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My MNTII Test 1 > From Review > Flashcards

From Review Flashcards

1
Q

Crohn’s disease s/s:

A

Abdominal pain, fever, weight loss, nausea, vomiting, GI bleeding, chronic diarrhea, poor growth in children, nutrient deficiencies.

Intestinal obstruction (blockage), GI sores/ulcers, fistulas thru affected area into surrounding tissues such as bladder, vagina, or skin.

Arthritis, skin probs, inflammation in eyes or mouth, kidney stones, gallstones, or other diseases of the liver and biliary system.

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2
Q

ulcerative colitis s/s:

A 
Rectal bleeding
Iron deficiency
Diarrhea & Abdominal cramps
Weight loss in severe cases
Synovitis
Ankylosing spondylitis Sacroiliitis
Erythema nodosum
Pyoderma
Aphthous stomatitis
Episcleritis
Iritis
Uric acid renal stones
thromboembolic events or syndromes
Mild fever
Tachycardia
Dehydration
Malnutrition
Abdominal tenderness
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3
Q

irritable bowel syndrome (IBS) s/s:

A

gas, bloating, abdominal pain, cramps, spastic contractions, constipation and/or diarrhea, fecal incontinence, anxiety, back pain, mucous in the stool

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4
Q

National Dysphagia Diet (NDD)

A

4 levels

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5
Q

Level 1 - dysphagia pureed

A

Smooth pureed foods, cohesive, no lumps, homogeneous
Pudding like
No jello, fruited yogurt, peanut butter, scrambled eggs

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6
Q

Level 2 - dysphagia mechanically altered

A

Moist soft textured foods with some cohesion (easily form a bolus)
Tender ground or finely diced meats, soft tender cooked vegetables, soft fruit
No bread, dry cake, rice, cheese cubes, corn, peas, pineapple

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7
Q

Level 3 - dysphagia advanced

A

Nearly regular diet- no hard, crunchy, very dry, or sticky (adhesive) foods

Level 4 - regular diet

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8
Q

Viscosity

A

resistance to flow or the rate of flow per unit force. units= centipose (cP)

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9
Q

foods that decrease LES sphincter pressure

A 
(or irritate the esophagus)
High fat foods
Alcohol
Coffee/caffeine
Chocolate 
Smoking 
Peppermint/spearmint!
Acid foods like citrus or tomatoes
Hot spicy foods
mustard
Pepper
Red wine
Carbonated beverages
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10
Q

meds that decrease LES sphincter pressure

A 
Meds such as:
Estrogen
Progesterone
Valium
L-dopa
narcotics
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11
Q

factors that increase LES sphincter pressure

A

High protein intake

Metoclopramide (reglan)- speed gastric emptying

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12
Q

pyrosis - define

A

heartburn

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13
Q

pyrosis - complications

A

is a s/s of GERD. burning sensation in the upper abdomen

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14
Q

GERD - cause/risk factors

A

factors that lower LES pressure (fat, alcohol, mint, spicy, soda, valium, L-dopa), gastric acidity, surgery fundoplication.

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15
Q

GERD - MNT

A

avoid overeating, large fluid intake, constipation.
do not recline 2-3 hr after meals
avoid running, aspirin in some ppl.
add factors that raise LES pressure (high pro intake)/speed gastric emptying (metoclopramide [Reglan])

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16
Q

GERD - decrease gastric acid OTC meds

A

histamine receptor blockers - nizatidine (Axid), famotidine (Pepcid), cimetidine (Tagamet), or ranitidine (Zantac).

Antacids - Mylanta, Maalox Tums, Rolaids. Gaviscon-foams and decreases esophageal acid reflux.

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17
Q

GERD - decrease gastric acid PRES meds

A

PPI’s: work best to decrease acid production: esomeprazole (Nexium), lasoprazole (Prevacid), (omeprazole (Prilosec), pantoprazole (Protonix), rabeprozole (Acidphex), dexlansoprazole (Dexilant)

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18
Q

GERD - define

A

Lack of adequate LES closure and back flow of acidic gastric contents into the esophagus due to low LES pressure.

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19
Q

GERD - s/s

A 
Pyrosis (heartburn)
Dysphagia
Pulmonary symptoms/aspiration
Chest pain
Burning throat
bitter or sour taste of the acid in the back of the throat
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20
Q

define diverticulosis

A

small pouches in the colon that bulge outward through weak spots in the colon wall

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21
Q

diverticulosis - complications

A

may be asymptomatic or cause abdominal distress

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22
Q

diverticulosis - cause/risk factors

A

chronic constipation

low fiber diet

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23
Q

diverticulosis - MNT

A

high fiber diet to increase stool volume & softness.
stool softener meds like colase.
wheat bran as laxative but increase intake gradually to decrease gas, bloating, and discomfort.
MD prescribed fiber laxatives.

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24
Q

diverticulosis - avoid?

A

physicians recommend avoid nuts, popcorn, sunflower, pumpkin, caraway, sesame seeds. BUT no proof and 1 study found opp effect that eating these foods lessens the risk of diverticulosis.

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25
Q

Diverticulitis - define

A

pouches in colon become inflamed or infected due to trapped bacteria or irritants

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26
Q

Diverticulitis - s/s

A

abdominal pain and spasms, distension, n/v, constipation or diarrhea, chills, fever, bleeding, fistulas, obstruction

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27
Q

Diverticulitis - MNT

A

Bowel rest with IV hydration
Antibiotics
NPO, low residue or elemental diet, TPN may be used depending on nutritional status, anticipated length of time NPO, peritonitis, fistulas, and obstructions.
May need surgery to remove part of the colon.
After the acute episode is over and full recovery has occurred, the patient can gradually resume the high fiber diet.

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28
Q

Diverticulitis - meds

A

antibiotics: typically combine ciprofloxacin {flouroquinolone}, (trimethoprim-sulfamethoxazole) and metronidazole.

Amoxicillin penicillin monotherapy is acceptable as well.

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29
Q

Gluten sensitive enteropathy (celiac) - define

A

Sensitivity to gluten in wheat, spelt, triticale, kamut, rye, barley, and possibly oats that causes the pt’s immune system to damage their intestines.

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30
Q

Celiac (Non-Tropical Sprue) - risk factors

A

Usually has a childhood onset but occasionally begins in adulthood.
Genetic disorder that is highest in populations that consume wheat - 1 in 133 Americans.
unknown cause, Caucasian & Europeans, more in women.

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31
Q

GSE - diagnosis

A

Blood test for IgA endomysial antibodies (EMA), IgA tissue transglutaminase (tTG), IgG tissue transglutaminase and Total IgA antibodies.
Endoscopy and small bowel biopsy.

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32
Q

GSE - s/s

A

diarrhea, fatigue, cramping, weakness, bloating, flatus, dehydration, electrolyte depletion or acidosis, rectal prolapse, clubbed fingers. failure to grow, weight loss or failure to gain weight irritability and inability to concentrate

*Steatorrhea with foul, floating, clay-colored, light tan or gray; highly rancid and frothy stools.

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33
Q

GSE - refractory iron def anemia

A

PEM, muscle wasting, rickets, back pain as a result of a collapsed lumbar vertabrae; osteopenic bone disease; hyperparathyroidism; amenorrhea, fat soluble vitamin deficiencies

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34
Q

GSE - complications

A

dermatitis herpetiformis- skin rash with or without GI symptoms.
Stomatitis and recurrent aphthous ulcers.
Increased cancer risk (lymphomas & GI tract) especially if gluten is consumed.

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35
Q

GSE - risk factors

A

More common in people with autoimmune disorders such as Grave’s disease, type 1 diabetes, Sjogren’s disease, collagen diseases, rheumatoid arthritis, IgA deficiency.

May occur without GI symptoms and can cause osteoporosis, nervous system disorders, pancreatic or liver problems, internal bleeding.

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36
Q

Gluten free diet

A

Some doctors recommend the complete avoidance of gluten/gliadin and dairy products when this allergy is suspected in cases of Graves’ disease or other autoimmune disease.”
CONCLUSIONS: “The greater frequency of thyroid disease among celiac disease patients justifies a thyroid functional assessment. In distinct cases, gluten withdrawal may single-handedly reverse the abnormality.”

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37
Q

Celiac - MNT

A

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

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38
Q

Celiac - what to eat

A

*Check all labels carefully as for example some cereals that say RICE WHATEVERS may have some wheat in them.

Plain meat, fish, rice, fruits, and vegetables and potato, rice, soy, or bean flour are OK. Or gluten-free bread, pasta, and other products can be bought from specialty food companies

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39
Q

Gluten sensitivity

A

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

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40
Q

radiation enteritis - define

A

damage to the lining of the intestines (bowels) caused by radiation therapy, a type of cancer treatment.

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41
Q

radiation enteritis - an ex of

A

exudative diarrhea gut inflammation that results in excretion of blood, mucus, plasma proteins, and electrolytes.

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42
Q

radiation enteritis - SBS

A

Short Bowel Syndrome: cause for removal of part or all of the SI. other causes: thromboses/bowel necrosis, strangulated hernias, Crohn’s, trauma, cancer, necrotizing enterocolitis/infection.

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43
Q

Menetrier’s disease - aka

A

hyperplastic hypersecretory gastropathy

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44
Q

Menetrier’s disease - define

A

a rare, acquired, premalignant disease of the stomach characterized by massive gastric folds, excessive mucous production with resultant protein loss, and little or no acid production.

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45
Q

Menetrier’s disease - a cause of

A

gastritis - inflammation of stomach lining

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46
Q

pro rec in Menetrier’s disease or hypertrophic gastritis management

A

high protein diet (20% kcals) is recommended as albumin is low

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47
Q

gastritis - most common cause

A

Helicobacter pylori.

WBC appear in stomach lining in response to H. pylori bacteria, leading to gastritis.

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48
Q

gastritis - may be caused by

A

bacteria, viruses, alcohol, allergies, autoimmune rxns as in pernicious anemia, meds, chemical damage, bile reflux, Crohn’s, radiation gastritis, GVHD, Menetrier’s.

49
Q

gastritis - s/s

A

Burning sensation, pain, n/v, burping, bloating, red or coffee ground vomit, melena (black stool due to blood), anorexia, weight loss, diarrhea

50
Q

gastritis - MNT

A

Give antibiotics if gastritis is bacterial.
Avoid meds etc that irritate the stomach.
If pernicious anemia, give high dose oral or IM vitamin B-12.
In Menetrier’s disease or hypertrophic gastritis, a high protein diet (20% kcals) is recommended as albumin is low.

51
Q

peptic ulcer disease - define

A

Mucosal break in the stomach or duodenum

52
Q

PUD - % cases

A

15% gastric, 85% in duodenum

53
Q

PUD - common cause

A

Helicobacter pylori (like in gastritis)

54
Q

PUD - other causes

A 
Helicobacter pylori - most common.
NSAIDs, aspirin, Alcohol.
Gastrinoma (Zollinger-Ellison syndrome).
Severe stress (eg, trauma, burns), Curling ulcers.
Bile reflux.
Pancreatic enzyme reflux.
Radiation.
Staphylococcus aureus exotoxin.
Bacterial or viral infection.
55
Q

peptic ulcer disease - gastric s/s

A

pain ½ -1 hr after eating which is not relieved by food intake, vomiting, hematemesis (vomiting bright red blood), gastric cancer-rare, weight loss

56
Q

peptic ulcer disease - duodenal s/s

A

pain 2-3 hrs after eating that is lessened by food intake, pain at night, vomiting-rare, melena ( dark to black tar like stools), weight gain

57
Q

peptic ulcer disease - diagnosis

A

Gastroscopy/endoscopy

Barium Swallow/upper GI series

58
Q

PUD - Management

A

Stop taking nsaids and aspirin and any other meds as directed by MD.
Stop smoking.
Take meds for the ulcer as directed by MD.

59
Q

PUD - Helicobacter meds

A

flagyl, tetracycline, pepto bismol, PPI, carafate (Sucralfate) - coats ulcer and decreases its exposure to acid and pepsin.

60
Q

PUD - Helicobacter PPI meds

A

esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), *Dexlansoprazole (Dexilant) or rabeprozole (Aciphex)

61
Q

PUD - OTC meds

A

less effective.
histamine receptor blockers
antacids

62
Q

PUD - OTC histamine receptor blocker meds

A

nizatidine (Axid), famotidine (Pepcid), cimetidine (Tagamet), or ranitidine (Zantac)

63
Q

PUD - OTC antacid meds

A

Mylanta, Maalox, Tums, or Rolaids etcGaviscon- foams and decreases acid reflux into the esophagus

64
Q

PUD - adjunctive MNT

A

*diet does not cause & cannot cure an ulcer.
avoid irritant/acid production stimulants as for GERD.
avoid eating w/in 3 hrs of bedtime.
avoid skipping meals/eating large meals.

65
Q

PUD - MNT check for

A

check for anemia esp if pt has had hemetemesis or melena - may need iron.

66
Q

PUD - vagotomy surgery

A

rare, last resort if meds don’t work and ulcer perforates or hemmorages.
Cut vagus nerve to decrease stimulation, not effective

67
Q

PUD - antrectomy/partial gastrectomy

A

The lower half of the stomach that makes most of the acid is removed with a Billroth I, II, or a Roux-en-Y gastrojejunostomy

68
Q

PUD - partial gastrectomy

A

a portion of the stomach is surgically removed and the remainder must be reattached to the bowel

69
Q

PUD - Billroth I

A

aka gastroduodenostomy. joining the upper stomach back to the duodenum

70
Q

PUD - Billroth II

A

Joining the upper stomach with the jejunum and creating a “y” with the bile drainage and the duodenum forming the second branch of the “y”

71
Q

Borchardt’s triad - develops from

A

hiatal hernias

72
Q

Borchardt’s triad - s/s

A

chest pain, retching but unable to vomit, and inability to pass a nasogastric tube indicate gastric volvulus

73
Q

Borchardt’s triad - MNT

A

Often requires emergency surgery

74
Q

hiatal hernias - define

A

stomach protrudes up thru diaphragm where the esophagus enters the diaphragm and up into the thoracic cavity

75
Q

hiatal hernias - types

A

sliding

rolling (paraesophageal)

76
Q

hiatal hernias - s/s

A

May have no symptoms or have symptoms similar to GERD.
ulceration of the herniated stomach with resultant bleeding and anemia, obstruction, torsion, gangrene, and perforation may occur.

77
Q

hiatal hernias - gastric volvulus

A

with strangulation. usually occurs post-prandially. is life threatening and is a surgical emergency if stomach cannot be decompressed.
in almost 30% of paraesophageal (rolling) hernias - stomach becomes twisted and angulated in its midportion.

78
Q

hiatal hernias - MNT

A

same as GERD, may need surgery

79
Q

zollinger-ellison syndrome - define

A

Tumors (cancerous/benign) of the delta cells in the islets of Langerhans in the pancreas (or sometimes at other sites like lymph nodes or duodenum) that produce gastrin and cause the parietal cells in the stomach to over secrete acid.

80
Q

zollinger-ellison syndrome - s/s

A 
Ulcers in the stomach and/or duodenum
Pain
Secretory diarrhea
Diarrhea, steatorrhea, malabsorption (due to inactivation of pancreatic enzymes by the excess acid)
Weight loss/poor appetite/malnutrition
Vomiting blood
81
Q

zollinger-ellison syndrome - MNT

A

Surgical removal of tumors
Proton pump inhibitors
If these do not work, a surgical resection or total gastrectomy is needed

82
Q

dumping syndrome - post

A

gastrectomy

83
Q

dumping syndrome - s/s

A

flushing, sweating, syncope (fainting), abdominal fullness, diarrhea, nausea & vomiting, weakness, tachycardia, hunger, tremors, anxiety

84
Q

dumping syndrome - early cause

A

due to high osmolarity of simple carbs entering rapidly the SI and rapid distension of the SI by too much chyme entering too fast

85
Q

dumping syndrome - late cause

A

due to reactive hypoglycemia where BG rises quickly followed by an over response with too much insulin production leading to hypoglycemia

86
Q

bezoar - post

A

gastrectomy. risk of bezoar (fibrous blockages) in GI tract is increased

87
Q

bezoar - avoid

A

fibrous foods: orange, coconut, persimmon, berries, green beans, apple, fig, celery, psyllium, sauerkraut, brussel sprouts, potato peel, legumes to decrease risk of a phytobezoar.

88
Q

acute diarrhea

A

frequent evacuation of liquid stools, often severe w/rapid onset and usually caused by a GI infection.
temporary lactose intolerance may occur after an acute episode.

89
Q

acute diarrhea - manage

A

may need rehydration, electrolytes (IV/equalyte, ricelyte, pedialyte) and maybe antibiotics.

90
Q

acute diarrhea - meds

A

lomotil, imodium, kaopectate as directed by MD

91
Q

acute diarrhea - severe

A

see MD if severe and not over in a couple days.

may use fecal transplant if severe infection like Clostridium difficile.

92
Q

acute diarrhea - early refeeding

A

may help the gut recover and about 60% of intake may be absorbed

93
Q

acute diarrhea - avoid

A

milk products, greasy, high-fiber, very sweet foods (aggrevate diarrhea).
progress to soft, bland foods like banana, rice, boiled potato, toast, cracker, cooked carrot, baked chicken w/out skin and fat.

94
Q

acute diarrhea - children diet

A

BRAT diet - bananas, rice, applesauce, toast

95
Q

chronic diarrhea

A

required a thorough workup and evaluation such as endoscopic exam and stool test for malabsorption, bacteria, etc.

treatment will vary w/cause of diarrhea.

96
Q

types of diarrhea

A
  1. osmotic
  2. exudative
  3. steatorrhea/small intestinal disorders/lack of digestive enzymes.
97
Q
  1. osmotic diarrhea - examples
A

lactose intolerance

dumping syndrome

98
Q
  1. osmotic diarrhea - cause
A

poor digestion and absorption resulting in osmotically active solutes in the GI tract causing water to be pulled into the GI tract causing diarrhea

99
Q
  1. osmotic diarrhea - relieved by
A

fasting/avoidance of the substance that cannot be digested

100
Q
  1. exudative diarrhea - examples
A

radiation enteritis, ulcerative colitis, severe infection like C. diff

101
Q
  1. exudative diarrhea
A

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

102
Q
  1. steatorrhea/SI disorder/lack of dig enzy diarrhea
A

inadequate exposure of chyme to the intestinal epithelium, lack of or inactivation of pancreatic enzymes, SI damage, post-gastrectomy

103
Q
  1. steatorrhea/SI disorder/lack of dig enzy diarrhea - examples
A

lack of pancreatic/biliary excretions, pancreatitis, CF, enterohepatic recirculation problems, bacterial overgrowth.

104
Q

PUD -total gastrectomy

A

entire stomach is removed and esophagus is anastomosed to the duodenum

105
Q

ileostomy

A

SI is brought to the surface of the abdomen to form a stoma. Have the ileum form the stoma if entire colon is removed.

106
Q

ileostomy - stoma

A

many pts will have to wear pounch/bag to collect feces, control odor and protect skin.

107
Q

traditional ileostomy

A

as there is no colon to absorb fluid and electrolytes, ensure adequate intake.
if part of the ileum was removed in surgery, there may be some malabsorption of fat, pro, cobalamin.

108
Q

ileostomy MNT

A

As the stoma is higher in the ileum (more ileum removed), there may be malabsorption of fat, bile acids, cobalamin, water, sodium, potassium, and protein.
MNT similar to pouch.
For all ileostomy pts it is a good idea to take a multi vit/min supplement.

109
Q

colectomy

A

surgical removal of the colon to cure UC

110
Q

reasons for colectomy

A

cancer, familial polyposis, ulcerative colitis, ischemic bowel, trauma, severe diverticulosis, etc.

111
Q

colectomy internal pouch

A

pt may elect to have an internal pouch connected to a stoma on the abdomen or the anus to store feces instead of wearing a bag.

112
Q

colectomy BCIR

A

a Kock pouch or Barnett Continent Intestinal Reservoir (BCIR) may be created after a colectomy

113
Q

ileoanal reservoir

A

an internal pouch is created using part of the ileum and is pulled thru the rectal wall and attached to the anus.

114
Q

ileoanal reservoir - pouchitis

A

imodium is often taken to decrease diarrhea. pouchitis may cause pain, fever, bleeding. fecal leakage.

115
Q

ileoanal reservoir MNT

A

eat slowly, small freq meals.
increase fluid & electrolyte intake.
limit simple sugars and caffeine.
soluble fiber like spyllium or guar gum may help stools be more solid.
foods reported to increase output or cause discomfort include nuts, corn, chocolate, lettuce, oranges, milk, alcohol, tomatoes.

116
Q

ileoanal reservoir - avoid

A

insoluble fiber foods like fruit peels, mushroom, corn, celery, lettuce, bean sprouts, coleslaw, coconut, pineapple, nuts, seeds, tough meat shrimp or lobster may cause mechanical bowel obstruction.

117
Q

ileoanal reservoir - gas & odor causing foods

A 
asparagus 
dried beans and peas 
mustard 
cabbage family 
onions 
carbonated beverages 
eggs 
radishes
pickles 
beer 
fish 
cucumbers 
strong flavored cheeses 
melons 
spiced foods 
fatty foods (pastries/deep fried foods) 
whips and meringues
118
Q

ileoanal reservoir - anal irritation foods

A 
certain raw fruits and vegetables (e.g., oranges, apples, coleslaw, celery and corn) 
popcorn 
Chinese/oriental vegetables 
nuts 
coconut 
dried fruits (e.g. raisins, figs) 
food with seeds 
spicy foods
119
Q

ileoanal reservoir - pouch output decreasing foods

A 
applesauce 
bananas 
boiled rice, pasta 
cheese 
creamy peanut butter 
tapioca pudding 
potatoes (without skins)

My MNTII Test 1 (10 decks)

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