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Clin 2 > IBS > Flashcards

IBS Flashcards

1
Q

What is Crohn’s disease characterized by? What is the major player?

A

dysfunctional regulatory T cells, which normally control proinflammatory cytokine release. If activated antigen presenting cells and lymphocytes are allowed to overly secrete proinflammatory cytokines, then tissue damage may result from prolonged inflammation
TNF alpha

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2
Q

What is the difference between ulcerative colitis and corhn’s?

A

Ulcerative is a full section of the colon whereas crohn’s is varias small sections

UC: ulcerations lead to toxic megacolon, thin, ulcerated colon
Crohn’s: fistulas, strictures, obstruction

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3
Q

How can IBD be diagnosed?

A
  • symptoms
  • upper GI series
  • plain xRays
  • upper GI endoscopy
  • ultrasound
  • MRI
  • colonoscopy
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4
Q

How can a patient prepare for a colonoscopy (4 steps)?

A
  • obtain a bowel preparation solution at least 2 days before the test
  • clear liquids all day before the test. From 6-8pm drink 2L of any PEG-based solution
  • 4h before appointment drink remaining 2L of the PEG-based solution and finish 2h before the test
  • stop drinking all liquids including water 2h before the test
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5
Q

What are the clinical manifestations of IBD?

A
  • abdominal pain
  • febrile, tachycardic
  • CRP elevated
  • WBC elevated
  • weight loss
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6
Q

What are the characteristics/symptoms of small intestinal Crohn’s?

A
  • obstructive in nature
  • pain with eating
  • palpitation causes pain in lower right quadrant
  • anorexia and diarrhea
  • malabsorption (lactose intolerance)
  • ileocolonic disease
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7
Q

What are the characteristics of colonic Crohn’s?

A
  • similar to UC but with:
  • diarrhea often contains blood -> hematochezia)
  • pain prior to defecation
  • perianal skin tags
  • deep anal fissures
  • perianal fistula
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8
Q

What are the systemic and extraintestinal manifestations?

A
  • fever
  • weight loss
  • arthritis
  • oral ulcers and skin lesions
  • urinary tract disease
  • enhanced oxalate absorption (kidney stones)
  • altered body composition
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9
Q

What are the 4 stages of Crohn’s disease?

A
  1. Mild-moderate
    - ambulatory
    - able to tolerate oral intake without dehydration
    - toxicity (fevers)
    - abdominal tenderness
    - painful mass
    - obstruction
    >10% weight loss
  2. Moderate-severe
    - failure to respond to treatment for mild-moderate disease or
    - those with more major symptoms of fevers
    - significant weight loss
    - abdominal pain or tenderness
    - intermittent nausea or vomiting
    - significant anemia
  3. Severe-fulminant
    - persisting symptoms in spite of steroid Rx or
    - those presenting with high fever, persistent vomiting
    - evidence intestinal obstruction
    - rebound tenderness
    - cachexia
    - evidence of abscess
  4. Remission
    - asymptomatic
    - without inflammation sequelae and
    - includes those who have responded to acute medical intervention or surgical resection without gross evidence or residual disease
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10
Q

What are the 4 tests of absorption?

A
  1. xylose test - low excretion = malabsorption
  2. 72h fecal test - >6g = malabsorption
  3. lactose breath - 50g of lactose and hydrogen in breath is measured
  4. low excretion of B12 = deficiency
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11
Q

What are the 5 main feeding issues?

A
  1. long-term steroid use = calcium and vit D deficiency
  2. insufficient intake/anorexia = PEM
  3. medications to treat IBD = folate deficiency
  4. SBS/intestinal losses = Mg, Zc, fluid and electrolyte deficiencies
  5. Blood losses in IBD = iron deficiency
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12
Q

What is necessary in the low oxalate diet?

A
  • 3-4L water/d
  • low fat
  • vit C supplements NOT recommended
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13
Q

What is the most common CAM?

A

probiotics

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14
Q

What meds contribute to folate deficiency and what does it cause?

A

sulfasalazine and methotrexate

- contributes to anemia

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15
Q

What medication contributes to calcium and vitamin D deficiency?

A

glucocorticoids (prednisone)

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16
Q

What is the nutritional management for IBD?

A 
Fluids: 1ml/kcal
E: 25-30kcal/kg or more
Pro: 1-1.5g/kg
High minerals and vitamins
normal fiber
complex carb 
no need to limit lactose
fat as tolerated
ca and vit D supplements if needed (if on glucosteroids)
17
Q

What is done in active IBD according to the Nutrition Care Manual?

A

nutrition support (EN > PN)
progress to low-fat, low-fiber, high protein, small frequent meals
give vit D, B12, zinc, calcium, magnesium, folate, iron

18
Q

What is done in remission IBD according to the Nutrition Care Manual?

A

maximize E and Pro intake for maintenance or gain of weight
Avoid high oxalate
Increase antioxidant intake
Consider supplementation with O3 and glutamine
Use pro+prebiotics

Clin 2 (11 decks)

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