the small intestine, is passed through this opening and stitched into place. Your digested food is released into a pouch worn externally. It is basically a bowel diversion procedure.

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bowel rest (NPO), fluid and electrolytes, initiate trophic enteral feeding

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stage 1 MNT after small bowel surgery

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enteral nutrition then clear liquid to full liquid to soft low residue

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stage 2 MNT after small bowel surgery

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small frequent meals, restrict fat, low lactose, supplements (if necessary)

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stage 3 MNT after small bowel surgery

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colostomy

answer

surgical procedure in which an opening (stoma) is formed by drawing the healthy end of the large intestine or colon through an incision in the anterior abdominal wall and suturing it into place

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NPO 24-48 hours, fluid and electrolytes

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stage 1 MNT after colostomy

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clear to full liquid, then soft, low residue, increase diet as tolerated, adequate fluids

answer

stage 2 MNT after colostomy

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Eliminate odor forming foods (onions, cabbage family vegetables, beans, etc) and foods that could cause obstruction

answer

special considerations after colostomy

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diverticulosis

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small outpouchings on colonic wall due to increased pressure

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diverticulitis

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infected, inflamed outpouchings on colonic wall

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diverticular disease

answer

Symptoms: asymptomatic --> cramping, diarrhea/constipation, severe pain Cause: low fiber diet, poor colonic muscle tone, low fluid intake, chronic constipation

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gradual increase fiber and fluids, avoid foods that get stuck

answer

MNT diverticulosis

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NPO or clear liquids (acute stage), progress to full/soft/ regular diet

answer

MNT diverticulitis

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Low residue

answer

-Avoid whole grains -Grain Products Safe to Eat: Enriched refined white bread, buns, bagels, english muffins Plain cereals e.g. Cheerios, Cornflakes, Cream of Wheat, Rice Krispies, Special K Arrowroot cookies, tea biscuits, soda crackers, plain melba toast White rice, refined pasta and noodles -Fruits: Fruit juices except prune juice Applesauce, apricots, banana (1/2), cantaloupe, canned fruit cocktail, grapes, honeydew melon, peaches, watermelon -Avoid raw and dried fruits, raisins and berries

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safe vegetables (low residue)

answer

Vegetable juices Potatoes (no skin) Alfalfa sprouts, beets, green/yellow beans, carrots, celery, cucumber, eggplant, lettuce, mushrooms, green/red peppers, potatoes (peeled), squash, zucchini Avoid vegetables from the cruciferous family such as broccoli, cauliflower, brussels sprouts, cabbage, kale, Swiss chard etc

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meat, protein, dairy choices (low residue)

answer

Well-cooked, tender meat, fish and eggs Avoid beans and lentils Avoid all nuts and hard seeds, as well as foods that may contain seeds As directed by your healthcare providers, some may suffer lactose intolerance

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entire colon, rectum and anus

answer

removed during ileostomy

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rectum and anus

answer

removed during colostomy

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ostomy (problems)

answer

Excessive fluid loss Dehydration, electrolyte abnormalities Malodorous stool Risk of obstruction at opening

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IBS (irritable bowel syndrome)

answer

Chronic abdominal discomfort, pain or altered bowel habits Other symptoms- bloating, incomplete evacuation, mucus in stool, straining or increased urgency Increased GI distress associated with psychological distress

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