What Is The Function Of Bile Quizlet – A 40-year-old woman with a history of Crohn’s disease presents with a 3-week history of intermittent abdominal pain, 8 watery bowel movements per day, and weight loss of 8 kg. leave his weight of 50 kg. Three years ago, he needed surgery for a small bowel obstruction, and in that case about 130 cm of ileum and 30 cm of colon were reconstructed. He recovered after this operation and gained weight, and he has been taking 5-amino salicylic acid, 4 g/day, to prevent the recurrence of his inflammatory bowel disease. You decide to admit a patient for investigation and treatment of possible Crohn’s disease. An upper abdominal radiograph with follow-up of the small intestine reveals multiple dimensions of the small intestine with dilatation of the small intestine between these lungs. In order to control the progression of the disease, the patient was prescribed prednisone starting at 40 mg/day and decreasing by 5 mg/week. In addition, azathioprine, 100 mg daily, was started at the same time to allow prednisone withdrawal, but the patient developed vomiting, abdominal distension, and worsening abdominal pain and it is assumed that he has a stomach problem. He is taken to the operating room, where another 120 cm of intestine is removed. After this operation, you have severe, watery diarrhea after eating or drinking anything. How do you explain the origin of his diarrhea? What vitamins and minerals would you expect him to be deficient in? In terms of nutrition, what can be done to reduce his diarrhea?

The normal small intestine of an adult is about 400 cm long and consists of the duodenum, 25-30 cm, and the jejunum, 160-200 cm, and the rest is the leal. Carbohydrate and protein absorption occurs in the duodenum and jejunum, and the ileum is responsible for the absorption of fat bound to bile salts (protected by the liver), fat-soluble vitamins and B vitamins.

What Is The Function Of Bile Quizlet

(bound to the substance produced by the stomach). Most fluids and electrolytes are absorbed into the ileum and large intestine. Normally, 2-3 L of food and drinking water, on top of 7-9 L of secreted fluid, is absorbed per day in the distal stomach.

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Short bowel syndrome occurs after the small intestine becomes enlarged and interferes with the normal absorption of nutrients and fluids. It often occurs after endometrial resection (such as Crohn’s disease or postradiation enteritis), acute inflammation of the infarcted bowel (due to blood loss) and surgical treatment of the stomach. of losing weight. Common pediatric causes of short bowel syndrome include resection after episodes of necrotizing enterocolitis and volvulus repair.

Symptoms of colitis usually appear in the immediate post-operative period and include diarrhea and watery stools that are worsened by oral intake. There are short-term and long-term complications of malabsorption, leading to fluid retention, weight loss, anemia and vitamin deficiencies. A better understanding of the areas related to intake for different nutrients can help to find the deficiencies that occur with malabsorption (Figure 1) and to define the system of treatment and nutrition described here (Table 1) .

Figure 1: Areas involved in digestion and absorption of nutrients in a healthy gastrointestinal tract. CHO = carbohydrates. Photo: Lianne Friesen and Nicholas Woolridge

The first step in approaching patients with short bowel disease is to determine the extent and extent of surgery that may cause diarrhea, malabsorption, and malnutrition. Diarrhea and malnutrition associated with short bowel disease are caused by malabsorption, changes in gastric motility and the ability of other parts of the intestine to compensate for the regurgitated parts. The location and extent of the resection will affect whether the patient will need nutritional supplementation.

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Damage to the small intestine involving loss of more than 100 cm of ileum often leads to severe malabsorption problems. Undigested salts enter the colon and stimulate the production of fat and water, which causes diarrhea. In addition, the lack of bile salts leads to fat malabsorption, which contributes to the patient’s diarrhea in the form of steatorrhea. It is usually not necessary to do any research when this condition appears immediately after reconstruction, because the return of Crohn’s disease is not common within 2-4 weeks after colon reconstruction.

Any significant operation of the small intestine increases gastric motility, 2 but the results of this depend on the site as well as the size of the resection. Proximal (jejunal) resection does not increase the speed of intestinal transit, because the remaining ileum continues to absorb bile salts and therefore only a small amount reaches the colon to prevent salt and water. too much fluid and electrolyte load also accommodates bile salts, which reduce its ability to absorb salt and water, causing diarrhea. Furthermore, if the colon is stimulated, the patient’s ability to maintain fluid and electrolyte homeostasis is severely impaired. In patients with short bowel and non-abdominal bowel, the oral tablet will be completely eliminated within a few hours.4

Like malabsorption and diarrhea, the likelihood and severity of malnutrition that occurs after a bowel movement is determined by the location and size of the bowel movement. Despite the important role of nutrient absorption played by the jejunum, especially in relation to fat absorption, if one jejunum is removed, malabsorption and malnutrition do not appear to occur. This is because the intact ileum takes over what is normally the jejunum’s job of absorbing fat. On the other hand, even the loss of 100 cm of ileum causes steatorrhea.1 The degree of malabsorption increases and the variety of malabsorbed nutrients increases with the length of the resection.5

6 Comparative studies of energy absorption after ingestion of leal and partial jejunal portions from between 30 and 100 cm of the small intestine show that absorption of fat and carbohydrates is reduced between of 50% and 75% of intake.7 However, nitrogen absorption is not as affected and remains about 80% of intake. The rate of absorption of calcium, magnesium, zinc and phosphorus is reduced, but the extent of malabsorption does not correlate well with the remaining length of the intestine. In my experience, the condition of complete ileal and partial jejunal resection will require parenteral nutrition, especially for providing electrolytes and divalent ions (since oral intake is usually sufficient to meet the patient’s strength and nitrogen requirements). A review of the literature published prior to the availability of parenteral nutrition indicates that the distal (from the ileocecal valve upwards) up to 33% of the length of the small intestine results in protein-energy malnutrition. Up to 50% withdrawal can be tolerated without nutritional support, but more than 75% will require parental nutritional support to avoid malnutrition.

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It would be reasonable to expect that preserving the ileocecal valve would improve absorption by delaying bowel movements. However, this theory has not been supported by experimental evidence. Fich and their colleagues8 showed that the removal of the valve at the exit of the small intestine does not change the motility of the intestine, because the valve plays a small role in controlling the motility of the intestine.

Thus, the approach to the patient with small bowel disease depends on the extent of the resection. Other important factors include the presence of progressive bowel disease that reduces the length of bowel movement and sufficient time for the bowel to adapt to the necessary change in function. Patient progress over time will lead to changes in treatment.

The main step in managing irritable bowel syndrome is to replace fluid loss and control diarrhea. Diarrhea often occurs and is caused by the combination of increased secretions and increased motility and osmotic stimulation of water secretion due to malabsorption of the intestinal tract. Initially, diarrhea is controlled by having the patient take nothing by mouth to reduce any osmotic component. Gastric hypersecretion occurs immediately after bowel movement and is usually temporary, but in some patients it leads to peptic ulcer. Treatment with proton pump inhibitors is the norm in the immediate period after surgery using intravenous pantoprazole, which is given as an 80-mg bolus followed by an infusion at 8 mg/hour. When you start drinking again, proton pump inhibitors are given orally twice a day as omeprazole, 20 mg, lanzoprazole, 30 mg, or pantoprazole, 40 mg, to suppress hypersecretion. In addition, loperamide, 2-12 tablets, can be used to slow down the passage through the stomach and intestines to 1-3 organs per day. If loperamide does not work, then codeine or diphenoxylate-atropine (Lomotil) may be used.9 Intravenous fluids will be needed to replace fluid and electrolyte losses during immediate action. In general, replace the loss of gastric juice with normal saline loss, pancreatic and above with a 4:1 mixture of normal salt: sodium lactate or sodium acetate. Add about 20 mmol/L of potassium and 7–10 mmol/L of magnesium sulfate. Sodium and potassium chloride as

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