Exam 2 Material

Question 1

Breath Hydrogen Test

Answer 1

For diagnosing lactase deficiency: measure H2 in expired air, give controlled dose of lactose, bacteria ferments undigested lactose, H2 in expired air increases with lactase deficiency

Question 2

Lactose Tolerance Test

Answer 2

For diagnosing lactase deficiency: measure glucose in blood before a controlled lactose dose, then at 30 minute increments afterwards. If lactase deficient, glucose level will be similar to baseline.

Question 3

5-aminosalicylic acid

Answer 3

5-ASA, medication for Crohn’s disease, reduces/controls inflammation, sulfasalazine

Question 4

Antibiotics

Answer 4

change environment, treatment for fistula/abscess, medication for Crohn’s disease/UC

Question 5

Corticosteroids

Answer 5

decrease inflammation, medicine for Crohn’s disease/UC, prednisone

Question 6

Steroid-sparing anti-inflammatory (immunosuppressant) agents

Answer 6

blocks immune reaction to decrease inflammation, medicine for Crohn’s disease/UC, methotrexate

Question 7

Biological agents

Answer 7

monoclonal antibody to fight TNF and cytokine cascade, decreases inflammation, medicine for Crohn’s disease

Question 8

Antidiarrheal agents

Answer 8

reduce control diarrhea, medicine for Crohn’s disease, cholestyramine

Question 9

Sulfasalazine

Answer 9

competitive inhibitor for folate, 5-ASA used for Crohn’s disease

Question 10

Methotrexate

Answer 10

folate metabolism interference, steroid-sparing immunosuppressant for Crohn’s disease

Question 11

Cholestyramine

Answer 11

interferes with fat (and fat soluble vitamin) absorption, antidiarrheal agent for Crohn’s disease

Question 12

Acute Crohn’s disease Nutrition

Answer 12

weight maintenance/gain kcals, 1.0-1.5 g/kg BW or higher protein, if steatorrhea present: restrict fat, MCT, decrease oxalate intake, provide adequate calcium, until steatorrhea decreases, evaluate on individual basis for deficiencies in minerals/vitamins

Question 13

Oxalate

Answer 13

usually binds calcium, but with fat malabsorption fat binds calcium and oxalate is absorbed instead of calcium, increases risk for oxalate kidney stones, found in green leafy veggies, tea, sweet potatoes

Question 14

Disrupted enterohepatic cycle supplements needed

Answer 14

vitamin D/K

Question 15

Low fiber during acute attack of Crohn’s

Answer 15

if acute exacerbations, partial/total obstruction, stenonsis/stricture

Question 16

Ulcerative colitis

Answer 16

inflammation of rectum (LI only), extension of disease into colon, mucosal damage ONLY

Question 17

Crohn’s disease

Answer 17

regional enteritis, inflammation of GI tract (anywhere), inflammation extends to serosa, granulomas usually present, frequent fistulas, scarring ,strictures, obstruction, usually terminal ileum or right colon

Question 18

Colazal

Answer 18

anti-inflammatory specially for ulcerative colitis, converted to active form in large intestine only

Question 19

Ulcerative Colitis nutrition

Answer 19

kcals: BEE * 1.5, protein: 1.0-1.5 g/kg BW, fiber/lactose: as tolerated if symptomatic (no restriction otherwise), ensure adequate vitamin/mineral/fluid/electrolytes

Question 20

Short bowel syndrome meds to reduce acid production

Answer 20

H2 blockers, PPIs

Question 21

Liver blood supply

Answer 21

portal vein and hepatic artery connected to sinusoids (capillary like), leads to central hepatic vein and central vena cava

Question 22

Standard liver panel

Answer 22

AST, ALT, Alkaline phosphatase, albumin, total protin, total bilirubin

Question 23

Bilirubin

Answer 23

waste product of hemoglobin (RBC), conjugated by hepatocytes to make water-soluble (direct), unconjugated bilirubin can only be indirectly measured

Question 24

Corrected serum calcium

Answer 24

((4.0 - actual serum albumin) * 0.8) + actual serum calcium

Question 25

Hepatitis A

Answer 25

oral-fecal route, self-limited, first world countries

Question 26

Hepatitis B

Answer 26

body fluids, vaccine available

Question 27

Hepatitis C

Answer 27

blood, no vaccine, most likely to progress to chronic cirrhosis

Question 28

Hepatitis D

Answer 28

blood, requires Hepatitis B virus to replicate

Question 29

Hepatitis E

Answer 29

oral-fecal route, after natural disasters, self-limited

Question 30

Jaundice

Answer 30

icterus, yellow eyes because bilirubin not packaging into bile

Question 31

Wernicke's encephalopathy

Answer 31

thiamin deficiency (from alcoholic liver disease), hallucinations

Question 32

Korsakoff's psychosis

Answer 32

progression of Wernicke's encephalopathy, short term memory loss, thiamin deficiency

Question 33

Peripheral neuropathy

Answer 33

thiamin and B6 deficiency (from alcoholic liver disease)

Question 34

Pellagrous psychosis

Answer 34

niacin deficiency (from alcoholic liver disease)

Question 35

Niacin

Answer 35

used to metabolize alcohol, decreases in chronic alcoholism

Question 36

Aromatic Amino Acids (AAA)

Answer 36

Tyrosine, phenylalanine, tryptophan

Question 37

Branched Chain Amino Acids (BCAA)

Answer 37

leucine, isoleucine, valine

Question 38

Rifaximin

Answer 38

antibiotic for hepatic encephalopathy, to reduce the ammonia in the body (which starts cascade)

Question 39

Lactulose

Answer 39

undigestible carbohydrate, when fermented produces organic acids (in LI) to irritate LI and stimulate diarrhea, pulls out ammonia and "sweeps out" bacteria.

Question 40

Enterokinase

Answer 40

brush border enzyme, converts trypsin to active form (which stimulates cascade to activate other enzymes)

Question 41

Contraindications to TF

Answer 41

ischemic bowel, prolonged SI ileus, nonfunctional GI, high output fistula/obstruction that can't be bypassed, insufficient absorptive capacity