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F. Other Organ Systems
F.1 Gastrointestinal Disease
Content
Areas
- Overview
of function: digestion and absorption
- Peptic
ulcer disease
- Gastroesophageal
reflux disease
- Liver
disease
- Short
bowel syndrome
- Malabsorption
- Dumping
syndrome
- Inflammatory
bowel disease (Crohn’s disease, ulcerative colitis, IBD)
- Diverticulitis/diverticulosis
- Pancreatitis
- Constipation
- Nutritional
consequences of GI surgery
- Fiber:
soluble and insoluble
- Prevention
of colorectal cancer
- Medical
nutrition therapy
| After
training, the learner will be able to: |
| Knowledge
Objectives: Medical Students |
- Explain
how common GI diseases (Crohn’s disease, ulcerative
colitis, chronic pancreatitis, cystic fibrosis, and hepatic
cirrhosis) affect a patient’s nutrition health, including
effects on appetite, digestion/absorption, weight loss,
and vitamin and mineral levels.
- Describe
the processes of digestion and absorption of specific macro-
and micronutrients, including the roles of different organs,
regions, and cells in the GI tract, pancreatic and intestinal
cell secretions, and the hepatobiliary circulation.
- Identify
dietary components that interfere with or enhance the digestion/absorption
of specific nutrients (including those that influence GI
transit time, affect gastric acid secretion, or cause irritation
of the mucosa), and explain how each component affects nutritional
status.
- Describe
the nutritional and metabolic consequences of small and
large intestinal resection.
- Describe
the relationship between dietary habits and the risk of
colorectal cancer, and identify those dietary and physical
activity changes that appear to be the most efficacious
in preventing this type of cancer.
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| Knowledge
Objectives: Residents |
- Identify
the four most common causes of diarrhea and constipation,
outline the direct nutritional effects of each condition
on patient nutritional status, and describe the nutritional
treatment regimen most commonly used to treat each condition.
- Explain
how to determine when a patient’s diet should be advanced
from NPO to solid foods after major GI surgery.
- List
the indications for fecal fat, d-xylose, and hydrogen breath
tests, and explain how to interpret the results of each
test.
- Identify
the potential nutritional consequences of medications used
to treat GI diseases.
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| Knowledge
Objective: Specialists |
- Identify
at least four diseases of the GI system that can be treated
by specialized nutritional support, identify three specific
nutrients utilized, and describe the scientific evidence
that supports this approach.
- Practice
Behavior Skills: Medical Students
- Given
a patient complaining of constipation, identify the likely
causes and make appropriate recommendations to correct the
condition and prevent future episodes.
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| Practice
Behavior Skills: Residents |
- Evaluate
the nutritional status of a patient with a gastrointestinal
complaint by taking his/her medical, diet and social histories,
conducting a physical examination, and selecting appropriate
laboratory tests and diagnostic procedures.
- Effectively
counsel patients to establish appropriate dietary and behavioral
goals and to adopt strategies to achieve these goals. Develop
a plan to monitor the patient’s progress and elicit
his/her commitment.
- Based
on an accurate assessment of the physician’s own knowledge
and limitations, seek consultation with and refer patients
to a registered dietitian or other credentialed healthcare
professionals as appropriate.
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| Practice
Behavior Skills: Specialists |
- Given
the history of a patient with GI disease, develop an appropriate
nutritional management plan that incorporates individualized
nutritional recommendations based on a patient’s nutritional
status, food preferences, disease state, and socio- cultural-,
and economic background.
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| Attitude
Objectives: All Learners |
- Recognize
the central importance of nutrition in the treatment and
management of patients with GI disease and demonstrate a
commitment to providing appropriate nutritional intervention
(including dietary modification and enteral or parenteral
nutrition therapy).
- Recognize
the importance of dietary and lifestyle factors in the prevention
of GI diseases.
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