Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Nutrition- Final > Common GI disease- Dx & Tx plans > Flashcards

Common GI disease- Dx & Tx plans Flashcards

1
Q

common GI symptoms

A 
--pain 
QUAL: Burning, cramping
LOCATION: RUQ, LLQ, epigastric
--N/V/ loss of appetite
--swelling, bloating, excessive or prolonged "fullness" after eating
--air/gas 
--diarrhea or constipation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

1st: Rule out serious disease

- -omnious signs

A
  • -acute, severe symptoms
  • -progressive worsening
  • -fever, inflammation
  • -palpable masses, difficulty swallowing
  • -bleeding, jaundice
  • -unexplained weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

1st: Rule out serious disease

- -abnormal lab screening tests

A

–CBC
–SED rate
–liver function
etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

2nd: Try to find a Dx

A

–peptic ulcer?
–GERD?
–early gallbladder disease?
–IBS?
–Celiac?
NOTEmany GI complaints end up with no Dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Peptic ulcer =

A

–burning pain or ache in upper abdomen btw meals, relieved by eating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

causes of peptic ulcer =

A
  • -60% assoc w/ H. Pylori
  • -NSAID
  • -Aggravated by stress, smoking, alcohol, diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

peptic ulcer Tx

A
  • -H. Pylori infection must be Tx medically
  • -avoid NSAIDs
  • -healthy diet (milk & bland food = no help// fiber = reduce recurrences)
  • -consider sensitivities: salt, spices, alcohol, caffeine, food allergy?
  • -supplements: chewable DGL licorice, zinc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

DGL licorice actions

A
  • -inhibits irritating acid secretion
  • -increases protective mucus secretions
  • -inhibits H. pylori
  • -increases blood flow & growth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

DGL licorice how to take it:

A
  • -2/day-chewed before meals
  • -relief from chronic ulcer pain w.in 5-7days
  • -usually as effective as ulcer meds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

DGL preparation

A

1) deglycyrrizinated (DG) extract
- -removal of glycyrrhizin eliminates undesirable side effects (high BP, water retention)
2) chewable tablets before each meal
- -extract must mix with saliva for efficacy
- -capsules don’t work in ulcer research
- -useful for other conditions (ex: mouth sores)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

GERD what is it?

A

–a disorder of lower esophageal sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

GERD - symptoms?

A

Classic = chronic, recurrent retrosternal burning pain (“heartburn”)

–not necessarily associated with hiatal hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

GERD Tx

A

1) keep food in lower portion of stomach only: small frequent meals, avoid laying down after meals, no tight clothes!
2) obesity increases risk but effectiveness of weight loss is controversial
3) consider potential aggravators: smoking/alcohol/ caffeine/ spicy or acidic food/ chocolate/ mint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

GERD Tx

supplement specific

A

1) chewable DGL licorice?
- -helps mouth & peptic ulcers
- -no clinical studies on DGL & GERD
- -therapeutic trial makes sense if patient desires alternative/adjunct to antacid therapy
2) Digestive aids? (enzymes)
- -might speed digestion to encourage more rapid emptying
- -no clinical studies
- -*caution d/t risk of worsening symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

early gall baldder disease

A

RUQ pain sometimes associated with high-fat meals

  • -stones may only be visible w. U/S
  • -ominous signs (severe pain, fever) suggest acute cholecystitis, which should be referred
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

who gets gall bladder disease?

6F’s

A 
Family Hx
Female
40's
Fat
Fair skin
Fertility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Strategy for early gall bladder disease

A

decrease biliary cholesterol, increase bile acids and phospholipids, increase bile flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

dietary approaches to prevent progression of gall bladder disease

A

1) weight loss (but not rapid)
2) low cholesterol, vegetarian, high fiber, longevity-type diet
–healthy diet improves hepatic cholesterol metabolism to reduce biliary cholesterol
–COFFEE = reduce risk
bcuz it increases bile flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

supplementation for gall bladder disease

A

agents that affect stone formation/dissolution by affecting bile flow or bile composition

  • -concentrated bile acids = good evidence in long-term (OTC ox bile salt has not been evaluated)
  • -concentrated lecithin
  • -Vit C (required for bile acid synthesis)
  • -Milk thistle
  • -artichoke extract
  • -curcumin (gall bladder contraction by 50%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

“lipotropic” formulas

A
  • -contains vitamins, minerals, amino acids, herbs, etc. thought to be important for optimum bile flow and composition
  • -mostly theoretical. no clinical studies for preventing or treating gallbladder disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what do they say about Tx’s that are designed to expel stones?

A
  • -not safe or effective
  • -“gall bladder flush” with olive oil is controversial. analysis of recovered “stones: show no chemical or structural resemblance to gall stones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

for some reason she has a slide that says:

Dx-related supplements

A

1) peptic ulcer?
- -zine & chewable DGL licorice
2) GERD?
- -chewable DGL licorice
3) Early Gall bladder?
- -artichoke leaf extract
4) Celiac?
- -gluten-specific enzymes
5) IBS?
- -enteric-coated peppermint
6) IBD?
- -probiotics & fish oil (omega-3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Celiac disease?

A

autoimmune disease triggered by dietary protein called gluten (aka gluten intolerance, celiac sprue)
–immune rxn damages intestinal villi, causing malabsorption & chronic GI distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what if you suspect someone has celiacs disease?

A

screening test for unique antibodies, followed up by endoscopic biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Celiac disease Symptoms

A

1) Malabsorption: weight loss, impaired growth in kids, anemia, fatigue, bone loss, infertility, dermatitis herpetiformis, aphthous stomatitis, peripheral neuropathy
2) GI distress: gas, recurring ab pain, chronic diarrhea/constipation, N/V, pale, foul-smelling, or fatty stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Celiac disease Tx

A

1) gluten-free diet
(avoid: wheat, rye, barley; oat may be OK)
- -also wheat relative: spelt, triticale, kamut
- -initially avoid lactose
* recover of vili takes weeks–> months
2) multiple vitamin-mineral supplement to help reverse malnutrition
3) generic digestive enzyme supplements may speed recovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Gluten-specific digestive enzymes

A

one RCT showed DPP-IV activity may help celiac patients by breaking down gluten metabolites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

IBS

A

a disorder of gut motility or microflora imbalance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

symptoms of IBS

A
  • -recurrent cramping pain
  • -bloating
  • -soreness
  • -gas
  • -diarrhea, constipation
  • -NO BLEEDING/ signs of inflammation

**symptoms are often flora, stress or food-related

30
Q

IBS possible triggers

A

1) over eating
2) gas-forming foods: legumes, crucifers, onion, bran
3) stress

31
Q

IBS possible sensitivites

A
  • -milk products
  • -gluten
  • -fructose, sorbitol
  • -chocolate
  • -alcohol
  • -caffeine
  • -carbonated drinks
  • -fatty foods
  • -food allergies??
32
Q

FODMAP diet for IBS

A

FODMAP = reduce Fermentable Oligo, Di, Monosaccharides and Polyols

foods to avoid: apple, beans, white bread, milk, wheat, rye, barley, onion, legumes, lactose-containing, pears, watermelon, asparagus, honey, sorbitol, mannitol, xylitol, apricots, peaches, artificially sweetened products

33
Q

Fiber & IBS

A

fiber may help control symtoms
–avoid sources w/ sensitivities
–psyllium husk has helped in most studies
(wheat bran may aggravate)

34
Q

Peppermint oil & IBS

A
  • -enteric coated capsules TID

- -effective for IBS in many studies

35
Q

Melatonin for IBS

A
  • -melatonin in GI tissues.
  • -often IBS patients have sleep disturbances
  • -3 recent RCTs: reduced ab pain
36
Q

probiotics for IBS

A

inconsistent…may help w. pain, bloating, gas
–may depend on bacterial strain used:
Bifido = adults
Lactobacillus rhamnous = kids
–may depend on subtype of IBS
–large placebo effect hampers research

37
Q

2 types of IBD

A

1) Crohn’s

2) Ulcerative colitis

38
Q

Crohn’s =

A

effects small intestine, proximal colon

39
Q

Crohn’s symptoms =

A
  • -ab pain, usually RLQ

- -chronic diarrhea, fever, malabsorption symptoms

40
Q

Crohn’s diagnosis

A

imaging &/or colonoscopy

41
Q

ulcerative colitis

A

affects colon only

42
Q

ulcerative colitis symptoms =

A

ab pain & bloody diarrhea, anemia

43
Q

ulcerative colitis diagnosis =

A

imaging &/or colonoscopy

44
Q

Crohn’s disease supplements specific to crohn’s

A
  • -eliminate sensitivites to lactose and amines
  • -multiple vitamin-mineral
  • -Vit D
  • -Boswellia serrata
  • -Artemisia Absinthium
45
Q

Ulcerative Colitis supplements specific to UC

A

–eliminate sensitivites to lactose, raw fruits & veggies
–probiotic bacteria:
bifidobacteria, lactobacillus, streptococcus
Aloe vera juice
**wheat grass juice
*Ayurvedic medicing: boswellia serrata gum resin

46
Q

supplements that work for any IBD

A
  • -healthy diet
  • -food allergy elimination of lactose
  • -probiotic yeast -saccharomyces boulardii
  • -fish oil
  • -curcumin
47
Q

describe conservative Tx of peptic ulcer

A

–check H. pylori
–avoid NSAIDS
–avoid some foodsL smoking, salt, spices, alcohol
–increase fiber intake
(no milk/bland diet)
–chewable DGL (does 4 things)
–zinc
*goal is to avoid extreme elevations of gastric acid

48
Q

what 4 things does DGL do?

A

1) inhibit irritating acid secretion
2) inhibit H. pylori
3) increase protective mucus secretions, blood flow & cell growth
4) taken before meals

49
Q

list the substances that may decrease lower esophageal sphincter tone & exacerbate heartburn

A
  • -smoking
  • -alcohol
  • -caffeine
  • -spice/acids
  • -chocolate
  • -peppermint & spearmint
50
Q

describe the conservative Tx of GERD

A
  • -avoid overeating
  • -avoid eating before bed
  • -avoid abdominal compression
  • -obesity increases the risk, but weight loss effectiveness is controversial
  • -avoid sphincter inhibitors & irritants
    1) chewable DGL before each meal (no clin studies)
    2) digestive aids (enzymes) = speed digestion = faster emptying = risk of worsening symptoms
51
Q

describe the conservative Tx of early gall bladder disease

A

1) decrease biliary cholesterol
2) increase bile acids & phospholipids
3) increase bile flow
4) prevent progression
(low cholesterol, vegetarian, high fiber, longevity diet, caffeine)
5) concentrated bile acids
6) concentrated lecithin
7) Vit C
8) milk thistle
9) artichoke extract
10) curcumin
11) lipotropin formulas
12) regular exercise
13) gall bladder flush (controversial)

52
Q

describe the conservative Tx of early gall bladder disease

milk thistle

A

no clinical studies

53
Q

describe the conservative Tx of early gall bladder disease

concentrated lecithin

A

increases phospholipid content

54
Q

describe the conservative Tx of early gall bladder disease

bile acids

A
  • -contraindicated in active ulcer & liver disease

- -high doses may cause diarrhea

55
Q

describe the conservative Tx of early gall bladder disease

artichoke extract

A

take with each meal

  • -reduce pain
  • -reduce fat intolerance
56
Q

describe the conservative Tx of early gall bladder disease

lipotropin formulas

A

–not been validated by human clinical research

57
Q

which botanicals have bile flow-enhancing substances that increase bile flow

A

ONLY artichoke

–Tx dyspepsia related to gall bladder dysfunction

58
Q

what part of the artichoke plant is used in botanical medicine?

A

same part as food???

–standardized artichoke lead extracts should deliver 500mg of cynarin (same part food uses)

59
Q

list the gluten-containing grains that must be avoided in celiac disease

A

1) wheat products
- -wheat starch, wheat bran, wheat germ, cracked wheat, hydrolyzed wheat protein, einkorn, emmer, spelt, kamut
2) barley
3) rye
4) triticale (wheat & rye)
* recovery of vili can take months

60
Q

what supplements might improve the recovery rate in cases of celiac disease?

A

generic digestive enzymes

  • -DPP-IV is a celiac-specific enzyme that may break down gluten metabolites
  • -pancreatic enzyme therapy is useful in the first 30 days after dx of celiac disease
61
Q

describe the conservative Tx of IBS

A
  • -R/O GI path
  • -stress reduction & mind body therapies
  • -increase fiber via psyllium & veggies (no brown rice, oatmeal)
  • -avoid sensitivities
  • -FODMAP
  • -avoid large meals
  • -decrease fat intake, gas-producing foods
  • -enteric coated peppermint oil
  • -melatonin at bedtime
  • -probiotics
62
Q

conservative Tx of IBS

probiotics

A
  • -beneficial for pain, bloating, gas
  • -bifidobacterium bifidum = adults
  • -lactobacillus rhamnosys = kids
63
Q

conservative Tx of IBS

peppermint oil

A

–prevents side effects

64
Q

conservative Tx of IBS

melatonin

A

–significant reduction in symptoms

65
Q

list gas-forming foods that should be avoided in IBS

A
  • -beans
  • -legumes
  • -cabbage
  • -onions
  • -crucifers
  • -bran
66
Q

describe the conservative Tx of IBD for the small intestine

Crohn’s

A
  • -monitor malnutrition with CBC & serum proteins
  • -food elimination, sensitivities to lactose, amines
  • -multiple vitamin-minerals (Vit K)
  • -probiotic yeast **(saccaromyces boulardii)
  • -omega 3 fish oils **
  • -curcumin
  • -Vit D
  • -Boswellia serrata
  • -Artemisia absinthium
67
Q

describe the conservative Tx of IBD for the large intestine

Ulcerative Colitis

A
  • -Monitor anemia with CBC & serum proteins
  • -food elimination, sensitivities to lactose, raw fruits & veggies
  • -probiotic bacteria **
  • -omega 3**
  • -aloe vera
  • -wheat grass juice
  • -boswellia gum resin extract
  • -curcumin
68
Q

what supplements might improve symptoms of ulcerative colitis

A

aloe vera
wheat grass juice
boswellia serrata gum resin

69
Q

deficiency of what vitamin was recently ID as partly responsible for the increased incidence of bone loss in Crohn’s disease patients?

A

Vitamin D

70
Q

Describe the conservation treatment of dyspepsia

A

1) R/O Dx pathologies & emotional psychological factors investigate eating habits
–too much or too fast
–under stress
–swallowing air
2) try elimination of suspected food sensitivities
–gas-form
–high fat or protein
–suspected allergens
3) consider trial of digestive aid supplements
–betaine hydrochloride
(hypochlorhydria)
–pancreatic enzymes
(digestive enzyme insufficiencies)
–probiotics
(bacterial flora imbalance)
–bile salts
(biliary insufficiency)
–peppermint
(indigestion & IBS)
–artichoke leaf
(fat intolerance, bloating, flatulence, constipation, pain & nausea

Clinical Nutrition- Final (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions