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the\tmuscle.\tThe\tprevalence\tof\tdiverticulosis\tis\tdifficult\tto\tdetermine\tgiven\tthat\tmost\tindividuals\nremain\tasymptomatic.\tThis\tcondition\tbecomes\tmore\tcommon\tas\tpeople\tage,\tparticularly\tin\tpeople\nolder\tthan\tage\t60\t(\nFeuerstein\tand\tFalchuk,\t2016\n).\t\nDiverticulitis\n\tis\ta\tcomplication\tof\tdiverticulosis
|
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).\t\nDiverticulitis\n\tis\ta\tcomplication\tof\tdiverticulosis\nthat\tindicates\tinflammation\tof\tone\tor\tmore\tdiverticulum.\tIt\toften\trepresents\ta\tflare-up\tof\ndiverticulosis,\tand\tafter\tit\tsubsides\tinto\ta\tperiod\tof\tremission,\tit\treverts\tto\tthe\tstate\tof\tdiverticulosis.\nEtiology
|
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] |
Etiology\nThe\tcause\tof\tdiverticulosis\thas\tnot\tbeen\telucidated\tclearly.\tEpidemiologic\tstudies\thave\timplicated\nlow-fiber\tdiets\tin\tthe\tdevelopment\tof\tdiverticular\tdisease,\tbut\tthe\tevidence\tis\tambiguous\n\tregarding
|
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] |
high-\tversus\tlow-fiber\tdiets\tand\tdiverticular\tdisease\twith\tregard\tto\tprevention\tand\ttreatment.\tLow-\nfiber\tdiets\treduce\tstool\tvolume,\tpredisposing\tindividuals\tto\tconstipation\tand\tincreased\tintracolonic\npressures,\twhich\tsuggests\tthat\tdiverticulosis\toccurs\tas\ta\tconsequence\tof\tpressure-induced\tdamage
|
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to\tthe\tcolon.\tHowever,\twhile\tdietary\tfiber\tintake\thas\tbeen\tshown\tas\tinversely\trelated\tto\n\tthe\trisk\tof\ndeveloping\tthe\tdisease,\ta\tlarge\trecent\tstudy\tfailed\tto\tshow\ta\tdirect\tcorrelation\tbetween\tlow-fiber\ndiets\tand\tdiverticulosis.\tIn\tthat\tstudy,\thigher-fiber\tdiets\twere\tassociated\twith\ta\thigher\tprevalence\tof
|
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diverticulosis.\tThe\tAmerican\tGastroenterology\tAssociation\trecommends\tincreasing\tfiber\tafter\ta\ndiverticulitis\tattack\tbut\teven\tit\tstates\tthat\tthe\trecommendation\tis\tconditional\tbased\ton\tweak\nevidence\t(\nFeuerstein\tand\tFalchuk,\t2016\n).\nMore\trecent\tresearch\thas\tstarted\tto\texplore\ttheories\tincluding\tgenetic\tdifferences,\tdiet,\tmotility,
|
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microbiome,\tand\tinflammation\t(\nFeuerstein\tand\tFalchuk,\t2016\n).\tOther\tstudies\thave\tfocused\ton\tthe\nrole\tof\tdecreased\tlevels\tof\tthe\tneurotransmitter\tserotonin\tin\tcausing\tdecreased\trelaxation\tand\nincreased\tspasms\tof\tthe\tcolon\tmuscle.\tStudies\thave\tfound\tlinks\tbetween\n\tdiverticular\tdisease\tand
|
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] |
diverticular\tdisease\tand\ndiets\thigh\tin\tred\tmeat\tand\tfat,\tobesity,\tvitamin\tD\tinsufficiency,\tlack\tof\texercise,\tsmoking,\tand\tcertain\nmedications,\tincluding\tnonsteroidal\tantiinflammatory\tdrugs\tsuch\tas\taspirin\tand\tsteroids\t(\nMaguire\tet\nal,\t2015\n;\t\nFeuerstein\tand\tFalchuk,\t2016\n).\nPathophysiology
|
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0.01706499047577381,
0.09528376907110214,
0.07179313153028488,
0.04339484125375748
] |
al,\t2015\n;\t\nFeuerstein\tand\tFalchuk,\t2016\n).\nPathophysiology\nEvolving\tpathophysiologic\tmechanisms\tin\tdiverticulosis\tand\tdiverticulitis\tsuggest\tchronic\ninflammation,\talterations\n\tin\tcolonic\tmicrobiota,\tdisturbed\tcolonic\tsensorimotor\tfunction,\tand\nabnormal\tcolon\tmotility\thave\tinterrelated\troles\tin\tthe\tdevelopment\tof\tdiverticular\tdisease\n(
|
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] |
(\nFeuerstein\tand\tFalchuk,\t2016\n).\tComplications\tof\tdiverticular\tdisease\trange\tfrom\tpainless,\tmild\nbleeding\tand\taltered\tbowel\thabits\tto\tdiverticulitis.\tAcute\tdiverticulitis\tincludes\ta\tspectrum\tof\ninflammation,\tabscess\tformation,\tbleeding,\tobstruction,\n\tfistula,\tand\tsepsis\tfrom\tperforation\n(rupture).\nMedical\tand\tsurgical\ttreatment
|
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(rupture).\nMedical\tand\tsurgical\ttreatment\nTreatment\ttypically\tincludes\tantibiotics\tand\tadjustment\tof\toral\tintake\tas\ttolerated.\tPatients\twith\nsevere\tcases\tof\tdiverticulitis\twith\tacute\tpain\tand\tcomplications\toften\trequire\ta\thospital\tstay\tand\ntreatment\twith\tintravenous\t(IV)\tantibiotics\tand\ta\tfew\tdays\tof\tbowel\trest\t(clear\tliquids\tonly,\tno\tsolid
|
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] |
foods).\tSurgery\n\tis\treserved\tfor\tpatients\twith\trecurrent\tepisodes\tof\tdiverticulitis\tand\tcomplications\nwhen\tthere\tis\tlittle\tor\tno\tresponse\tto\tmedication.\tSurgical\ttreatment\tfor\tdiverticulitis\tremoves\tthe\ndiseased\tpart\tof\tthe\tcolon:\tmost\tcommonly,\tthe\tleft\tor\tsigmoid\tcolon.\nMedical\tnutrition\ttherapy
|
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Medical\tnutrition\ttherapy\nHistorically,\tit\thas\tbeen\tcommon\tin\tclinical\tpractice\tto\trecommend\tavoidance\tof\tnuts,\tseeds,\thulls,\ncorn,\tand\n\tpopcorn\tto\tprevent\tsymptoms\tor\tcomplications\tof\tdiverticular\tdisease.\tHowever,\tnewer\nstudies\thave\tfound\tno\tassociation\tbetween\tnut,\tcorn,\tor\tpopcorn\tconsumption\tand\tdiverticular\nbleeding\t(
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] |
bleeding\t(\nFeuerstein\tand\tFalchuk,\t2016\n).\tIn\tfact,\tan\tinverse\trelationship\tbetween\tnut\tand\tpopcorn\nconsumption\tand\tthe\trisk\tof\tdiverticulitis\twas\tdemonstrated,\tsuggesting\ta\tprotective\teffect.\nDuring\tan\tacute\tepisode\tof\n\tdiverticulitis\tor\tdiverticular\tbleeding,\toral\tintake\tis\tusually\treduced
|
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] |
until\tsymptoms\tsubside.\tComplicated\tcases\tmay\tnecessitate\tbowel\trest\tand\trequire\tPN.\tOnce\toral\nintake\tis\tresumed\tit\tis\tprudent\tto\tbegin\ta\tlow-fiber\tdiet\t(10\tto\t15\tg/day)\tas\tthe\tdiet\tis\tbeing\nadvanced,\tfollowed\tby\ta\tgradual\treturn\tto\ta\thigh-fiber\tdiet.\nAlthough\tthere\tis\tconflicting\tevidence\tregarding\tfiber\tintake\tand\tdiverticular\n\tdisease,\tin
|
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0.1105191707611084,
0.01434365101158619
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swiftly\tand\trequire\tless\tstraining\twith\tdefecation.\tRecommended\tintakes\tof\tdietary\tfiber,\tpreferably\nfrom\tfoods,\tare\t25\tg/day\tfor\tadult\twomen\tand\t38\tg/day\tfor\tmen.\nFiber\tintake\tshould\tbe\tincreased\tgradually\tbecause\tit\tmay\tcause\tbloating\tor\tgas.\tIf\ta\tpatient\ncannot\tor\twill\tnot\tconsume\tthe\tnecessary\tamount\tof\tfiber,\tmethylcellulose\tor\tpsyllium\tfiber
|
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] |
supplements\thave\tbeen\tused\twith\tgood\tresults.\tA\thigh-fiber\tdiet,\tsometimes\twith\tfiber\nsupplementation,\tis\tadvocated\tin\tasymptomatic\tdiverticulosis\n\tto\treduce\tthe\tlikelihood\tof\tdisease\nprogression,\tprevent\tthe\trecurrence\tof\tsymptom\tepisodes,\tand\tprevent\tacute\tdiverticulitis.\tAdequate
|
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fluid\tintake\tshould\taccompany\tthe\thigh\tfiber\tintake.\tA\trecent\tsystematic\treview\tinvolving\t11\t(mostly\nuncontrolled)\tstudies\tof\tprobiotic\tuse\tfor\tthe\ttreatment\tof\tdiverticular\tdisease\tconcluded\tthat\tthe\nevidence\tdid\tnot\tshow\ta\tclear\tbenefit\t(\nLahner\tet\tal,\t2016\n;\t\nFeuerstein\tand\tFalchuk,\t2016\n).\nIntestinal\tpolyps\tand\tcolorectal\tcancer
|
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] |
).\nIntestinal\tpolyps\tand\tcolorectal\tcancer\nIn\tthe\tUnited\tStates,\tcolorectal\tcancer\t(CRC)\tis\tthe\tfourth\tmost\tcommon\tcancer\tin\tadults\tand\tthe\nsecond\tleading\tcause\tof\tcancer\tdeath.\tIt\tis\testimated\tthat\tthere\twere\t140,250\tnew\tcases\tof\tCRC\tin\n2018,\tand\tthe\tincidence\tis\tmore\tcommon\tin\tmen\tthan\twomen\tand\tamong\tthose\tof\tAfrican\tAmerican\ndescent\t(
|
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] |
descent\t(\nNational\tCancer\tInstitute,\t2018\n).\nEtiology\nAbout\n\t85%\tof\tCRCs\tare\tconsidered\tto\tbe\tsporadic,\twhereas\tabout\t15%\tare\tfamilial.\tFamilial\nadenomatous\tpolyposis\t(FAP)\taccounts\tfor\tless\tthan\t1%\tof\tCRCs.\tIt\tis\ta\thereditary\tsyndrome\ncharacterized\tby\tthe\tdevelopment\tof\thundreds\tto\tthousands\tof\tpolyps\tin\tthe\tcolon\tand\trectum\tduring
|
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] |
the\tsecond\tdecade\tof\tlife.\tAlmost\tall\tpatients\twith\tFAP\twill\tdevelop\tCRC\tif\tthey\tare\tnot\tidentified\tand\ntreated\tat\tan\tearly\tstage.\nAn\tevaluation\tof\tthe\tassociation\tof\tmajor\tknown\trisk\tfactors\tfor\tCRC\twith\tcolorectal\tpolyp\trisk\tby\nhistology\ttype,\tquantified\tthe\timpact\tof\tlifestyle\tmodifications\ton\tthe\tprevention\tof\tpolyps\t(\nFu\tet\tal,\n2012
|
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] |
Fu\tet\tal,\n2012\n).\tSeveral\tlifestyle\tfactors,\tincluding\tcigarette\tsmoking,\tobesity,\thigh\tintake\tof\tred\tmeat,\tlow
|
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intake\tof\tfiber,\tlow\tintake\tof\tcalcium,\tand\tlow\tvitamin\tD\tlevels\twere\tfound\tto\tbe\tindependently\nassociated\twith\tthe\trisk\tof\tpolyps.\tAdditionally,\tuse\tof\tnonsteroidal\tantiinflammatory\tdrugs\thas\nshown\tto\tbe\tprotective.\tThe\trisk\tof\tpolyps\tincreased\tprogressively\twith\tan\tincreasing\tnumber\tof\nthese\tadverse\tlifestyle\tfactors\t(\nBostick,\t2015\n;
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0.07571008056402206,
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0.08316073566675186,
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] |
these\tadverse\tlifestyle\tfactors\t(\nBostick,\t2015\n;\t\nFu\tet\tal,\t2012\n).\nPathophysiology\nPolyps\n\tare\testablished\tprecursors\tof\tCRCs\tand\tdefined\tas\ta\tmass\tthat\tarises\tfrom\tthe\tsurface\tof\tthe\nintestinal\tepithelium\n\tand\tprojects\tinto\tthe\tintestinal\tlumen.\tFactors\tthat\tincrease\tthe\trisk\tof\tCRC
|
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] |
include\tfamily\thistory,\tchronic\tIBD,\tFAP,\tadenomatous\tpolyps,\tand\tseveral\tdietary\tcomponents.\nPatterns\tof\tdietary\tpractices\trather\tthan\tspecific\tnutrients\tmay\tbe\tmore\tpredictive\tof\tthe\trisk\tof\ndeveloping\tCRC.\nMedical\tmanagement\nThe\ttreatment\tof\ta\tcolorectal\tpolyp\tis\tremoval,\tusually\tby\tcolonoscopy.\tLarge\tpolyps\toften\n\trequire
|
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] |
require\nsurgery\tfor\tcomplete\tremoval,\teven\tif\tthe\tpresence\tof\tcancer\tis\tnot\tconfirmed\tbefore\tresection.\nPatients\tdiagnosed\twith\tCRC\tmay\trequire\tmoderate\tto\tsignificant\tinterventions,\tincluding\nmedications,\tradiation\ttherapy,\tchemotherapy,\tsurgery,\tand\tEN\tand/or\tPN\tsupport.\nMedical\tnutrition\ttherapy
|
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] |
Medical\tnutrition\ttherapy\nRecommendations\tfrom\tnational\tcancer\torganizations\tinclude\tsufficient\texercise;\tweight\nmaintenance\n\tor\treduction;\tmodest\tand\tbalanced\tintake\tof\tlipids;\tadequate\tintake\tof\tfiber\tand\toptimal\nmicronutrients\tfrom\tfruits,\tvegetables,\tlegumes,\tand\twhole\tgrains;\tand\tlimited\tuse\tof\talcohol.
|
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Supplements\tare\tnormally\tencouraged\tif\tthe\tdiet\tis\tnot\tadequate\tin\tcalories,\tprotein,\tor\nmicronutrients.\tThe\tdiet\tfor\tcancer\tsurvivors\ttypically\tfollows\tthese\tprevention\tguidelines\t(see\nChapter\t35\n).\nNutritional\n\tconsequences\tof\tintestinal\tsurgery\nSmall\tbowel\tresections\tand\tshort-bowel\tsyndrome\nShort-bowel\tsyndrome\t(SBS)
|
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] |
Short-bowel\tsyndrome\t(SBS)\n\tcan\tbe\tdefined\tas\tinadequate\tabsorptive\tcapacity\tresulting\tfrom\nreduced\tlength\tor\tdecreased\tfunctional\tbowel\tafter\tresection.\tA\tloss\tof\t70%\tto\t75%\tof\tsmall\tbowel\nusually\tresults\tin\tSBS,\tdefined\tas\t100\tto\t120\tcm\tof\tsmall\tbowel\twithout\ta\tcolon,\tor\t50\tcm\tof\tsmall\nbowel\twith\tthe\tcolon\tremaining.
|
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] |
bowel\twith\tthe\tcolon\tremaining.\n\tA\tmore\tpractical\tdefinition\tof\tSBS\tis\tthe\tinability\tto\tmaintain\nnutrition\tand\thydration\tneeds\twith\tnormal\tfluid\tand\tfood\tintake,\tregardless\tof\tbowel\tlength,\tas\nadaptation\tto\tbowel\tresections\tcan\tvary\twidely\tamong\tthose\twho\thave\thad\tthem.
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] |
Patients\twith\tSBS\toften\thave\tcomplex\tfluid,\telectrolyte,\tand\tnutritional\tmanagement\tissues.\nConsequences\tof\tSBS\tinclude\tmalabsorption\tof\tmicronutrients\tand\tmacronutrients,\n\tfrequent\ndiarrhea,\tsteatorrhea,\tdehydration,\telectrolyte\timbalances,\tweight\tloss,\tand\tgrowth\tfailure\tin\nchildren\t(\nLimketkai,\t2017
|
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] |
children\t(\nLimketkai,\t2017\n).\tOther\tcomplications\tinclude\tgastric\thypersecretion,\toxalate\trenal\tstones,\nand\tcholesterol\tgallstones.\tIndividuals\twho\teventually\tneed\tlong-term\tPN\thave\tincreased\trisk\tof\ncatheter\tinfection,\tsepsis,\tcholestasis,\tand\tliver\tdisease,\tand\treduced\tquality\tof\tlife\tassociated\n\twith\nchronic\tintravenous\tnutrition\tsupport\t(
|
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] |
with\nchronic\tintravenous\tnutrition\tsupport\t(\nDiBaise,\t2014\n).\nEtiology\nThe\tmost\tcommon\treasons\tfor\tmajor\tresections\tof\tthe\tintestine\tin\tadults\tinclude\tCrohn’s\tdisease,\nradiation\tenteritis,\tmesenteric\tinfarct,\tmalignant\tdisease,\tand\tvolvulus.\tIn\tthe\tpediatric\tpopulation
|
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0.022343328222632408
] |
most\tcases\tof\tSBS\tresult\tfrom\tcongenital\tanomalies\tof\tthe\tGI\ttract,\tatresia,\tvolvulus,\tor\tnecrotizing\nenterocolitis\t(\nShatnawei\tet\tal,\t2010\n).\nPathophysiology\nDuodenal\tresection.\nResection\tof\tthe\tduodenum\t(approximately\t10\tto\t15\tinches)\tis\trare,\twhich\tis\tfortunate\tbecause\tit\tis
|
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] |
the\tpreferred\tsite\tfor\tabsorption\tof\tkey\tnutrients\tsuch\tas\tiron,\tzinc,\tcopper,\tand\tfolate.\tThe\nduodenum\tis\ta\tkey\tplayer\tin\tthe\tdigestion\tand\tabsorption\tof\tnutrients,\tbecause\tit\tis\tthe\tportal\tof\nentry\tfor\tpancreatic\tenzymes\tand\tbile\tsalts\t(see\t\nChapter\t1\n).\nJejunal\tresections.
|
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] |
Chapter\t1\n).\nJejunal\tresections.\nThe\tjejunum\t(6\tto\t10\tfeet)\tis\talso\tresponsible\tfor\ta\tlarge\tportion\tof\tnutrient\tabsorption.\tNormally\nmost\tdigestion\tand\tabsorption\tof\tfood\tand\tnutrients\toccurs\tin\tthe\tfirst\t100\tcm\tof\tsmall\tintestine,\nwhich\talso\tincludes\tthe\tduodenum.\tJejunal\tenterohormones\tplay\tkey\troles\tin\tdigestion\tand
|
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0.07735805958509445,
0.11842553317546844,
0.03885650634765625,
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] |
absorption.\tCholecystokinin\t(CCK)\tstimulates\tpancreatic\tsecretion\tand\tgallbladder\tcontraction,\n\tand\nsecretin\tstimulates\tsecretion\tof\tbicarbonate\tfrom\tthe\tpancreas.\tGastric\tinhibitory\tpeptide\tslows\ngastric\tsecretion\tand\tgastric\tmotility,\twhereas\tvasoactive\tinhibitory\tpeptide\tinhibits\tgastric\tand\nbicarbonate\tsecretion\t(see\t\nChapter\t1
|
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] |
bicarbonate\tsecretion\t(see\t\nChapter\t1\n).\tWhat\tremains\tto\tbe\tdigested\tor\tfermented\tand\tabsorbed\tare\nsmall\tamounts\tof\tsugars,\tresistant\tstarch,\tlipids,\tdietary\tfiber,\tand\tfluids.\tAfter\tjejunal\tresections,\n\tthe\nileum\ttypically\tadapts\tto\tperform\tthe\tfunctions\tof\tthe\tjejunum.\tThe\tmotility\tof\tthe\tileum\tis
|
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] |
comparatively\tslow,\tand\thormones\tsecreted\tin\tthe\tileum\tand\tcolon\thelp\tto\tslow\tgastric\temptying\tand\nsecretions.\tBecause\tjejunal\tresections\tresult\tin\treduced\tsurface\tarea\tand\tfaster\tintestinal\ttransit,\tthe\nfunctional\treserve\tfor\tabsorption\tof\tmicronutrients,\texcess\tamounts\tof\tsugars\t(especially\tlactose),\nand\tlipids\tis\treduced.\nIleal\tresections.
|
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0.07870090007781982,
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] |
Significant\tresections\tof\tthe\tileum,\tespecially\tthe\tdistal\tileum,\tproduce\tmajor\tnutritional\tand\tmedical\ncomplications.\tThe\tdistal\tileum\tis\tthe\tonly\tsite\tfor\tabsorption\tof\tbile\tsalts\tand\tthe\tvitamin\tB\n12\n-\nintrinsic\tfactor\tcomplex.\tThe\tileum\talso\tabsorbs\ta\tmajor\tportion\tof\tthe\t7\tto\t10\tL\tof\tfluid\tingested\tand\nsecreted\tinto\tthe\tGI\ttract\tdaily\t(see
|
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] |
secreted\tinto\tthe\tGI\ttract\tdaily\t(see\t\nChapter\t1\n).\tThe\tileocecal\tvalve,\tat\tthe\tjunction\tof\tthe\tileum\tand\ncecum,\tmaximizes\tnutrient\tabsorption\tby\tcontrolling\tthe\trate\tof\tpassage\tof\tileal\tcontents\tinto\tthe\ncolon\tand\tpreventing\treflux\tof\tcolonic\tbacteria,\twhich\tmay\tdecrease\trisk\tfor\tSIBO.
|
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Although\tmalabsorption\tof\tbile\tsalts\tmay\tappear\tto\tbe\tbenign,\tit\tcreates\ta\tcascade\tof\nconsequences.\tIf\tthe\tileum\tcannot\t“recycle”\tbile\tsalts\tsecreted\tinto\tthe\n\tGI\ttract,\thepatic\tproduction\ncannot\tmaintain\ta\tsufficient\tbile\tsalt\tpool\tor\tthe\tsecretions\tto\temulsify\tlipids.\tThe\tgastric\tand
|
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] |
In\taddition,\tmalabsorption\tof\tfatty\nacids\tresults\tin\ttheir\tcombination\twith\tcalcium,\tzinc,\tand\tmagnesium\tto\tform\tfatty\tacid–mineral\nsoaps,\tthus\tleading\tto\ttheir\tmalabsorption\tas\twell.\tTo\tcompound\tmatters,\tcolonic\tabsorption\tof\noxalate\tis\tincreased,\tleading\tto\thyperoxaluria\tand\tincreased\tfrequency\tof\trenal\toxalate\tstones.
|
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] |
Relative\tdehydration\tand\tconcentrated\turine,\twhich\tare\tcommon\twith\tileal\tresections,\n\tfurther\nincrease\tthe\trisk\tof\tstone\tformation\t(see\t\nChapter\t34\n).\nColon\tresections\nThe\tcolon\t(approximately\t5\tft\tlong)\tis\tresponsible\tfor\treabsorbing\t1\tto\t1.5\tL\tof\telectrolyte-rich
|
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] |
(particularly\tsodium\tand\tchloride)\tfluid\teach\tday\tbut\tis\tcapable\tof\tadapting\tto\tincrease\tthis\tcapacity\nto\t5\tto\t6\tL\tdaily.\tPreservation\tof\tcolon\tis\tkey\tto\tmaintaining\thydration\tstatus.\tHowever,\tif\tthe\tpatient\nhas\n\tany\tcolon\tleft,\tmalabsorption\tof\tbile\tsalts\tcan\tact\tas\ta\tmucosal\tirritant,\tincreasing\tcolonic
|
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motility\twith\tfluid\tand\telectrolyte\tlosses.\tConsumption\tof\thigh-fat\tdiets\twith\tileal\tresections\tand\nretained\tcolon\talso\tmay\tresult\tin\tthe\tformation\tof\thydroxy\tfatty\tacids,\twhich\talso\tincrease\tfluid\tloss.\nCholesterol\tgallstones\toccur\tbecause\tthe\tratio\tof\tbile\tacid,\tphospholipid,\tand\tcholesterol\tin\tbiliary
|
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secretions\tis\taltered.\tDependence\ton\tPN\tincreases\tthe\trisk\tof\tbiliary\t“sludge,”\tsecondary\tto\ndecreased\tstimulus\tfor\tevacuation\tof\tthe\tbiliary\ttract\t(see\t\nChapters\t12\n\tand\t\n28\n).\nMedical\tand\tsurgical\tmanagement\tof\tresections\nThe\tfirst\tstep\tin\tmanagement\tis\tassessment\tof\tthe\tremaining\tbowel\tlength\tfrom\tpatient\tsurgical\tand
|
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health\trecords\tor\tinterview.\tAssessment\tshould\tquantify\tdietary\tintake,\tas\n\twell\tas\tstool\tand\turine\noutput,\tover\t24\thours.\tMedications\tand\thydration\tstatus\tshould\tbe\tassessed.\tMedications\tmay\tbe\nprescribed\tto\tslow\tGI\tmotility,\tdecrease\tsecretions,\tincrease\tabsorption\twith\tthe\tremaining\tbowel,\tor
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treat\tbacterial\tovergrowth.\tThe\tprimary\t“gut\tslowing”\tmedications\tinclude\tloperamide\tand\noccasionally\tnarcotic\tmedications,\tsuch\tas\ttincture\tof\topium\tand\tliquid\tcodeine.\tSomatostatin\n\tand\nsomatostatin\tanalogs;\tgrowth\thormone;\tand\tother\thormones\twith\tantisecretory,\tantimotility,\tor
|
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] |
trophic\tactions\thave\tbeen\tstudied\tfor\tuse\tto\tslow\tmotility\tand\tsecretions.\tFurther,\tglucagon-like\npeptide\tanalog,\tTeduglutide,\tcarries\tthe\tunique\tability\tto\tenhance\tabsorptive\tcapacity\tin\tan\tattempt\nto\treduce\tor\teliminate\tthe\tneed\tfor\tPN\t(\nKim\tand\tKeam,\t2017\n).\tSurgical\tprocedures\tsuch\tas\tcreation\nof
|
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Kim\tand\tKeam,\t2017\n).\tSurgical\tprocedures\tsuch\tas\tcreation\nof\n\treservoirs\t(“pouches”)\tto\tserve\tas\ta\tform\tof\tcolon,\tintestinal\tlengthening,\tand\tintestinal\ttransplant\nhave\tbeen\tperformed\tto\thelp\tpatients\twith\tmajor\tGI\tresections.\tIntestinal\ttransplant\tis\tvery\tcomplex
|
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Enteral\tfeeding\tprovides\ta\ntrophic\tstimulus\tto\tthe\tGI\ttract;\tPN\tis\tused\tto\trestore\tand\tmaintain\tnutrient\tstatus.\nThe\tmore\textreme\tand\tsevere\tthe\tproblem,\tthe\tslower\tthe\tprogression\tto\ta\tnormal\tdiet.\tSmall,\nfrequent\tmini\tmeals\t(six\tto\tten\tper\tday)\tare\tlikely\tto\tbe\tbetter\ttolerated\tthan\tlarger\tfeedings.\tTube
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feeding\tmay\tbe\tuseful\tto\tmaximize\tintake\twhen\ta\tpatient\twould\tnot\ttypically\teat,\tsuch\tas\n\tduring\tthe\nnight\t(see\t\nChapter\t12\n).\tBecause\tof\tmalnutrition\tand\tdisuse\tof\tthe\tGI\ttract,\tthe\tdigestive\tand\nabsorptive\tfunctions\tof\tthe\tremaining\tGI\ttract\tmay\tbe\tcompromised,\tand\tmalnutrition\twill\tdelay
|
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postsurgical\tadaptation.\tThe\ttransition\tto\tmore\tnormal\tfoods\tmay\ttake\tweeks\tto\tmonths,\tand\tsome\npatients\tmay\tnever\ttolerate\tnormal\tconcentrations\tor\tvolumes\tof\tfoods\tand\talways\trequire\nsupplemental\n\tPN\tto\tmaintain\tadequate\tfluid\tand\tnutritional\tstatus.\nMaximum\tadaptation\tof\tthe\tGI\ttract\tmay\ttake\t1\tto\t2\tyears\tafter\tsurgery.\tAdaptation\timproves
|
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] |
function,\tbut\tit\tdoes\tnot\trestore\tthe\tintestine\tto\tnormal\tlength\tor\tcapacity.\tComplex,\tintact\tnutrients\n(vs.\telemental/\tpre-digested\tformulas)\tare\tthe\tmost\timportant\tstimuli\tof\tthe\tGI\ttract.\tOther\nnutritional\tmeasures\talso\thave\tbeen\tstudied\tas\ta\tmeans\n\tof\thastening\tthe\tadaptive\tprocess\tand
|
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] |
of\thastening\tthe\tadaptive\tprocess\tand\ndecreasing\tmalabsorption,\tbut\ttheir\tevidence\tfor\tuse\tis\tlimited.\tFor\texample,\tthe\tamino\tacid\nglutamine\n\tis\tthe\tpreferred\tfuel\tfor\tsmall\tintestinal\tenterocytes\tand\tthus\tmay\tbe\tvaluable\tin\nenhancing\tadaptation.\tNucleotides\t(in\tthe\tform\tof\tpurines,\tpyrimidine,\tribonucleic\tacid)\talso\tmay
|
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enhance\tmucosal\tadaptation,\tbut\tunfortunately\tthey\tare\toften\tlacking\tin\tparenteral\n\tand\tenteral\nnutritional\tproducts.\tSCFAs\t(e.g.,\tbutyrate,\tpropionate,\tacetate),\tcarbohydrate\tfermentation\nbyproducts\tof\tcommensal\tgut\tmicrobiota,\tare\tmajor\tfuels\tfor\tthe\tcolonic\tepithelium.
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Patients\twith\tjejunal\tresections\tand\tan\tintact\tileum\tand\tcolon\twill\thave\ta\tgood\tchance\tof\tadapting\nquickly\tto\ta\tnormal\tdiet\twith\ta\tbalance\tof\tprotein,\tfat,\tand\tcarbohydrate\tthat\tis\tsatisfactory.\tSix\tsmall\nfeedings\n\twith\tavoidance\tof\tlactose,\tlarge\tamounts\tof\tconcentrated\tsweets,\tand\tcaffeine\tmay\thelp\tto
|
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] |
reduce\tthe\trisk\tof\tbloating,\tabdominal\tpain,\tand\tdiarrhea.\tBecause\tthe\ttypical\tAmerican\tdiet\tmay\tbe\nnutritionally\tlacking,\tand\tthe\tintake\tof\tsome\tmicronutrients\tmay\tbe\tmarginal,\tpatients\tshould\tbe
|
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advised\tthat\tthe\tquality\tof\tthe\tdiet\tis\tof\tutmost\timportance.\tA\tmultivitamin\tand\tmineral\tsupplement\nmay\tbe\n\trequired\tto\tmeet\tnutritional\tneeds.\nPatients\twith\tileal\tresections\trequire\tincreased\ttime\tand\tpatience\tin\tthe\tadvancement\tfrom\tPN\tto\nEN.\tBecause\tof\tlosses,\tfat-soluble\tvitamins,\tcalcium,\tmagnesium,\tand\tzinc\tmay\thave\tto\tbe
|
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supplemented.\tDietary\tfat\tmay\thave\tto\tbe\tlimited,\tespecially\tin\tthose\twith\tlittle\tremaining\tcolon.\nSmall\tamounts\tat\teach\tfeeding\tare\tmore\tlikely\tto\tbe\ttolerated\tand\tabsorbed.\nMCT\tproducts\tadd\tto\tthe\tcaloric\tintake\tand\tserve\tas\ta\tvehicle\tfor\tlipid-soluble\tnutrients.\tBecause
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boluses\tof\tMCT\toil\t(e.g.,\ttaken\tas\ta\tmedication\tin\ttablespoon\tamounts)\tmay\tadd\tto\tthe\tpatient’s\ndiarrhea,\tit\tis\tbest\tto\tdivide\tthe\tdoses\tequally\tin\tfeedings\tthroughout\tthe\tday.\tFluid\tand\telectrolytes,\nespecially\tsodium,\tshould\tbe\tprovided\tin\tsmall\tamounts\tand\tfrequently.\nIn\tpatients\twith\tSBS\tan
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In\tpatients\twith\tSBS\tan\n\toral\tdiet\tor\tEN\tplus\tthe\tuse\tof\tgut-slowing\tmedications\tshould\tbe\nmaximized\tto\tprevent\tdependence\ton\tPN.\tFrequent\tmeals,\tremoval\tof\tosmotic\tmedications\tand\nfoods,\tuse\tof\toral\thydration\ttherapies,\tand\tother\tinterventions\tshould\tbe\tpursued.\tIn\tsome\tcases,
|
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overfeeding\tin\tan\tattempt\tto\tcompensate\tfor\tmalabsorption\tresults\tin\tfurther\tmalabsorption,\tnot\nonly\tof\tingested\tfoods\tand\tliquids\tbut\talso\tof\tthe\n\tsignificant\tamounts\tof\tGI\tfluids\tsecreted\tin\nresponse\tto\tfood\tingestion.\tPatients\twith\tan\textremely\tshort\tbowel\tmay\tdepend\ton\tparenteral
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] |
solutions\tfor\tat\tleast\tpart\tof\ttheir\tnutrient\tand\tfluid\tsupply.\tSmall,\tfrequent\tsnacks\tprovide\tsome\toral\ngratification\tfor\tthese\tpatients,\tbut\ttypically\tthey\tcan\tsupply\tonly\ta\tportion\tof\ttheir\tfluid\tand\tnutrient\nneeds\t(see\t\nChapter\t12\n\tfor\tdiscussion\tof\thome\tPN).\nSmall\tintestine\tbacterial\tovergrowth\nSmall\tintestinal\tbacterial\tovergrowth\t(SIBO)
|
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] |
Small\tintestinal\tbacterial\tovergrowth\t(SIBO)\n\tis\ta\tsyndrome\tcharacterized\tby\toverproliferation\tof\nbacteria\tnormally\tfound\tin\tthe\tlarge\tintestine\twithin\tthe\tsmall\tintestine.\tIn\ta\tnormally\tfunctioning\nbowel,\ta\tnumber\tof\tphysiologic\tprocesses\tlimit\tthe\tnumber\tof\tbacteria\tin\tthe\tsmall\tintestine.\tAmong
|
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|
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] |
numbers\tof\tcolonic\tbacteria\tinto\tthe\tsmall\tintestine.\tSIBO\talso\thas\tbeen\treferred\tto\tas\t“blind\tloop\nsyndrome”\tbecause\tone\tcause\tof\tbacterial\tovergrowth\tcan\tresult\tfrom\n\tstasis\tof\tthe\tintestinal\ttract\tas\na\tresult\tof\tobstructive\tdisease,\tstrictures,\tadhesions\t(scar\ttissue),\tradiation\tenteritis,\tor\tsurgical
|
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0.050604719668626785,
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0.06676444411277771,
0.02242758683860302
] |
procedures\tthat\tleave\ta\tportion\tof\tbowel\twithout\tnormal\tflow\t(a\tblind\tloop\tor\tRoux\tlimb).\nEtiology\nFrequently,\tmore\tthan\tone\tof\tthe\tnormal\thomeostatic\tdefenses\tlisted\tpreviously\tmust\tbe\timpaired\nbefore\tsmall\tintestine\tbacteria\toverproliferate\tto\tthe\tpoint\n\tthat\tsymptoms\tdevelop.\tChronic\tuse\tof
|
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] |
that\tsymptoms\tdevelop.\tChronic\tuse\tof\nantibiotics\tor\tmedications\tthat\tsuppress\tgastric\tacid\tallow\tmore\tingested\tbacteria\tto\tsurvive\tand\npass\tinto\tthe\tsmall\tbowel.\tLiver\tdiseases\tor\tchronic\tpancreatitis\tcan\tdecrease\tthe\tproduction\tor\tflow\ninto\tthe\tbowel\tof\tbile\tand\tpancreatic\tenzymes\tthat\tcontrol\tbacterial\tgrowth.\tGastroparesis,\tnarcotic
|
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medications,\tor\tbowel\tdysmotility\tdisorders\tdecrease\tperistalsis\n\tand\tcan\timpair\tthe\tability\tto\tpropel\nbacteria\tto\tthe\tdistal\tbowel.\tSurgical\tresection\tof\tthe\tdistal\tileum\tand\tileocecal\tvalve\tcan\tresult\tin\nretrograde\tproliferation\tof\tcolonic\tbacteria.\tResearch\talso\tdemonstrates\tthat\tSIBO\tis\ta\tcommon
|
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] |
problem\tfor\tpatients\twith\tIBS-D\t(diarrhea\tpredominant)\t(\nPalmer\tet\tal,\t2017\n).\nPathophysiology\nAlthough\tsymptoms\tvary\tdepending\ton\tthe\tamount\tand\ttype\tof\tbacteria\n\tpresent\tin\tthe\tsmall\nintestine,\tthe\tmost\tcommon\tsymptoms\tof\tSIBO\tinclude\tgas,\tbloating,\tnausea,\tconstipation,\tdiarrhea,
|
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to\tthe\tbrush\tborder\nsecondary\tto\tthe\ttoxic\teffects\tof\tbacterial\tproducts\tand\tconsequent\tenzyme\tloss\t(\nPalmer\tet\tal,\t2017\n).\nThe\texpanding\tnumbers\tof\tbacteria\tuse\tthe\tavailable\tvitamin\tB\n12\n\tand\tother\tnutrients\tfor\ttheir\town\ngrowth,\tand\tthe\thost\tbecomes\tdeficient.\tBacteria\twithin\tthe\tsmall\tbowel\tproduce\tfolate\tas\ta
|
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byproduct\tof\ttheir\tmetabolism,\tand\tvitamin\tB\n12\n\tdeficiency\twith\tnormal\tor\televated\tserum\n\tfolate\tis\ncommon.\tBloating\tand\tdistention\talso\tare\treported\tfrequently\tin\tSIBO,\tresulting\tfrom\tthe\taction\tof\nbacteria\ton\tcarbohydrates\twith\tproduction\tof\thydrogen\tand\tmethane\twithin\tthe\tsmall\tbowel.
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D-lactic\tacidosis\tor\tD-lactate\tencephalopathy\tis\ta\trare\tcomplication\tof\tSIBO\tin\tSBS\tpatients\twith\nthe\tcolon\tin\tcontinuity\tand\tileocecal\tvalve\tremoved.\tIn\tthese\tindividuals,\tmalabsorption\tof\ta\tlarge\ncarbohydrate\tload\tcan\tlead\tto\texcess\tcarbohydrates\tbeing\tdelivered\tto\tthe\tbacteria\tin\tthe\tcolon.\tA
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from\tlethargy\n\tto\taltered\tmental\tstatus,\tataxia,\tand\tslurred\tspeech\tto\taggression\tand\tcoma\t(\nHtyte\tet\nal,\t2011\n;\t\nWhite,\t2015\n).\nMedical\ttreatment\nThe\tmost\tcommon\tpathway\tfor\tmedical\tdiagnosis\tof\tSIBO\tis\ta\tlactulose\tbreath\ttest\twhich\tmeasures\nlevels\tof\tbreath\thydrogen\tand\tmethane.\tHigher\tlevels\tcorrelate\twith\tbacterial\tovergrowth\tin\tthe
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] |
small\tintestine\t(\nRezaie\tet\tal,\t2017\n;\t\nPalmer\tet\tal,\t2017\n).\tA\tmore\tinvasive,\n\tsmall\tbowel\taspirate\tand\nculture\tis\tthe\ttraditional\tgold\tstandard.\tTesting\tfor\tSIBO\tin\tpatients\twith\tSBS\tmay\tpresent\tmore\nchallenges.\tSome\tclinicians\ttreat\tbased\ton\tsymptomatology\treports\tin\tcombination\twith\tpreexisting
|
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] |
risk\tfactors.\tTreatment\tis\tdirected\ttoward\tcontrol\tof\tthe\tbacterial\tgrowth\tby\tadministration\tof\nantibiotics\tor\therbs\tor\tthe\tuse\tof\tan\telemental\tdiet.\tHistorically,\tthe\tmost\tfavored\n\tantibiotics\thave\nincluded\trifaximin,\tmetronidazole,\tciprofloxacin,\tamoxicillin/clavulanate,\tor\tdoxycycline.\tTreatment
|
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may\tinvolve\tcycling\tof\tseveral\tantibiotics\tuntil\timprovement\tof\tsymptoms\tis\tobserved\t(\nRezaie\tet\tal,
|
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] |
2016\n).\tUnfortunately,\trecurrences\tcan\toccur,\twarranting\tfurther\ttreatment\t(\nPalmer\tet\tal,\t2017\n).\nTypically,\ta\t7-\tto\t10-day\tcourse\tof\tantibiotics\tis\tsuccessful,\tbut\tsome\tpatients\tmay\n\trequire\t1\tto\t2\nmonths\tof\ttreatment\t(\nBohm\tet\tal,\t2013\n).\tThe\tantibiotic\tshould\tbe\trotated\tto\tprevent\tbacterial
|
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] |
).\tThe\tantibiotic\tshould\tbe\trotated\tto\tprevent\tbacterial\nresistance.\tThere\tis\tsome\tevidence\tthat\tspecific\therbal\tpreparations\tmay\tbe\tas\tbeneficial\tas\nantibiotic\ttherapies\tin\tthe\ttreatment\tof\tSIBO\t(\nMullin,\t2014\n).\tResearch\tis\tongoing\twith\tregard\tto\npairing\tprobiotics\tand\tantibiotic\ttherapies.\nMedical\tnutrition\ttherapy\nDietary\tmodification\tshould
|
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Medical\tnutrition\ttherapy\nDietary\tmodification\tshould\n\ttarget\talleviation\tof\tsymptoms\tand\tcorrection\tof\tnutrient\tdeficiencies.\nWith\tbacterial\tovergrowth\tin\tthe\tsmall\tintestine,\tcarbohydrates\treaching\tthe\tsite\twhere\tmicrobes\nare\tharbored\tserve\tas\tfuel\tfor\ttheir\tproliferation,\twith\tsubsequent\tincreased\tproduction\tof\tgases\tand
|
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organic\tacids.\tA\tlow\tFODMAP\tdiet\t(previously\tdiscussed\tin\tIBS\tsection)\thas\tthe\tmost\tevidence\tfor\nreducing\tGI\tsymptoms\tin\tSIBO.\n\tIf\tthe\tpatient\texhibits\tmore\tsevere\tcarbohydrate\tsensitivity,\ta\tmore\nrestrictive\tspecific\tcarbohydrate\tdiet\t(SCD)\tor\ta\tcombination\tof\tboth\tcould\tbe\ttried.\tIn\textreme
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cases,\tmedically\tsupervised\telemental\tdiets\tmay\tbe\trecommended\talong\twith\tthe\tantibiotics\tuntil\nremission\tis\tachieved.\tClose\tsupport\tand\tmonitoring\tof\ta\ttrained\tnutrition\tprofessional\tis\talways\nrecommended\tas\tan\tadjunct\tto\tmedical\n\ttreatments\tas\tnoted\tabove.\tMore\tinformation\tcan\tbe\tfound\tat\nMonash\tUniversity\tat\t\nhttps://www.monash.edu\n,
|
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] |
Monash\tUniversity\tat\t\nhttps://www.monash.edu\n,\t\nhttps://www.katescarlata.com\n,\tand\tSIBO\tCenter\tfor\nDigestive\tHealth\tat\t\nhttps://sibocenter.com/category/sibo-diets/\n.\nAn\tassessment\tof\tthe\tmedical\tproblem\tand\tthe\tpatient’s\tdietary\tintake\tis\tnecessary,\tas\tvitamin\tB\n12\nmay\tbe\tlost\tin\tfermentation;\tthe\tdiet\tmay\tlack\tkey\tdietary\tnutrients;\tor\tthe
|
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] |
absence\tor\tremoval\tof\ngreater\tthan\t60\tcm\tof\tthe\tterminal\tileum\thas\toccurred,\tputting\tthe\tpatient\tat\trisk\tfor\tdeficiencies.\tA\nroutine\tintramuscular\tvitamin\tB\n12\n\tmay\tbe\trequired.\tIf\tbile\tsalts\tare\tbeing\tdegraded,\tas\tin\tthe\tcase\tof\nblind\tloop\tsyndrome,\tMCTs\tmay\tbe\thelpful\tif\tthey\tprovide\ta\tsource\tof\tlipid\tand\tenergy.\tDeficiencies
|
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] |
enterocutaneous\tfistula\t(ECF)\n\tis\tan\tabnormal\tpassage\tfrom\ta\tportion\tof\tthe\tintestinal\ttract\tto\tthe\nskin\tor\tto\ta\twound\t(e.g.,\tcolocutaneous\tfistula\tbetween\tthe\tlarge\tintestine\tand\tthe\tskin).\nEtiology\nFistulas\tmay\toccur\tin\tany\tpart\tof\tthe\tGI\ttract\tbut\tare\tmost\tcommon\tin\tthe\tsmall\tand\tlarge\tintestine.
|
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] |
ECF\tcan\tbe\tclassified\tseveral\tways:\tby\tvolume\tof\toutput\tper\tday,\tcause\t(surgical\tvs.\tspontaneous),\nsite\tof\torigin,\tand\tnumber\tof\tfistula\ttracts.\tSurgery\taccounts\tfor\tthe\tmajority\tof\tECF\tdevelopment\nand\tusually\tmanifests\t7\tto\t10\tdays\tpostoperatively.\tFistulas\tof\tthe\tintestinal\ttract\tcan\tbe\tserious
|
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] |
threats\tto\tnutrition\tstatus\tbecause\tlarge\tamounts\tof\tfluids\tand\telectrolytes\tare\tlost,\tand\nmalabsorption\tand\tsepsis\tcan\toccur.\t\nBox\t27.11\n\tlists\tconditions\tassociated\twith\tfistula\tdevelopment.\nBOX\t27.11\nConditions\tAssociated\tWith\tFistula\tDevelopment\nBowel\tresection\tfor\tcancer\nBowel\tresection\tfor\tinflammatory\tbowel\tdisease\nSurgery\tfor\tpancreatitis
|
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0.07900653034448624,
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0.03868062049150467
] |
Surgery\tfor\tpancreatitis\nSurgery\ton\tradiated\tbowel\nEmergent\n\tsurgery\nSurgical\twound\tdehiscence\nInflammatory\tbowel\tdisease\t(Crohn’s\tdisease\tor\tulcerative\tcolitis)\nRadiation\tenteritis\nBowel\tischemia\nDiverticular\tdisease\nData\tfrom\tFrantz\tD\tet\tal:\tGastrointestinal\tdisease.\tIn\tMueller\tCM\tet\tal,\teditors:\t\nThe\tASPEN\tAdult
|
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] |
The\tASPEN\tAdult\nNutrition\tSupport\tCore\tCurriculum,\n\ted\t2,\tSilver\tSpring,\tMd,\t2012,\tAmerican\tSociety\tfor\tParenteral\tand\nEnteral\tNutrition.\nMedical\n\ttreatment\nWound\tcare,\tresuscitation,\tsource\tcontrol,\tand\tthe\tuse\tof\tnutrition\tsupport\tduring\tthe\thealing\tphase\nare\tthe\tprimary\tapproaches\tfor\tmedical\ttreatment\t(\nBhutiani\tet\tal,\t2017
|
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Bhutiani\tet\tal,\t2017\n).\tA\tfistulogram\tis\tconsidered\nthe\tgold\tstandard\tfor\tidentifying\tthe\tlocation\tand\troute\tof\tthe\tfistulous\ttract.\tFluid\tand\telectrolyte\nbalance\tmust\tbe\trestored,\tinfection\tmust\tbe\tbrought\tunder\tcontrol,\tand\taggressive\n\tnutrition\tsupport
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0.04886337369680405,
0.048676859587430954,
0.032906387001276016,
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] |
nutrition\tsupport\nmay\tbe\tnecessary\tto\tpermit\tspontaneous\tclosure\tor\tto\tmaintain\toptimal\tnutritional\tstatus\tbefore\nsurgical\tclosure.\nMedical\tnutrition\ttherapy\nNutrition\tmanagement\tof\tpatients\twith\tECF\tcan\tbe\tvery\tchallenging.\tInitial\tmanagement\tmay\ninclude\tkeeping\tthe\tpatient\t\nnil\tper\tos\n\t(NPO)\tas\tfistula\toutput\tis\tquantified\tand\tadministering
|
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] |
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