Ch 29 GI Flashcards
Which is an atypical sign of reflux?
A.) Chronic cough
B.) Hoarse voice
C.) Asthma
D.) All of the above
All of the above
Which food should be avoided in patients with GERD, as it increases gastric acidity?
A.) chocolate
B.) mint
C.) decaf coffee
D.) fried chicken
decaf coffee
Which supplement should NOT be recommended for a patient with GERD who is taking Prilosec?
A.) Vit B6
B.) Vit B12
C.) Ca+ carbonate
D.) Ca+ citrate
Ca+ carbonate
A patient presents with a history of previous peptic ulcers. She has not been to a gastroenterologist in 10 years. She complains of frequent heartburn and has developed a chronic cough. After adjusting her multiple times, The pain persists. Therefore, you should refer her to a gastroenterologist.
True or False
true
Uncontrolled gastric reflux puts a patient at risk for which of the following?
A.) Peptic ulcers
B.) esophageal cancer
C.) gastric lymphoma
D.) all of the above
all of the above
A patient reports currently taking Prilosec to control her reflux. What supplements may be indicated in this patient?
A.) iron, calcium, and B12
B.) D, E, K
C.) iron, B6, and folic acid
D.) niacin, thiamin, and riboflavin
A.) iron, calcium and B12
What is the main etiology for excessive gas production?
carb malabsorption
Cereal, rice, applesauce, and milk are used to help treat complications associated with which disorder?
diarrhea
A patient with _____ malabsorption has an increased risk of developing kidney stones.
lipid
A 17 year old male presents with unintended weight loss, extreme fatigue, steatorrhea and a cachectic appearance. He also shows you a small lesion on his ankle that has not healed since he injured it 3 weeks ago. You suspect the patient has celiac disease. You want to do some testing. Does he need to consume gluten at the time of testing?
yes
You recently diagnosed your patient with celiac disease. Which nutritional intervention is required initially?
A.) gluten-free
B.) lactose-free
C.) low fructose
D.) all of the above
D.) all of the above
Which grain is okay to recommend to your celiac patient?
A.) spelt
B.) orzo
C.) commercial oatmeal
D.) quinoa
D.) quinoa
Most gluten-free diets are nutritionally adequate?
True or False
false
Wheat allergies are diagnosed using serum-specific IgA.
True or FAlse
false
Which disorder is associated with decreased B12 absorption?
A.) kidney stones
B.) chrohn’s disease
C.) ulcerative colitis
D. IBS
B.) chron’s disease
Which probiotic has been shown to decrease intestinal permeability?
A.) Saccharomyces
B.) Lactobacilli
C.) Streptococcus
D.) Prevotella
Lactobacilli
Which micronutrients are the most important for maintaining proper intestinal permeability?
A.) protein and fat
B.) iron and copper
C.) calcium and Vit D
D.) zinc and magnesium
D.) zinc magnesium
Gluten-free diets are often low in __________.
B vitamins
You suspect your patient has leaky gut. What test should you order to confirm your diagnosis?
lactulose:mannitol challenge
A patient reports repeated bouts of frothy, odorous stools. Which supplement(s) may be the MOST helpful in correcting the situation?
A.) water-soluble forms of ADEK
B.) lactase
C.) pancreatic enzymes and bile salts
D.) zinc and iron
pancreatic enzymes and bile salts
A patient reports repeated bouts of frothy, odorous stools. Which dietary recommendation should you make?
A.) limit protein to 30-45 g/d
B.) limit fat to < 20 g/d
C.) limit carbs to < 35 g/d
D.) limit fat to 30-45 g/d
D.) limit fat to 30-45 g/d
Which is condition is LEAST likely to present with steatorrhea?
A.) A patient with stage 4 pancreatic cancer.
B.) A patient with a recurrent gallstones.
C.) A patient newly diagnosed with celiac disease.
D.) A patient with a previous diagnosis of ulcerative colitis.
D.) A patient with a previous diagnosis of ulcerative colitis
A 17 year old male presents with unintended weight loss, extreme fatigue, steatorrhea and a cachectic appearance. He also shows you a small lesion on his ankle that has not healed since he injured it 3 weeks ago. You suspect the patient has celiac disease. Which test would you begin with?
A.) H2 breath test
B.) upper endoscopy and biopsy
C.) serum antibody panel
D.) lactulose:mannitol challenge
C.) serum antibody panel
A 17 year old male presents with unintended weight loss, extreme fatigue, steatorrhea and a cachectic appearance. He also shows you a small lesion on his ankle that has not healed since he injured it 3 weeks ago. You suspect his wound is not healing due to a _______ deficiency and you recommend increasing his __________ intake to correct the imbalance.
zinc; seafood
Your newest patient is a 39 year old female that reports a history of Crohn’s disease. She accidentally had a soda yesterday that triggered a flare. She currently weighs 118 pounds. What should her daily protein intake be during her flare? (1 kg = 2.2 lb.)
(118/2.2) X 1.5 = 80 g/day protein
Your newest patient is a 12 year old female that reports a history of Crohn’s disease. She accidentally had a small piece of chocolate yesterday that triggered a flare. She currently weighs 71 pounds. What should her daily protein intake be during her flare? (1 kg = 2.2 lb.)
(71/2.2) X 2 = 54 g/day protein
A patient presents with abdominal discomfort and bloating, which you suspect is due to small intestinal bacterial overgrowth. Which micronutrient deficiency are they most likely to have?
B12
Which gastrointestinal disorder is LEAST likely to respond well to the FODMAP diet?
A.) IBS
B.) SIBO
C.) Chronic cholecystitis
D.) Kidney stones
Kidney stones
Which meal contains only foods allowed for a patient following the FODMAP diet?
A.) Spinach salad with tomatoes, avocado, apples, almonds, raspberry vinegarette dressing
B.) Baked chicken with a side of sweet potatoes mashed with cinnamon and honey
C.) Broiled salmon with a side of roasted carrots and fruit salad containing cantaloupe, pineapple and blueberries
D.) Smoothie made of kale, almond milk, banana, cherries, plain nonfat yogurt
C.) Broiled salmon with a side of roasted carrots and fruit salad containing cantaloupe, pineapple and blueberries
Where is most B12 absorbed in vivo?
A.) ileum
B.) stomach
C.) duodenum
D.) jejunum
ileum
What nutritional deficiencies are associated w/ GERD?
Ca, B12, Fe
What is the most common cause of gas?
lactose intolerance
what are the 3 most common gas producing foods?
legumes, wheat, cruciferous veggies
What are 2 nutritional strategies for women?
8-10 cups/day fluids
25 g/day fiber
What are 2 nutritional strategies for men?
8-10 cups/day fluids
38 g/day fiber
What are 5 nutritional strategies would you recommend for your patients w/ diarrhea?
increase fluids decrease simple sugars decrease alcohol decrease caffeine decrease sugar alcohols
what are 4 foods that thicken stools?
cereal
rice
applesauce
milk
what probiotic decreases diarrhea episodes?
sachromyces boyardi
If someone has fat malabsorption, what should they restrict fat intake to?
30-45 g/day
What supplements should someone w/ fat malabsorption take?
PERT or bile salts
–(increase lipid absorption)
What is the most common cause of carb malabsorption?
lactose intolerance
How is carb malabsorption diagnosed?
lactose H breath test
What compound causes an inflammatory response in celiac disease?
gliadin
What genes are associated w/ celiacs?
HLA-DQ2 and DQ8
What age should gluten be introduced?
< 4 or > 6 months
What antibody is associated w/ diagnosing celiacs?
IgA serology
what are 5 nutritional deficiences associated w/ celiacs?
fiber, folate, niacin, riboflavin, b12
What nutritional intervention is performed following diagnosis of celiacs?
month 1: eliminate gluten, lactose and fructose
Post month 1: eliminate gluten
After a month of so, how much gluten can someone w/ celiacs have per day?
50 g/day
What are some gluten-free options?
- > 5 servings fuits/veggies
- - meat, fish, dairy
What antibody is associated w/ wheat allergy?
IgE
At what age should you introduce wheat to kids?
> 6 months
how is NON-celiac gluten sensitivity difference from celiacs?
NON-celiac = gluten ingestion causes symptoms w/out change in IgA
–(no correlation b/w gluten intake and GI symptoms)
Which type of diarrhea is limited to the colon, but continuous?
ulcerative collitis
Which type of diarrhea is mostly in ileum and colon, but random?
chron’s
What is the peak onset for Ulcerative collitis and chron’s?
UC = 20-30 chrons = teens to 20's
What nutritional deficiency is associated w/ chron’s?
B12
W/ chron’s flareups, how much protein should adults and kids get?
adults = 1.5 kids = 2
What are 5 supplements to have w/ chron’s flareups?
- Multivitamin
- B12
- Mg/Zn
- Ca
- Vit D
What is the cause of diarrhea predominate IBS?
increased serotonin
What is the cause of constipation predominate IBS?
decreased serotonin
What are the worst 3 FODMAP foods?
garlic, onion, wheat
What is the key sign/symptom of SIBO?
chronic diarrhea from fat malabsorption
–(distention and bloating)
Leaky gut can lead to what 4 diseases?
- food allergies
- inflammatory disorders
- autoimmune disorders
- insullin resistance
How is leaky gut diagnosed?
lactulose:mannitol challenge
What 2 supplements are needed w/ leaky gut?
magnesium and zinc
