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nutritional\tsupport\tduring\tthe\tinitial\tworkup\tphase.\n\tPN,\tEN,\toral\tdiet,\tor\ta\tcombination\tis\tused\tin\npatients\twith\tECF.\tThe\tdecision\tregarding\twhich\troute\tto\tfeed\tpatients\twith\tECF\tdepends\ton\tseveral\nfactors,\tincluding\tthe\torigin\tof\tthe\tfistula,\tthe\tpresence\tof\tobstructions\tor\tabscesses,\tthe\tlength\tof
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functional\tbowel,\tthe\tlikelihood\tof\tfistula\tclosure,\tthe\tability\tto\tmanage\tfistula\toutput,\tand\tthe\npatient’s\toverall\tmedical\tcondition\t(see\t\nChapter\t12\n).\nIntestinal\tostomies\nThe\tword\t\nostomy\n,\tderived\tfrom\tthe\tLatin\tword\t\nostium\n,\trefers\tto\tmouth\tor\topening.\tAn\t\nintestinal\nostomy
|
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] |
ostium\n,\trefers\tto\tmouth\tor\topening.\tAn\t\nintestinal\nostomy\n\tis\ta\tsurgically\tcreated\topening\tbetween\tthe\tintestinal\ttract\tand\tthe\tskin\tand\tis\tspecifically\nnamed\taccording\tto\tthe\tsite\tof\torigin\talong\tthe\tintestinal\ttract.\tAbout\t100,000\tpeople\tin\tthe\tUnited\nStates\tundergo\toperations\tthat\tresult\tin\ta\tcolostomy\tor\tileostomy\teach\tyear\n\t(
|
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] |
(\nSheetz\tet\tal,\t2014\n).\tThe\nhigh\tincidence\tof\tostomy\tis\tdue\tin\tpart\tto\tthe\tincreasing\tprevalence\tof\tCRC\tand\tdiverticular\nsurgeries\tin\tthe\tUnited\tStates.\tOstomies\tare\tcreated\tfor\tmany\treasons;\t\nTable\t27.7\n\tlists\tindications\nfor\tthe\tcreation\tof\tostomies.\nTABLE\t27.7\nPotential\tIndications\tfor\tCreation\tof\tIntestinal\tOstomy\nIleostomy\nColostomy
|
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] |
Ileostomy\nColostomy\nCrohn’s\tdisease\nUlcerative\tcolitis\nFAP\nColon\tcancer\nRectal\tcancer\nBowel\tperforation\nBowel\tischemia\nRectal\ttrauma\nFecal\tincontinence\nFecal\tdiversion\nColonic\tdysmotility\nToxic\tcolitis\nAnastomotic\tleak\nDistal\tobstruction\nEnterocutaneous\tfistula\nColon\tcancer\nRectal\tcancer\nDiverticulitis\nRectal\ttrauma\nRadiation\tproctitis
|
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] |
Rectal\tcancer\nDiverticulitis\nRectal\ttrauma\nRadiation\tproctitis\nDistal\tobstruction\nFecal\tincontinence\nComplex\tfistula\nFAP,\n\tFamilial\tadenomatous\tpolyposis.\nColostomies\tand\n\tileostomies\tcan\tbe\tcategorized\tas\teither\tloop\tor\tend\tostomies.\tA\t\nloop\tostomy\n\tis\nformed\twhen\ta\tloop\tof\tbowel\tis\tbrought\tup\tto\tthe\tskin,\tand\tan\tincision\tis\tmade\ton\tone\tside.\tThe
|
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] |
distal\tend\tis\tsutured\tto\tthe\tskin,\twhereas\tthe\tproximal\tside\tof\tthe\tloop\tis\teverted\tback\ton\titself\n(\nMartin\tand\tVogel,\t2012\n).\tThe\tresult\tis\ta\tstoma\twith\ttwo\topenings:\tthe\tproximal\t(functional)\tlimb\nfrom\twhich\tthe\teffluent\n\tor\tstool\tis\tdischarged,\tand\tthe\tdistal\tlimb,\twhich\tmay\tconnect\tto\tthe\tanus
|
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] |
and\tsecrete\tmucus.\tA\tloop\tostomy\tis\tused\tmost\toften\twhen\ta\ttemporary\tostomy\tis\tformed.\tAn\t\nend\nostomy\n\tis\tcreated\twhen\tthe\tbowel\tis\tcut\tand\tthe\tend\tis\tbrought\tthrough\tthe\tskin\tto\tcreate\tthe\nstoma.\tEnd\tand\tloop\tostomies\tare\tpotentially\treversible.\tThe\toutput\tfrom\tan\tileostomy\tis\ttermed\neffluent,\twhereas\toutput\tfrom\ta\tcolostomy\n\tis\tstool.\nColostomy
|
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0.06288757920265198,
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0.02711041085422039,
0.06413216888904572,
0.06434612721204758,
0.06557556241750717,
-0.0031369987409561872
] |
effluent,\twhereas\toutput\tfrom\ta\tcolostomy\n\tis\tstool.\nColostomy\nA\t\ncolostomy\n\tis\ta\tsurgically\tcreated\topening\tfrom\tthe\tcolon\tto\tthe\tskin\twhen\ta\tportion\tof\tthe\tlarge\nintestine\tis\tremoved\tor\tbypassed\t(\nFig.\t27.6\n).\tIt\tcan\toriginate\tfrom\tany\tpart\tof\tthe\tcolon:\tascending,
|
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] |
Fig.\t27.6\n).\tIt\tcan\toriginate\tfrom\tany\tpart\tof\tthe\tcolon:\tascending,\ntransverse,\tdescending,\tor\tsigmoid.\tIt\ttypically\tstarts\tfunctioning\t2\tto\t5\tdays\tafter\tsurgery\tand\tthe\namount\tand\ttype\tof\toutput\tvaries\tslightly,\tdepending\ton\tthe\tamount\tof\n\tremaining\tcolon.\tStool\tfrom\ta
|
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] |
remaining\tcolon.\tStool\tfrom\ta\ncolostomy\ton\tthe\tleft\tside\tof\tthe\tcolon\tis\tfirmer\tthan\tthat\tfrom\ta\tcolostomy\ton\tthe\tright\tside,\twith\nstool\toutput\tranging\tfrom\t200\tto\t600\tmL/day.\tPatients\twith\tsigmoid\tcolostomies\thave\telimination\npatterns\tsimilar\tto\ttheir\tpreoperative\tstates,\tusually\tone\tto\ttwo\tsoft\tstools\tdaily.
|
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] |
FIG.\t27.6\nColostomy.\n\t\nSource:\n\t(Cleveland\tClinic,\tCleveland,\tOhio,\tUSA.)\nIleostomy\nAn\t\nileostomy\n\tis\ta\tsurgically\tcreated\topening\tfrom\tthe\tdistal\tsmall\tbowel\t(most\toften\tthe\tterminal\nileum)\tto\tthe\tskin\twhen\tthe\tentire\tcolon,\trectum,\tand\tanus\tare\tremoved\tor\tbypassed\t(\nFig.\t27.7\n).
|
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] |
Fig.\t27.7\n).\nTypically,\ta\tnew\tileostomy\twill\tstart\tfunctioning\twithin\t24\thours\tafter\tsurgery,\tand\tthe\teffluent\tis\ninitially\tbilious\n\tin\tcolor\tand\twatery\t(\nWillcutts\tand\tTouger-Decker,\t2013\n).\tStoma\toutput\tincreases\ninitially\tto\tabout\t1200\tmL\tper\t24\thours\tfor\tthe\tfirst\t1\tto\t2\tweeks.\tAs\tthe\tbowel\tadapts\tover\tthe\tnext\t2
|
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] |
to\t3\tmonths,\tthe\teffluent\tthickens\t(semiliquid\tto\tporridge-like\tconsistency)\tand\toutput\tdrops\tto\tless\nthan\ta\tliter\tper\tday.\nFIG.\t27.7\nIleostomy.\n\t\nSource:\n\t(Cleveland\tClinic,\tCleveland,\tOhio,\tUSA.)\nMedical\tmanagement
|
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] |
Management\tof\ta\tnew\tostomy\tpatient\tinvolves\tmaintenance\tof\tnutritional\tand\thydration\tstatus,\nmeticulous\tskin\tcare,\tand\tadequate\tcontainment\tof\tthe\tfecal\tstream\tusing\ta\tpouching\tsystem\tin\tthe\nhospital\tand\tas\tthe\tpatient\ttransitions\tto\thome\t(\nMcDonough,\t2013\n).\tIt\tis\tvery\thelpful\twhen\ta\tpatient\nis\tevaluated
|
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] |
McDonough,\t2013\n).\tIt\tis\tvery\thelpful\twhen\ta\tpatient\nis\tevaluated\n\tby\tan\tenterostomal\ttherapist\t(a\tnurse\twho\tspecializes\tin\tthe\tcare\tof\tstomas)\tbefore\nsurgery\tto\tmark\tthe\tmost\tappropriate\tsite\tfor\tan\tostomy.\tThis\tminimizes\tpotential\tskin\tand\tpouch\nsystem\tproblems.\tA\tpoorly\tconstructed\tostomy\tcan\tcause\tskin\texcoriation\tand\tdifficulty\twith\tpouch
|
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application\tand\tmay\tsignificantly\taffect\tpatient\tquality\tof\tlife\t(QoL).\tA\twell-functioning\tostomy\tis\nassociated\twith\n\ta\tsuperior\tQoL.\tIn\tthose\tpatients\twho\texpress\tconcerns\tregarding\tsuboptimal\tQoL,\nsocial\trestrictions,\tpsychosexual\tissues,\tand\tfear\tof\tthe\tostomy\tappliance\tleaking\tseem\tto\tbe\tthe\nmajor\tlimiting\tfactors\t(\nCharua-Guindic\tet\tal,\t2011
|
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] |
major\tlimiting\tfactors\t(\nCharua-Guindic\tet\tal,\t2011\n).\nMedical\tnutrition\ttherapy\nTraditional\trecommendations\tfor\tpostoperative\tfeeding\tof\tpatients\twith\teither\ta\tcolostomy\tor\nileostomy\twas\tto\thold\tfeeding\tuntil\tthe\tbowel\n\tstarted\tto\t“function”\tor\tput\tout\tstool\tor\teffluent.
|
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started\tto\t“function”\tor\tput\tout\tstool\tor\teffluent.\nHowever,\tthere\tis\tevidence\tthat\tan\toral\tdiet\tor\ttube\tfeeding\tcan\tstart\tearly\tafter\tsurgery\tfor\tany\ttype\nof\tfecal\tdiversion\tstoma\tthat\twas\tcreated\tduring\tan\telective\tsurgery.\tThe\tAND\tand\tthe\tUnited\nOstomy\tAssociations\tof\tAmerica\trecommend\ta\tlow-fiber\tdiet\tfor\tapproximately\t6\tto\t8\tweeks\tafter
|
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] |
surgery\t(\nAND,\t2014\n;\t\nUnited\tOstomy\tAssociations\tof\tAmerica,\t2011\n).\tThis\tadvice\tis\tbased\ton\tthe\npremise\tthat\tthe\tbowel\tis\tedematous\tand\ttherefore\tat\trisk\tfor\tbeing\tdamaged\tand\tor\tbecoming\nobstructed\tafter\tsurgery.\tMost\tpatients\ttransition\tto\ta\tnormal\tdiet\twith\ta\tgradual\tincrease\tin\tdietary\nfiber\tintake\tafter\t6\tweeks.\nVitamin\tB\n12
|
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] |
fiber\tintake\tafter\t6\tweeks.\nVitamin\tB\n12\n\tand\tbile\tsalts\tor\tfat\tmalabsorption\tare\tnormally\tnot\ta\tconcern\twith\ta\tdistal\tileostomy.\nGreater\tthan\t100\tcm\tof\tileum\tmust\tbe\tresected\n\tbefore\tsteatorrhea\tor\tfat-soluble\tvitamin\tdeficiency\noccurs,\tand\tgreater\tthan\t60\tcm\tmust\tbe\tresected\tbefore\tvitamin\tB\n12\n\tabsorption\tis\tcompromised\n(
|
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] |
12\n\tabsorption\tis\tcompromised\n(\nParrish\tand\tDiBaise,\t2014\n).\nControlling\tflatus\tand\todor\tis\ta\tcommon\tconcern\tfor\tthe\tcolostomy\tpatient\trather\tthan\tfor\ta\tpatient\nwith\tan\tileostomy.\tMany\tpatients\telect\tto\tlimit\tfoods\tthat\thave\tthe\tpotential\tto\tincrease\tflatus\tor\ncause\tincreased\todor
|
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] |
cause\tincreased\todor\n\tof\tstool\toutput.\tA\tpatient\tmust\texperiment\twith\thow\tdifferent\tfoods\taffect\noutput.\tDeodorants\tare\tavailable,\tand\tostomy\tappliances\tare\tmade\twith\todor-barrier\tmaterial\tand\ncan\tinclude\tcharcoal\tfilters\tthat\tvent\tand\tdeodorize\tgas.\nAnother\tconcern\tfor\tan\tileostomy\tis\tthe\tpotential\tfor\tintestinal\tblockage\tor\tobstruction\tat\tthe
|
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0.0696183294057846,
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0.03428923338651657,
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] |
incorporate\tthickening\tfoods\tto\thelp\tthicken\tstoma\toutput.\tThe\tpatient\tmay\thave\tto\texperiment\nbecause\tthickened\toutput\tmay\tbe\tdesirable\tat\ttimes\tbut\tcan\tcause\tdiscomfort\tif\toutput\n\tis\tthickened\ntoo\tmuch.\tRefer\tto\t\nTable\t27.8\n\tfor\tthe\teffects\tof\tvarious\tfoods\ton\tostomy\toutput.
|
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] |
TABLE\t27.8\nFoods\tThat\tAffect\tOstomy\tOutput\nGas-Forming\tFoods\nOdor-Producing\tFoods\nFoods\tThat\tMay\tControl\tOdor\nBroccoli\nBrussels\tsprouts\nCabbage\nCauliflower\nGarlic\nOnions\nFish\nEggs\nCarbonated\tbeverages\nAlcoholic\tbeverages\nDairy\tproducts\nLegumes\t(dried\tbeans)\nChewing\tgum\nAsparagus\nBeans\nBroccoli\nBrussels\tsprouts\nCabbage\nCauliflower\nGarlic\nOnions\nFish
|
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] |
Broccoli\nBrussels\tsprouts\nCabbage\nCauliflower\nGarlic\nOnions\nFish\nEggs\nSome\tvitamins\nStrong\tcheese\nButtermilk\nCranberry\tjuice\nOrange\tjuice\nYogurt\nParsley\nSpinach\nTomato\tjuice\nFoods\tThat\tMay\tThicken\nStool\nFoods\tThat\tMay\tCause\nObstruction\nFoods\tThat\tMay\tCause\tDiarrhea\nPasta\nWhite\tbread\nWhite\trice\nPotatoes\nCheese\nPretzels\nCreamy\tpeanut\tbutter
|
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] |
White\tbread\nWhite\trice\nPotatoes\nCheese\nPretzels\nCreamy\tpeanut\tbutter\nApplesauce\nBanana\nMarshmallow\nTapioca\nApple\tpeel\nOrange\nPineapple\nGrapes\nDried\tfruits\nRaw\tcabbage\nRaw\tcelery\nChinese\tvegetables\nCorn\nMushrooms\nCoconut\nPopcorn\nNuts\nAlcoholic\tbeverages\nCaffeinated\tfluids\nChocolate\nWhole\tgrains\nBran\tcereals\nFresh\tfruits\nGrape\tjuice\nPrune\tjuice
|
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] |
Whole\tgrains\nBran\tcereals\nFresh\tfruits\nGrape\tjuice\nPrune\tjuice\nRaw\tvegetables\nSpicy\tfoods\nFried\tfoods\nHigh-fat\tfoods\nFoods\thigh\tin\trefined\tsugar\tor\nsorbitol\nData\tfrom\tAcademy\n\tof\tNutrition\tand\tDietetics:\t\nNutrition\tCare\tManual,\tIleostomy\n\t(website):\t\nhttp://nutritioncaremanual.org/\n,\t2018.\tMcDonough\tMR:\tA
|
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] |
(website):\t\nhttp://nutritioncaremanual.org/\n,\t2018.\tMcDonough\tMR:\tA\ndietitian’s\tguide\tto\tcolostomies\tand\tileostomies,\t\nSupport\tLine\n\t35(3):3,\t2013;\tUnited\tOstomy\tAssociations\tof\tAmerica:\tDiet\tand\tNutrition\tGuide\n(website):\t\nhttp://www.ostomy.org/ostomy_info/pubs/OstomyNutritionGuide.pdf
|
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http://www.ostomy.org/ostomy_info/pubs/OstomyNutritionGuide.pdf\n,\t2011;\tWillcutts\tK\tet\tal:\tOstomies\tand\tfistulas:\ta\tcollaborative\napproach,\t\nPract\tGastroenterol\n\t29:63,\t2005.\nMaintenance\tof\tadequate\tfluid\tand\telectrolyte\tstatus\tis\tan\timportant\tnutrition-related\tissue\tin
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] |
managing\ta\tpatient\twith\tcolostomy\tor\tileostomy.\tPatients\twith\tan\tileostomy\tmust\trecognize\tthe\nsymptoms\tof\tdehydration\tand\tunderstand\tthe\timportance\tof\tmaintaining\tadequate\tfluid\tintake\nthroughout\tthe\tday.\tIn\taddition,\tpatients\tmay\thave\tto\tincrease\ttheir\n\tsalt,\tpotassium,\tand\tmagnesium\nintake\tresulting\tfrom\tlosses\tin\tileostomy\toutput.
|
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] |
intake\tresulting\tfrom\tlosses\tin\tileostomy\toutput.\nOstomy\toutput\tmay\tbecome\tacutely\tor\tchronically\televated,\tand\tthis\tis\tmuch\tmore\tcommon\twith\nan\tileostomy.\tThe\tgenerally\taccepted\tdefinition\tof\ta\t\nhigh-output\tstoma\t(HOS)\n\tis\toutput\tthat\nexceeds\t2000\tmL/day\tover\t3\tconsecutive\tdays,\tat\twhich\tpoint\twater,\tsodium,\tand\tmagnesium\ndepletion\tare\texpected\t(
|
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] |
depletion\tare\texpected\t(\nBaker\tet\tal,\t2011\n).\tThere\tare\tmultiple\tpotential\tcauses\tof\tHOS,\tincluding\nIBD,\t\nClostridium\tdifficile\n,\tintraabdominal\tsepsis,\tpartial\tor\tintermittent\tobstruction,\tmedication-\nrelated\tcauses,\tdrinking\ttoo\tmuch\tfluid\t(especially\thypertonic/hyperosmotic\tfluids),\tor\tsurgery\tthat
|
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0.07431504875421524,
0.08790858834981918,
-0.03083639405667782
] |
results\tin\tless\tthan\t200\tcm\tof\tresidual\tsmall\tbowel\tand\tno\tcolon\t(\nParrish\tand\tDiBaise,\t2014\n).\nManagement\tof\tHOS\tincludes\tassessment\tand\tcorrection\n\tof\tdepleted\telectrolytes\tand\tminerals;\ninitiation\tof\tan\tORS\tsipped\tthroughout\tthe\tday;\tavoidance\tof\thypertonic,\tsimple\tsugar–containing
|
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0.03870639577507973,
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] |
liquids\tand\tfoods;\trestriction\tof\tfoods\thigh\tin\tinsoluble\tfiber;\tseparation\tof\tsolids\tand\tliquids\tat\nmeals;\tand\tconsumption\tof\tsmaller\tmeals,\tmore\toften\t(up\tto\tsix\tto\teight\tper\tday)\t(\nMcDonough,\t2013\n;\nParrish\tand\tDiBaise,\t2014\n).\tMalnutrition\tcan\toccur\tin\tcases\n\tof\tpersistent\tHOS,\tand\tmany\tpatients
|
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of\tpersistent\tHOS,\tand\tmany\tpatients\nmust\tincrease\ttheir\tintake\tto\tmaintain\ttheir\tnutritional\tstatus.\tMeeting\tthe\tincreased\tnutritional\ndemand\tmay\tnot\tbe\tpossible\tvia\toral\tmeans\tfor\tsome\tpatients,\tand\tnutrition\tsupport\tvia\tenteral\ttube\nfeeding\tmay\tbecome\tnecessary.\tAntidiarrheal\tand\tantisecretory\tmedications\tare\tthe\ttwo\tmajor
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] |
classes\tof\tmedications\trecommended\tto\treduce\toutput\tin\tHOS.\nRestorative\n\tproctocolectomy\twith\tileal\tpouch\tanal\tanastomosis\nRestorative\t\nproctocolectomy\n\twith\t\nileal\tpouch\tanal\tanastomosis\t(IPAA)\n\thas\tevolved\tas\tthe\nsurgical\ttreatment\tof\tchoice\tfor\tpatients\twith\tmedically\trefractory\tUC\tand\tFAP.\tFor\tUC\tpatients
|
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] |
requiring\ta\tcolectomy,\tthe\tmajority\telect\tto\thave\tan\tIPAA.\tThis\tprocedure\tinvolves\tremoval\tof\tthe\nentire\tcolon\tand\trectum\t(proctocolectomy)\twhile\tpreserving\tthe\tanal\n\tsphincter,\tfollowed\tby\tcreation\nof\ta\treservoir\tusing\ta\tportion\tof\tthe\tdistal\tileum\t(ileal\tpouch).\tThis\tpouch\tis\tthen\treconnected
|
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] |
(pouch-anal\tanastomosis)\tto\tthe\tpreserved\tanal\tcanal\tin\twhich\tthe\tdiseased\tmucosa\thas\tbeen\nremoved,\tthus\tmaintaining\tcontinence\tand\tvoluntary\tfunction.\tThis\toffers\ta\tcure\tfor\tthe\tdisease\nprocesses\tand\tavoids\ta\tpermanent\tileostomy.\nConstruction\tusually\trequires\tuse\tof\n\tthe\tdistalmost\t30\tto\t40\tcm\tof\tileum,\twith\tpouch\tconfiguration
|
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the\tdistalmost\t30\tto\t40\tcm\tof\tileum,\twith\tpouch\tconfiguration\ndetermined\tby\tthe\tnumber\tof\tbowel\tlimbs\tused.\tThe\tmost\tcommon\tpouch\tis\tthe\t\nileal\tJ-pouch\n,\twhich\nuses\ttwo\tlimbs\tof\tbowel\t(\nFig.\t27.8\n)\tto\tcreate\ta\t“J”-shaped\treservoir\tout\tof\tthe\tpatient’s\town\tsmall
|
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] |
)\tto\tcreate\ta\t“J”-shaped\treservoir\tout\tof\tthe\tpatient’s\town\tsmall\nintestine.\tIt\tis\tthe\tpreferred\tileal\tpouch\tbecause\tof\tthe\tefficiency\tof\tconstruction\tand\toptimal\nfunctional\tresults\tby\tallowing\ta\tmore\tnormal\n\troute\tof\tdefecation.\tAlternatives\tto\tthe\tJ-pouch
|
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] |
configuration\tinclude\tthree-\tand\tfour-limbed\tpouches,\tsuch\tas\tan\t\nS-pouch\n\tor\t\nW-pouch\n.\tThese\nalternative\tconfigurations\tare\trarely\tperformed\tbecause\tof\tthe\tcomplexity\tof\tconstruction.\tThe\tfinal\ndecision\tas\tto\twhich\ttype\tis\tused\tremains\tat\tthe\tdiscretion\tof\tthe\tsurgeon.\nFIG.\t27.8\nJ-pouch.\n\t\nSource:\n\t(Cleveland\tClinic,\tCleveland,\tOhio,\tUSA.\t)
|
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] |
J-pouch.\n\t\nSource:\n\t(Cleveland\tClinic,\tCleveland,\tOhio,\tUSA.\t)\nWith\tany\tpouch\tsurgery\tthe\trecovery\tis\tlonger\tthan\tin\tthose\twho\thave\ta\tconventional\tileostomy\nbecause\tof\tthe\ttwo-stage\tprocedure.\tThere\twill\tbe\ta\tperiod\tof\tadaptation\tof\tthe\tnew\treservoir\tafter
|
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the\tileostomy\tis\tclosed.\tInitially,\tthere\tcould\tbe\tup\tto\t15\tbowel\tmovements\ta\tday\twith\tsome\tproblems\nof\tcontrol\tand\tthe\tneed\tto\n\tget\tup\tseveral\ttimes\tat\tnight.\tEventually,\tmost\tpatients\texperience\tfour\tto\nsix\tbowel\tmovements\tdaily,\thave\tgood\tcontrol,\tand\tare\tnot\ttroubled\tby\tnighttime\tincontinence.\tThis
|
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] |
improves\tover\ttime\tas\tthe\tpouch\tcapacity\tgradually\tincreases.\nA\t\nKoch\tpouch\n\tis\ta\ttype\tof\tappliance-less\tileostomy\tthat\tuses\tan\tinternal\treservoir\twith\ta\tone-way\nvalve,\tconstructed\tfrom\ta\tloop\tof\tintestine\tthat\tis\tattached\n\tto\tthe\tabdominal\twall\twith\ta\tskin-level
|
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] |
to\tthe\tabdominal\twall\twith\ta\tskin-level\nstoma.\tPatients\tmust\tinsert\ta\ttube\tor\tcatheter\tinto\tthe\tstoma\tto\topen\tthe\tvalve\tand\tallow\tdrainage\tof\nthe\tileostomy\tcontents.\tThe\ttechnical\tdifficulties\tof\tsurgical\tconstruction\tand\tthe\tpotential\tfor\ncomplications\thas\tled\tto\tdecreased\tuse\tof\tthe\tKoch\tpouch\tin\tfavor\tof\tthe\tileal\tJ-pouch.\nMedical\tmanagement
|
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Medical\tmanagement\nAcute\tand\tchronic\tcomplications\tcan\tnecessitate\n\tremoval\tof\tthe\tileal\tpouch\tand\teventual\nconstruction\tof\ta\tpermanent\tileostomy.\t\nPouchitis\n\tis\ta\tnonspecific\tinflammation\tof\tthe\tmucosal\ttissue\nforming\tthe\tileal\tpouch\tand\tis\tthe\tmost\tfrequent\tlong-term\tcomplication\tof\tIPAA\tin\tpatients\twith\tUC.
|
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] |
The\tcause\tof\tpouchitis\tis\tnot\tentirely\tclear,\tbut\tit\tmay\tbe\trelated\tto\tbacterial\tovergrowth,\nunrecognized\tCrohn’s\tdisease,\timmunologic\tchanges,\tbile\tsalt\n\tmalabsorption,\tor\tinsufficient\tSCFA\nproduction.\tThe\tusual\tpresenting\tsymptoms\tinclude\tincreased\tstool\tfrequency,\turgency,
|
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] |
incontinence,\tnocturnal\tseepage,\tabdominal\tcramps,\tand\tpelvic\tdiscomfort.\tPouchitis\tmay\tbe\nclassified\tbased\ton\tthe\tcause,\tdisease\tduration\tand\tactivity,\tand\tresponse\tto\tmedical\ttherapy.\tIn\tthe\nmajority\tof\tpatients\tthe\tetiology\tof\tpouchitis\tis\tnot\tclear\tand\tthus\ttermed\tas\tidiopathic\n\tpouchitis\n(\nZezos\tand\tSaibil,\t2015\n).
|
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] |
pouchitis\n(\nZezos\tand\tSaibil,\t2015\n).\nPouch\tendoscopy\tis\tthe\tmain\tmodality\tin\tthe\tdiagnosis\tand\tdifferential\tdiagnosis\tin\tpatients\twith\npouch\tdysfunction.\tAntibiotic\ttherapy\tis\tthe\tmainstay\tof\ttreatment\tfor\tactive\tpouchitis.\tSome\npatients\tmay\tdevelop\tdependency\ton\tantibiotics,\trequiring\tlong-term\tmaintenance\ttherapy.\tThe
|
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] |
evidence\tfor\tthe\tuse\tof\tprobiotics\tin\tmaintenance\ttreatment\tof\tpouchitis\tis\n\tcontroversial.\tThere\tmay\nbe\troles\tfor\tpostoperative\tprobiotic\tsupplementation\tto\tprevent\tpouchitis\tand\tin\tmaintaining\nremission\tin\tantibiotic-dependent\tpouchitis\t(\nShen\tet\tal,\t2014\n).\tClinical\texpert-generated\tguidelines
|
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] |
Shen\tet\tal,\t2014\n).\tClinical\texpert-generated\tguidelines\nconcur\tthat\tthe\tprobiotic\tcalled\tVSL#3\tcan\tbe\teffective\tfor\tpreventing\trecurrence\tof\tpouchitis\n(\nCiorba,\t2012\n;\t\nShen\tet\tal,\t2014\n).\nMedical\tnutrition\ttherapy\nPatients\twho\thave\n\tundergone\tan\tIPAA\tprocedure\tusually\trequire\tsupplemental\tvitamin\tB\n12\ninjections.\tThe\tcause\tof\tvitamin\tB\n12
|
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] |
12\ninjections.\tThe\tcause\tof\tvitamin\tB\n12\n\tdeficiency\tmay\tbe\tmultifactorial:\t(1)\treduced\tabsorptive\tcapacity\ndue\tto\tdistal\tileal\tresection\t(main\tsite\tof\tvitamin\tB\n12\n\tabsorption);\t(2)\tbacterial\tovergrowth\tis\ta\twell-\nknown\tphenomenon\tin\tpatients\twith\tan\tileal\tpouch,\tand\tanaerobic\tbacteria\tcan\tbind\tvitamin\tB\n12\n\tin\nits\tfree\tand\tintrinsic
|
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] |
12\n\tin\nits\tfree\tand\tintrinsic\n\tforms,\tleading\tto\ta\tdecreased\tconcentration\tavailable\tfor\tabsorption;\tand\t(3)\ninsufficient\tB\n12\n\tintake.\tThe\tanemia\texperienced\tby\tpatients\tafter\tIPAA\tcan\talso\tbe\tdue\tto\tiron
|
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] |
deficiency\tbecause\tof\timpaired\tabsorption,\tdecreased\toral\tintake,\tincreased\trequirements,\tand\tblood\nloss.\nPatients\twith\ta\tpouch\toften\tdescribe\tspecific\tfood\tsensitivities\tthat\tmay\trequire\tdiet\talteration,\neven\tmore\tso\tthan\n\tdo\tpatients\twith\tpermanent\tileostomy\t(\nUnited\tOstomy\tAssociations\tof\tAmerica,\n2011
|
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United\tOstomy\tAssociations\tof\tAmerica,\n2011\n).\tProblems\toften\treported\tinclude\tobstructive\tsymptoms\tand\tincreased\tstool\toutput,\tfrequency,\nand\tgas.\tThe\tincidence\tof\tobstruction\tmay\tbe\tavoided\tby\tlimiting\tinsoluble\tfibers,\tchewing\nthoroughly,\tand\tconsuming\tsmall\tmeals\tfrequently\tthroughout\tthe\tday.\tPatients\tmay\ttry\tto
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lactase-deficient,\tand\tlimitation\tof\tfoods\thigh\tin\tsimple\tsugars,\tfructose,\tand\tsorbitol)\twill\tlikely\nreduce\tstool\tvolume\tand\tfrequency\tin\tpatients\n\twith\tIPAA.\nCLINICAL\tCASE\tSTUDY\nJimmy\tis\ta\t76-year-old\tmale\twith\ta\trecent\temergent\tsmall\tbowel\tresection\tdue\tto\ta\truptured\tmesh
|
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] |
C.\tdifficile\n\tinfection,\ta\tnutrition\n\tconsult\twas\treceived\tfor\nmanagement\tof\tdiarrhea\tand\thydration\tstatus,\tand\tto\tassess\tfor\tany\tnutrient\tmalabsorption.\nNutrition\tassessment\n•\t\nAnatomy:\tDuring\tsurgery,\t100\tcm\tof\tthe\tsmall\tintestine\twas\tremoved,\tincluding\tthe\tileocecal\nvalve\t(ICV).\tThe\tmajority\tof\tthe\tcolon\tremains\tintact.\n•
|
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] |
valve\t(ICV).\tThe\tmajority\tof\tthe\tcolon\tremains\tintact.\n•\t\nOral\tintake\thistory:\tDecline\tin\tappetite\tand\toral\tintake\tsince\tsurgery\tdue\tto\tvery\tpoor\nappetite\tand\n\tdiarrhea.\tBefore\tadmission\tJimmy\twas\teating\t¼\tof\this\tusual\tmeals\twith\t½\tof\nthe\tusual\tsnacks\tand\ttaking\tone\toral\tnutrition\tsupplement\tper\tday.\tFluids:\tdrinks\tcoffee,\ticed
|
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] |
tea,\tand\twater,\tand\testimates\the\tis\ttaking\tin\t3\tto\t4\tcups\tper\tday.\n•\t\nCurrent\tintake:\tIn\tthe\thospital,\tJimmy\tis\teating\t50%\tof\tmeals\tprovided,\ttolerating\tsnacks,\nand\tsipping\tup\tto\t500\tmL\tof\tcommercial\telectrolyte\tbeverage\tper\tday.\n\tHe\treports\tnever\nfeeling\thungry,\tis\tapathetic\tabout\teating,\tand\treports\tnot\twanting\tto\t“overdo\tit”\tfor\tfear\tof
|
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more\tbathroom\ttrips.\n•\t\nWeight\tand\tbody\tmass\tindex\t(BMI):\tHeight:\t177.8\tcm\t(70\tinches),\tWeight:\t75\tkg\t(165\tlb),\nBMI:\t23.7\tkg/m\n2\n•\t\nUsual\tbody\tweight\t(UBW):\t100\tkg\t(220\tlb):\t25%\tweight\tloss\t×\t3\tmonths\t(clinically\nsignificant\tloss)\n•\t\nPhysical\texamination:\tpale\tskin;\tdark\teye\tsockets;\tslight\n\tdepression\tat\ttemples;\tscapula
|
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] |
depression\tat\ttemples;\tscapula\npronounced;\tnoted\tlosses\tat\tquadriceps,\tgastrocnemius,\tand\ttriceps;\tno\tedema\tnoted\n•\t\nFunctional\tcapacity:\tlow\tenergy\tlevel\tover\tpast\t3\tmonths,\tunable\tto\tgarden\tor\tcook\tmeals,\nwhich\the\tpreviously\tenjoyed,\tfatigued\tand\ttired\tall\tthe\ttime,\tmemory\tslightly\tdecreased\n•
|
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] |
•\t\nMedications:\tstarted\tloperamide\t2\tmg\tbefore\tmeals\tand\tbedtime,\tsenior\tmultivitamin,\npotassium\tchloride\n\t(KCl)\tsustained-release\ttablet,\tlisinopril\tdose\treduced\tdue\tto\tweight\tloss,\nstatin\tdiscontinued\tdue\tto\tcholesterol\tlevels\tnormalized\twithin\ta\tfew\tmonths\tof\tsurgery\n•\t\n24-hour\turine\tand\tstool\toutput:\t650\tmL\tand\t2200\tmL\n•
|
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] |
•\t\n24-hour\turine\tand\tstool\toutput:\t650\tmL\tand\t2200\tmL\n•\t\nPertinent\tlabs:\thigh\tserum\tsodium\t(147),\tlow\tserum\tpotassium\t(3.0\tmEq/L),\tlow\tnormal\nserum\tmagnesium\t(1.3),\thigh\tblood\turea\tnitrogen\t(BUN):\t7.6\tmmol/L,\tstool\ttoxin\tanalysis\tfor\nC\tdifficile:\n\tpositive\n•\t\nCurrent\tdiet:\tGeneral\tdiet\nNutrition\tdiagnostic\tstatements\n•
|
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0.016879327595233917,
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0.0898602232336998,
0.013399412855505943
] |
•\t\nCurrent\tdiet:\tGeneral\tdiet\nNutrition\tdiagnostic\tstatements\n•\t\nSevere\tprotein\tcalorie\tmalnutrition\trelated\tto\tpoor\tappetite\tas\tevidenced\tby\tenergy\tintake\n25%\tto\t50%\tx\t3\tmonths,\tinvoluntary\tweight\tloss\tat\t25%\tx\t3\tmonths,\tsubcutaneous\tfat\tloss,\nmuscle\tloss,\tand\tdecline\tin\tstrength\tand\tfunctional\tcapacity\n•
|
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] |
muscle\tloss,\tand\tdecline\tin\tstrength\tand\tfunctional\tcapacity\n•\t\nSuboptimal\tprotein-energy\tintake\trelated\tto\taltered\tgastrointestinal\n\t(GI)\tfunction\tas\nevidenced\tby\tdiarrhea,\tinvoluntary\tweight\tloss\tat\t25%\tx\t3\tmonths,\tUBW\t220\tlbs\nInterventions\n•\t\nEstimated\tenergy\tneeds:\t2625\tto\t3000\tcalories/day\t(35\tto\t40\tkcal/kg/day)\n•
|
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] |
•\t\nEstimated\tprotein\tneeds:\t115\tto\t150\tg\tprotein/day\t(1.5\tto\t2.0\tg\tprotein/kg/day)\n•\t\nNutrition\tgoal(s):\tOral\tintake\tto\tmeet\testimated\tneeds,\tdecrease\tstool\toutput\tto\tthe\tpoint\nwhere\tpatient’s\thydration\n\tis\tmaintained;\tmaintain\toptimal\tmicronutrient\tstatus.\n•\t\nReplace\telectrolyte\tand\tfluid\tlosses.\tMonitor\tfluid\tbalance.\n•
|
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] |
•\t\nReplace\telectrolyte\tand\tfluid\tlosses.\tMonitor\tfluid\tbalance.\n•\t\nContinue\tgeneral\tdiet\twith\tmoderate\tinsoluble\tfiber\tuntil\tdiarrhea\tis\tunder\tcontrol,\treduce\nsimple\tsugars\tin\tthe\tdiet.\tPatient\tto\tmake\thigh-salt,\thigh-starch,\tlow-simple\tsugar\tfood\nchoices\tfrom\tthe\tmenu.\tEncourage\tseparation\tof\tbeverages\tat\tmealtimes.\n•\t\nProvide\tsalty/starchy
|
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•\t\nProvide\tsalty/starchy\n\tsnacks\tbetween\tmeals.\tEncourage\t“thickening\tfoods,”\tsuch\tas\tboiled\nwhite\trice,\tpasta,\tnoodles,\tbread,\tpotatoes,\tbanana,\toatmeal,\tapplesauce,\tpeanut\tbutter,\ncheese,\tand\ttapioca\tpudding.\n•\t\nSip\t2\tL\tof\toral\trehydration\tsolution\t(ORS)\tbetween\tmeals\tas\tan\talternative\tto\tcommercial\nelectrolyte\tbeverage.
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] |
•\t\nAvoid\tcaffeinated\tand\thypertonic\tfluids.\n•\t\nConsider\ttrial\tof\tsoluble\tfiber\tsupplement\tto\tslow\n\tdown\ttransit\ttime\tand\tthicken\tstool.\n•\t\nContinue\tantidiarrheal\tmedications\twith\tdosage\tadjusted\tby\tphysician\tdepending\ton\tvolume\nand\tconsistency\tof\tstool.\n•\t\nDiet\teducation:\tDiscuss\twith\tpatient\tand\tfamily\tnutrition\tmanagement\tof\tmicronutrient
|
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] |
status,\tincluding\tintake\tof\twater-miscible\tversions\tof\tfat-soluble\tvitamins,\tand\tvitamin\tB\n12\nshots\tmonthly,\tand\tmaintaining\tadequate\tweight\tand\thydration\n\tstatus\twith\tchanged\tbowel\nlength.\n•\t\nRecommend\toutpatient\tfollow\tup\twith\tnutrition\tprofessional\tspecializing\tin\tGI\tnutrition.\n•\t\nEvaluate\tmicronutrient\tstatus.\nMonitoring\tand\tevaluation\n•
|
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] |
•\t\nEvaluate\tmicronutrient\tstatus.\nMonitoring\tand\tevaluation\n•\t\nMonitor\toral\tintake\tvia\tcalorie\tcounts\twith\ta\tgoal\tof\tmeeting\t75%\tto\t100%\tof\testimated\nenergy\tand\tprotein\tneeds.\n•\t\nMonitor\tstool\tand\turinary\toutput\tand\tweight\ttrends\tto\tassess\tneed\tfor\thome\tintravenous
|
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0.06259012222290039,
0.01088536437600851
] |
fluids\t(HIVF)\tor\thome\tparenteral\tnutrition\t(HPN)\tif\tweight\tand\tfluid\tstatus\tdo\tnot\tstabilize\nwith\tincreased\tintake\tand\tORS.\nUseful\twebsites\nCeliac\tDisease\tFoundation\nCeliac\tSprue\tAssociation\nCrohn’s\tand\tColitis\tFoundation\tof\tAmerica\nGluten\tIntolerance\tGroup\nInternational\tScientific\tAssociation\tfor\tProbiotics\tand\tPrebiotics
|
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] |
International\tScientific\tAssociation\tfor\tProbiotics\tand\tPrebiotics\nMonash\tUniversity\tLow\tFODMAP\tDiet\nNational\tInstitute\n\tof\tDiabetes\tand\tDigestive\tand\tKidney\tDiseases\nNutrition\tin\tImmune\tBalance\t(NiMBAL)\nUnited\tOstomy\tAssociations\tof\tAmerica,\tInc.\nUniversity\tof\tVirginia\tGI\tNutrition\tSupport\tTeam\nUSDA\tFood\tComposition\tDatabases
|
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USDA\tFood\tComposition\tDatabases\nWound,\tOstomy\tand\tContinence\tNurses\tSociety\nPortions\tof\tthis\tchapter\twere\twritten\tby\tGail\tCresci,\tPhD,\tRDN,\tLD,\tCNSC\tand\tArlene\tEscuro,\tMS,\tRDN,\nCNSC.
|
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28\nMedical\tnutrition\ttherapy\tfor\nhepatobiliary\tand\tpancreatic\tdisorders\nJeanette\tM.\tHasse,\tPhD,\tRDN,\tLD,\tCNSC,\tFADA,\tLaura\tE.\tMatarese,\tPhD,\tRDN,\tLDN,\tCNSC,\tFADA,\tFASPEN,\tFAND\nKEY\tTERMS\nacalculous\tcholecystitis\nalcoholic\tliver\tdisease\naromatic\tamino\tacids\t(AAAs)\nascites\nbile\nbranched-chain\tamino\tacids\t(BCAAs)\ncalculi\ncholangitis\ncholecystectomy
|
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] |
calculi\ncholangitis\ncholecystectomy\ncholecystitis\ncholedocholithiasis\ncholelithiasis\ncholestasis\ncirrhosis\ndetoxification\ndry\tweight\nencephalopathy\nend\tstage\tliver\tdisease\t(ESLD)\nfasting\thypoglycemia\nfatty\tliver\nfulminant\tliver\tdisease\nhemochromatosis\nhepatic\tencephalopathy\nhepatic\tfailure\nhepatic\tosteodystrophy\nhepatic\tsteatosis\nhepatitis
|
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hepatic\tfailure\nhepatic\tosteodystrophy\nhepatic\tsteatosis\nhepatitis\nhepatorenal\tsyndrome\nicteric\njaundice\nKayser-Fleischer\tring\nKupffer\tcells\nnonalcoholic\tfatty\tliver\tdisease\n\t(NAFLD)\nnonalcoholic\tsteatohepatitis\t(NASH)\noxidative\tdeamination\npancreaticoduodenectomy\t(Whipple\tprocedure)\npancreatic\tislet\tautotransplantation\npancreatitis\nparacentesis
|
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pancreatic\tislet\tautotransplantation\npancreatitis\nparacentesis\nportal\thypertension\nportal\tsystemic\tencephalopathy\npostcholecystectomy\tsyndrome\nprimary\tbiliary\tcirrhosis\t(PBC)\nprimary\tsclerosing\tcholangitis\t(PSC)\nsecondary\tbiliary\tcirrhosis\nsteatorrhea\ntransamination
|
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] |
varices\nWernicke\tencephalopathy\nWilson’s\tdisease\nThe\tliver\tis\tof\tprimary\timportance;\tone\tcannot\tsurvive\twithout\ta\tliver.\tThe\tliver\tand\tpancreas\tare\tessential\tto\ndigestion\tand\tmetabolism.\tAlthough\tit\tis\timportant,\tthe\tgallbladder\tcan\tbe\tremoved,\tand\tthe\tbody\twill\tadapt
|
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comfortably\tto\tits\tabsence.\tKnowledge\tof\tthe\tstructure\tand\tfunctions\tof\tthese\torgans\tis\tvital.\tWhen\tthey\tare\ndiseased,\tthe\tnecessary\n\tmedical\tnutrition\ttherapy\t(MNT)\tis\tcomplex.\nPhysiology\tand\tfunctions\tof\tthe\tliver\nStructure\nThe\tliver\tis\tthe\tlargest\tgland\tin\tthe\tbody,\tweighing\tapproximately\t1500\tg.\tThe\tliver\thas\ttwo\tmain\tlobes:\tthe\tright\tand
|
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] |
left.\tThe\tright\tlobe\tis\tfurther\tdivided\tinto\tthe\tanterior\tand\tposterior\tsegments;\tthe\tright\tsegmental\tfissure,\twhich\ncannot\tbe\tseen\texternally,\tseparates\tthe\tsegments.\tThe\texternally\n\tvisible\tfalciform\tligament\tdivides\tthe\tleft\tlobe\tinto
|
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] |
visible\tfalciform\tligament\tdivides\tthe\tleft\tlobe\tinto\nthe\tmedial\tand\tlateral\tsegments.\tThe\tliver\tis\tsupplied\twith\tblood\tfrom\ttwo\tsources:\tthe\thepatic\tartery,\twhich\tsupplies\napproximately\tone\tthird\tof\tthe\tblood\tfrom\tthe\taorta;\tand\tthe\tportal\tvein,\twhich\tsupplies\tthe\tother\ttwo\tthirds\tand\ncollects\tblood\tdrained\tfrom\tthe\tdigestive\ttract.
|
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] |
collects\tblood\tdrained\tfrom\tthe\tdigestive\ttract.\nApproximately\t1500\tmL\tof\tblood\tper\tminute\tcirculates\tthrough\n\tthe\tliver\tand\texits\tvia\tthe\tright\tand\tleft\thepatic\nveins\tinto\tthe\tinferior\tvena\tcava.\tThe\tliver\thas\ta\tsystem\tof\tblood\tvessels\tand\ta\tseries\tof\tbile\tducts.\t\nBile\n,\twhich\tis
|
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Bile\n,\twhich\tis\nformed\tin\tthe\tliver\tcells,\texits\tthe\tliver\tthrough\ta\tseries\tof\tbile\tducts\tthat\tincrease\tin\tsize\tas\tthey\tapproach\tthe\ncommon\tbile\tduct.\tBile\tis\ta\tthick,\tviscous\tfluid\tsecreted\tfrom\tthe\tliver,\tstored\tin\tthe\tgallbladder,\tand\treleased\n\tinto\tthe
|
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into\tthe\nduodenum\twhen\tfatty\tfoods\tenter\tthe\tduodenum.\tIt\temulsifies\tfats\tin\tthe\tintestine\tand\tforms\tcompounds\twith\tfatty\nacids\tto\tfacilitate\ttheir\tabsorption.\nFunctions\nThe\tliver\thas\tthe\tability\tto\tregenerate\titself.\tOnly\t10%\tto\t20%\tof\tfunctioning\tliver\tis\trequired\tto\tsustain\tlife,\talthough
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removal\tof\tthe\tliver\tresults\tin\tdeath,\tusually\twithin\t24\thours.\tThe\tliver\tis\tintegral\tto\tmost\tmetabolic\n\tfunctions\tof\tthe\nbody\tand\tperforms\tmore\tthan\t500\ttasks.\tThe\tmain\tfunctions\tof\tthe\tliver\tinclude\t(1)\tmetabolism\tof\tcarbohydrate,\nprotein,\tand\tfat;\t(2)\tstorage\tand\tactivation\tof\tvitamins\tand\tminerals;\t(3)\tformation\tand\texcretion\tof\tbile;\t(4)
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] |
conversion\tof\tammonia\tto\turea;\t(5)\tmetabolism\tof\tsteroid\thormones;\t(6)\tdetoxification\tof\tsubstances\tsuch\tas\tdrugs,\nalcohol,\tand\torganic\tcompounds;\tand\t(7)\n\tacting\tas\ta\tfilter\tand\tflood\tchamber.\nThe\tliver\tplays\ta\tmajor\trole\tin\tcarbohydrate\tmetabolism.\tGalactose\tand\tfructose,\tproducts\tof\tcarbohydrate
|
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] |
digestion,\tare\tconverted\tinto\tglucose\tin\tthe\thepatocyte\t(liver\tcell).\tThe\tliver\tstores\tglucose\tas\tglycogen\n(glycogenesis)\tand\tthen\treturns\tit\tto\tthe\tblood\twhen\tglucose\tlevels\tbecome\tlow\t(glycogenolysis).\tThe\tliver\talso\nproduces\t“new”\tglucose\t(gluconeogenesis)\n\tfrom\tprecursors\tsuch\tas\tlactic\tacid,\tglycogenic\tamino\tacids,\tand
|
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] |
from\tprecursors\tsuch\tas\tlactic\tacid,\tglycogenic\tamino\tacids,\tand\nintermediates\tof\tthe\ttricarboxylic\tacid\t(TCA)\tcycle.\nImportant\tprotein\tmetabolic\tpathways\toccur\tin\tthe\tliver.\t\nTransamination\n\t(transfer\tof\tan\tamino\tgroup\tfrom\tone\ncompound\tto\tanother)\tand\t\noxidative\tdeamination\n\t(removal\tof\tan\tamino\tgroup\tfrom\tan\tamino\tacid\tor\tother
|
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prothrombin,\tas\twell\tas\tserum\tproteins\tincluding\talbumin,\talpha-globulin,\tbeta-globulin,\ttransferrin,\tceruloplasmin,\nand\tlipoproteins,\tare\tformed\tby\tthe\tliver.\nFatty\tacids\tfrom\tthe\tdiet\tand\tadipose\ttissue\tare\tconverted\tin\tthe\tliver\tto\tacetyl-coenzyme\n\tA\tby\tthe\tprocess\tof\tbeta-
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A\tby\tthe\tprocess\tof\tbeta-\noxidation\tto\tproduce\tenergy.\tKetones\talso\tare\tproduced.\tThe\tliver\tsynthesizes\tand\thydrolyzes\ttriglycerides,\nphospholipids,\tcholesterol,\tand\tlipoproteins\tas\twell.\nThe\tliver\tis\tinvolved\tin\tthe\tstorage,\tactivation,\tand\ttransport\tof\tmany\tvitamins\tand\tminerals.\tIt\tstores\tall\tthe\tfat-\nsoluble\tvitamins\tin\taddition\tto\tvitamin\tB
|
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] |
soluble\tvitamins\tin\taddition\tto\tvitamin\tB\n12\n\tand\tthe\tminerals\tzinc,\tiron,\tcopper,\tand\tmanganese.\n\tHepatically\nsynthesized\tproteins\ttransport\tvitamin\tA\t(retinol\tbinding\tprotein),\tiron\t(transferrin),\tzinc\t(metallothionein),\tand\ncopper\t(ceruloplasmin)\tin\tthe\tbloodstream.\tCarotene\tis\tconverted\tto\tvitamin\tA,\tfolate\tto\t5-methyl\ttetrahydrofolic
|
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] |
acid,\tand\tvitamin\tD\tto\tan\tactive\tform\t(25-hydroxycholecalciferol,\tcalcitriol)\tby\tthe\tliver.\nIn\taddition\tto\tfunctions\tof\tnutrient\tmetabolism\tand\tstorage,\n\tthe\tliver\tforms\tand\texcretes\tbile.\tBile\tsalts\tare\nmetabolized\tand\tused\tfor\tthe\tdigestion\tand\tabsorption\tof\tfats\tand\tfat-soluble\tvitamins.\tBilirubin\tis\ta\tmetabolic\tend
|
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product\tfrom\tred\tblood\tcell\tdestruction;\tit\tis\tconjugated\tand\texcreted\tin\tthe\tbile.\nHepatocytes\tdetoxify\tammonia\tby\tconverting\tit\tto\turea,\t75%\tof\twhich\tis\texcreted\tby\tthe\tkidneys.\tThe\tremaining\nurea\tfinds\tits\tway\tback\tto\tthe\tgastrointestinal\n\ttract\t(GIT).\tThe\tliver\talso\tmetabolizes\tsteroid\thormones.\tIt\tinactivates
|
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] |
and\texcretes\taldosterone,\tglucocorticoids,\testrogen,\tprogesterone,\tand\ttestosterone.\tIt\tis\tresponsible\tfor\tthe\ndetoxification\n\tof\tsubstances,\tincluding\tdrugs\tand\talcohol,\tas\twell\tas\ttoxins\tsuch\tas\tpollutants,\tchemicals,\tpesticides\nand\therbicides,\tbioactive\tcompounds,\tand\tbiological\tpoisons\tsuch\tas\tthose\tfrom\ttoxic\tmushrooms.\n\tFinally,\tthe\tliver
|
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] |
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