Inflammatory bowel disease(IBD)-ulcerative colitis and Crohn

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Inflammatory bowel disease(IBD)-ulcerative
colitis and Crohns alterations in microbiome
play a role in IBD 1)different oxidative pathways
in the altered microbiome 2)more aggressive
nutrient uptake by altered microbiome-this
favours the altered microbiome 3) altered
microbiome is more virulent
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Exam 180 minutes 120 multiple choice
questions-120 points -4 short answer
question-60 points multiple choice-lecture
7a-12c inclusive short answer-whole Nutr2105
course
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Note Nutrition 2106-Fall 2013- Principles of
Nutrition in Metabolism Nutrition
2101-Nutritional Assessment-Theory-Fall
2013 Nutrition 2107- Introduction to Sports
Nutrition-Winter 2014
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Lecture 10a 18 March 2013   Enteral and
Parenteral Feeding
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Enteral Feeding   -refers to use of intestine
(uses oral or tube feeding to direct nutrients to
intestine)   -called complete enteral feeding if
formula is primary source of nutrients   -complete
formulas can be used in smaller quantities to
supplement table foods   -complete formulas
required if patient is on tube feeding or oral
liquid diet for more than a few days
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Types of enteral formulations -standardised
-hydrolysed -modular -characterised by
type of protein in the formulation
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Types of enteral formulations Standardised   Appro
priate for people who are able to digest and
absorb   Contain complete proteins (complete
refers to whole proteins or combination of
protein isolates(purified proteins))   Blenderised
formulas contain protein from pureed foods (e.g.
blenderised meats)
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• Types of enteral formulations
• Hydrolysed
•  
• Pre-digested protein- so only get small
  peptides or just free amino acids
•  
• Some have medium chain triglycerides or are
  very low in fat

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Types of enteral formulation Modular   Provide a
single nutrient   Modules can be combined with
other modules or with minerals and/or vitamins to
address the specific needs of a patient
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• Candidates for tube feeding
• Anybody who
• can not get food down orally or
• has mental incapacitation
• are malnourished or
• have high nutrient requirements or
• extensive intestinal resections or
• is on a ventilator
• gastrointestinal obstructions or fistulas
• in short anyone who cannot access or utilise GI
  tract on their own

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• Distinguishing characteristics of enteral
  formulations
•  
• Nutrient density
• 1.0  kcal/ml- standard
• 1.2 2.0 kcal/ml for nutrient dense formulas
  -nutrient dense formulations are given in
  smaller volumes to persons with fluid
• balance issue- e.g. congestive heart
  patients

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Distinguishing characteristics of enteral
formulations 2) Fibre   if administered over
short time - low to moderate fibre - otherwise
gas and distension can be an issue   if long term
administration -then higher amounts of fibre
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Distinguishing characteristics of enteral
formulations 3) Osmolality- measure of
concentration of molecular and ionic particles in
solution -serum is 300 milliosmoles/kg of
solution -isotonic solution is 300
milliosmoles/kg -hypertonic is greater
than 300 milliosmoles/kg of solution
-hypertonic can induce diarrhea in intestine-
slow introduction of hypertonic solution for
intestinal route is essential  
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Tube placement-1) transnasal or 2) direct
catheter  1)Transnasal Nasogastric-children and
adults-larger nose than infants so nasogastric
is used in children and adults Orogastric-infa
nts- smaller nose than adults and children so
orogastric is used   Nasoduodenal-nose to
duodenum   Nasojejunal placement-nose to
jejunum  
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Tube placement 2) Catheter direct to stomach or
jejunum Enterostomies- surgical placement of
catheter   -Gastrostomy- direct to
stomach   -Jejunostomy-direct to jejunum
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Safehandling of formulations   Open and closed
systems   Open- exposed to air   Closed-not
exposed to air   Keep your fingers out of the
soup for open systems
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• Initiating and progressing a tube feeding
•  
• Formula delivery techniques
• Intermittent feeding
•  
• Best to stomach
• No more than 250-400 ml over 30 minutes
• Use- depends on tolerance
•  
• Bolus feeding included here (300- 400 ml) in
  10 minutes
•  

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Initiating and progressing a tube feeding  
Formula delivery techniques Continuous
feeding Delivered slowly over 8-24
hours   Good for people who have received
nothing though GI tract for a long time,
hypermetabolising persons and those
receiving intestinal feedings   Formula
volume and strength institutionally based-
standard operating procedures (sops)  
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Initiating and progressing a tube feeding  
Additional matters Supplemental
water -standard formulas contain about 850
ml of water/per formula -most people need
about 2 L of water per day   Gastric
residual volume -amount left over from
previous feedings-significance of this?
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2 Youtubes- enteral feeding https//www.youtube.c
om/watch?vEWtqxJeyCMA   https//www.youtube.com/w
atch?vhploKHe-V4U
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Class activity Design an enteral feeding for the
pathology/problem of your choice that meets the
dietary principles of adequacy, variety,
moderation, nutrient density, energy control, and
balance