4924 GI disorders Flashcards
What is GERD
A condition that develops when the reflux of stomach contents causes troublesome symptoms &/or complications
What is the etiology of GERD
Multi-factorial, including both lifestyle and physiological factors.
What is GERD attributed to?
The incompetence of the lower esophageal sphincter.
Where is the atmospheric pressure greater as it related to GERD?
Atmospheric pressure is great in the esophagus, which keeps stomach contents in the stomach.
What three hormones decrease LES pressure?
Gastrin, estrogen, progesterone.
The presence of what medical conditions decrease LES?
Hiatal hernia, scleroderma
Scleroderma
An autoimmune disorder of the connective tissue causing inflammation & thickening of tissue.
What three medicines lead to decreased LES pressure?
Dopamine, morphine, theophylline
What foods decrease LES pressure?
Spear/peppermint & foods high in fat.
What other 2 factors can decrease LES pressure?
cigarette smoking, obesity.
Symptoms of GERD
Dysphagia, heartburn, increased saliva production, belching. Pain maybe severe and radiate to jaw and neck.
Complications of GERD
Dysphagia, aspiration, pneumonia & asthma, ulceration, perforation or stricture of the esophagus, Barrett’s esophagus.
Medical treatment of GERD
Antacids or buffering agents. Histamine blocking agents. Prokinetics. PPIs. Mucosal protectants.
What is the most common surgical treatment of GERD>
Nissen fundoplication.
Nissen fundoplication
The upper portion of the stomach is wrapped around the LES to strengthen it.
Stretta procedure
Radio frequency is delivered to LES, which strengths it.
Which foods increase gastric acid production?
Coffee, alcohol, red & black pepper.
What foods decrease LES pressure?
Chocolate. Mint. Foods with a high fat content
Lifestyle changes to reduce GERD
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.
When should you encourage pt to drink fluids?
Drink liquids between meals as much as possible to reduce volume in stomach.
How does GERD/PUD lead to inadequate nutritional intake?
Changes in appetite. Abdominal pain. Specific food intolerances.
Why might a pt with GERD/PUD have electrolyte imbalances?
Vomiting
What may cause iron deficiency in GERD/PUD?
Blood loss. Use of medications which alter the acidic environment of the stomach needed to reduce iron to the ferrous state.
Long term use of medication to treat GERD/PUD may lead to which nutrient deficiencies?
Iron, B12, calcium. Due to reduced stomach acid.
Peptic Ulcer Disease (PUD)
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.
What are the symptoms of an esophageal ulcer?
Dysphagia and heartburn.
What are the symptoms of a gastric or duodenal ulcer?
Epigastric pain when stomach is empty, which is relieved by food or medications.
What are the symptoms of a jejunal ulcer?
Left upper quadrant pain, which is not relieved by food intake.
Etiology of PUD
The stomach produces excess pepsin & acid. The lining becomes damaged and more susceptible to further damage from pepsin & acid.
What factors cause damage to the mucosal lining?
H. pylori. NSAIDs. Aspirin. Alcohol. Steroids.
What factors decrease blood supply to the stomach mucosa?
Smoking. Stress. Injury (Curling’s ulcer r/t brain injury)
What factors increase gastric acid secretion?
Foods: pepper, alcohol, caffeine. Rapid gastric emptying. Stress. Other conditions, ex. Zollinger-Ellison syndrome.
General symptoms of PUD
Abdominal pain. Burning sensation. Abdominal pain may be relieved by food consumption and antacids, in other eating may make pain worse.
Medical treatment for PUD
Antibiotics. Antacids. PPIs. Histamine blocking agents. Prokinetics. Mucosal protectants.
MNT for PUD
Optimize intake to reduce deficiencies. Avoid foods the lower LES pressure, increase acid secretion. ID individual trigger foods. Do not eat 2hr before bed.
What are potentially protective factors against PUD?
Vitamins A & C intake. Fiber intake.
Crohn’s disease
Inflammation of all layers of the digestive tract - typically the small intestine.
Symptoms of Crohn’s disease
Diarrhea, pain, cramping.
Ulcerative colitis
Inflammation of inner lining of digestive tract, only found in the colon
Symptoms of Ulcerative colitis
Diarrhea, pain, cramping, N/V, wt loss, fatigue.
Fistula
Abnormal connections between organs as a result of deep ulcers.
What are the goals for treatment of IBD?
Manage symptoms. Maintain nutritional status. Quality of life w/ variety & balance of foods.
MNT for IBD
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.
Recommend supplements for IBD
Multivitamin w/ minimally the following: B12, iron, zinc, magnesium, folate; psyllium; anti-inflammatory: turmeric, omega 3, Boswellia
Irritable bowel syndrome (IBS)
Is a functional bowel disorder - pt has no abnormal tests.
Symptoms of IBS
Diarrhea, constipation, bloating, pain, mucous. Can be diarrhea dominant, or constipation dominant.
IBS is triggered by?
Hormones, stress, activity, diet: caffeine, carbonated beverages, fats, simple sugars, sorbitol, some high fiber foods.
MNT for IBS
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.
What things can be consumed to help IBD
Peppermint oil. Chamomile. Probiotics.
MNT for N/V
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.
Recommended beverages for N/V
Rehydration. Diluted juice. Sport drink. Warm or cold tea. Lemonade.
When can foods be reintroduced after N/V?
No vomiting for at least 8hrs, initiate oral intake slowly, adding 1 solid food at a time in sm. increments.
What are the best types of foods to add after N/V?
Without odor. Low-fat and low-fiber. With Na and K. Ginger chews.
Goals of treatment of N/V
ID underlying cause. Use anti emetics, prokinetics. Prevent anticipatory N/V. Maintain optimal fluid balance & nutritional status.
Diarrhea
Large volume losses can quickly lead to the following: dehydration, electrolyte imbalance, acid-base imbalance, hyponatremia, hypokalemia, metabolic acidosis
What is the best way to restore normal fluid, electrolyte, & acid-base balance?
Oral rehydration solution.
Treatment for diarrhea
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.
What foods should be avoided w/ diarrhea?
Clear liquids and simple CHO. Caffeine, alcohol, high-fiber & gas producing foods.
Fiber treatment for constipation
Eat adequate fiber 25-38g per day at least 5 days per week.
What type of fiber has the greatest impact on constipation?
Insoluble fiber appears to have the greatest effect: whole grains, vegetables, fruit skins.
Why does insoluble fiber help constipation?
It adds bulk to the stool, causing it to push against the intestinal wall to force waste through more rapidly and thus, prevent constipation.
What are the goals of medical treatment for constipation?
To increase frequency of bowel movements. To prevent straining while eliminating.
MNT for constipation
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.
Fiber supplements
aka bulk laxatives, are generally considered the safest of laxatives. ex, FiberCon. Must be taken with plenty of water.
Stimulant medications for constipation
Cause rhythmic contractions in the intestines. ex. correctol
Lubricants
Enable stool to move through colon more easily, ex. Fleet, mineral oil
Osmotics
Help fluids to move through colon. ex. Miralax, Sorbitol
Saline laxatives
Act like a sponge to draw water into the colon for easier passage of stool, ex. milk of magnesia, Haley’s M-O
Anorexia
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.
MNT for anorexia
Assess intake adequacy. Sm. frequent meals. Nutrient-dense foods. Liberalize restricted diets. Dietary supplements. Appetite stimulants. Nutrition support if needed.
Two drugs that will increase appetite?
Marinol - cannabinoid. Megace - steroid hormone.
Celiac disease
Is a genetically based, permanent immunologic intolerance to gluten. GI villi are damaged and cannot absorb nutrients.
Why is celiac a unique autoimmune disease
The environmental trigger is known. The genetic factors are known. If trigger is eliminated = resolution of disease.
Pathophysiology of celiac
DQ2 or DQ8 haplotype + gluten exposure = Recruitment of T-lymphocytes = cytokines–> damaged epithelium –> Tissue transglutaminase (tTg) –> villous atrophy
What are the classifications of celiac
Classical-GI. Atypical-Non-GI. Silent - asymptomatic, + serology, + biopsy. Latent - asymptomatic, + serology, - biopsy, symptoms may develop later.
Most common Classical GI symptoms
Diarrhea, constipation, gas, bloating, distention, abdominal pain, wt loss, FTT, chronic fatigue/pain.
Asymptomatic pt are most commonly diagnosed when?
They present with anemia and chronic fatigue.
Complications w/ untreated or undiagnosed celiac
Osteoporosis/penia. Intestinal lymphoma. Malnutrition, malabsorption disorders. Increased risk of development of other autoimmune disorders.
Celiac crisis
Severe edema, hypoproteinemia, electrolyte abnormalities, shock-like state.
Gluten intolerance or sensitivity
Negative biopsy and serology but react to gluten in diet.
What grains contain gluten?
Wheat, barley, rye,
Other foods that should be avoided?
Malt. Oats
FALCPA
Food Allergen Labeling and Consumer Protection Act - top 8 allergens must be on the food label.
Food allergen advisory labeling
Is voluntary. Indicated the potential for unintended contamination.
What is considered a ‘safe’ level of gluten
10µg - 30µg
Recommendations for MNT for Celiac Disease
Discuss & educate on whole-grain, gluten free products or enriched gluten-free products. Ensure nutritional adequacy. Follow-up appointments. Provide resources.
Common nutrient deficiencies in celiac
CHO, iron, folate, niacin (B3), fiber, B12, Ca, Zn, P, vitamin D
