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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
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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
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3
Q

1st: Rule out serious disease

- -abnormal lab screening tests

A

–CBC
–SED rate
–liver function
etc

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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

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5
Q

Peptic ulcer =

A

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

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6
Q

causes of peptic ulcer =

A
  • -60% assoc w/ H. Pylori
  • -NSAID
  • -Aggravated by stress, smoking, alcohol, diet
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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
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8
Q

DGL licorice actions

A
  • -inhibits irritating acid secretion
  • -increases protective mucus secretions
  • -inhibits H. pylori
  • -increases blood flow & growth
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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
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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)

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11
Q

GERD what is it?

A

–a disorder of lower esophageal sphincter

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12
Q

GERD - symptoms?

A

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

–not necessarily associated with hiatal hernia

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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

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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

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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
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16
Q

who gets gall bladder disease?

6F’s

A 
Family Hx
Female
40's
Fat
Fair skin
Fertility
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17
Q

Strategy for early gall bladder disease

A

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

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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

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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%)
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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
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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
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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)

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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

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24
Q

what if you suspect someone has celiacs disease?

A

screening test for unique antibodies, followed up by endoscopic biopsy

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25
Celiac disease Symptoms
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
26
Celiac disease Tx
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
27
Gluten-specific digestive enzymes
one RCT showed DPP-IV activity may help celiac patients by breaking down gluten metabolites
28
IBS
a disorder of gut motility or microflora imbalance
29
symptoms of IBS
- -recurrent cramping pain - -bloating - -soreness - -gas - -diarrhea, constipation - -NO BLEEDING/ signs of inflammation **symptoms are often flora, stress or food-related
30
IBS possible triggers
1) over eating 2) gas-forming foods: legumes, crucifers, onion, bran 3) stress
31
IBS possible sensitivites
- -milk products - -gluten - -fructose, sorbitol - -chocolate - -alcohol - -caffeine - -carbonated drinks - -fatty foods - -food allergies??
32
FODMAP diet for IBS
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
Fiber & IBS
fiber may help control symtoms --avoid sources w/ sensitivities --psyllium husk has helped in most studies (wheat bran may aggravate)
34
Peppermint oil & IBS
- -enteric coated capsules TID | - -effective for IBS in many studies
35
Melatonin for IBS
- -melatonin in GI tissues. - -often IBS patients have sleep disturbances - -3 recent RCTs: reduced ab pain
36
probiotics for IBS
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
2 types of IBD
1) Crohn's | 2) Ulcerative colitis
38
Crohn's =
effects small intestine, proximal colon
39
Crohn's symptoms =
- -ab pain, usually RLQ | - -chronic diarrhea, fever, malabsorption symptoms
40
Crohn's diagnosis
imaging &/or colonoscopy
41
ulcerative colitis
affects colon only
42
ulcerative colitis symptoms =
ab pain & bloody diarrhea, anemia
43
ulcerative colitis diagnosis =
imaging &/or colonoscopy
44
Crohn's disease supplements specific to crohn's
- -eliminate sensitivites to lactose and amines - -multiple vitamin-mineral - -Vit D - -Boswellia serrata - -Artemisia Absinthium
45
Ulcerative Colitis supplements specific to UC
--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
supplements that work for any IBD
- -healthy diet - -food allergy elimination of lactose - -probiotic yeast -saccharomyces boulardii - -fish oil - -curcumin
47
describe conservative Tx of peptic ulcer
--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
what 4 things does DGL do?
1) inhibit irritating acid secretion 2) inhibit H. pylori 3) increase protective mucus secretions, blood flow & cell growth 4) taken before meals
49
list the substances that may decrease lower esophageal sphincter tone & exacerbate heartburn
- -smoking - -alcohol - -caffeine - -spice/acids - -chocolate - -peppermint & spearmint
50
describe the conservative Tx of GERD
- -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
describe the conservative Tx of early gall bladder disease
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
describe the conservative Tx of early gall bladder disease | milk thistle
no clinical studies
53
describe the conservative Tx of early gall bladder disease | concentrated lecithin
increases phospholipid content
54
describe the conservative Tx of early gall bladder disease | bile acids
- -contraindicated in active ulcer & liver disease | - -high doses may cause diarrhea
55
describe the conservative Tx of early gall bladder disease | artichoke extract
take with each meal - -reduce pain - -reduce fat intolerance
56
describe the conservative Tx of early gall bladder disease | lipotropin formulas
--not been validated by human clinical research
57
which botanicals have bile flow-enhancing substances that increase bile flow
ONLY artichoke | --Tx dyspepsia related to gall bladder dysfunction
58
what part of the artichoke plant is used in botanical medicine?
same part as food??? | --standardized artichoke lead extracts should deliver 500mg of cynarin (same part food uses)
59
list the gluten-containing grains that must be avoided in celiac disease
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
what supplements might improve the recovery rate in cases of celiac disease?
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
describe the conservative Tx of IBS
- -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
conservative Tx of IBS | probiotics
- -beneficial for pain, bloating, gas - -bifidobacterium bifidum = adults - -lactobacillus rhamnosys = kids
63
conservative Tx of IBS | peppermint oil
--prevents side effects
64
conservative Tx of IBS | melatonin
--significant reduction in symptoms
65
list gas-forming foods that should be avoided in IBS
- -beans - -legumes - -cabbage - -onions - -crucifers - -bran
66
describe the conservative Tx of IBD for the small intestine | Crohn's
- -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
describe the conservative Tx of IBD for the large intestine | Ulcerative Colitis
- -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
what supplements might improve symptoms of ulcerative colitis
aloe vera wheat grass juice boswellia serrata gum resin
69
deficiency of what vitamin was recently ID as partly responsible for the increased incidence of bone loss in Crohn's disease patients?
Vitamin D
70
Describe the conservation treatment of dyspepsia
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)

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