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Clinical Nutrition- Final > GI disorders > Flashcards

GI disorders Flashcards

1
Q

Natural Therapy of Peptic Ulcer

A

1) Check/Tx H. Pylori infection
2) Avoid mucosal irritants & gastric acid secretagogues
3) normal diet, fiber OK as tolerated
4) deglycyrrhizinated licorice
5) zinc

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2
Q

Licorice

–scientific name

A

glycyrrhiza glabra

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3
Q

licorice

–where it grows

A

cultivated throughout europe, the middle east, and asia

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4
Q

licorice

–parts of plant used

A

root

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5
Q

licorice

–active constituents

A

1) Glycyrrhizin

2) Flavonoids

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6
Q

licorice

–bioavailability

A

no information

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7
Q

licorice

–metabolism

A

1) Increased production of gastric protective mucin

2) Flavonoids & polysaccharides have been shown to inhibit H. pylori in vitro

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8
Q

licorice

–uses

A

1) peptic ulcer

2) GERD

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9
Q

licorice

–dosage & administration

A

1) DGL prep = 4:1 concentration TID chewed before meals
2) dried powdered root
3) fluid extract (not clinically tested)

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10
Q

licorice

–contraindications

A

1) liver & severe kidney disorders

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11
Q

licorice

–side effects

A

1) glcyrrhizin in large amounts can produce pseudoaldosteronism = elevated blood pressure, electrolyte disturbances, and <3 problems.
* *Deglycyrrhizinated licorice (DGL) does NOT pose these risks**

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12
Q

licorice

–interactions with other botanicals and drugs

A

1) licorice
- -influence corticosteroid
- -add hypokalemic effects of thiazide & loop diuretics & may increase risk of digitalis (drug that stimulates <3 m) toxicity
2) DGL
- -human fecal blood loss induced w/ aspirin

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13
Q

licorice

-use during preggers/lactation

A

contraindicated

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14
Q

GERD - Tx

A

1) avoid abdominal compression
2) avoid over eating
3) avoid sphincter inhibitors & irritants (smoking, alcohol, caffeine, spices, acids, chocolate, peppermint, spearmint)
4) Deglycyrrhizinated licorice (DGL)

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15
Q

Dx of gallbladder

6 F’s

A 
Fam Hx
Female
40
Fat
Fair (white)
Fertile (lots of kids)
w/ RUQ pain
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16
Q

prevention of gallbladder

disease

A

maintain low [biliary cholesterol] & high concentration of phospholipids & bile acids to prevent stone formation & progression.

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17
Q

diet & lifestyle changes for gallbladder disease

A

assoc w/ = animal fats, trans fat, eggs, obesity, high glycemic carbohydrates

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18
Q

supplements to Tx gallbladder disease

A
  • -only prescribed = Ox bile concentrations
  • -highly concentrated lecithin (phosphatidyl choline)
  • -lipotropic formulas
  • -ARTICHOKE, dandelion, milk thistle
  • -“gallbladder flush” = large dose of vegetable oil
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19
Q

celiac disease

–overview

A
  • -screen with anti-body test
  • -gluten-free diet for life
  • -initially avoid lactose
  • -digestive enzyme supplements may speed recovery; celiac-specific enzymes to improve gluten-tolerance during meals
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20
Q

Irritable Bowel Syndrome (IBS)

–overview

A
  • -R/O GI pathology & alternative Dx
  • -stress reduction & mind-body therapies
  • -increase dietary fibers
  • -food sensitivities
  • -peppermint oil
  • -melatonin @ bedtime
  • -consider probiotics
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21
Q

peppermint

–scientific name

A

menthe piperita

22
Q

peppermint

–where it grows or is cultivated

A

europe & NA

23
Q

peppermint

–part(s) of the plant used:

A

leaf, essential oil

24
Q

peppermint

–active constituents

A

menthol/ methone

25
peppermint | --bioavailability
1) peppermint oil is rapidly absorbed in the upper digestive tract, necessitating enteric=coated products when target tissue is the lower GI tract & upper GI tract actions are not desired
26
peppermint | --metabolism
1) eliminated mainly in the bile
27
peppermint | --physiological effects
1) carminative - -release gas - -enhances gastric emptying 2) antispasmodic - -(-) smooth muscle contraction in GI by antagonizing Ca2+ - -reduced # of contractions & amplitude - -(-) gallbladder contraction
28
peppermint | --Hx/ traditional use
- -spastic discomfort of upper GI & bile ducts - -irritable colon - -catarrhs of respiratory tract - -inflammation of oral mucosa - -external use for myalgia & neuralgia
29
peppermint | --clinical research
1) Irritable bowel syndrome 2) Non-ulcer dyspepsia (chronic indigestion) 3) Tension HA
30
Irritable bowel syndrome Dx criteria
12 weeks that do not have to be consecutive but must have 2/3 features 1) relieved with defecation 2) onset associated w/ change in frequency of stool 3) onset associated w/ change in form of stool.
31
symptoms of IBS | there can be diarrhea or constipation-predominant forms
- -abnormal stool frequency (>3 bowel movements/day OR <3 bowel movements/ week) - -abnormal stool form - -abnormal stool passage - -passage of mucus - -bloating or feeling of abdominal distention
32
RED FLAGS NOT typical of IBS =
- -pain that awakens - -diarrhea that awakens - -blood in your stool - -weight loss - -fever - -abnormal physical exam
33
peppermint | --dosages & administration
essential oil obtained from steam distillation of fresh flowering springs
34
peppermint | --contraindications
liver/gall bladder disease
35
peppermint | --side effects
occasional heartburn & stomach upset
36
peppermint | --interactions w. other botanicals & drugs
none reported
37
peppermint | --use during preggers & lactation
non investigated
38
Inflammatory Bowel Disease =
1) Crohns disease | 2) Ulcerative Colitis
39
Crohns disease
- -effects small intestine, proximal colon. - -monitor malnutrition with CBC, serum proteins - -healthy diet - -consider food allergy elimination - -multiple vitamin-mineral, vit K - -probiotic yeast - -fish oil, Omega-3 - -curcumin - -vit D - -boswellia serrata - -artemisia absinthium
40
ulcerative colitis
- -affects colon only - -monitor anemia w/ CBC; also serum proteins & electrolytes - -healthy diet, fiber as tolerated - -consider food allergy elimination, sensitivities to lactose, raw fruits & veggies - -probiotic bacteria, several billion per day - -fish oil - -aloe vera, wheat grass juice, boswellia gum resin extract - -curcumin
41
Indigestion (non-ulcer dyspepsia) | --symptoms
- -bloating, excessive or prolonged "fullness" - -gas - -nausea, loss of appetite - -diarrhea/ constipation - -often pain, altho the stay suggest ulcer or IBS
42
indigestion (non-ulcer dyspepsia) | --assessment
- -R/O GI pathologies: GERD, heartburn, peptic ulcer, gallbladder - -R/O precipitating eating habits - -R/O sensitivity to gas-forming foods, food allergies - -consider psychological & emotional factors which sometimes contribute to nonspecific GI complaints - -some alternative health practitioners make use of functional tests of digestive function such as the comprehensive stool analysis (CSA) & gastric analysis
43
indigestion (non-ulcer dyspepsia) | --management
Tx = dietary changes & supplemental aids --hydrochloric acid --digestive enzymes --probiotics --botanicals (bitters-->digestive stimulants// carminatives// demulcents -->soothing)
44
Small intestinal bacterial overgrowth (SIBO) | --symptoms
- -bloating - -flatulence - -abdominal pain - -belching - -diarrhea - -malabsorption - -steatorrhea (abnormal [fat] in feces) - -joint pain - -rosacea - -anemia
45
Small intestinal bacterial overgrowth (SIBO) | --Tx
- -avoid contributors, antibiotics, peppermint, allium - -essential oils --> oregano, thyme, clove (enteric coated) - -specific CHO diet, FODMAP diet, Elemental diet
46
peptic ulcer studies
the major goal of diet is to avoid extreme elevations of gastric acid secretion and the direct irritation of gastric mucosa.
47
licorice studies
- -licorice: a possible anti-inflammatory & anti-ulcer drug - -no sig diff btw 2 drug regiments --> 4 ulcer recurrences in each group - -ulcers recurred rapidly after maintenance therapy; Caved-S 2/22; cimetidine 7/23; within 4 months = safe & reasonably effective - -therapy in high risk or elderly pt should be for life - -may = severe hypertension & hypokalemic metabolic alkalosis - -a high intake = hyper- mineralcorticoidism w. Na retention & K loss, edema, increased blood pressure & depression of the renin-angiotensinaldosterone system.
48
Biliary Dyspepsia & gallstone formation studies
artichoke lead extract
49
celiac disease studies
pancreatic enzyme in childhood celiac disease. Good for the 1st 30 days after Dx. --by combo-ing gastric activity & complementary substrate specificity, it should be possible to increase the safe threshold of ingested gluten, thereby ameliorating the burden of a highly restricted diet for patients with celiac sprue.
50
IBS studies
- -melatonin | - -bifidobacterium
51
peppermint studies
- -a dose-related anti-spasmodic effect on the smooth musculature due to the interference of menthol with the movement of calcium across the cell membrane - -optimal pH triggered enteric coated formulations start releasing PO in the small intestine extending release over 10-12h thus providing PO to the target organ in irritable bowel syndrome, ex: the colon. - -relaxing effect on gall-bladder & the former slows small intestinal transit - -might be drug of choice with non-serious constipation or diarrhea to alleviate general symptoms and to improve quality of life.
52
Inflammatory Bowel Disease Studies
- -oral aloe vera gel for active ulcerative colitis - -wheat grass juice for distal U.C. - -Boswellia serrata for chronic colitis

Clinical Nutrition- Final (5 decks)

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