Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Nutrition 2 > IBD - Crohn's Disease > Flashcards

IBD - Crohn's Disease Flashcards

1
Q

What is the aetiology of IBD and Crohns?

A
  • Largely unknown

- An interaction between luminal microbial antigens, genetic susceptibility, immune response and environmental triggers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Crohn’s disease characterized by?

A
  • Dysfunctional regulatory T-cells which normally control pro-inflammatory cytokine releases.
  • If activated antigen presenting cells and lymphocytes are allowed to secrete these pro-inflammatory cytokines, then tissue damage may result from prolonged inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a key player in crohn’s disease?

A

TNF alpha

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the prevalence of IBD? Is CD and UC more common?

A
  • 0.67%

- CD slightly more common (129,000) compared to UC (104,000)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Whats the difference between IBS and IBD?

A

IBD has presence of ulcerations

-May share similar symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the prevalence of crohn’s disease in Canada?

A

319 per 100,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In CD there are more females (T/F)

A

T

In UC, there are slightly more males, however we don’t know why

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the common characteristics of IBD? (3)

A
  • Affects all levels of the GIT
  • Often onset in youth
  • 30-50% of people have the colon affected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which parts of the colon are often affected in IBD?

A
  • Ileocolonic (50-60%)

- Crohn’s colitis (10-30%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

(T/F) Crohn’s disease affects only the large intestine

A

F

Can be the small or large intestine, often “patches” throughout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the difference between ileocolic and colon originates crohn’s disease?

A
  • ileocolic will present with affected arears in the terminal ileum, and patches throughout the colon
  • Colon means the patches are distributed throughout the colon only
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Where is the affected area in recto-sigmoid crohns?

A
  • In the terminal sigmoid colon and rectum

- Continuous and not patchy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When may UC be misdiagnosed for chron’s?

A

If it’s initial presentation is in the colon, and is patchy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When may crohn’s be a misdiagnosis of UC?

A

When it is present in the colon and not yet pathcy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the presentation of UC?

A

-Continuous, not patchy throughout the colon to anus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the Montreal Disease Activity Score?

A

Allows us to define UC by the extent of affected area. Considers 3 subgroups.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does E1 represents in the MDAS?

A
  • Ulcerative proctitis

- Involvement limited to the rectum (i.e, proximal extend of inflammation is distal to the rectosigmoid junction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does E2 represent in the MDAS?

A
  • Left sided UC, or distal UC

- Involvement limited to the portion of the colorectum distal to the splenic flexure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does E3 represent in the MDAS?

A
  • Extensive US, or pan-colitis

- Involvement extents proximal to the splenic flexure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the significance of tool required to diagnose IBD?

A

-There is often lengthly preparation to undergo these diagnoses, such as fasting, and often patients with IBD are malnourished at baseline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Preparation for endoscopy?

A
  • 8 hr NPO

- May exacerbate malnutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Discuss the 2-3 day preparation in order to undergo a colonoscopy

A

1) Obtain bowel preparation solution at least 2 days before the test
2) 1 day before test; clear liquids all dat, Then, from 6-8pm drink 2L of any PEG-based solution
3) Dat of test, no solid food , and 4 hour before appointment, drink remaining 2L of PEG based solution
4) Stop drinking all liquids including water 2 h before the test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the PEG solution?

A
  • PIC-SALAX

- Contents are not absorbed, and will function to “clean the bowel” so that we can observe ulcerations upon colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Overall preparation guielines for colonoscopy on Pico-Salax?

A
  • No fibre 3 days prior

- Day prior can have breakfast and then clear fluid only plus lavage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When assessing a patient with potential IBD, what do we need to investigate?

A
  • Is it UC or Crohn’s? Where is the inflammation? (Recall that Crohn’s can go from anus to mouth
  • Are there stricture, ulcers? How deep are the strictures?
  • What is the patient currently able to eat?
  • Has there been weight-loss?
  • What medication is she on?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

A1?

A

16 years or younger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

A2?

A

17-40 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

A3?

A

Over 40 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

L1?

A

Terminal ileum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

L2?

A

Colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

L3?

A

Ileocolon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

L4?

A

Upper GI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

B1?

A

Non-stricturing, non-penetrating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

B2?

A

Stricturing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

B3?

A

Penetrating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

B1 or 2 or 3 with p?

A

+ perianal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

In UC, what do the ulcerations on the colon lead to?

A
  • Toxic megacolin
  • A thin, ulcerated colon which has complete lack of the strong-muscular walls
  • People can due for this as the thin walls can perforate and cause sepsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the solution for toxic megacolon?

A
  • Take out the large intestine

- Likely have an ostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What does Crohn’s disease primarily present with?

A
  • Ulcers, fistulas, strictures and obstructions

- Makes the lumen and peristalsis less functional and flexible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is transmural?

A
  • All the way through
  • Through the mucosa, submucosa and musculature into the peritoneal cavity (high risk of sepsis)
  • Can transverse both circular an longitudinal muscle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the mesentery?

A

A set of tissues that attaches the intestines to the posterior abdominal wall in humans and is formed by the double fold of peritoneum.
-Helps lead nutrients to the surrounding vascular system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What happens when the mesentery is thickened?

A

-Will have difficulties in supplying nutrients from the villi, and will also not transport nutrients to the liver (bidirectional) may not have enough oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is commonly observed in the affected area during IBD?

A

-Enlarged lymph nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is an aphthoid ulcer?

A

-Ulcer over payer’s path’
-Ulcer over immune spots
and similar to canker sores

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are skip lesions?

A
  • Patchy distribution of inflammation

- Recall the inflammation is normally continuous and contained to the colon in UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is a fissure?

A

-Deep cleft, slit or linear ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is a fistula?

A

An abnormal passage from a hollow organ to surface of another organ stricture; narrowing of hollow organ can ensure, causing scaring and fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are abscesses?

A

a swollen area within body tissue, containing an accumulation of pus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are granuloma?

A

When tissue in an organ becomes inflamed — often in response to an infection — groups of cells called histiocytes cluster to form little nodules. May become calcified and hardened over time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What type of IBD is at higher risk of fistula development?

A

Crohn’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What else is consistent with IBD pathology?

A
  • Perianal disease (when complication occur in the anus/rectum)
  • Inflamed mucosa with adjacent normal tissue (recall skip lesions)
  • Perianal skin tags
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are common clinical presentations of crohns?

A
  • “Cobble-stoning” of intestinal lumen
  • Marked thickening of bowel wall
  • fat wrapping around outside of GI tract (due to high inflammatory state)
  • Deep fissures
  • -> MAJOR impacts on absorption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are common clinical presentations of ulcerative colitis?

A

-Extremely thin, ulcerated wall
-“surviving” mucosa is known as pseudopolyps
-Loss of haustra
(the sacs)
—> MAJOR impact on absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What are the general clinical features of IBD?

A
  • Skip lesions
  • Thickened bowel wall
  • Stricture formation
  • Decreased brush-border lactase
  • Diminished serum folate
  • Reduce dietary intake (to avoid symptoms)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Which clinical features are conducive to malabsorption?

A
  • Skip lesions

- Decreased brush border lactase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Which clinical features are conducive to obstruction?

A
  • Thickening of bowel wall

- Stricture formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

(T/F) Due to decreased brush-border lactase, IBD patients must eliminate milk intake

A
  • Not necessarily
  • If tolerated, include in diet
  • Important source of energy and protein
  • Recall that patient likely malnourished at baseline, and if on corticosteroids even more so
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

If we must eliminate lactose from diet, what could be a compromise?

A
  • Consider lactase enzyme supplement or lactose-free products to avoid omission of high protein high energy foods
  • People with IBD are often already at increased risk of osteoporosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What are the general clinical manifestations of IBD?

A
  • Abdominal pain, bloody diarrhea, tenesmus
  • Febrile, tachycardia
  • CRP and WBC elevated
  • Weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is tenesmus? What may it be caused by?

A
  • The feeling of needing to pass stools even if there are none
  • May be caused by strictures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What happens when people are tachychardic?

A

They often don’t sleep well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is common in IBD?

A
  • Anemia is very common

- Must determine whether IDA or AOCD (as both are likely)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What may indicate IDA?

A
  • High CRP
  • Low/normal Serum Ferritin
  • Low HmG, low HcT
  • Normal hydration status
  • Historical low PO intake
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What may indicated AOCD?

A
  • High CRP
  • HIGH serum ferritin (+APP)
  • Low HmG, low Hct
  • Normal Hydration status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What may low or normal WBC and CRP indicate?

A

That “inflammation” is still occurring, but managed by corticosteroids
-Consider when interpreting AOCD and IDA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Why do we need to make sure we interpret AOCD and IDA appropriately

A
  • As we don’t want to unnecessarily provide an iron supplement as they can be irritating and cause constipation
  • On the other hand, if they are really IDA this must be addressed as there is recurring blood loss and we want to avoid further decline in nutritional state
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Common characteristics of small intestine crohn’s in the adult?

A
  • Obstructive in nature (require Sx)
  • Pain when eating
  • Palpitation causes pain in LRQ
  • Anorexia/diarrhea
  • Malabsorption, including lactose intolerance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Which type of IBS has a high incidence of fistula formation?

A

-Ileocolonic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is located in the LRQ?

A

Ileocolonic area, likely ileocolonic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

How do many people manage diarrhea?

A

Will often just not eat –> anorexia and weight-loss

71
Q

Colonic Crohn’s can be similar to UC, What are 5 clinical presentations which may differentiate CC from UC?

A
  • Hematochezia
  • Pain prior to defecation
  • Perianal skin tags
  • Deep anal fissures
  • Perianal fistula
72
Q

What is hematochezia?

A

Diarrhea which often contains blood

73
Q

What are systematic and extra-intestinal manifestations of crohn’s?

A
  • Fever
  • Weight loss
  • Arthritis
  • Oral ulcers, skin lesions
  • UTI
  • Enhanced oxalate absorption (kidney stones)
  • Altered body composition
74
Q

What are the 4 stages of Crohn’s disease? Important

A
  • Mild-moderate
  • Moderate-severe
  • Severe-fulminant
  • Remission
75
Q

Mild-moderate score?

A

CDAI 15-220

76
Q

Moderate-Severe Disease?

A

CDAI 220-450

77
Q

Severe-Fulminant Disease?

78
Q

Mild-moderate crohn’s?

A
  • Ambulatory
  • Able to tolerate oral intake without dehydration
  • Toxicity (fevers)
  • Abdo tenderness
  • Painful mass, obstruction
  • -> OR 10% weight-loss
79
Q

Moderate-severe crohn’s?

A
  • Failure to respond to treatment for mild-moderate disease OR
  • Those with major fevers
  • Significant weight-loss
  • Abdo pain/tenderness
  • Intermittent nausea/vomiting (w/o obstruction)
  • Significant aneamia
80
Q

What does fulminant mean?

A

When it cannot be under-control

81
Q

Severe-fulminant Crohn’s?

A
  • Persisting symptoms in spite of steroid Rx OR
  • Those with high fever, persistent vomiting
  • Intestinal obstruction
  • Rebound tenderness
  • Cachexia OTR
  • EvidenceIn of abscess
82
Q

Remission crohns?

A
  • Asymptomatic
  • Without inflammatory sequela AND
  • includes those who have responded to acute medical intervention or surgical resection w/o gross evidence or residual disease
83
Q

(T/F) Remission includes those who have receive steroids and are asymptomatic F

84
Q

What does the crohns activity index consider?

A

Numerical score based on:

  • # of diarrheal stools
  • abdo pain
  • general well-being
  • systemic manifestations
  • use of anti-diarrheal agents
  • presence of abdo mass
  • body weight
85
Q

Index values of ___ and below are associated with quiescent disease. Values above ___ are seen with extremely sever disease

86
Q

Lowering of ___ points id indicative of positive change in the crohn’s activity index

87
Q

Whats another use of the crohn’s activity index?

A

These parameters could be turned into questions to ask patients or consider in the chart

88
Q

In the CAI, which parameter has the largest weighting factor? Which factor is weighted more than # liquid stool, abdo pain, or hct level?

A
  • Anti-diarrheal use

- General well-being

89
Q

In CDAI, how are # of stools calculated?

A

Total/week x 2

90
Q

In CDAI, how is pain calculated?

A
  • Scale of 0-3 (non to severe)

- Sum score/wk x 5

91
Q

In CDAI, how is well being calculated?

A

0-4 (well to terrible)

92
Q

How is weight calculated in CDAI?

A

100 x [(std wt - actual wt/std wt]

93
Q

What does the Truelove and Witts Criteria assess?

A

–Disease activity for US

94
Q

TWC daily BM for mild and severe activity?

95
Q

TWC hematochezia for mild and severe activity?

A
  • Small amounts

- Large amounts

96
Q

TWC temperature for mild and severe activity?

A
  • <37.5

- >/=37.5

97
Q

TWC pulse for mild and severe activity?

A
  • <90/minn

- >/= 90/min

98
Q

TWC erythrocyte sedimentation rate for mild and severe activity?

A
  • <30 mm/h

- >/= 30 mm/h

99
Q

TWC hmg mild and severe activity?

A
  • > 10 g/dl

- = 10 g/dl

100
Q

At what score are those with UC suggested to have moderately active disease?

A

-When less than all 6 of the criteria for severe disease activity has been met

101
Q

Prior to planning, what should we know about the patient Hx?

A
  • Their appetite and activity
  • Type and duration of IBD, relapse
  • Severity and extent of current symptoms
  • Meds
  • 3 day food record to assess for insufficiencies
102
Q

Prior to planning, what should we observe for in our physical exam?

A
  • Height and weight
  • loss of subcutaneous fat
  • muscle wasting, edema, skin rash
  • hepatomegaly
103
Q

What is stool guaiac?

A

blood in stool

104
Q

Prior to planning, which special tests may be ordered?

A
  • Tests of absorption
  • xylose
  • 73 hr fecal fat
  • lactose breath test (uncomfortable and must consume a lot of lot of lactose(
  • Schillings test
105
Q

What is the xylose absorption test?

A

-Dose of d-xylose provided, which is normally absorbed
-Urine is collected and if xylose low = malabsorption (not absorbed into the bloodstream,
lost in stool)

106
Q

A 72 hr fecal fat tests requires prep for 2 days prior and during the test, what kind of diet needs to be adhered to? Which result indicates malabsorption? When may it indicate crohns’s?

A
  • Regular diet containing 100 g fat or max tolerated
  • Constant amount of fat = best
  • Daily fat intake calculates
  • MCT oil NOT used
  • Then stool fat measured and subtracted
  • -> 6 indicates malabsorption, which is usually very high in Crohn’s
107
Q

What is the lactose breath test/hydrogen breath test?

A
  • 50 g of lactose ( a LOT)
  • If undigested, bacteria in colon will break down
  • H2 absorbed and measured in breath
108
Q

What is the schilling’s test?

A
  • Intravenous B12 is given first, then radioactive B12
  • Look for normal excretion of radioactive B12 in urine
  • -> Lower excretion indicates deficiency (3%(, normal is 8%
109
Q

What does ADA suggest for active IBD nutrition prescription?

A
  • If NS, caution for RF

- If oral; progress to low-fat, low-fibre, high-protein high kcal, SFM and then progress to normal diet as tolerated

110
Q

Which vitamin and minerals are recommended for active IBD?

A
  • Vit , zinc, calcium and magnesium’

- Folate, vit B12,iron

111
Q

Which vit/mins are exceptions to the DRI?

A

-All previously mentioned plus vit E, K, C and copper

112
Q

When should fibre be restricted?

A
  • CI
  • Active IBD
  • Acute flare-ups with exacerbations o strictures
113
Q

Nutrition prescription of IBD in remission?

A
  • Maximize E and P intake for maintenance of weight
  • Avoid foods high in oxalate (FFA)
  • Increase antioxidant intake
  • Consider omega-3 FA and glutamine supplementation
  • Use of pro and prebiotics
114
Q

What is oxalate normally bound to?

A

FFA, but in Crohn’s there is an increase in FFA in lumen due to malabsorption which will bind calcium instead. Oxalate is consequently absorbed, and can form oxalate kidney stones

115
Q

What is a major reason for sub-optimal calcium and vitamin D status?

A

Long term steroid use

116
Q

What is a major reason for sub-optimal folate status? (And subsequent anemia)

A

-Medications, such as methotrexate

117
Q

Province of PEM in CD? UC?

A
  • 50-70%

- 18-62%

118
Q

% of CD underweight at presentation?

119
Q

Is hypoalbuminemia more common in CD or UC hospitalized patients?

120
Q

How does hypoalbuminemia develop in CD compared to UC?

A
  • Develop chronically in CD and more acutely in UC, depending on severity of disease
  • Basis is multi-factorial, pro-inflammatory cytokines, malabsorption, maldigestion, GI losses and reduced intakes
121
Q

What is the general high nutrient density diet in IBD?-

A
  • Fluid of 1ml/kcal
  • E of 25-30 kcal/kg
  • Protein of 1-1.5 g/kg/day
  • High minerals and vitamins
122
Q

Is there as SF consistent for IBD?

A

No, based on symptoms

123
Q

Which key vitamin/minerals to consider in UC?

A
  • Iron
  • Ca (1500 mg)
  • Vitamin D (800-1000 IU)
  • Increase fibre as long as not an acute exacerbated state
124
Q

Other macronutrient considerations of nutritional management with IBD?

A
  • Fibre should be normal (high fibre may prevent relapse)
  • Complex CHO
  • Lactose OK
  • Fat as tolerated, but sometimes low in the event of steatorrhea
125
Q

Why should complex CHO be used?

A

-Keep osmolality low if malabsorption and diarrhea (larger, less quick breakdown)

126
Q

Why should lactose still be included?

A

-Even if we suspect intolerance, we should not entirely exclude milk products –> w e should gradually adapt

127
Q

What are the beneficial effects of dietary fibre intake?

A
  • Decrease gut transit time
  • Increase stool bulking
  • Decreased diarrhea
  • Decreased constipation
128
Q

Which type of fibre will decrease diarrhea?

129
Q

Which type of fibre will decease constipation?

130
Q

What are the effects of fibre in the gut microbiota?

A

-Changes in microbe composition, facilitating SCFA production, regulating gut motility and maintaining functional imunne homeostasis

131
Q

What else does fibre effect on the gut?

A
  • Decrease inflammation
  • Increase permeability
  • Increase tissue healing
  • –> We want to prioritize keeping the gut mucosa healthy
132
Q

You are following two patients. One patient c/o of frequent oily stools and another one has frequent watery stools , which one would benefit from a low oxalate diet?

A
  • Oily stool sis indicative of fat malabsorption

- Therefore, would benefit from low oxalate diet

133
Q

What is the problem with low oxalate intake?

A

We are not 100% sure of the oxalate content in foods

134
Q

What could be an alternative to the low oxalate diet?

A

-Combine with water intake and low fat diet

135
Q

What would be the low-oxalate diet prescription?

A
  • 3-4 L/day water and low fat if steatorrhea
  • Avoid Vitamin C supplements (DRI OK)
  • Urinary oxalate measurements (should be low0
  • One choice/day of high oxalate foods (125 ml)
136
Q

Examples of high oxalate foods?

A
  • Chocolate
  • Tea
  • rhubarb
  • Beets
137
Q

In the high oxalate diet, how should be limit our fruits and vegetables? Whole grains?

A
  • No more than 4-5 servings AND avoid high-oxalate

- Whole grains, breads and cereals nor more the 3/day

138
Q

Examples of appropriate choices for low oxalate diet?

A
  • Apples
  • Pears
  • Bananas
  • Yellow corn
  • Red pepper
  • Onions
  • Mushrooms
  • Peas
139
Q

What are FODMAPs?

A

-Fermentable oligo-di-monosaccharies

and polyols

140
Q

What are examples of disaccharides that are excluded in the low FODMAP diet?

A
  • Fructose, including honey and fruit

- Lactose, including milk, yogurt, cottage cheese and ice-cream

141
Q

What are oligosaccharides excluded in the low FODMAP diet?

A

-Wheat, rye, onions, garlic,legumess

142
Q

What polyols are excluded in the low FODMAP diet?

A

-Plums, avocado, mushrooms, sugar-free gum,tomatoes

143
Q

(T/F) The low FODMAP diet has been should to help manage symptoms in IBD

A

T

But does NOT improve IBD disease activity

144
Q

Is there a validated protocol to reintroduce FODMAPs?

145
Q

What may be a disadvantage of the low FODMAP diet?

A

-Elimination can be a disadvantage to energy intakes, as fermentable SCFA contribute energy

146
Q

Which CAM is on the rise for IBD treatment?

A

Probiotics

147
Q

What was CAM use associated with?

A
  • Less favourable adherence to conventional therapy
  • Those who only used CAM specifically for IBD has this lower adherence
  • Inquiring why a patient uses CAM is important
148
Q

What have trials of probiotics show in Crohn’s disease?

A

-No effects

149
Q

What did trials of probiotics show in UC?

A

-Significant effects with the combination of pre and probiotics

150
Q

Reasons of use of medicinal cannabis?

A
  • Stimulate appetite

- Cannabinoid receptors in GIT and immune system; promise for immune modulating effects

151
Q

What can cannabis be used to alleviate?

A
  • Diarrhea
  • Abdo pain
  • Loss of appetite
152
Q

What is the current evidence to date about cannabis?

A
  • May be helpful for certain symptom of IBD, but lack clear guidelines
  • Cannot recommend as standard tx as of today
153
Q

-RINE and Methotrexate?

A

Immunosuppressive drugs

154
Q

-AZIDE, -AMINE, -AINE?

A
  • Aminosalicylate

- Enteric coated or bacterial cleavage of 5-ADA

155
Q

-IDE/ONE?

A
  • Glucocorticoid

- Oral or IV

156
Q

Ciprofloxacin?

A

-Flouroquinolone antibiotic

157
Q

Infliximab?

A

Anti-TNF monoclonal antibody

158
Q

Metronidazole?

A

Antibiotic

159
Q

Cylocsporine?

A

Immunosuppressive

160
Q

What can cyclosporine elevate?

A

-Elevate serum cholesterol, and grapefruit will increase absorption and increase elimination of the oral form of the drug

161
Q

What are the top nutrient deficiencies in IBD?

A
  • Folate
  • Calcium
  • Vitamin D
162
Q

Which drugs can cause folate deficiency?

A
  • Sulfasalazine (Aminsalicylates)
  • Competes with folate in the intestinal lumen, causes reduced availability of folate
  • Methotrexate –> antagonist to folic acid
163
Q

% deficiency of folate in IBD patients?

164
Q

What happens if there is a folate deficiency? how can we avoid?

A
  • Megoblastic anemia
  • Reduce medications or ad supplemental folate if feasible
  • Consider that DFE is higher for supplements (more bioavailable)
165
Q

Which drugs will impair absorption and retention of calcium

A

Glucocorticoids

166
Q

Why do glucocorticoids impair absorption and retention of calcium?

A

-They alter the action of 1-alpha hydroxylase, an therefore the conversion of 12-OH-D to 1,25 OH-D is altered, implication of bone deminieralization

167
Q

What may glucorticoids increase?

A

Protein needs, cause Na retention

168
Q

____ improved the health-related quality of life in Crohn’s disease patients with long-term disease duration

169
Q

What should be recommended for one of the options for maintenance therapy for Crohns?

170
Q

What needs to be considered about TPN with EN?

A

HIGH risk of infections because of corticosteroids, and the GI tract is an important modulation of the immune symptoms
–> Last resort

171
Q

Contraindications to EN in IBD?

A
  • Oral intake adequate, or can use supplements
  • Fistula
  • SBS (Start with PN)
172
Q

When do fistulas occur? When is PN required?

A
  • Most after Sx, where may take 4-6 weeks to close

- PN needed if high output >500 ml/day

173
Q

When is EN possible with fistula?

A
  • if low output <500 mol/day
  • possible if proximal duodenal or jejunal or lower distal ileal or colonic
  • use low or no fibre
  • feed as distal or proximal to the fistula as possible

Clinical Nutrition 2 (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions