Nutrition and Metabolism in SBS and SIBO

Short Bowel Syndrome (SBS)

• Insufficient intestine length leads to malabsorption of nutrients
• Severe dehydration and nutrient deficiencies can occur after surgery
• Electrolyte and vitamin levels (B12) need monitoring.
• High-calorie, nutrient-dense foods are necessary
• Medications may need adjustment based on nutrient absorption issues

Small Intestinal Bacterial Overgrowth (SIBO)

• Excess bacteria in the small intestine disrupts digestion causing malabsorption
• Can cause malnutrition, weight loss, and low albumin and B12 levels
• Low-carb diets may help reduce symptoms
• Certain antibiotics can alter gut flora and affect absorption

Calculations

• Be able to calculate BMI and classifications
• Be able to calculate IBW, %IBW, and convert pounds to kilograms
• Be able to calculate % weight change and classifications
• Be able to calculate the Penn State Formula using kilograms and centimeters
• Convert pounds to kilograms (1 kg = 2.2 lb)
• Convert inches to centimeters (1 inch = 2.54 centimeters)
• BMI = (Weight in kg) / (Height in meters)^2

Upper and Lower GI Tract Anatomy

• Sphincters are circular muscles regulating content flow through the GI tract
• Key sphincters include - Upper Esophageal Sphincter (UES), Lower Esophageal Sphincter (LES), Pyloric Sphincter, Ileocecal Valve, and Anal Sphincters
• Sphincters prevent backflow and control the movement of food and waste

Digestion

• Mechanical and chemical digestion starts in the mouth
• Ileum is the site of B12 absorption
• Malabsorption conditions like Celiac Disease and IBD can lead to issues like steatorrhea (fat in stool)

Medications with Food/Nutrient Interactions

• Mesalamine (Asacol): used for IBD, may interact with nutrients
• Corticosteroids: can increase appetite and affect glucose levels
• Methotrexate: folate antagonist, may require folate supplementation
• Common micronutrient deficiencies: Vitamin K, B12, Iron, Vitamin D, and Zinc

Medications that Alter Liver Enzymes

• Acetaminophen: overuse can lead to liver damage
• Statins: used for cholesterol management and can elevate liver enzymes
• Antiepileptics: Phenytoin and carbamazepine can affect liver function
• Antibiotics (e.g., tetracycline): can bind with calcium in dairy products
• Warfarin: interacts with vitamin K-rich foods affecting blood clotting
• Proton Pump Inhibitors (e.g., omeprazole): can hinder absorption of nutrients like vitamin B12 and iron

Lab Abnormalities

• Dehydration leads to elevated creatinine and electrolyte imbalances
• Metabolic stress can cause changes in glucose and electrolyte levels
• Medication effects can alter liver enzymes or kidney function, impacting lab results

Mean Arterial Pressure (MAP)

• Used to assess perfusion
• A MAP of 65 mmHg or higher is generally considered adequate for organ perfusion

Enteral Nutrition (EN)

• Initiated after hemodynamic stability is achieved, usually when a patient can tolerate oral intake.

Lower GI

• Peptic Ulcer Disease (PUD): can be caused by H. pylori, NSAIDs, and stress
• Nutrition for PUD focuses on avoiding irritants and promoting healing
• Gastrectomy (stomach removal) complications include malabsorption and nutrient deficiencies
• Supplementation with vitamins B12, iron, and calcium may be necessary after gastrectomy
• Two types of diarrhea: Osmotic (resolves with fasting) and Secretory (does not resolve with fasting)
• Nutritional consequences of diarrhea include dehydration and malnutrition
• Common causes of malabsorption include celiac disease and IBS
• Low-fat diets should avoid high-fat foods like butter and oils
• Celiac disease symptoms include diarrhea and weight loss
• Avoid gluten-containing foods (wheat, barley, rye)
• IBS symptoms include abdominal pain and bloating
• FODMAP diet restricts fermentable carbohydrates
• FODMAPs are Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols
• FODMAP foods to avoid: Wheat, garlic, onions, dairy, certain fruits (like apples and pears), and sugar alcohols (like sorbitol)

Crohn's Disease

• Symptoms include diarrhea, nausea, vomiting, and cobble-stoning effect on the gut
• Can lead to low albumin, electrolyte imbalances, malabsorption, malnutrition and dehydration
• May need parenteral nutrition (PN) then enteral nutrition (EN)
• Mesalamine (Asacol): may need an artificial sweetener in steroid form as an alternative

Irritable Bowel Syndrome (IBS)

• Motility disorder causing constipation, diarrhea, or a mix of both
• Electrolyte imbalances are possible
• Following a FODMAP diet helps manage the condition
• FODMAP foods to avoid: Wheat, garlic, onions, dairy, certain fruits (like apples and pears), and sugar alcohols (like sorbitol)