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MD 4924 > 4924 GI disorders > Flashcards

4924 GI disorders Flashcards

1
Q

What is GERD

A

A condition that develops when the reflux of stomach contents causes troublesome symptoms &/or complications

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2
Q

What is the etiology of GERD

A

Multi-factorial, including both lifestyle and physiological factors.

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3
Q

What is GERD attributed to?

A

The incompetence of the lower esophageal sphincter.

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4
Q

Where is the atmospheric pressure greater as it related to GERD?

A

Atmospheric pressure is great in the esophagus, which keeps stomach contents in the stomach.

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5
Q

What three hormones decrease LES pressure?

A

Gastrin, estrogen, progesterone.

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6
Q

The presence of what medical conditions decrease LES?

A

Hiatal hernia, scleroderma

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7
Q

Scleroderma

A

An autoimmune disorder of the connective tissue causing inflammation & thickening of tissue.

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8
Q

What three medicines lead to decreased LES pressure?

A

Dopamine, morphine, theophylline

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9
Q

What foods decrease LES pressure?

A

Spear/peppermint & foods high in fat.

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10
Q

What other 2 factors can decrease LES pressure?

A

cigarette smoking, obesity.

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11
Q

Symptoms of GERD

A

Dysphagia, heartburn, increased saliva production, belching. Pain maybe severe and radiate to jaw and neck.

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12
Q

Complications of GERD

A

Dysphagia, aspiration, pneumonia & asthma, ulceration, perforation or stricture of the esophagus, Barrett’s esophagus.

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13
Q

Medical treatment of GERD

A

Antacids or buffering agents. Histamine blocking agents. Prokinetics. PPIs. Mucosal protectants.

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14
Q

What is the most common surgical treatment of GERD>

A

Nissen fundoplication.

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15
Q

Nissen fundoplication

A

The upper portion of the stomach is wrapped around the LES to strengthen it.

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16
Q

Stretta procedure

A

Radio frequency is delivered to LES, which strengths it.

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17
Q

Which foods increase gastric acid production?

A

Coffee, alcohol, red & black pepper.

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18
Q

What foods decrease LES pressure?

A

Chocolate. Mint. Foods with a high fat content

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19
Q

Lifestyle changes to reduce GERD

A

Eat smaller, more frequent meals. Lose wt. Smoking cessation. Remain upright after eating. Eat at least 3 hours before going to bed. Wear lose clothing. Raise the HOB 6”-9” for sleeping.

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20
Q

When should you encourage pt to drink fluids?

A

Drink liquids between meals as much as possible to reduce volume in stomach.

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21
Q

How does GERD/PUD lead to inadequate nutritional intake?

A

Changes in appetite. Abdominal pain. Specific food intolerances.

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22
Q

Why might a pt with GERD/PUD have electrolyte imbalances?

A

Vomiting

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23
Q

What may cause iron deficiency in GERD/PUD?

A

Blood loss. Use of medications which alter the acidic environment of the stomach needed to reduce iron to the ferrous state.

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24
Q

Long term use of medication to treat GERD/PUD may lead to which nutrient deficiencies?

A

Iron, B12, calcium. Due to reduced stomach acid.

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25
Q

Peptic Ulcer Disease (PUD)

A

A disease involving the ulceration of the mucosa of the GI tract & can occur in the esophagus. The break in the mucosa results in a crater surrounded by an acute & chronic inflammatory cell infiltrate.

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26
Q

What are the symptoms of an esophageal ulcer?

A

Dysphagia and heartburn.

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27
Q

What are the symptoms of a gastric or duodenal ulcer?

A

Epigastric pain when stomach is empty, which is relieved by food or medications.

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28
Q

What are the symptoms of a jejunal ulcer?

A

Left upper quadrant pain, which is not relieved by food intake.

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29
Q

Etiology of PUD

A

The stomach produces excess pepsin & acid. The lining becomes damaged and more susceptible to further damage from pepsin & acid.

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30
Q

What factors cause damage to the mucosal lining?

A

H. pylori. NSAIDs. Aspirin. Alcohol. Steroids.

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31
Q

What factors decrease blood supply to the stomach mucosa?

A

Smoking. Stress. Injury (Curling’s ulcer r/t brain injury)

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32
Q

What factors increase gastric acid secretion?

A

Foods: pepper, alcohol, caffeine. Rapid gastric emptying. Stress. Other conditions, ex. Zollinger-Ellison syndrome.

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33
Q

General symptoms of PUD

A

Abdominal pain. Burning sensation. Abdominal pain may be relieved by food consumption and antacids, in other eating may make pain worse.

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34
Q

Medical treatment for PUD

A

Antibiotics. Antacids. PPIs. Histamine blocking agents. Prokinetics. Mucosal protectants.

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35
Q

MNT for PUD

A

Optimize intake to reduce deficiencies. Avoid foods the lower LES pressure, increase acid secretion. ID individual trigger foods. Do not eat 2hr before bed.

36
Q

What are potentially protective factors against PUD?

A

Vitamins A & C intake. Fiber intake.

37
Q

Crohn’s disease

A

Inflammation of all layers of the digestive tract - typically the small intestine.

38
Q

Symptoms of Crohn’s disease

A

Diarrhea, pain, cramping.

39
Q

Ulcerative colitis

A

Inflammation of inner lining of digestive tract, only found in the colon

40
Q

Symptoms of Ulcerative colitis

A

Diarrhea, pain, cramping, N/V, wt loss, fatigue.

41
Q

Fistula

A

Abnormal connections between organs as a result of deep ulcers.

42
Q

What are the goals for treatment of IBD?

A

Manage symptoms. Maintain nutritional status. Quality of life w/ variety & balance of foods.

43
Q

MNT for IBD

A

Individualized meal plan. Limit un-tolerated foods. Sm frequent meals w/ mix of macros. Low fiber during flares. Avoid seeds, nuts, kernels, beans, corn w/ strictures.

44
Q

Recommend supplements for IBD

A

Multivitamin w/ minimally the following: B12, iron, zinc, magnesium, folate; psyllium; anti-inflammatory: turmeric, omega 3, Boswellia

45
Q

Irritable bowel syndrome (IBS)

A

Is a functional bowel disorder - pt has no abnormal tests.

46
Q

Symptoms of IBS

A

Diarrhea, constipation, bloating, pain, mucous. Can be diarrhea dominant, or constipation dominant.

47
Q

IBS is triggered by?

A

Hormones, stress, activity, diet: caffeine, carbonated beverages, fats, simple sugars, sorbitol, some high fiber foods.

48
Q

MNT for IBS

A

Individualized meal plan. Limit un-tolerated foods. Sm frequent meals. Eat slowly, in relaxing environment. Eat general high-fiber diet w/ plenty of water, low-fiber during flares. Avoid seeds, kernels, beans, corn, nuts w/ strictures.

49
Q

What things can be consumed to help IBD

A

Peppermint oil. Chamomile. Probiotics.

50
Q

MNT for N/V

A

Introduce ice chips if >3yo. If tolerated, start w/ rehydration beverage or clear liquids. I tsp every 10 min, increase to 1 Tbsp every 20 min. Double amount of fluid every hour.

51
Q

Recommended beverages for N/V

A

Rehydration. Diluted juice. Sport drink. Warm or cold tea. Lemonade.

52
Q

When can foods be reintroduced after N/V?

A

No vomiting for at least 8hrs, initiate oral intake slowly, adding 1 solid food at a time in sm. increments.

53
Q

What are the best types of foods to add after N/V?

A

Without odor. Low-fat and low-fiber. With Na and K. Ginger chews.

54
Q

Goals of treatment of N/V

A

ID underlying cause. Use anti emetics, prokinetics. Prevent anticipatory N/V. Maintain optimal fluid balance & nutritional status.

55
Q

Diarrhea

A

Large volume losses can quickly lead to the following: dehydration, electrolyte imbalance, acid-base imbalance, hyponatremia, hypokalemia, metabolic acidosis

56
Q

What is the best way to restore normal fluid, electrolyte, & acid-base balance?

A

Oral rehydration solution.

57
Q

Treatment for diarrhea

A

Decrease GI motility. Thicken consistency of stool w/ soluble fiber: BRAT diet. Repopulate normal GI flora. Gradually intro low-fiber, low-fat, possibly lactose free foods.

58
Q

What foods should be avoided w/ diarrhea?

A

Clear liquids and simple CHO. Caffeine, alcohol, high-fiber & gas producing foods.

59
Q

Fiber treatment for constipation

A

Eat adequate fiber 25-38g per day at least 5 days per week.

60
Q

What type of fiber has the greatest impact on constipation?

A

Insoluble fiber appears to have the greatest effect: whole grains, vegetables, fruit skins.

61
Q

Why does insoluble fiber help constipation?

A

It adds bulk to the stool, causing it to push against the intestinal wall to force waste through more rapidly and thus, prevent constipation.

62
Q

What are the goals of medical treatment for constipation?

A

To increase frequency of bowel movements. To prevent straining while eliminating.

63
Q

MNT for constipation

A

Increase fluid intake to min 64oz/day. Daily PA. Pro/pre-biotics. Avoid stool retention - bowel retrying program if needed. General high-fiber diet, low-fiber during diverticular flares; avoid nuts, seeds, beans, kernels, corn.

64
Q

Fiber supplements

A

aka bulk laxatives, are generally considered the safest of laxatives. ex, FiberCon. Must be taken with plenty of water.

65
Q

Stimulant medications for constipation

A

Cause rhythmic contractions in the intestines. ex. correctol

66
Q

Lubricants

A

Enable stool to move through colon more easily, ex. Fleet, mineral oil

67
Q

Osmotics

A

Help fluids to move through colon. ex. Miralax, Sorbitol

68
Q

Saline laxatives

A

Act like a sponge to draw water into the colon for easier passage of stool, ex. milk of magnesia, Haley’s M-O

69
Q

Anorexia

A

Characterized by a decrease in appetite and oral intake, may arise as a result of the following: GI obstruction, N/V associated w/ oncologic treatment, alteration in taste or smell, food aversions, pain, anxiety and depression.

70
Q

MNT for anorexia

A

Assess intake adequacy. Sm. frequent meals. Nutrient-dense foods. Liberalize restricted diets. Dietary supplements. Appetite stimulants. Nutrition support if needed.

71
Q

Two drugs that will increase appetite?

A

Marinol - cannabinoid. Megace - steroid hormone.

72
Q

Celiac disease

A

Is a genetically based, permanent immunologic intolerance to gluten. GI villi are damaged and cannot absorb nutrients.

73
Q

Why is celiac a unique autoimmune disease

A

The environmental trigger is known. The genetic factors are known. If trigger is eliminated = resolution of disease.

74
Q

Pathophysiology of celiac

A

DQ2 or DQ8 haplotype + gluten exposure = Recruitment of T-lymphocytes = cytokines–> damaged epithelium –> Tissue transglutaminase (tTg) –> villous atrophy

75
Q

What are the classifications of celiac

A

Classical-GI. Atypical-Non-GI. Silent - asymptomatic, + serology, + biopsy. Latent - asymptomatic, + serology, - biopsy, symptoms may develop later.

76
Q

Most common Classical GI symptoms

A

Diarrhea, constipation, gas, bloating, distention, abdominal pain, wt loss, FTT, chronic fatigue/pain.

77
Q

Asymptomatic pt are most commonly diagnosed when?

A

They present with anemia and chronic fatigue.

78
Q

Complications w/ untreated or undiagnosed celiac

A

Osteoporosis/penia. Intestinal lymphoma. Malnutrition, malabsorption disorders. Increased risk of development of other autoimmune disorders.

79
Q

Celiac crisis

A

Severe edema, hypoproteinemia, electrolyte abnormalities, shock-like state.

80
Q

Gluten intolerance or sensitivity

A

Negative biopsy and serology but react to gluten in diet.

81
Q

What grains contain gluten?

A

Wheat, barley, rye,

82
Q

Other foods that should be avoided?

A

Malt. Oats

83
Q

FALCPA

A

Food Allergen Labeling and Consumer Protection Act - top 8 allergens must be on the food label.

84
Q

Food allergen advisory labeling

A

Is voluntary. Indicated the potential for unintended contamination.

85
Q

What is considered a ‘safe’ level of gluten

A

10µg - 30µg

86
Q

Recommendations for MNT for Celiac Disease

A

Discuss & educate on whole-grain, gluten free products or enriched gluten-free products. Ensure nutritional adequacy. Follow-up appointments. Provide resources.

87
Q

Common nutrient deficiencies in celiac

A

CHO, iron, folate, niacin (B3), fiber, B12, Ca, Zn, P, vitamin D

MD 4924 (6 decks)

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