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clinical nutrition > Chapter 18 book notes > Flashcards

Chapter 18 book notes Flashcards

1
Q

A diagnosis of constipation is based, in part, on a defecation frequency of fewer than

A

-three bowel movements per week

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2
Q

The prevalence of constipation is higher in ?? than in ?? and is especially
high in older adults (??years and older).

A

-women than in men
-65

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3
Q

The risk of constipation is increased in individuals with a

A

-low-fiber diet, low food intake, inadequate fluid intake, or low level of physical activity.

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4
Q

Medical conditions often associated with constipation include:

A

-diabetes mellitus and hypothyroidism

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5
Q

Neurological conditions such as ?? disease, ??? ,
and ??? may cause motor problems that lead to constipation.

A

-Parkinson’s disease
-spinal cord injury
-multiple sclerosis

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6
Q

In individuals with a low fiber intake,
the initial treatment for constipation is a gradual increase in fiber
intake to at least ?? to ?? `grams per day

A

-20 to 30

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7
Q

High-fiber diets increase ??? and ??? content
and promote a more rapid transit of materials through the colon

A

-stool weight and fecal water

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8
Q

The transition to a high-fiber diet may be difficult for some people because it can increase intestinal ???

A

-gas
-so the transition should be gradual

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9
Q

Fiber supplements can also be used to help constipation such as:

A

-methylcellulose
-psyllium
-polycarboyphil

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10
Q

Which fiber supplements do not increase intestinal gas?

A

-methylcellulose and polycarbophil

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11
Q

Consuming ?? or ??juice is often recommended because
they contain compounds that have a mild laxative effect

A

-prunes or prune juice

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12
Q

Skipping breakfast is discouraged, as ??? is highest after a morning meal

A

-colonic motility

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13
Q

Structural/ functional abnormalities that inhibit elimination:

A

-slow colonic transit
-altered pelvic or anal functioning

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14
Q

For patients with severe constipation who do
not respond to dietary or laxative treatments, physicians may prescribe
medications called:

A

-prokinetic agents that stimulate colonic contractions

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15
Q

flatulence:

A

-the condition of having excessive intestinal gas, which causes abdominal discomfort.

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16
Q

dietary fibers are not ?? , they pass into the colon and are fermented by ?? , which produce ?? as a by-product

A

-digested
-fermented
-gas

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17
Q

Other incompletely digested or poorly absorbed carbohydrates have similar effects; these include:

A

-indigestible carbohydrates in beans (raffinose and stachyose)
-lactose
-fructose
-some sugar alcohols (sorbitol, xylitol, mannitol)

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18
Q

FODMAPs:
What kind of FODMAP diet will help reduce flatulence and diarrhea

A

-an acronym for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which are incompletely
digested or poorly absorbed carbohydrates that are fermented in the large intestine;
-a low-FODMAP diet may help to reduce flatulence, abdominal distention, and diarrhea

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19
Q

Carbonated beverages contain dissolved ??? gas, which
contributes to intestinal gas

A

-carbon dioxide

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20
Q

Diarrhea is characterized by the passage of ?? . In most cases, it lasts for only

A

-frequent, watery stools
-a day or two and subsides without complication.

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21
Q

Severe or persistent diarrhea, however, can cause

A

-dehydration and electrolyte imbalances.

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22
Q

Diarrhea is a complication of multiple GI disorders and may also be
caused by

A

-GI infections,
-medications,
-dietary substances

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23
Q

osmotic diarrhea and common causes

A

-a type of diarrhea that occurs when the intestines do not absorb enough fluids or electrolytes due to the presence of poorly absorbed solutes
-common causes include: high intakes of poorly absorbed sugars, lactase deficiency, and indigestion of laxatives that contain magnesium or phosphates

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24
Q

secretory diarrhea and common causes

A

-fluid secreted by the intestines exceeds the amount that can be reabsorbed by intestinal cells.
-foodborne illness, intestinal inflammation and various chemical substances

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25
Q

Motility disorders that cause rapid intestinal transit may also result in ?? because they reduce

A

-diarrhea
-the contact time available for fluid reabsorption

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26
Q

medical treatment of diarrhea

A

-antibiotics are prescribed to treat intestinal infections
-If a medication is the cause of diarrhea, a different drug may be prescribed.
-If certain foods are responsible, they can be omitted from the diet.

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27
Q

People with severe, intractable diarrhea sometimes require

A

-total parenteral nutrition.

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28
Q

the presence of glucose in the solution
enhances

A

-sodium and water absorption.

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28
Q

Oral rehydration solutions can be purchased or easily mixed using

A

-water, salts, and a source of glucose

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29
Q

Sports drinks and oral rehydration therapy:

A

-not ideal fluids for rehydration because their sodium content is too low, but they can be used if accompanied by salty snack foods.

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30
Q

The dietary treatment initially recommended is often a

A

-low-fiber, low-fat, lactose-free diet

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31
Q

?? and??? , which are poorly absorbed, retain fluids in the colon and contribute to osmotic diarrhea.

A

-fructose and sugar alcohols

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32
Q

dairy products may worsen ??? diarrhea in persons who are lactose intolerant

A

-osmotic

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33
Q

patients should avoid caffeinated coffee and tea
because caffeine

A

-stimulates GI motility and can thereby reduce water reabsorption.

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34
Q

What pectin sources can be added to foods or baby formulas to help thicken stool consistency?

A

-apple powder and banana flakes

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35
Q

foods that may worsen diarrhea:

A

-high fiber foods
-indigestible carbohydrates
-fructose or sugar alcohols
-dairy products (especially a lactose intolerant person)
-Gas producing foods
-caffeine

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36
Q

To digest and absorb nutrients, we depend on normal digestive…

A

-secretions and healthy intestinal mucosa

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37
Q

Malabsorption can therefore be caused by what disorders?

A

-pancreatic disorders that cause enzyme or bicarbonate deficiencies

-disorders that result in bile deficiency,
-inflammatory diseases damage intestinal tissue.

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38
Q

In some cases, the treatment of an intestinal disease requires surgical removal of a section (resection) of the small intestine, leaving minimal…

A

-absorptive capacity

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39
Q

Malabsorption rarely involves a

A
  • single nutrient
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40
Q

When fat is malabsorbed, what is also malabsorbed?

A

-fat-soluble vitamins
-minerals
-food energy

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41
Q

Which nutrient is most frequently malabsorbed and why?

A

-fat
-because both digestive enzymes and bile must be present for its digestion

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42
Q

chronic pancreatitis and cystic fibrosis can decrease the secretion of ??, whereas severe liver disease can cause ?? insufficiency

A

-pancreatic lipase
-bile

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43
Q

Fat malabsorption can also be caused by conditions or treatments that damage the intestinal mucosa, such as

A

-inflammatory bowel diseases,
-AIDS,
-radiation treatments for cancer.

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44
Q

Fat malabsorption is often evidenced by ???

A

-steatorrhea
-presence of excessive fat in the stools

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45
Q

Elimination of more than ?? to ?? percent of the fat intake generally indicates fat malabsorption

A

-7 to 8

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46
Q

Malabsorption of some minerals, including ?? , ?? ,
and ?? , often occurs because the minerals form ?? with the unabsorbed fatty acids and bile acids.

A

-calcium, magnesium, and zinc
-soaps

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47
Q

soaps:

A

-chemical compounds formed from fatty acids and positively
charged minerals.

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48
Q

Another consequence of fat malabsorption is an increased risk of ??? , which are most often composed of calcium ?? .

A

-kidney stones
-oxalates

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49
Q

The oxalates in foods ordinarily bind to
?? in the small intestine and are eliminated in the stool.

A

-calcium

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50
Q

If calcium instead binds to fatty acids or bile acids, the oxalates are free to be absorbed into the ?? and are ultimately excreted in the ??.

A

-blood
-urine

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51
Q

If the steatorrhea does not improve, a
??-restricted diet may be recommended

A

-fat

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52
Q

Because fat is a primary energy source, it should
not be

A

-restricted more than necessary.

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53
Q

What can be used as a alternative source of dietary fat?

A

-medium chain triglycerides
-do not require lipase or bile for digestion and absorption

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54
Q

how is the small intestine protected from bacterial growth?

A

-gastric acid, which destroys bacteria
-peristalsis, which flushes bacteria through small intestine before multiplying
-immunoglobulins, they are secreted into the GI lumen

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55
Q

What happens when bacterial overgrowth does occur?

A

-it leads to fat malabsorption because the bacteria dismantle the bile acids that are needed for emulsifying fat.

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56
Q

Bacterial overgrowth leads to what vitamin deficiencies?

A

-A, D, and E

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57
Q

The bacteria may also produce…

A

-enzymes and toxins that injure the intestinal mucosa,
-bacteria translocation can occur

58
Q

bacterial translocation:

A
  • the migration of viable bacteria from the GI tract to normally sterile tissues such as the bloodstream, lymph nodes, or internal organs, potentially causing infection or tissue injury.
59
Q

intestinal motility can be reduced by

A

-strictures,
-obstructions,
-diverticula (protrusions) in the small intestine,
-blind loops created in certain types of gastrectomy procedures

60
Q

blind loops:

A

-bypassed sections of small intestine that are cut off from the normal flow of food material, allowing bacteria to flourish; created in certain types of gastrectomy procedures.

61
Q

treatment for bacterial overgrowth:

A

-antibiotics to suppress bacterial growth,
-prokinetic drugs to enhance motility,
-surgical correction of the anatomical defects that contribute to a motility disorder.

62
Q

Patients with fat malabsorption may benefit from
fat restriction and use of ?? oil.

A

-MCT

63
Q

primary symptoms of lactose intolerance are :

A

-diarrhea,
-bloating,
-flatulence,
-abdominal cramps.

64
Q

clinical studies have found that individuals with lactose intolerance can tolerate up to ?? cups of milk daily without significant symptoms

A

-2

65
Q

what dairy products are tolerated better?

A

-chocolate milk
-aged cheese
-yogurt

66
Q

acute pancreatitis:

A

-the digestive enzymes within pancreatic cells
become prematurely activated, causing destruction of pancreatic tissue and subsequent inflammation.

67
Q

-In most patients, the condition resolves within a ?? with no complications.
-More severe cases may lead to

A

-week
-chronic pancreatitis, infection, the SIRS or multiple organ failure.

68
Q

In cases of mild-to-moderate pancreatitis, oral fluids and food may be withheld until the patient is

A

-pain-free and experiences no nausea or vomiting

69
Q

Afterward, patients are usually prescribed a ??? diet; the fat restriction may be gradually lifted if the diet is well tolerated and symptoms of fat malabsorption (such as steatorrhea and abdominal
pain) remain absent.

A

-regular, low-fat

70
Q

if complications arise, the use of ?? formulas (formulas that contain hydrolyzed nutrients) may improve patient tolerance.

A

-elemental

71
Q

At least ?? percent of chronic pancreatitis cases are associated with
excessive alcohol consumption;
other risk factors include:

A

-50
-cigarette smoking and repeated episodes of acute pancreatitis

72
Q

Some enzyme preparations are ?? coated to resist the acidity of the stomach and do not..

A

-enteric
-dissolve until they reach the small intestine.

73
Q

If non-enteric-coated preparations are used, what other drug is required?

A

-acid-suppressing drugs are also required

74
Q

Patients who cannot be successfully treated
with enzyme replacement may be prescribed a ?? diet to reduce their symptoms

A

-low fat

75
Q

cystic fibrosis:

A

-a genetic disorder characterized by abnormal chloride
and sodium levels in exocrine secretions;
-often leads to respiratory illness and pancreatic insufficiency.

76
Q

occurring in approximately 1 in ?? to ??White births.

A

-2500 to 3200

77
Q

with early detection and advances in medical treatment, the median life span has reached nearly ?? years of age, with many patients surviving into their ??`

A

-43
-50s

78
Q

cystic fibrosis is characterized by abnormal levels
of ?? , ??, and ??in exocrine secretions.

A

-sodium, chloride, and biocarbonate

79
Q

what is the results of the abnormal levels of these minerals in exocrine secretions:

A

-dehydration of mucosal surfaces
-thickened secretions that can obstruct the ducts and passageways of body organs (lungs, pancreas, and sweat glands)

80
Q

cystic fibrosis and pancreatic disease:

A

-production of thickened pancreatic secretions that obstruct the
pancreatic ducts;
-the trapped pancreatic enzymes eventually damage pancreatic tissue, leading to progressive atrophy and scarring
-occurs in 85 to 90% of patients

81
Q

cystic fibrous and sweat galnds:

A

-Salt losses in sweat are usually excessive, increasing the risk of
dehydration.

82
Q

Children with cystic fibrosis are chronically:

A

-undernourished and grow poorly

83
Q

Energy requirements may
range from ?? to ?? percent of DRI values

A

-120 to 150

84
Q

diet for patients with cystic fibrosis

A

-high-kcalorie, high-protein, high-fat diet
-eat frequent meals and snacks, and supplement meals with milkshakes or oral supplements

85
Q

what is the main nutrition therapy treatment for cystic fibrous?

A

-pancreatic enzyme replacement therapy

86
Q

celiac disease:

A

-an immune disorder characterized by an abnormal immune response to wheat gluten and related proteins;

87
Q

The reaction to gluten causes severe damage to the

A

-intestinal mucosa and subsequent malabsorption

88
Q

Celiac disease affects approximately ?? percent of Americans, with its prevalence being higher in the ?? population

A

-0.7
-white

89
Q

Celiac disease causes what changes in intestinal tissue?

A

-villi may be shortened or absent (decreasing absorptive area)
-duodenum or whole small intestine may be damaged

90
Q

Individuals with severe disease may malabsorb all ?? to some degree; in mild cases, the nutrients malabsorbed vary according to the..

A

-nutrients
-extent of damage and portion of intestine affected

91
Q

Symptoms of celiac disease may include

A

-diarrhea, steatorrhea, abdominal discomfort, flatulence, and bloating

92
Q

dermatitis herpetiformis:

A

-a glutensensitive disorder characterized by a severe skin rash.

93
Q

The treatment for celiac disease is lifelong
adherence to a

A

-gluten-free diet

94
Q

A gluten-free diet eliminates foods that contain

A

-wheat, barley, and rye

95
Q

Although most people with celiac disease can safely consume
moderate amounts of oats, most oats grown in the United States are

A

-contaminated with wheat, barley, or rye

96
Q

Inflammatory bowel diseases are

A

-chronic inflammatory disorders characterized by abnormal immune responses to microbes that inhabit the GI tract
-contributed by both genetic and environmental factors

97
Q

two major forms of inflammatory bowel disease:

A

1)Crohns disease
2) ulcerative colitis

98
Q

Crohn’s disease:

A

-an inflammatory bowel disease that usually occurs in the lower portion of the small intestine and the colon;

99
Q

ulcerative colitis:

A

-an inflammatory bowel disease that involves the rectum and colon;
-the inflammation affects the mucosa and submucosa of the intestinal wall.

100
Q

A colectomy (????? )
is performed in ?? to ?? percent of patients and prevents future recurrence

A

-removal of colon
-10 to 20

101
Q

drug treatment of inflammatory bowel disease

A

-immunosuppressants
-anti-inflammatory drugs (corticosteroids and salicylates)
-biological therapies
-antibiotics

102
Q

diet for chrons diease

A

-high kcalorie, high protein
-oral supplements
-vitamin/mineral supplements

103
Q

diet for ulcerative disease

A

-adequate protein, energy, fluid, and electrolyes

104
Q

short bowel syndrome:

A

-malabsorption syndrome that follows resection of the small intestine;
-characterized by inadequate absorptive capacity in the remaining intestine.

105
Q

Symptoms of short bowel syndrome include:

A

-diarrhea, steatorrhea, dehydration, weight loss, and growth
impairment in children.

106
Q

About ??% to ??% of nutrient absorption takes place in the first half of the small intestine.

A

-90 to 95

107
Q

what is absorbed in the duodenum/jejunum? (6)

A

-carbs
-fats
-amino acids
-vitamins
-minerals
-water

108
Q

what is absorbed in the ileum?

A

-bile salts
-vitamin B12
-water

109
Q

what is absorbed in the colon?

A

-water, electrolytes, short chain fatty acids

110
Q

possible consequences of resection in duodenum/jejunum:

A

-minimal consequences if ileum is intact
-calcium and iron malabsorption if duodenum is resected

111
Q

possible consequences of resection of ileum:

A

-fat malabsorption
-protein malabsorption
-fat soluble vitamins and vB12 malabsorption
-reduced calcium, magnesium, and zinc absorption
-fluid losses
-dirrhea/steatorrhea

112
Q

possible consequences of resection of colon:

A

-fluid and electrolyte losses
-diarrhea

113
Q

After an intestinal resection, the remaining intestine undergoes

A

-intestinal adaptation,

114
Q

intestinal adaptation:

A

-physiological changes in the small intestine that increase its absorptive capacity after resection.
-taller villi, deeper crypts, and grows in length and diameter

115
Q

The ?? has a greater capacity for adaptation than the
?? ; thus, removal of the ileum has more severe consequences than removal of the jejunum.

A

-ileum
-jejunum
-

116
Q

nutrition therapy for short bowel syndrome:

A

-Immediately after a resection, fluids and
electrolytes must be supplied intravenously.
-Central parenteral nutrition meets nutritional needs after surgery and is gradually replaced by tube feedings and/or oral feedings.

117
Q

To promote intestinal adaptation, the
feedings may be started within a ?? after surgery, after diarrhea subsides somewhat and some bowel function is restored

A

-week

118
Q

The exact diet prescribed for short bowel syndrome depends on the portion of intestine

A

-removed,
-the length of remaining intestine,
-whether the colon is still intact

119
Q

irritable bowel syndrome:

A

-an intestinal disorder of unknown cause that disturbs the functioning of the large intestine;
-symptoms include abdominal pain, flatulence, diarrhea, and constipation.

120
Q

Irritable bowel syndrome affects nearly ?? percent
of the adult population in the United States and occurs twice as often in ?? as in ??

A

-5
-women as in men

121
Q

Although the causes of irritable bowel syndrome remain ?? , people with the disorder tend to have excessive colonic responses to

A

-elusive (hard to capture)
-meals, gastrointestinal hormones, and psychological stress.

122
Q

Medical treatment of irritable bowel syndrome
often includes

A

-dietary adjustments,
-stress management,
-behavioral therapies.

123
Q

diverticulosis:

A

-presence of small herniations (called diverticula) in the intestinal wall.

124
Q

The prevalence of diverticulosis increases with age, occurring in about ?? percent of individuals who are ??years and older.

A

-66%
-80

125
Q

Although the cause of diverticulosis is unclear, changes in ??? that occur with aging may contribute to its development.

A

-connective tissue proteins

126
Q

diverticulitis

A

-inflammation or infection involving diverticula.

127
Q

stoma:

A

-a surgically created
opening in a body tissue or organ.

128
Q

ostomy:

A

-surgically created opening in the abdominal wall through which dietary wastes can be eliminated

129
Q

a permanent ostomy is necessary after
a ?? or ?? ?? ,
-a temporary ostomy is sometimes constructed to bypass the
colon after

A

-partial or total colectomy
-injury or extensive surgery.

130
Q

The stoma can be formed from a section
of the ??? or ???

A

-colon (colostomy)
-ileum (ileostomy)

131
Q

Conditions that may require these procedures include

A

-inflammatory bowel diseases, diverticulitis, and colorectal cancers.

132
Q

To collect wastes, a disposable bag is affixed to the

A

-skin around the stoma and emptied during the day as needed

133
Q

an internal pouch is constructed from

A

-ileal tissue and attached to the anus so that the anal sphincter can control output.

134
Q

Stool consistency varies according to the length of

A

-colon that is functional

135
Q

If a small portion of the colon is absent or bypassed, the stools may continue to be ??.

A

-semisolid

136
Q

If the entire colon has been removed or is bypassed, the ability to reabsorb ??? is substantially reduced, and the output is ??

A

-fluid and electrolytes
-liquid

137
Q

People with ileostomies need to ?? thoroughly to ensure that foods are adequately digested and to prevent obstructions, a common complication due to

A

-chew
-the small diameter of the ileal lumen

138
Q

Dietary concerns after colostomies depend on the length of ???remaining.

A

-colon

139
Q

foods that are incompletely digested can cause
obstructions, a primary concern of persons with an ??

A
  • ileostomy
    -foods such as: celery, coconut, coleslaw, corn, cucumbers, dried fruit and veggies, and etc.
140
Q

Persons with ostomies are often concerned about foods that
may increase ?? production or cause strong ??.

A

-gas
-odors

141
Q

foods that produce unpleasant odors:
foods that help reduce odors:

A

-asparagus, broccoli, brussels sprouts, cabbage, cauliflower
-buttermilk, cranberry juice, parsley, yogurt

142
Q

Foods that may thicken stool include:

A
  • applesauce, banana, cheese, oatmeal, pasta,
    potatoes (without skin), smooth peanut butter, tapioca, white rice

clinical nutrition (26 decks)

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