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My MNTII Test 1 > from 3. Lower GI Disorders > Flashcards

from 3. Lower GI Disorders Flashcards

1
Q

common GI probs

A

flatus, constipation, diarrhea

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2
Q

inflammatory bowel diseases

A

Crohn’s disease & UC

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3
Q

Lower GI Dx tests

A

barium enema (BE) & x-ray.
CT, MRI, ultrasound.
stool tests.
colonoscopy/endoscopy

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4
Q

stool tests

A

bacteria, malabsorption, blood, etc

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5
Q

colonoscopy/endoscopy

A

direct visual exam of colon, ileocecal valve, and portions of terminal ileum w/fiberoptic endoscope

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6
Q

virtual colonoscopy

A

small tube inserted in anus to inflate colon w/air. a CT is then used to take hundreds of pics of inside of colon

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7
Q

wireless capsule endoscopy

A

pt swallows tiny imaging capsule that takes pictures

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8
Q

flatus: cause

A

bacterial fermentation of fiber and nondigestible CHO (stachyose and raffinose in beans) in GI tract and most is reabsorbed.

also can be produced from undigested starch/sugars as in pancreatic enzyme insufficiency or lactose/disaccharide intolerance

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9
Q

flatus : Tx

A

beano (enzyme that digests CHO likes raffinose).

Gas X

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10
Q

gas forming foods

A 
beans, peas, legumes
broccoli/cabbage
onion
cucumber
corn
turnip, rutabaga, radish
melon
raw apple, pear
any high fiber food
(carbonated beverages, chewing gum, sorbitol, sugar alcohols, FOS)
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11
Q

constipation

A

less than 2 stools/wk or difficulty, pain, bloating.

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12
Q

constipation: common in

A

women, whites, elderly.

not caused by any certain foods.

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13
Q

constipation: contributing factors

A 
low fiber/fluid/exercise,
med side effects,
ignoring need to defecate/not allowing adequate time,
AN/bulimia,
pg,
laxative dependency,
large intestinal obstruction, lack of peristalsis,
cancer
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14
Q

constipation: contribution disorders

A

neuromuscular/autoimmune disorders: MS, Parkinson’s, scleroderma, lupus, spinal cord injury.

endocrine disorders: hypothyroidism,
diabetic gastroparesis

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15
Q

constipation: Management

A

first rule our serious medical causes. consult MD before taking OTC fiber supps as some fibers decrease absorption of some meds and risk of bezoars in pts w/intestinal strictures/poor peristalsis.

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16
Q

constipation: fiber

A

25-35 g/day
8 cups of fluid
wheat bran - effective stool bulking agent which holds water and increases stool bulk.
volatile short chain FAa produced by bacterial acting on the fiber may stimulate colon.

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17
Q

constipation: other foods to help

A

prunes contain high fiber and dihydroxyphenyl isatin which stimulates GI motility.

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18
Q

constipation: prebiotics

A

fiber, resistant starches, sugar alcohols, FOS promote growth of lactobacillus and bifidobacteria. gas may be produced.

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19
Q

constipation: probiotics

A

food/sup like culturelle w/live bacteria may normalize bowel fcn

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20
Q

constipation: fiber laxatives

A

some may decrease absorption of some meds. do not swallow dry form (except perdiem), drink w/16oz water to avoid blockage in esophagus.

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21
Q

constipation: fiber laxative side effects

A

difficulty breathing and swallowing, intestinal blockage, skin rash.

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22
Q

constipation: kidney failure pts avoid

A

avoid Haley MO, milk of magnesia, and any Mg laxatives.

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23
Q

constipation: stool softeners

A

MiraLAX, Colace, Dialose, Surfak

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24
Q

constipation: stimulant laxatives

A

senna, Correctol, Dulcolax, Purge, Feen-A-Mint, Senokot.

some herbal laxatives are stimulants.

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25
Q

constipation: osmotic agents

A

milk of Magnesia, Citrate of Magnesia, Haley’s M-O also has mineral oil.

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26
Q

constipation: other laxatives

A

targeted chloride channel activation to regulate intestinal fluid balance (Amitiza).

chronic enema use may cause bowel probs & dependency

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27
Q

constipation: mineral (Agora1)

A

slight decrease in fat sol vit absorption but no major change has been reported, best to not take w/meals.

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28
Q

acute diarrhea

A

often severe w/rapid onset caused by GI infection. rehydrate, electolytes (IV, equalyte, ricelyte, pedialyte) and maybe antibiotics

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29
Q

acute diarrhea: early refeeding

A

may help gut recover and 60% of intake may be absorbed. lactose intolerance may occur after acute episode.

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30
Q

acute diarrhea: meds

A

lomitil, Imodium, kaopectate

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31
Q

acute diarrhea: severe infection

A

like Clostridium difficile (c. diff) may need decal transplant

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32
Q

acute diarrhea: avoid

A

milk products, greasy food, high-fiber, very sweet

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33
Q

acute diarrhea: BRAT diet

A

bananas, rice, applesauce, toast

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34
Q

chronic diarrhea

A

requires workup & eval such as endoscopic exam/stool test for malabsorption, bac, etc.
Tx varies w/cause

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35
Q
  1. osmotic diarrhea: example
A

lactose intolerance

dumping syndrome

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36
Q
  1. osmotic diarrhea: cause
A

poor digestion/absorption resulting in osmotically active solutes pulling water into GI tract

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37
Q
  1. osmotic diarrhea: relieved by
A

fasting/avoidance of the indigestible substance

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38
Q
  1. exudative diarrhea: examples
A

radiation enteritis
UC
c. diff

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39
Q
  1. exudative diarrhea: cause
A

gut inflammation results in excretion of blood, mucus, plasma proteins, electrolytes

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40
Q
  1. steatorrhea/SI disorders/lack of enzymes diarrhea: examples
A

lack of pancreatic/biliary excretions, pancreatitis, CF, enterohepatic recirculation probs, bac overgrowth

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41
Q
  1. steatorrhea/SI disorders/lack of enzymes diarrhea: cause
A

inadequate exposure of chymeoo to intestinal epithelium, lack/inactivation of pancreatic enzymes, damage to DI, post-gastrectomy

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42
Q

Crohn’s disease: area

A

usually in terminal ileum (ileitis), may occur in any area of GI tract.
there is
transmural (thru the wall) inflammation w/granulomatous areas that lead to scarring, obstruction, fistulas

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43
Q

Crohn’s: onset

A

cause is immune related.

age 15-35 yrs, not inherited but higher risk in some families

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44
Q

Crohn’s: s/s

A

ab pain, fever, wt loss, N&V, GI bleed, chronic dia, poor child growth, nutr def.
Instestinal obstruction, GI sores/ulcers, fistulas.
Arthritis, skin probs, infla in eye/mouth, kidney stones, gallstones, other liver/biliary diseases.

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45
Q

crohn’s: nutr defs

A

marasmus, hypoalbuminemia, anemia (iron or B12 & folate def), Ca, Mg, Zn, Cu, K, vit A, C, D, K

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46
Q

crohn’s: management

A

decrease s/s (causes disease remission) and correct any nutr defs.
med to decrease inflamm or infections, surgery is often needed.

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47
Q

crohn’s: meds

A

Sulfasalazine.

Mesalamine (Asacol®, Mesalazine, Pentasa®, Rowasa®, Lialda)

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48
Q

crohn’s: supps

A

sup folate 800-1000 ug/day.
drink 8-10 c fluid/day.
Fe and PABA may lessen effect.

49
Q

crohn’s: corticosteroids

A

long term high dose use - pro catabolism, wt gain, glucose intolerance hypertension, Na & water retention, K excretion, osteomalacia, Ca def.

eat more protein, take Ca sup

50
Q

crohn’s: other meds

A

6-mercaptopurine (immunosuppressive).

azathioprine (Imuran).

Anti- TNF- Cimzia® (certolizumab pegol), Enbrel® (etanercept), Humira® (adalimumab), Remicade® (infliximab), and Simponi® (golimumab).

Natalizumab (Tysabri).

methotrexate.

cyclosporine.

cholestyramine.

51
Q

crohn’s: methotrexate

A

need folate supp

52
Q

crohn’s: cholesyramine

A

fat sol vit & folate sup are needed

53
Q

crohn’s MNT: remission/nonacute periods Kcal needs

A

use normal food & sups to maintain (+300-500 kcal to gain wt, 1.5g pro/kg).

Kcal & pro based on acceptable wt for ht, not current wt, may add extra for malabsorption.

may need G tube or NG each night for wt maintenance/children

54
Q

crohn’s MNT: insoluble fiber

A

cause distress & obstruction risk in pts w/int lumen narrowing or partial obstruction. avoid popcorn, seeds, nut, fruit peel, broccoli, dried beans

55
Q

crohn’s MNT: fat

A

some pt need to restrict fat, but be liberal as possible. steatorrhea pts 50-70g fat per day and can use MCT oil. if less fat is tolerated, have a low fat oral sup/nocturnal TF.

56
Q

crohn’s MNT: when to do fecal fat study

A 
wt loss/poor growth w/adequate diet.
frothy, oil, fatty stools.
oxalate crystal in urine/kidney stones. 
low serum Ca/Mg/cholesterol.
Hx of ileal resection
57
Q

crohn’s MNT: TPN

A

may cause short term remission. expensive, needed in severe malabsorption.

58
Q

crohn’s MNT: elemental formulas

A

may decrease stool freq, reduce immune stimulation, rest the bowel and decrease motility & secretions, alter gut flora& permeability, improve nutr absorption, provide nutr for gut such as glutamine

59
Q

crohn’s MNT: fistulas

A

complication of crohn’s - often at site of obstruction, inflam, or surgery. bowel rest & TPN may heal 30% fistulas, but surgery may be needed. high output (over 500 mLs) esp SI, TPN or elemental formulas may be needed as tolerated.

60
Q

module IBD

A

contains Transforming Growth Factor-Beta 2 (TGF-B2).

low in proinflammatory O-6 FAs.

61
Q

TGF- B2

A

naturally present in human and cow milk protein. mechanism - may down regulate inflammation

62
Q

crohn’s MNT: children formula

A

peptide-based elemental diet for nutr support of GI-impaired children ages 1-10. may help reverse growth failure secondary to crohn’s.

63
Q

UC: areas

A

usually in colon, but may be in terminal ileum. inflamm in the colonic mucosa w/sores

64
Q

UC: onset

A

age 15-35 years. immune-mediated inflammatory response, cause unknown. increased risk of colon cancer.

65
Q

UC: s/s

A 
rectal bleed.
Fe def.
dia & ab cramps.
wt loss if severe.
uric acid renal stones.
mild fever.
tachycardia.
dehydration.
malnutrition.
ab tenderness.
66
Q

UC: meds

A

same as crohn’s:

sulfasalazine, mesalamine, corticosteroids, methotrexate, cyclosporine, Anti-TNF

67
Q

UC: uceris med

A

Uceris (Santarus) contains budesonide a corticosteroid that is in a matric that is reported to reach the entire colon

68
Q

UC: psyllium

A

taking 20 g of psyllium (Plantago ovate) seeds w/mesalamine for 12 mo may improve maintaining of UC remission

69
Q

UC: MNT during remission

A

no specific diet, avoid dia/discomfort foods, small freq meals.

70
Q

UC: MNT during acute exacerbations

A

may have 20+ stools per day w/mucous, blood (iron loss), pus & loss of protein, iron, water, electrolytes, and trace minerals in stool

71
Q

UC: colectomy

A

to cure UC. removal of colon followed by an ileostomy and often an ileoanal reservoir.

72
Q

Small bowel length

A

10-28 ft or 650-800 cm

73
Q

duodenum length

A

10 in long

74
Q

jejunum length

A

6-8 ft/200-300 cm long

75
Q

ileum length

A

up to 13 ft long

76
Q

short bowel syndrome (SBS): causes for removing SI

A 
thrombosis/bowel necrosis
strangulated hernias
crohn's
trauma
cancer
radiation enteritis
necrotizing enterocolitis/infection
77
Q

SBS: s/s

A

30-50% resections cause diarrhea, steatorrhea, bloating, fatigue, malnutr

78
Q

SBS: steatorrhea

A

does not develop unless >100 cm (3.3 ft) of terminal ileum has been removed

79
Q

SBS: TPN

A

may be needed is >2/3 of SI is removed

80
Q

jejunal resection

A

ileum will adapt and take over if entire jejunum is removed. maybe lactose intolerance. most absorption takes place in proximal jejunum.

81
Q

jejunal resection: MNT

A

initially ileum undergoes hypertrophy & hyperplasia.

take MVT daily

82
Q

jejunal resection: avoid

A

lactose, hyperosmotic liquids (gas, bloating, dia). may have mild fat & nitrogen malabsorption, trouble w/sorbital/sugar alcohol in prunes, pears, berries, sugar free foods.

83
Q

jejunal resection MNT: hyperoxaluria

A

lead to kidney stones due to: FAs in bowel bind to Ca leaving less Ca to bind w/oxalate, so more oxalate s absorbed. also, the FA may make gut more permeable which increases oxalate absorption.
decrease high oxalate foods. increase Ca and fluid.

84
Q

ileal resection

A

where cobalamine, chloride, Na, K is absorbed. distal 100 cm most critical. 90% bile salts are reabsorbed here after a meal. bile salts that are not reabsorbed may cause diarrhea. this causes poor fat absorption which also result in dia.

85
Q

ileal resection: risks

A

rapid transit time & less digestion in proximal gut.

hyperoxaluria and oxalate kidney stones.

86
Q

ileal resection: loss of ileocecal valve

A

probs w/malabsorption, diarrhea, bac overgrowth.

87
Q

ileal resection: malabsorption of

A

CHO, N, fat, Ca, iron, zinc, Mg, fat sol vit

88
Q

ileal resection: B12

A

terminal ileum is only site where cobalamin is absorbed w/gastric intrinsic factor. need IM B12 injections to prevent megaloblastic anemia & neuropathy

89
Q

ileal resection: MNT

A

TPN is needed initially after surgery. wean to elemental high N, low fat formula (may have MCT oil). glutamine in formula is beneficial. give IM B12.

90
Q

Massive small bowel resection

A

if >2/3 SI is removed, pt may need PN for life.

gastric hypersecretion makes enzymes less active. PUD risk is high. try to wean to elemental formula

91
Q

SBS: teduglutide (Gattex)

A

Tx for adults w/ SBS. less TPN needed and may be able to wean off it.

92
Q

ileostomy: malabsorption of

A

fat, protein, cobalamin if part of the ileum was removed during colectomy. since no colon, ensure intake of fluid and electrolytes.

93
Q

ileoanal reservoir/pouch

A

4-8 liquid/soft bowels/day. Imodium can be taken to decrease diarrhea

94
Q

ileoanal reservoir/pouch: MNT

A

eat slow, small, freq meals. increased fluid & electr.
limit simple sugars and caffeine.
soluble fiber (psyllium, guar gum) may help stools be more solid.

95
Q

ileoanal reservoir/pouch: avoid

A

insoluble fiber (fruit peel, mushroom, corn, celery, lettuce, bean sprout, coleslaw, coconut, pineapple, nut, seed, tough meat, shrimp/lobster which may cuase mechanical bowel obstruction

96
Q

ileoanal reservoir/pouch: gas/odor causing foods

A

asparagus, dried bean/pea, mustard, cabbage, onion, carbonated bev, egg, radish, pickle, beer, fish, cucumber, strong cheeses, melon, spices, fatty food, whips & meringues

97
Q

ileoanal reservoir/pouch: anal irritating foods

A

certain raw F&V, popcorn, oriental vegs, nut ,coconut, dried fruit, seeds, spicy food

98
Q

ileoanal reservoir/pouch: pouch output decreasing foods

A

applesauce, banana, boiled rice, pasta, cheese, creamy PB, tapioca pudding, skinless potato.

99
Q

ileostomy MNT: malabsorption of

A

fat, bile acids, cobalamin, water, sodium, K, protein as the stoma is higher in the ileum (more ileum removed). take MVT supp

100
Q

diverticulosis: cause

A

chronic constipation, low fiber diet. may be asymptomatic or cause abdominal distress

101
Q

diverticulosis: MNT

A

high fiber diet to soften & increase stool volume.

stool softener meds like colase. wheat bran as a laxative. fiber laxatives

102
Q

diverticulitis: s/s

A

ab pain and spasms, distension, N&V, constipation/diarrhea, chills, fever, bleeding, fistula, obstruction

103
Q

diverticulitis: MNT

A

bowel rest w/IV hydration, antibiotics, NPO, low residue/elemental diet. may need surgery to remove part of colon

104
Q

irritable bowel syndrome =

A

spastic colon

105
Q

IBS: possible causes

A

bac overgrowth in SI, hypermotility/abnormal brain guy connection from stress, rarely due to endometriosis w/uterine lining cells growing on the bowel.

106
Q

bacterial IBS: med

A

antibiotics like Xifaxan (Refaximin)

107
Q

IBS: s/s

A

gas, bloating, ab pain, cramps, spastic contractions, constipation/diarrhea, fecal incontinence, anxiety, back pain, mucous in stool

108
Q

IBS: irritant foods

A

keep diary, some are sensitive to caffeine, polyols, beef, wheat, citrus, corn, milk, lactose, equal, MSG, sulfites, alcohol.

109
Q

IBS: Management

A

high fiber (psyllium) may help. regular exercise, relaxation, less stress

110
Q

IBS: restrict FODMAP’s

A 
high fructan
wheat
rye
onion
garlic
excess fructose
mango
high polyol
apricot
plum
sugar-free gums & sugar-free mints
high GOS
baked beans
kidney beans
lentils
high lactose
cow & goat's milk
111
Q

IBS: Tx

A

aloe, ginger, chamomile, enteric coated peppermint tablets may help?
pre & probiotics?

112
Q

IBS: meds

A

antibiotics.
antidepressants.
anticholinergic like Bentyl to decrease spasms.
Alosetron (Lotronex) - associated w/7 deaths.
Linzess (linaclotide) to tx both IBS w/constipation (IBS-C) and chronic idiopathic constipation (CIC).
antidiarrheals/laxatives.

113
Q

Gluten Sensitive Enteropathy: s/s

A

steatorrhea w/foul, floating, clay-colored, light tan/gray, highly rancid & frothy stools

dia, fatigue, cramping, weakness, bloating, flatus, dehydration, electrolyte depletion/acidosis, rectal prolapse, clubbed fingers. failure to grow, wt loss, irritability & inability to concentrate. refractory iron def anemia, PEM, rickets, back pain as result of a collapsed lumbar vertebrae, osteopenic bone disease, hyperparathyroidism, amenorrhea, fat sol vit def.

114
Q

GSE: risks

A

dermatitis herpetiformis - skin rash.
stomatitis and recurrent aphthous ulcers.
increased cancer risk (lymphomas & GI tract)

115
Q

GSE: more common in

A

ppl w/autoimmune disorders (Grave’s disease, T1DM, Sjögren’s syndrome, collagen diseases, RA, IgA deficiency.

116
Q

GSE: may cause

A

osteoporosis, nervous system disorders, pancreatic/liver probs, internal bleeding

117
Q

GSE: conclusion of studies

A

“the greater freq of thyroid disease among celia pts justifies a thyroid functional assessment. In distinct cases, gluten withdrawal may singlehandedly reverse the abnormality”

118
Q

GSE: avoid all

A

wheat (gliadin), spelt, triticale, kamut, rye (secalin), barley (hordein), maybe oats

119
Q

gluten sensitivity: s/s

A

6% of population. s/s: ab pain similar to IBS, fatigue, headaches, brain dog, tingling in extremities.

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