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Integrative Nutrition and Pathophysiology > GI 2 > Flashcards

GI 2 Flashcards

1
Q

what are the 2 types of IBD

A

Crohn’s disease
Ulcerative Colitis (UC)

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2
Q

genetics of IBD

A

genetic predisposition
ATG16L1
NOD2
IL23R

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3
Q

environmental factors of IBD

A

smoking
environment
hygiene
diet

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4
Q

secondary insult/trigger of IBD

A

infections
drugs

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5
Q

disease initiation of IBD characterized by

A
  1. loss of epithelial barrier integrity
  2. loss of tolerance to enteric commensal bacteria
  3. dysbiosis
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6
Q

IBD has __ inflammation

A

IBD has sub-clinical inflammation

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7
Q

what is sub-clinical inflammation overview

A

has to do with hyperglycemia and insulin resistance

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8
Q

sub-clinical inflammation specific to IBD

A
  1. expansion of auto-inflammatory process
  2. activated innate and acquired immune responses
  3. circulating antimicrobial antibodies
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9
Q

5 factors IBD is diagnosed based on

A
  1. symptoms
  2. lab data
  3. imaging studies
  4. endoscopic evaluation
  5. histology
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10
Q

IBD diagnosis requires (2)

A
  1. uncontrolled immune response
  2. bowel damage/tissue remodeling
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11
Q

Crohn’s symptoms are very __

A

Crohn’s symptoms are very variable, depends on location

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12
Q

constitutional symptom of Crohn’s

A

weight loss

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13
Q

symptoms more common in Crohn’s than UC

A

abdominal pain
fever
growth retardation

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14
Q

Crohn’s may present with

A

small bowel obstruction

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15
Q

UC symptoms

A

diarrhea
rectal bleeding
tenesmus
urgency

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16
Q

what is tenesmus

A

feeling that you need to pass stools even when your bowels are empty

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17
Q

__ and __ are only seen in severe UC

A

fever and weight loss are only seen in severe UC

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18
Q

goal of endoscopy

A

guide treatment by looking into body

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19
Q

what type of endoscopy used to looke at disease extent in Crohn’s

A

capsule endoscopy

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20
Q

goal of treatment

A

mucosal healing (absence of ulcerations and erosions)

21
Q

mucosal healing in IBD associated with
decreased need for __
decreased __ rates
sustained __
decreased risk of __

A

mucosal healing in IBD associated with
decreased need for corticosteroids
decreased hospitalization rates
sustained clinical remission
decreased risk of colorectal cancer

22
Q

histology of UC
inflammation limited to __ and __
__ often compromised
epitheloid granulomas __

A

histology of UC
inflammation limited to mucosa and submucosa
submucosa often compromised
epitheloid granulomas absent

23
Q

histology of Crohn’s disease
__ inflammation with __ aggregates
__ expanded by __ and __
epitheliod granulomas __

A

histology of Crohn’s disease
transmural inflammation with lymphoid aggregates expanded by **inflammation ** and fibrosis
epitheliod granulomas present

24
Q

complication of Crohn’s

A
  1. incidence of enterocutaneous or perianal fistulas (35%)
  2. internal fistulas (35%)
  3. rectovaginal fistulas (5-10% of females)
  4. strictures
25
2 types of strictures in Crohn's 1. __ (__) at areas of acute inflammation 2. __ at areas of long-standing inflammation and at anastomotic areas
1. **edematous** (**inflammatory**) at areas of acute inflammation 2. **fibrotic** at areas of long-standing inflammation and at anastomotic areas
26
indications for surgery in Crohn's
1. abcess 2. fistula 3. fibrotic stricture causing obstruction 4. toxic megacolon 5. hemorrhage 6. cancer 7. symptoms refractory to medical therapy
27
indications for surgery in UC
1. toxic megacolon 2. uncontrolled colonic bleeding 3. perforation 4. obstruction and stricture with suspicion for cancer
28
main nutritional issue in IBD
weight loss
29
how common is weight loss IBD: Crohn's:
how common is weight loss IBD: 70-80% of hospitalized patients Crohn's: 20-40% of outpatients
30
4 causes of weight loss in IBD
1. decreased food intake 2. nutrient malabsorption 3. increased intestinal loss 4. drug interactions
31
diarrhea causes increased loss of
Zn K Mg
32
IBD causes Steatorrhea which is
increased loss of fat from stools
33
Steatorrhea causes increased malabsoption of __ and loss of __
fat soluble vitamins Zn, Mg, Ca, Cu
34
drug interactions causing weight loss in IBD
drugs interacting with absorption of foods/nutrients
35
parenteral nutrition in IBD pros
1. remission! (short-lived though, ususally only 3 months) 2. fistula healing
36
risks of parenteral nutrition in IBD
bacteremia thrombosis
37
when is parenteral nutrition used in IBD
severe malnutrition nutritional support pre- and post-op
38
EEN in IBD pros
reduces remission in 85% of newly diagnosed patients
39
in IBD, EEN has similar efficacy to
corticosteroids
40
Rome IV definition of IBS
- Recurrent Abdominal pain on average at least 1 day per week in the last 3 months associated with 2 or more of the following criteria: - Associated with defecation - Change in Stool Frequency - Change in Form of Stool *Criteria should be fulfilled for last 3 months with symptoms onset at least 6 months prior to diagnosis
41
who is most likely to have IBS?
females <50
42
who is most likely to have IBS?
females < 50
43
3 subtypes of IBS
IBS-C (constipation) IBS-M (mixed bowel habits) IBS-D (diarrhea)
44
parenteral vs enteral nutrition
parenteral = through IV enteral = tube that goes into stomach/small intestine (bypasses digestive system)
45
Bristol stool form scale (BSFS)
Type 1: separate hard lumps (hard to pass) Type 2: sausage-shaped, but lumpy Type 3: sausage with cracks Type 4: sausage/snake, smooth and soft Type 5: soft blobs with clear-cut edges (passed easily) Type 6: fluffy pieces with ragged edges, mushy Type 7: entirely liquid
46
IBS-C > 25% type: < 25% type:
IBS-C > 25% type: 1 or 2 < 25% type: 6 or 7
47
IBS-M > 25% type: > 25% type:
IBS-M > 25% type: 1 or 2 > 25% type:
48
IBS-D > 25% type: < 25% type:
IBS-D > 25% type: 6 or 7 < 25% type: 1 or 2
49
predominant bowel habits are based on stool form on days with
at least 1 abnormal bowel movement

Integrative Nutrition and Pathophysiology (22 decks)

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