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IFM GI > IBS digestive insufficiency > Flashcards

IBS digestive insufficiency Flashcards

1
Q

Conjugated Bile Acid Deficiency -

Malabsorbed Substrate?

A

Fat, fat-soluble vitamins,

calcium, magnesium

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2
Q

Pancreatic insufficiency-

Malabsorbed Substrate?

A

Fat, protein, CHO
fat-soluble vitamins,
B12

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3
Q

Reduced mucosal digestion-

Malabsorbed Substrate?

A

CHO, protein

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4
Q

Intraluminal consumption of nutrients-

Malabsorbed Substrate?

A

B12, macronutrients

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5
Q

Reduced mucosal absorption-

Malabsorbed Substrate?

A

Fat, CHO, protein,
vitamins
minerals

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6
Q

Decreased transport-

Malabsorbed Substrate?

A

Fat, protein

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7
Q

Decreased gastric acid, IF-

Malabsorbed Substrate?

A

B12

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8
Q

Rapid gastric emptying,
decreased gastric mixing-
Malabsorbed Substrate?

A

Fat, protein

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9
Q

Conjugated Bile Acid Deficiency - Causes?

A 
Liver disease, 
biliary obstruction, 
SIBO, 
ileal disease,
CCK deficiency
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10
Q

Pancreatic insufficiency- Causes?

A

Congenital,
chronic pancreatitis,
pancreatic tumors,
hyperacidity (inactivating pancreatic enzymes)

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11
Q

Reduced mucosal digestion- Causes?

A 
Mucosal disease (i.e. Crohn’s, Celiac), 
brush border enzyme deficiency (i.e. lactase)
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12
Q

Intraluminal consumption of

nutrients- Causes?

A 
SIBO, 
parasitic infection (i.e. D. latum)
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13
Q

Reduced mucosal absorption - Causes?

A

Mucosal disease (i.e. Crohn’s, Celiac),
intestinal surgery,
infections,
malignancy

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14
Q

Decreased transport- Causes?

A 
Lymphatic disease
venous stasis (i.e. CHF)
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15
Q

Decreased gastric acid, IF- Causes?

A

Atrophic gastritis,
pernicious anemia,
prior gastric resection

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16
Q

Rapid gastric emptying,

decreased gastric mixing- Causes?

A

Gastroparesis
prior surgery,
autonomic dysfunction.*

*Prior gastric surgery (involving the pylorus and or including vagatomy)-accelerated emptying and decreased time for absorption in the small bowel;
Gastroparesis - decreased gastric mixing and impaired protein and fat assimilation

17
Q

Non-invasive marker for evaluating exocrine pancreatic function

A

elastase

18
Q

food derived proteolytic enzymes

A

Bromelain (from pineapple)

• Papain (from papaya)

19
Q

How to appropriately prescribe digestive enzymes

A

Pancreatin Range:
500-2500
units/kg/meal

20
Q

How to appropriately prescribe bile salts,

A

Bile salts (ox bile): 500–1000 mg with food

21
Q

How to appropriately prescribe betaine

hydrochloride

A

Take 1 Betaine HCl tablet (350-750 mg) with a meal that contains
protein.
• If ANY negative symptoms (tingling or warmth in stomach, GERD,
diarrhea, neck ache, etc.), STOP. Experiment is over.
• If no change or feel improvement: Continue for 2 days, then h to 2
tablets at the next protein-containing meal. Increase up to 2500 mg
with meals.

22
Q

Apply select laboratory tools that can help diagnose malabsorption
and maldigestion.

A

Pancreatic Elastase - to check pancreatic function
Increased putrefactive SCFA - think hypochlorhydria
Increased fecal fat – think low bile acid

23
Q

Cholagogues gb/Choleretics (liver)

BOTANICALS

A
  • Dandelion root
  • Taurine
  • Limonene:
24
Q

cholegogue foods

A
  • Coffee
  • Radishes (horse, red, daikon)
  • Dandelion
  • Chicory and other bitter greens
  • Artichoke
25
Q

Promotility drugs

A
  • Prucalopride
  • Low-dose naltrexone
  • Low-dose erythromycin
  • Metoclopramide
26
Q

Non-Pharmacologic Prokinetic Approaches

A
  • Iberogast (adaptogenic herbal formula):
  • Ginger root
  • Tryptophan:
  • Magnesium citrate:
  • Ascorbic acid or Sodium Ascorbate
  • Vitamin D: Minimum D3 5,000 IU qd
  • Swedish bitters:
  • D-Limonene: 1000 mg BID
  • Triphala
  • Chinese Herbs (TJ 43)
  • Acupuncture & acupressure
  • Deep breathing/stress reduction
  • Exercise
27
Q

Cholagogues g/Choleretics (liver)

A
  • Dandelion root (Taraxacum officinale):
  • Taurine: 500–1000 mg with food
  • Limonene:
28
Q

Foods that act as Cholagogues

A
  • Coffee
  • Radishes (horse, red, daikon)
  • Dandelion
  • Chicory and other bitter greens
  • Artichoke
29
Q

Optimal stool transit time

A

12-24 hrs

30
Q

Maintaining motility w food

A

• Increased fruits, vegetables, ancient grains, beans, seeds, water
• Probiotic-rich foods/fermented foods
• Psyllium husks, pectin
• Flax seeds (contain 6-12% mucilage), flaxseed oil
• Cod liver oil
• Natural colonic laxatives: Aloe vera, senna, buckthorn, rhubarb (note that
anthraquinones should not be used long-term as they are stimulant
laxatives)
• Address root causes! E.g., thyroid, diabetes, med side effects, etc

31
Q

promotility drugs

A
  • Prucalopride
  • Low-dose naltrexone
  • Low-dose erythromycin
  • Metoclopramide
32
Q

Non-Pharmacologic Prokinetic Approaches

A

• Iberogast (adaptogenic herbal formula): 20 drops tid
• Ginger root: 1000mg 1-3x/d or 1500-2000 mg/d
• Tryptophan: 1-3, 500 mg caps BID (GI motility is modulated by
serotonin.)
• Magnesium citrate: 250 mg 2-4x/d and/or increase dietary
magnesium consumption
• Ascorbic acid or Sodium Ascorbate: Up to 5 g/d
• Vitamin D: Minimum D3 5,000 IU qd
• Swedish bitters: Gastric - 1 Tbsp before meals
• D-Limonene: 1000 mg BID
• Triphala
• Chinese Herbs (TJ 43)
• Acupuncture & acupressure: 20-30 min, 3x/week
• Deep breathing/stress reduction
• Exercise

33
Q

Iberogast (

A

Prokinetic adaptogenic herbal

IFM GI (8 decks)

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