GI Problems -Covasa

Question 1

What is parenteral nutrition (PN or TPN)? When is it indicated?

Answer 1

supplying all the nutritional needs of the body by bypassing the digestive system and dripping nutrient solution directly into a central vein, (central line) or peripherally inserted central catheters, (PICC line)

d/t:

• bowel obstruction
• unable to access gut for enteral feeding
• Pt. intolerant to ON and TF

Question 2

What specific nutrient needs do pts with IBD have?

Answer 2

• protein needs might inc by 50% in active stages

- fat absorption is affected in CD but not UC

Question 3

What happens to the small intestine in celiac sprue?

Answer 3

atrophy of the villi in the proximal small intestine (and enlarged crypts) due to inflammatory response (IgA and IgG) to gluten-containing foods

gluten=the name for the water insoluble proteins in all cereal grains

Question 4

What is dermatitis herpetiformis (DH)? What is this associated with?

Answer 4

“celiac disease of the skin”
-Crusty, pruritic, itchy rash on Back, buttocks, knees, and elbows

• 10%- 30% have the rash, est. that 85% of pts with the rash have celiac sprue
• due to inflammation at the dermal/epidermal junction

Question 5

What is the gold standard for diagnosis of Celiac Sprue?

Answer 5

Distal Duodenal Biopsy –> flat bowel mucosa

Question 6

What is the pathophysiology of celiac sprue?

Answer 6

• autoimmunity
• ingested alpha-gliadin (rick in glutamin) that bind transglutaminase in enterocytes –>form glutamic acid which is more easily recognized as foreign ==> trigger cell mediated immunity (inc in IgA and IgG)

Question 7

What products can be added to the diet of pts with celiac sprue to maximize absorption and minimize diarrhea?

Answer 7

• add kcal/protein
• Medium chain triglycerides
• vitamins and minerals (A,D, E, K, folic acid, B12, thiamine, Fe, Ca)
• antiinflammatory agents (corticosteroids)
• laxatives

(caution: acetaminophen has gliadins)