nutdisease 2 exam review

nutdisease 2 exam review - TEST TWO: NUTRITION AND DISEASE...

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TEST TWO: NUTRITION AND DISEASE II Describe the symptoms/clinical manifestations associated with ulcerative colitis. -20-30 bowel movements a day! this causes distress obviously -bloody diarrhea (more likely than Crohn’s) -abdominal pain -tenesmus (urgency to defecate) -fever -negative N balance (due to loss of proteins,similar to Crohn’s) -edema b/c albumin levels are low -dehydration -anemia -anorexia -weight loss -periods of remission/exacerbation -“ESR” (erythrocyte sedimentation rate) is elevated -non-GI tract lesions: arthritis inflammation of the eye, like in Crohn’s -toxic megacolon: large intestine has no peristalsis colon will dilute b/c accumulating food can rupture life threatening immediate surgery Identify medications used to treat ulcerative colitis, how they work and any nutritionally relevant side effects discussed in class. -antibiotics -anti-inflammatory -immunomodulators: methotrexate -corticosteroids: predizone -antispasmodics: decrease spasms, cramping/pain -antidiarrheal Newer Drugs : not for Crohn’s; specific only for Ulcerative Colitis - colazol : sulfasalizine (active only in colon/large intestine); it decreases side effects b/c it’s localized to the colon) - keratinocyte growth factor : promote growth of healthy cells in large intestine Describe the types of surgical interventions. Consider, as appropriate, the nutritional implications of surgical intervention? -Proctocolectomy w/: * ileostomy : plastic appliance that catches feces/stoma constructed by bringing a loop or end of ileum to surface of skin so it can empty its contents * ileoanal pouch anal anastomosis: (newer) it pulls ileum down to anal area & forms a pouch there – can still defecate in a more normal manner -Nutritional implications of surgical intervention: depends on severity of symptoms, nutritional status, and medical/surgical management (i.e. whether or not large intestine was removed) Describe the nutritional management/adjustments that would be appropriate for symptomatic/asymptomatic individuals with ulcerative colitis and/or severe cases of ulcerative colitis. Nutritional Management for General UC (always use indirect calorimetry with UC & Chron’s) -Fiber : * symptomatic patient : as tolerated * asymptomatic patient : NO restriction -kcals : ~BEE * 1.5 (1.5 factor increase in order to make up for kcals)
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-protein : 1.0-1.5 g/kg BW (same for Crohn’s) -vitamins/minerals/fluids/electrolytes : ensure adequate intake, supplement as indicated -lactose : if it’s not digested it will get into colon and cause cramping due to excess lactic acid etc * symptomatic patient : as tolerated * asymptomatic patient : no restriction Nutritional Management for Severe Cases of UC -initial restriction of oral intake -parenteral nutrition (intractable diarrhea): use if you can’t stop the diarrhea *peripheral PN use for shorter amount of time/temporary *central PN use for longer amount of time
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This note was uploaded on 06/16/2009 for the course HUN 4446 taught by Professor Mathews during the Spring '09 term at University of Florida.

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nutdisease 2 exam review - TEST TWO: NUTRITION AND DISEASE...

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