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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
Q

peppermint

–bioavailability

A

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
Q

peppermint

–metabolism

A

1) eliminated mainly in the bile

27
Q

peppermint

–physiological effects

A

1) carminative
- -release gas
- -enhances gastric emptying
2) antispasmodic
- -(-) smooth muscle contraction in GI by antagonizing Ca2+
- -reduced # of contractions & amplitude
- -(-) gallbladder contraction

28
Q

peppermint

–Hx/ traditional use

A
  • -spastic discomfort of upper GI & bile ducts
  • -irritable colon
  • -catarrhs of respiratory tract
  • -inflammation of oral mucosa
  • -external use for myalgia & neuralgia
29
Q

peppermint

–clinical research

A

1) Irritable bowel syndrome
2) Non-ulcer dyspepsia (chronic indigestion)
3) Tension HA

30
Q

Irritable bowel syndrome Dx criteria

A

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
Q

symptoms of IBS

there can be diarrhea or constipation-predominant forms

A
  • -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
Q

RED FLAGS NOT typical of IBS =

A
  • -pain that awakens
  • -diarrhea that awakens
  • -blood in your stool
  • -weight loss
  • -fever
  • -abnormal physical exam
33
Q

peppermint

–dosages & administration

A

essential oil obtained from steam distillation of fresh flowering springs

34
Q

peppermint

–contraindications

A

liver/gall bladder disease

35
Q

peppermint

–side effects

A

occasional heartburn & stomach upset

36
Q

peppermint

–interactions w. other botanicals & drugs

A

none reported

37
Q

peppermint

–use during preggers & lactation

A

non investigated

38
Q

Inflammatory Bowel Disease =

A

1) Crohns disease

2) Ulcerative Colitis

39
Q

Crohns disease

A
  • -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
Q

ulcerative colitis

A
  • -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
Q

Indigestion (non-ulcer dyspepsia)

–symptoms

A
  • -bloating, excessive or prolonged “fullness”
  • -gas
  • -nausea, loss of appetite
  • -diarrhea/ constipation
  • -often pain, altho the stay suggest ulcer or IBS
42
Q

indigestion (non-ulcer dyspepsia)

–assessment

A
  • -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
Q

indigestion (non-ulcer dyspepsia)

–management

A

Tx = dietary changes & supplemental aids
–hydrochloric acid
–digestive enzymes
–probiotics
–botanicals
(bitters–>digestive stimulants// carminatives// demulcents –>soothing)

44
Q

Small intestinal bacterial overgrowth (SIBO)

–symptoms

A
  • -bloating
  • -flatulence
  • -abdominal pain
  • -belching
  • -diarrhea
  • -malabsorption
  • -steatorrhea (abnormal [fat] in feces)
  • -joint pain
  • -rosacea
  • -anemia
45
Q

Small intestinal bacterial overgrowth (SIBO)

–Tx

A
  • -avoid contributors, antibiotics, peppermint, allium
  • -essential oils –> oregano, thyme, clove (enteric coated)
  • -specific CHO diet, FODMAP diet, Elemental diet
46
Q

peptic ulcer studies

A

the major goal of diet is to avoid extreme elevations of gastric acid secretion and the direct irritation of gastric mucosa.

47
Q

licorice studies

A
  • -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
Q

Biliary Dyspepsia & gallstone formation studies

A

artichoke lead extract

49
Q

celiac disease studies

A

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
Q

IBS studies

A
  • -melatonin

- -bifidobacterium

51
Q

peppermint studies

A
  • -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
Q

Inflammatory Bowel Disease Studies

A
  • -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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