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
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
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.
4
Q
Medical conditions often associated with constipation include:
A
-diabetes mellitus and hypothyroidism
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
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
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
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
9
Q
Fiber supplements can also be used to help constipation such as:
A
-methylcellulose
-psyllium
-polycarboyphil
10
Q
Which fiber supplements do not increase intestinal gas?
A
-methylcellulose and polycarbophil
11
Q
Consuming ?? or ??juice is often recommended because
they contain compounds that have a mild laxative effect
A
-prunes or prune juice
12
Q
Skipping breakfast is discouraged, as ??? is highest after a morning meal
A
-colonic motility
13
Q
Structural/ functional abnormalities that inhibit elimination:
A
-slow colonic transit
-altered pelvic or anal functioning
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
15
Q
flatulence:
A
-the condition of having excessive intestinal gas, which causes abdominal discomfort.
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
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)
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
19
Q
Carbonated beverages contain dissolved ??? gas, which
contributes to intestinal gas
A
-carbon dioxide
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.
21
Q
Severe or persistent diarrhea, however, can cause
A
-dehydration and electrolyte imbalances.
22
Q
Diarrhea is a complication of multiple GI disorders and may also be
caused by
A
-GI infections,
-medications,
-dietary substances
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
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
25
Motility disorders that cause rapid intestinal transit may also result in ?? because they reduce
-diarrhea
-the contact time available for fluid reabsorption
26
medical treatment of diarrhea
-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.
27
People with severe, intractable diarrhea sometimes require
-total parenteral nutrition.
28
the presence of glucose in the solution
enhances
-sodium and water absorption.
28
Oral rehydration solutions can be purchased or easily mixed using
-water, salts, and a source of glucose
29
Sports drinks and oral rehydration therapy:
-not ideal fluids for rehydration because their sodium content is too low, but they can be used if accompanied by salty snack foods.
30
The dietary treatment initially recommended is often a
-low-fiber, low-fat, lactose-free diet
31
?? and??? , which are poorly absorbed, retain fluids in the colon and contribute to osmotic diarrhea.
-fructose and sugar alcohols
32
dairy products may worsen ??? diarrhea in persons who are lactose intolerant
-osmotic
33
patients should avoid caffeinated coffee and tea
because caffeine
-stimulates GI motility and can thereby reduce water reabsorption.
34
What pectin sources can be added to foods or baby formulas to help thicken stool consistency?
-apple powder and banana flakes
35
foods that may worsen diarrhea:
-high fiber foods
-indigestible carbohydrates
-fructose or sugar alcohols
-dairy products (especially a lactose intolerant person)
-Gas producing foods
-caffeine
36
To digest and absorb nutrients, we depend on normal digestive…
-secretions and healthy intestinal mucosa
37
Malabsorption can therefore be caused by what disorders?
-pancreatic disorders that cause enzyme or bicarbonate deficiencies
-disorders that result in bile deficiency,
-inflammatory diseases damage intestinal tissue.
38
In some cases, the treatment of an intestinal disease requires surgical removal of a section (resection) of the small intestine, leaving minimal...
-absorptive capacity
39
Malabsorption rarely involves a
- single nutrient
40
When fat is malabsorbed, what is also malabsorbed?
-fat-soluble vitamins
-minerals
-food energy
41
Which nutrient is most frequently malabsorbed and why?
-fat
-because both digestive enzymes and bile must be present for its digestion
42
chronic pancreatitis and cystic fibrosis can decrease the secretion of ??, whereas severe liver disease can cause ?? insufficiency
-pancreatic lipase
-bile
43
Fat malabsorption can also be caused by conditions or treatments that damage the intestinal mucosa, such as
-inflammatory bowel diseases,
-AIDS,
-radiation treatments for cancer.
44
Fat malabsorption is often evidenced by ???
-steatorrhea
-presence of excessive fat in the stools
45
Elimination of more than ?? to ?? percent of the fat intake generally indicates fat malabsorption
-7 to 8
46
Malabsorption of some minerals, including ?? , ?? ,
and ?? , often occurs because the minerals form ?? with the unabsorbed fatty acids and bile acids.
-calcium, magnesium, and zinc
-soaps
47
soaps:
-chemical compounds formed from fatty acids and positively
charged minerals.
48
Another consequence of fat malabsorption is an increased risk of ??? , which are most often composed of calcium ?? .
-kidney stones
-oxalates
49
The oxalates in foods ordinarily bind to
?? in the small intestine and are eliminated in the stool.
-calcium
50
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 ??.
-blood
-urine
51
If the steatorrhea does not improve, a
??-restricted diet may be recommended
-fat
52
Because fat is a primary energy source, it should
not be
-restricted more than necessary.
53
What can be used as a alternative source of dietary fat?
-medium chain triglycerides
-do not require lipase or bile for digestion and absorption
54
how is the small intestine protected from bacterial growth?
-gastric acid, which destroys bacteria
-peristalsis, which flushes bacteria through small intestine before multiplying
-immunoglobulins, they are secreted into the GI lumen
55
What happens when bacterial overgrowth does occur?
-it leads to fat malabsorption because the bacteria dismantle the bile acids that are needed for emulsifying fat.
56
Bacterial overgrowth leads to what vitamin deficiencies?
-A, D, and E
57
The bacteria may also produce...
-enzymes and toxins that injure the intestinal mucosa,
-bacteria translocation can occur
58
bacterial translocation:
- 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
intestinal motility can be reduced by
-strictures,
-obstructions,
-diverticula (protrusions) in the small intestine,
-blind loops created in certain types of gastrectomy procedures
60
blind loops:
-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
treatment for bacterial overgrowth:
-antibiotics to suppress bacterial growth,
-prokinetic drugs to enhance motility,
-surgical correction of the anatomical defects that contribute to a motility disorder.
62
Patients with fat malabsorption may benefit from
fat restriction and use of ?? oil.
-MCT
63
primary symptoms of lactose intolerance are :
-diarrhea,
-bloating,
-flatulence,
-abdominal cramps.
64
clinical studies have found that individuals with lactose intolerance can tolerate up to ?? cups of milk daily without significant symptoms
-2
65
what dairy products are tolerated better?
-chocolate milk
-aged cheese
-yogurt
66
acute pancreatitis:
-the digestive enzymes within pancreatic cells
become prematurely activated, causing destruction of pancreatic tissue and subsequent inflammation.
67
-In most patients, the condition resolves within a ?? with no complications.
-More severe cases may lead to
-week
-chronic pancreatitis, infection, the SIRS or multiple organ failure.
68
In cases of mild-to-moderate pancreatitis, oral fluids and food may be withheld until the patient is
-pain-free and experiences no nausea or vomiting
69
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.
-regular, low-fat
70
if complications arise, the use of ?? formulas (formulas that contain hydrolyzed nutrients) may improve patient tolerance.
-elemental
71
At least ?? percent of chronic pancreatitis cases are associated with
excessive alcohol consumption;
other risk factors include:
-50
-cigarette smoking and repeated episodes of acute pancreatitis
72
Some enzyme preparations are ?? coated to resist the acidity of the stomach and do not..
-enteric
-dissolve until they reach the small intestine.
73
If non-enteric-coated preparations are used, what other drug is required?
-acid-suppressing drugs are also required
74
Patients who cannot be successfully treated
with enzyme replacement may be prescribed a ?? diet to reduce their symptoms
-low fat
75
cystic fibrosis:
-a genetic disorder characterized by abnormal chloride
and sodium levels in exocrine secretions;
-often leads to respiratory illness and pancreatic insufficiency.
76
occurring in approximately 1 in ?? to ??White births.
-2500 to 3200
77
with early detection and advances in medical treatment, the median life span has reached nearly ?? years of age, with many patients surviving into their ??`
-43
-50s
78
cystic fibrosis is characterized by abnormal levels
of ?? , ??, and ??in exocrine secretions.
-sodium, chloride, and biocarbonate
79
what is the results of the abnormal levels of these minerals in exocrine secretions:
-dehydration of mucosal surfaces
-thickened secretions that can obstruct the ducts and passageways of body organs (lungs, pancreas, and sweat glands)
80
cystic fibrosis and pancreatic disease:
-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
cystic fibrous and sweat galnds:
-Salt losses in sweat are usually excessive, increasing the risk of
dehydration.
82
Children with cystic fibrosis are chronically:
-undernourished and grow poorly
83
Energy requirements may
range from ?? to ?? percent of DRI values
-120 to 150
84
diet for patients with cystic fibrosis
-high-kcalorie, high-protein, high-fat diet
-eat frequent meals and snacks, and supplement meals with milkshakes or oral supplements
85
what is the main nutrition therapy treatment for cystic fibrous?
-pancreatic enzyme replacement therapy
86
celiac disease:
-an immune disorder characterized by an abnormal immune response to wheat gluten and related proteins;
87
The reaction to gluten causes severe damage to the
-intestinal mucosa and subsequent malabsorption
88
Celiac disease affects approximately ?? percent of Americans, with its prevalence being higher in the ?? population
-0.7
-white
89
Celiac disease causes what changes in intestinal tissue?
-villi may be shortened or absent (decreasing absorptive area)
-duodenum or whole small intestine may be damaged
90
Individuals with severe disease may malabsorb all ?? to some degree; in mild cases, the nutrients malabsorbed vary according to the..
-nutrients
-extent of damage and portion of intestine affected
91
Symptoms of celiac disease may include
-diarrhea, steatorrhea, abdominal discomfort, flatulence, and bloating
92
dermatitis herpetiformis:
-a glutensensitive disorder characterized by a severe skin rash.
93
The treatment for celiac disease is lifelong
adherence to a
-gluten-free diet
94
A gluten-free diet eliminates foods that contain
-wheat, barley, and rye
95
Although most people with celiac disease can safely consume
moderate amounts of oats, most oats grown in the United States are
-contaminated with wheat, barley, or rye
96
Inflammatory bowel diseases are
-chronic inflammatory disorders characterized by abnormal immune responses to microbes that inhabit the GI tract
-contributed by both genetic and environmental factors
97
two major forms of inflammatory bowel disease:
1)Crohns disease
2) ulcerative colitis
98
Crohn’s disease:
-an inflammatory bowel disease that usually occurs in the lower portion of the small intestine and the colon;
99
ulcerative colitis:
-an inflammatory bowel disease that involves the rectum and colon;
-the inflammation affects the mucosa and submucosa of the intestinal wall.
100
A colectomy (????? )
is performed in ?? to ?? percent of patients and prevents future recurrence
-removal of colon
-10 to 20
101
drug treatment of inflammatory bowel disease
-immunosuppressants
-anti-inflammatory drugs (corticosteroids and salicylates)
-biological therapies
-antibiotics
102
diet for chrons diease
-high kcalorie, high protein
-oral supplements
-vitamin/mineral supplements
103
diet for ulcerative disease
-adequate protein, energy, fluid, and electrolyes
104
short bowel syndrome:
-malabsorption syndrome that follows resection of the small intestine;
-characterized by inadequate absorptive capacity in the remaining intestine.
105
Symptoms of short bowel syndrome include:
-diarrhea, steatorrhea, dehydration, weight loss, and growth
impairment in children.
106
About ??% to ??% of nutrient absorption takes place in the first half of the small intestine.
-90 to 95
107
what is absorbed in the duodenum/jejunum? (6)
-carbs
-fats
-amino acids
-vitamins
-minerals
-water
108
what is absorbed in the ileum?
-bile salts
-vitamin B12
-water
109
what is absorbed in the colon?
-water, electrolytes, short chain fatty acids
110
possible consequences of resection in duodenum/jejunum:
-minimal consequences if ileum is intact
-calcium and iron malabsorption if duodenum is resected
111
possible consequences of resection of ileum:
-fat malabsorption
-protein malabsorption
-fat soluble vitamins and vB12 malabsorption
-reduced calcium, magnesium, and zinc absorption
-fluid losses
-dirrhea/steatorrhea
112
possible consequences of resection of colon:
-fluid and electrolyte losses
-diarrhea
113
After an intestinal resection, the remaining intestine undergoes
-intestinal adaptation,
114
intestinal adaptation:
-physiological changes in the small intestine that increase its absorptive capacity after resection.
-taller villi, deeper crypts, and grows in length and diameter
115
The ?? has a greater capacity for adaptation than the
?? ; thus, removal of the ileum has more severe consequences than removal of the jejunum.
-ileum
-jejunum
-
116
nutrition therapy for short bowel syndrome:
-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
To promote intestinal adaptation, the
feedings may be started within a ?? after surgery, after diarrhea subsides somewhat and some bowel function is restored
-week
118
The exact diet prescribed for short bowel syndrome depends on the portion of intestine
-removed,
-the length of remaining intestine,
-whether the colon is still intact
119
irritable bowel syndrome:
-an intestinal disorder of unknown cause that disturbs the functioning of the large intestine;
-symptoms include abdominal pain, flatulence, diarrhea, and constipation.
120
Irritable bowel syndrome affects nearly ?? percent
of the adult population in the United States and occurs twice as often in ?? as in ??
-5
-women as in men
121
Although the causes of irritable bowel syndrome remain ?? , people with the disorder tend to have excessive colonic responses to
-elusive (hard to capture)
-meals, gastrointestinal hormones, and psychological stress.
122
Medical treatment of irritable bowel syndrome
often includes
-dietary adjustments,
-stress management,
-behavioral therapies.
123
diverticulosis:
-presence of small herniations (called diverticula) in the intestinal wall.
124
The prevalence of diverticulosis increases with age, occurring in about ?? percent of individuals who are ??years and older.
-66%
-80
125
Although the cause of diverticulosis is unclear, changes in ??? that occur with aging may contribute to its development.
-connective tissue proteins
126
diverticulitis
-inflammation or infection involving diverticula.
127
stoma:
-a surgically created
opening in a body tissue or organ.
128
ostomy:
-surgically created opening in the abdominal wall through which dietary wastes can be eliminated
129
a permanent ostomy is necessary after
a ?? or ?? ?? ,
-a temporary ostomy is sometimes constructed to bypass the
colon after
-partial or total colectomy
-injury or extensive surgery.
130
The stoma can be formed from a section
of the ??? or ???
-colon (colostomy)
-ileum (ileostomy)
131
Conditions that may require these procedures include
-inflammatory bowel diseases, diverticulitis, and colorectal cancers.
132
To collect wastes, a disposable bag is affixed to the
-skin around the stoma and emptied during the day as needed
133
an internal pouch is constructed from
-ileal tissue and attached to the anus so that the anal sphincter can control output.
134
Stool consistency varies according to the length of
-colon that is functional
135
If a small portion of the colon is absent or bypassed, the stools may continue to be ??.
-semisolid
136
If the entire colon has been removed or is bypassed, the ability to reabsorb ??? is substantially reduced, and the output is ??
-fluid and electrolytes
-liquid
137
People with ileostomies need to ?? thoroughly to ensure that foods are adequately digested and to prevent obstructions, a common complication due to
-chew
-the small diameter of the ileal lumen
138
Dietary concerns after colostomies depend on the length of ???remaining.
-colon
139
foods that are incompletely digested can cause
obstructions, a primary concern of persons with an ??
- ileostomy
-foods such as: celery, coconut, coleslaw, corn, cucumbers, dried fruit and veggies, and etc.
140
Persons with ostomies are often concerned about foods that
may increase ?? production or cause strong ??.
-gas
-odors
141
foods that produce unpleasant odors:
foods that help reduce odors:
-asparagus, broccoli, brussels sprouts, cabbage, cauliflower
-buttermilk, cranberry juice, parsley, yogurt
142
Foods that may thicken stool include:
- applesauce, banana, cheese, oatmeal, pasta,
potatoes (without skin), smooth peanut butter, tapioca, white rice
