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FNN 301 > FNN 401 Midterm > Flashcards

FNN 401 Midterm Flashcards

1
Q

this is a motility disorder characterized by an absence of or weakened peristalsis within the esophagus

A

achalasia

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2
Q

this is a complication of severe chronic GERD involving changines in the cells of the issue that line the bottom of the esophagus

A

barrett’s esophagus

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3
Q

vague upper ad symptoms that may include upper ab pain, bloating, early satiety, nausea, belching

A

dyspepsia

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4
Q

difficulty swallowing

A

dysphasia

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5
Q

chronic or reccurent gastric pain due to reflux of gastric seretions into the lower esophagus

A

gerd

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6
Q

profusion of part of the stomach through the diaphragm into the space normally occupied by the esophagus, heart, lungs

A

hiatal hernia

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7
Q

if osmolality is > 300 mosm/kg, this is

A

hyperosmolar

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8
Q

ulceration or perforation in the lining of the stomach, duodenum or esophagus

A

peptic ulcer disease

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9
Q

for this disease, nutrition therapy is the only treatment

A

celiac

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10
Q

the upper gi tract is composed of these 4 organs:

A

mouth
pharynx
esophagus
stomach

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11
Q

the lower gi tract is composed of these:

A

large intestine
small intestine

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12
Q

what are 4 functions of the stomach

A

motility
secretion
digestion
absorption

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13
Q

what are gastric juices made up of

A

water
mucus
hcl
gastric juices
electrolytes

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14
Q

these stomach cells secrete pepsinogen (which, when activated, begins protein digestion)

A

chief cells

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15
Q

these stomach cells secrete hcl and intrinsic factor (activates pepsinogen, kills microorganisms, denatures proteins, and helps absorb b12)

A

parietal cells

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16
Q

these cells secrete histamine

A

ECL cells

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17
Q

these cells secrete gastrin

A

G cells

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18
Q

these cells secrete somatostatin

A

D cells

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19
Q

what is the role of chief cells in stomach

A

they secrete pepsinogen. when activsated, this begins protein digestion

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20
Q

Which cells activate pepsinogen?

A

parietal cells

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21
Q

which cells stimulate parietal cells?

A

ECL cells
g cells
d cells

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22
Q

which are the 3 endocrine cells? the 3 exocrine cells?

A

endocrine:
- ecl
- g cells
- d cells

exocrine:
- mucous cells
- chief cells
- parietal cells

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23
Q

what are the 3 phases of gastric sectetion?

A

cephalic phase - hcl and pepsinogen are released when we smell or taste food
gastric phase - when food enters stomach
intestinal phase

cephalic and gastric phase stimulate gastric juices, while intestinal phase slows gastric secretions and prepares small intestine

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24
Q

what are the 5 different types of medications to treat GERD?

A
  1. PPIs
  2. histamine blocking agents
  3. prokinetic agents
  4. antacids
  5. foaming agents
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25
Q

what is the most common surgical procedure used for refractory gerd?

A

nissen fundoplication (fundus is wrapped around lower esophagus

other treatments: partial ffundoplication, roux-en-y for obese patients, LINX

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26
Q

common nutrition diagnoses related to GERD:

A

overweight/obesity, impaired nutrient utilization, inadequate vitamin/mineral intake, swallowing difficulty, altered GI function

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27
Q

nutrition recommendations for GERD

A
  1. eat small, frequent meals
  2. restrict foods that lower LES pressure
  3. weight loss (if overweight)
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28
Q

how to diagnose GERD?

A
  1. look at symptoms
  2. hthere is relief after PPI use
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29
Q

what are the 2 types of hiatal hernias?

A
  1. sliding (type 1) - most common - GE junction slides up (95%)
  2. paraesophageal/rolling (type 2) - part of fundus goes through hiatus rather than junction

incidence increase with age

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30
Q

causes of hiatal hernia

A

obesity
pregnancy
decreased muscle elasticity
trauma (seatbelt injury)
previous surgeries

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31
Q

signs and symptoms of hiatla hernia

A

heartburn
regurgitation
acidic taste
burping
nausea

persisten nighttime cough
chest pain (mistaken for heart attack)

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32
Q

a person who has food and fluids accumulating in the lower esophagus may have

A

achalasia

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33
Q

what are some causes of acute gastritis?

A

nsaids
food poisoning
alcohol

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34
Q

causes of chronic gastritis (type a and type b)

A

type a - less common. the development of antibidoies against parietal cells

type b - h pylori infection

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35
Q

epigastric pain is most commonly associated with

A

PUD

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36
Q

nutrition diagnosis associated with PUD:

A
  • inadequate beverage intake
  • altered GI function
  • involuntary weight loss
  • food and nutrition related knowledge deficit
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37
Q

historically milk was used to treat:

A

PUD

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38
Q

metalic taste and helltosis are symptoms of

A

GERD

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39
Q

Names 5 causes of GERD

A
  1. smoking
  2. obesity
  3. pregnancy (increased estrogen and progesterone)
  4. meds (calcium channel blockers)
  5. hiatal hernia
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40
Q

What are 5 symptoms of GERD?

A
  1. nausea/vomiting
  2. hoars voice, cough
  3. halletosis
  4. shortness of breath
  5. heartburn
  6. burping/hiccuping
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41
Q

opera singers often present with

A

GERD

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42
Q

what are 5 conditions related to reflux?

A
  1. esophagitis
  2. cancer
  3. dental caries
  4. barrets esophagus
  5. sleep apnea
  6. astha
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43
Q

if GERD goes untreated, it can progress to:

A

Barrett’s esophagus
Erosive esophagitis

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44
Q

What % of GERD cases end with barrett’s esophagus?

A

10% (but has no specific symptoms outside of GERD)

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45
Q

how do you diagnose GERD?

A

symptom description
medical trial
lifestyle modification

Tests:
- esophagael manometry
- barium swallow with contrast
- ambulatory esophagel pH monitoring
- screener for Barrett’s esophagus

there is potential for endoscopy

Response to PPIs does not necessarily correlate with objective measures of GERD

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46
Q

what are 5 treatments for GERD?

A
  1. meds that decrease gastric acidity
  2. behaviour modification - weight loss, stop smoking, loose clothing
  3. nissen fundoplication for refractory gerd
  4. bariatric surgery for refractory gerd
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47
Q

what are the 3 goals of GERD treatment?

A
  1. increase LES competence
  2. decrease acid secretion
  3. protect esophageal mucosa
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48
Q

Give one example of a PPI

A

omeprazole

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49
Q

give one example of a histamine2-receptor antagonist

A

ranitidine

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50
Q

give one example of a prokinetic agent

A

domperidone

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51
Q

when should PPIs be taken for GERD and why?

A

in the mornign, because the amount of H-K-ATPase in parietal cells is highest after a prolonged fast

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52
Q

what are the lab recommendations for PPI use?

A
  1. check magnesium before starting PPO for patients on it over 1 year
  2. check B12 levels yearly
  3. check CBC and ferritin (because there is decreased iron absorption)
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53
Q

safety concerns of long term PPI use include:

A

c diff
microscopic colitis
atrophic gastritis

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54
Q

antacids, for treatment of GERD, combine 3 basic salts with bicarbonate:

A
  1. magnesium
  2. calcium
  3. aluminum
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55
Q

Antacids (or is it foaming agents?) may decrease absorption of:

A

iron
folate
phosphorous

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56
Q

the use of H2 antagonists decreases absorption of:

A

calcium
iron
b12

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57
Q

which GERD medication are available OTC (vs. prescription)?

A

antacids
foaming agents
H2 antagonists

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58
Q

PPIs decrease absorption of:

A

calcium
iron
b12
magnesium

may also cause nausea/ab pain

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59
Q

What type of diet would help with reflux?

A
  1. strict diet for at least 2 weeks
  2. avoid foods below pH4
  3. avoid foods that increase gastric pressure
  4. avoids foods that relax the LES
  5. avoid large meals before bed
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60
Q

Name 5 foods to avoid and 5 foods to have with GERD:

A

avoid:
- peppermint
-coffee
- fatty foods
- alcohol
- citrus

Have:
- herbs
- fish
- eggs
- low acid fruits like pear and banana
- oats

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61
Q

5 behaviour modifications that can help with GERD

A
  1. wear loose clothes
  2. small frequent meals
  3. stop smoking
  4. lose weight
  5. dont lie down for 3 hours after meal
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62
Q

When would you do a fundoplication for GERD?

A
  1. if there is a hiatus hernia bigger than 2 CM
  2. if GERD is unresponsive to usual therapies
  3. if there is GERD complication like erosive esophagitis and barret’s esophagus
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63
Q

in severe cases of gerd, what is the nutrition protocol?

A
  1. clear fluids first
  2. pureed foods 1-2 weeks
  3. soft/minced foods 2-4 weeks
  4. avoid straws, gum, carb drinks
  5. small volumes of food
64
Q

Explain differences between acute and chronic gastritis

A

Acute gastritis
- related to infection
- associated with alcohol, food poisoning, NSAIDs
- short lived and resolves

Chronic gastritis
- Type A (pernicious anemia/autoimmunue) or Type B (H. pylori)

type a reuslts in achlorydia (low stomach acid), iron deficiency, b12 deficiency

65
Q

What are symptoms of gastritis?

A

belching
anorexia
ab pain
vomiting
bleeding
hematemesis
melena - jet black stool

66
Q

treatment for gastritis includes

A

antibiotics for h pylori
reduce acid secretion
anti-inflammatory meds other than NSAIDs

67
Q

What is the definition of PUD?

A

ulcers in gastric mucosa or duodena mucosa. these ulcers pentetrate the submucosa

68
Q

what are 5 causes of PUD?

A
  1. h pyolri (50% of cases)
  2. nsaids
  3. alcohol
  4. smoking
  5. stress
  6. genetics - 3x more common in 1st degree relative
69
Q

what are 5 differences between gastric ulcers and duodenal ulcers

A

gastric ulcers
- least common
- food increases pain
- pain 1 hour after meal
- weight loss
- vomiting

duodenal ulcers
- most common
- food decreases pain
- well nourished
- pain 3 hours after meal

70
Q

what are clinical manifestations of PUD?

A

epigastric pain, burning sensation
bloody stool
infection (WBC count)

71
Q

how do you diagnose PUD?

A

endoscopy with biopsy
C-urea breath test
stool antigen test

72
Q

how do you treat PUD?

A

3-4 meds to treat h. pylori
1-2 weeks of antibiotics + PPI

Refractory PUD requires surgery

73
Q

what are nutrition implications of PUD?

A
  1. impaired oral intake (anorexia)
  2. malaise
  3. weight loss
  4. atrophic gastritis - b12 deficiency
  5. nutrient imbalance
74
Q

which foods cause PUD?

A

non, but spices and coffee increase acid secretion but no association with ulcer development. PH OF FOOD DOESNT HAVE THERAPEUTIC RELEVANCE

but alcohol and smoking do contribute to ulcers

75
Q

milk and cream used to be used to treat

A

PUD

but it really increases gastrin and pepsin secretion

76
Q

what are the micronutrients of concern in PUD?

A

iron
calcium
b12

77
Q

____ helps prevent further ulcers in PUD

A

soluble fibre (chia, flaxseed

78
Q

what are 3 complications of PUD?

A
  1. hemmorage detetced in stool (melena) or hernatemesis (vomiting fresh blood)
  2. perforation
  3. gastric outlet obstruction
79
Q

___ results from prgroessive degentation of ganfglion cells

A

achalasia

the LES can relax

80
Q

symptoms of achalasia:

A

difficulty swallowing, regurgitation, belching, coughing at night

81
Q

what is achlordydia?

A

stomach doesnt produce Hcl which helps digest food

82
Q

How much of digestion and absorption occurs in the lower GI?

A

98%

83
Q

how long is the SI

A

400 cm

84
Q

what are the 3 parts of the SI? lengths?

A

duodenum - 25-30cm
jejenum - 160-200cm
ileum - 200-400m

85
Q

_____ is an autoimmune disease caused by immunological reaction to gluten

A

celiac disease

86
Q

how many canadians have celiac

A

1 in 133

87
Q

what % of people worldwide have celiac?

A

1% - mostly in european countries

88
Q

how does celiac disease work?

A

gliadin intake –> villous atrophy –> nutrient malabsorption, wasting, diarrhea

89
Q

What are risk factors for celiac disease?

A
  1. family history
  2. type 1 diabetes
  3. thyroid/liver disease
  4. downs syndrome

Celiac often occurs in conjunction with other autoimmune disorders like T1DM

90
Q

What happens when small intestine is exposed to gluten from wheat, rye, malt, barley?

A
  1. inflammatory response
  2. infiltration of WBC
  3. production of IgA antibodies
91
Q

What are 5 GI symptoms of celiac disease?

A

GI symptoms like:

  1. chronic diarrhea
  2. ab pain
  3. ab distension
  4. constipation
  5. weight loss
  6. vomiting
  7. GERD
92
Q

what are 5 extraintestinal symptoms of celiac disease?

A
  1. fatigue
  2. delayed puberty
  3. joint pain
  4. peripheral neuropathy
  5. oral ulcers
93
Q

How do you test for celiac disease?

A
  1. serological screener test for TTG-Iga - if positive, proceed to diagnostic test
    (accurate test, slight rise of false positive) - use ttg-iga to track progress
  2. endoscopy/biopsy
  3. genetics (if genetics are +, serology is -ve, do gluten challnge
94
Q

how much goten can increase enteropathy

A

50 mg gluten

95
Q

which nutrients are GFDs deficient in?

A

vitamins
calcium
iron
fibre

96
Q

In addition to GFD, what secondary diet is helpful until the intestine has healed?

A

low residue diet
low fat diet
lactose free diet

97
Q

how many gluten free oats is ok per day

A

40-100 g/day - only introduce them after all symptoms of CD have resolves

98
Q

5 random foods that have gluten

A
  1. dates?
  2. frozen turkey based with hydrolyzed wheat protein
  3. teriyake sauce
99
Q

What is the definition of IBS?

A

RECURRENT ab pain ONCE PER WEEK for 3 MONTHS, with 2 or more of: related to defecation, change in stool frequency, change in stool form

100
Q

What are the 4 subtypes of IBS?

A

IBS - D
IBS - C
IBS - Mixed
IBS - unspecified

101
Q

what is the prevalence of IBS in North America?

A

10% (more in women), develops before 50%

102
Q

what is a key identifier of IBS?

A

pain before passing bowel movement, relief of pain after passing bowel movement

103
Q

What is the cause of IBS?

A

unknown - continued to be a diagnosis of exclusion

104
Q

What are differential diagnoses for IBS?

A
  1. bile acid diarrhea
  2. pancreatic exocrine insufficiency
  3. microscopic colitis
  4. SIBO - small intestinal bacterial overgrowth
  5. pelvic floor dysfunction - occurs in 50-70% of IBS patients
  6. histamine intolerance
  7. non-IGE and ige mediated allergic reactions
105
Q

what is the pathophysiology of IBS?

A
  1. genetic predisposion
  2. environmental trigger (medication, hormonal change, oral contraceptives, infection)

foods DONT cause IBS. they just dont allow IBS to heal

106
Q

what are 5 risk factors for IBS?

A
  1. psych factors
  2. genetic factors
  3. environmental factors
  4. chronic infections
  5. antibiotics
  6. age
107
Q

What are 3 potential mechanisms of actions for IBS?

A
  1. cephalic phase - gut receptors are stimulated and volume is added to the lumen
  2. ingestion of poorly absorbably molecules (mono and disaccharides)
  3. chemostimulation of gut receptors. - peptides release CK and motilin, which activate mast cells, which lead to low grade inflammation
108
Q

Describe the gut brain axis

A

Our gut and brain are attached. Enteric nervous system - runs gums to bum - a complex mesh of neurons running throughout our digestive tract

the gut-brain axis plays a role in:
- nutrient metabolsim
- produce makes beneficial compounds
- immunity
-regulates hormones

109
Q

______ is the freeway between the gut and the brain

A

vagus nerve

110
Q

what is the ratio of bacteria to cells in the gut

A

10:1

111
Q

What are the responsibilities of SCFAs?

A
  1. provide main source of fuel to intestinal cells.
  2. create protective barrier
  3. help with muscular contraction
  4. reduce brain inflammation
  5. increase serotonin
  6. regulate appetite
112
Q

what is the classic characterization of ibs?

A
  • diarrhea
  • alternating constipating, gas, bloating

also mucous secretion, upper gi symptoms, feeling of incomplete elimination

ROME criteria

113
Q

IBS involves:

A
  1. abnormalities in brain-gut communication
  2. small intestinal bacterial overgrowth
  3. increased permeability of the mucosa
  4. altered microbial environment
114
Q

what are 5 non-pharmacological approaches to IBS?

A
  1. CBT (hypnosis, relaxation techniques)
  2. probiotics
  3. low FODMAPs diet
  4. pelvic floor physiotherapy
115
Q

What supplements do people use for IBS?

A
  1. probiotics
  2. digestive enzymes
  3. prebiotics
  4. apple cider vinegar
  5. IBgard (peppermint)
  6. biocidin (herbal)
  7. candibactin (herbal)
116
Q

What does medical treatment for IBS look like?

A
  1. antidiarrheal agents
  2. antispasmodics (take 30 minutes before meal)
  3. bulking agents, laxatives
  4. seratonin 5-HT4 receptor agonsts, SSRIs
117
Q

what are the 4 pillars of managing IBS?

A

diet
mental health
probiotics
exercise

118
Q

What does a nutritional diagnosis of IBS include?

A

inadequate oral intake
altered GI function
undesirable food choices
food and nutrition related deficit
disordered eating pattern

119
Q

FODMAPS diet is used for which GI issue

A

IBS

120
Q

When doing a food symptom diary for IBS, need ot include:

A

date
time
food item
quantity
time of symptoms
symptoms

121
Q

What are the types of carbs in FODMAP foods?

A
  1. fructans/galactins
  2. fructo-oligosaccharides/galacto-oligosaccharides
  3. polyols
122
Q

Give 5 examples of FODMAP foods, and 5 examples of foods ok to eat

A

5 FODMAP foods:
- apples, apricots, artichokes, brussel sprouts, broccoli

5 OK foods:
- carrot
- celery
- cereals
- cheese
- chilli (and other herbs)

123
Q

what are 5 steps to decrease gas production

A
  1. reduce fried/high fat foods
  2. eat small meals
  3. dont eat while anxious
  4. avoid pop
  5. exercise
  6. nonprescription antigas
  7. peppermint tea
  8. probiotics

Boost fibre intake
reduce caffeine

124
Q

_____ is an autoimmune, chronic inflammatory condition of the GI tract

A

IBD

125
Q

_____ is higher in caucasians and ashkenazi jews and norther hemisphere

A

IBD

126
Q

what are causes of IBD?

A
  1. smoking
  2. diet
  3. microbiome
  4. infectious agents
  5. hygiene hypothesis
  6. environment + genetics
127
Q

IBD involves the release of cytokines and destruction of mucosa

A
128
Q

What are similarities and differences between crohns and colitis?

A

Similarities:
- both are considered IBD
- all have pain, diarrhea, tenesmus (want to poo but bowel is empty)

Differences:
- Crohn’s affects any part of GI tract (cobblestone pattern), colitis affects colon and rectum
- Crohns affects all layers of tissue, UC affects 1st and 2nd layer
- Crohns results in fistulas, strictures, obstructions, UC results in toxic megacolon
- Crohn’s has muscle wasting and malnutrition, UC has bloody diarrhea

129
Q

How do you diagnose IBD?

A
  1. serology test for cytokines IL1, IL6, TNF and antigylcan antibodies
  2. Blood work: high CRP, high WBC
  3. stool test: calprotectin, lactoferrin under 200 ixs good
  4. scope every 6 motnhs
130
Q

What are 5 extraintestinal manifestations of IBD?

A
  1. dermatitis
  2. osteopenia
  3. rheumatological diseases
  4. ocular symptoms (uveitis)
  5. spondylitis
  6. gullstones
131
Q

what are 5 treatments for IBD?

A
  1. glucocorticoids (prednisone) - to calm everything down
  2. immunosuppressants (imuran)
  3. immunomodulators (methotrexate)
  4. biological therapies (remicade)
  5. antidarrheals
  6. antibiotics (flagyl, cipro)
132
Q

What are the most common surgeries for crohns and UC?

A

crohn’s: ileostomy (large bowel removed)
UC: total colectomy (colon is removed)

133
Q

____ is a surgically created artificial opening into the abdomen

A

stoma

134
Q

____ is a surgical connection between 2 parts of the intestine

A

anastomosis

135
Q

____ is the removal of the colon and rectum. the ileum gets attached to the stoma

A

ileostomy

136
Q

____ is the removal of the ileum, colon, rectum. attach the jejunum to the stoma (RARE)

A

jejunostomy

137
Q

_____ is the removal of the colon

A

colectomy

138
Q

How much liquid is gathered when you have an ileostomy?

A

1-1.5 L/day of liquidy/pasty output

4-6 xper day

139
Q

Hartmann’s procedure is an example of:

A

a colostomy (rectum and anus disconnected from GI tract)

140
Q

what are 4 surgical options for UC?

A
  1. proctocolectomy
  2. Brooke ileostomy
  3. Kock pouch ileostomy
  4. restorative proctocolectomy
141
Q

how many americans are living with a stoma?

A

750,000

142
Q

another name for an ileal pouch-anal anastomosis

A

J pouch (used for UC)

bowel function is NOT compltely normaal, but allows for more control. 5-8 stools per day

143
Q

what can irritate a j pouch?

A

spicy foods

144
Q

What are pros and cons of the J pouch?

A

Pros:
- no bag
- can go to bathroom
- dont need a stoma
- easier sanitation
- less social stigma

Cons
- might not take
- surgery
adhere to dietary restrictions

145
Q

What are 5 nutrition concerns related to ileal resection?

A
  1. decreases transit time
  2. loss of fluids, electrolytes, vit/min deficiency
  3. b12 malabsorption at terminal ileum
  4. inadequate bile salts for fat digestion
  5. malabsortion of calcium, magnesium, zinc due to formation of soaps
146
Q

if your ostomy output is more than 1.5 L of stool per day, you may be at risk of poor nutrition and dehydration

add 1-2 litres of extra fluid each day

A
147
Q

tips for people who have ileostompy

A

Avoid foods that block stoma:
1. coconut
2. dried fruit
3. fibrous fruit
4. peas, snow peas
5. veggie skins
6. popcorn
after 6-8 weeks, small amount of cooked foods

  1. stay hydrated with water, milk, 100% fruit juice, weak tea
  2. manage symptoms
148
Q

what are nutritiong oals for ileostomy:

A

avoid stoma irritation/obstruction

manage stool output

reduce gas/odour

maintain normal fluid/electrolye diet

149
Q

foods ot look out for during food history that may cause symptoms:

A
  1. high fiber foods
  2. caffeine
  3. dairy
  4. high sugar drinks
  5. gas forming foods
  6. carbonated drinks
150
Q

what are some nutritional concerns with ostomies?

A
  1. inadequate intake
  2. inadequate absorption
  3. medication side effects
  4. severe anemia
  5. incresased losses
151
Q

Abnormal presence of sac-line herniations on wall of S.I or colon

A

diverticulosis

152
Q

____ may result from:
- prolonged constipation
- chronic low fibre intake causing increased pressure in the colon

A

diverticular disease

153
Q

diverticular disease is associated with the following factors:

A
  1. obesity
  2. low physical activity
  3. steroid use
  4. alcohol
  5. caffeine
  6. smoking
154
Q

diverticulosis usually has no symptoms unless complications occur. resolves with stooling

A
155
Q

diverticulitis affects ___ % of patients with diverticulosis

A

20%

156
Q

in diverticulosis we recommend _____ fibre, whereas in diverticulitis we recommend _____ fibre

A

diverticulosis: increased fibre
diverticulitis: decreased fibre

157
Q
A

FNN 301 (10 decks)

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