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NUTR 442 > Krause 28: lower GI > Flashcards

Krause 28: lower GI Flashcards

1
Q

celiac disease also called:

A

gluten sensitive enteropathy

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2
Q

peak in diagnosis of celiac happens in ____ decade

A

4th to 6th

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3
Q

classic GI symptoms of celiac?

A

bloating, diarrhea, steatorrhea, malodorous stools, apathy, fatigue, poor wt gain

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4
Q

nutritional symptoms and conditions associated with celiac:

A

anemia, osteomalacia, lactase deficiency, delayed growth, dental enamel hypoplasia, coagulopathies

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5
Q

extraintestinal symptoms and conditions associated with celiac

A

lassitude, malaise, arthritis, arthralgia, dermatitis, infertility, hepatic steatosis, neuro symptoms, psych syndromes

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6
Q

disorders associated with celiac:

A

autoimmune disease, GI malignacy, IgA deficiency

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7
Q

celiac frequently misdiagnosed as :

A

IBS, lactase deficiency, gallbladder disease

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8
Q

a manifestation of CD that presents as itchy skin rash:

A

dermatitis herpetiformis

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9
Q

celiac is characterized by these 4 factors:

A

1) genetic susceptibility 2) exposure to gluten 3) enviro trigger 4) autoimmune response

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10
Q

specific peptide fractions of proteins found in wheat

A

gluten

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11
Q

why gluten problem in celiac?

A

resist complete digestions, reach small intestine intact and translocate from lumen, across epithelium, into lamina propria and trigger inflamm response–>flatten villi and systemic immune response triggered

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12
Q

term used to descibe ppl with nonspecific symptoms, without immune response of CD or intestinal damage

A

gluten sensitivity

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13
Q

term to describe ppl who have symptoms and may/may not have CD

A

gluten intolerance

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14
Q

why not follow GF diet until have workup to exclude/confirm diagnose CD?

A

1) underlying med condition for which GF diet is not treatment 2) after following GF diet for a while it is difficult to diagnose CD 3) GF diet expensive and restrictive

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15
Q

celiac mostly affects ___ sections of small bowel

A

proximal/mid

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16
Q

gold standard for celiac diagnosis?

A

biopsy

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17
Q

refractory celiac ppl may respond to:

A

steroids, cyclosporine, azathioprine

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18
Q

newly diagnosed celiac should have these lab values checked:

A

vit D, ferritin, red blood cell folate

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19
Q

2 types of antibodies considered in celiac:

A

antigluten and antiself

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20
Q

2 major forms of IBD

A

crohn’s and UC

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21
Q

onset of IBD usually occue in pt ____ yrs

A

15-30

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22
Q

shared clinical characteristics of crohn’s and colitis:

A

diarrhea, fever, wt loss, anemia, food intolerance, malnutrition, growth failure, extraintestinal manifestations

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23
Q

malnutrition more a concern in crohn’s or colitis?

A

crohn’s

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24
Q

enviro factors to IBD?

A

resident and transient microorganisms in GI tract, diet components

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25
Q

strictures and fistulas very rare in ___ and common in ___

A

UC; crohn’s

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26
Q

rectum always involved in ___

A

ulcerative colitis

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27
Q

___ is continuous whereas ___ can occur anywhere along GI

A

UC; crohn’s

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28
Q

which has more inflamm, crohn’s or UC?

A

crohn’s

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29
Q

deeper ulcers in UC or colitis?

A

UC

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30
Q

thin wall in ___ and thick wall in ___

A

UC; crohn’s

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31
Q

granulomas in crohn’s or UC?

A

crohn’s

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32
Q

bleeding more common uc or crohn’s

A

uc

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33
Q

goals of treatment in IBD are to induce and maintain ____ and to improve ___

A

remission; nutr status

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34
Q

___ normally used in severe Crohn’s but not UC

A

Anti-TNF

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35
Q

in terms of MNT for IBD, shown these 4 things:

A

1) nutr support may bring about some clinical remission when used solely 2) complete bowel rest using PN not necessarily required 3) EN potential to feed intestinal epithelium and alter GI flora and is preferred 4) EN may temper some inflamm and serve as valuable nutr source, steroid sparing 5) kids benefit from EN as sole or supplement

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36
Q

malnutrition compromises digestive and absorptive fxn cuz increases ____ of GI and potential ___ agents

A

permeability ;inflammatory

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37
Q

PN may need in pt with:

A

persistent bowel obstruction, fistulas, major GI resections (SBS)

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38
Q

___g/kg/d of pro recommended

A

1.3-1.5

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39
Q

use of omega 3s helpful?

A

yes (reduce disease activity and med sparing effect, ^ remission)

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40
Q

pt with _____ benefit from reduced fibre and smaller food particle size

A

strictures or partial bowel obstruction

41
Q

when fat malabsorption likely, supplement with foods made with:

A

MCTs

42
Q

___ probiotic supplements shown to be beneficial in maintaining remission in pt with UC who had ____

A

multistrain; pouchitis (inflamm of ileal pouch acter colectomy)

43
Q

using pro and prebiotics may prevent ___ and be used to treat ____

A

SIBO; diarrhea

44
Q

___ colitis characterized by inflammation not visible by inspection of colon during colonoscopy and apparent only when lining biopsied

A

microscopic

45
Q

types of microscopic colitis:

A

lymphocytic colitis and collagenous colitis

46
Q

what is SBS

A

inadequate absorptive capacity resulting from reduced length or decreased functional bowel after resection

47
Q

SBS is ___cm of small bowel without colon or ___cm with colon

A

100-120; 50

48
Q

jejunal enterohormones:

A

CCK (pancreatic secretion/gallbladder contraction), secretin (bicarbonate), gastric inhibitory peptide, vasoactive inhibitory peptide

49
Q

after jejunal resection, ___ adapts to replace fxn

A

ileum

50
Q

_____ is only site for absorption of bile salts and vit B12 - intrinsic factor complex, also a lot of fluid

A

distal ileum

51
Q

probs with malabsorbing bile salts?

A

can’t emulsify lipids so poorly absorbed and lead to malabsorb fat soluble vits as well, fats form f.a.-mineral soaps with Ca, Zn, and Mg so they are poorly absorbed as well, oxalate stones

52
Q

preservation of colon essential for ___ status

A

hydration

53
Q

malabsorption of bile salts can act as ____ which increases colonic motility with fluid and electrolyte losses

A

mucosal irritant

54
Q

high fat diet + ileal resection + retained colon =

A

hydroxy fatty acids (^ fluid loss)

55
Q

dependence on __ ^ risk of biliary sludge

A

PN

56
Q

primary gut slowing meds?

A

loperamide and narcotics

57
Q

most pt with significant bowel resection requires ___

A

PN

58
Q

__ is preferred fuel for small intestinal enterocytes

A

glutamine

59
Q

___ are major fuels for colon epithelium

A

SCFAs

60
Q

severity of SBS depends on:

A

length/anatomy of bowel resected, health of remaining mucosa, presence of intact stomach/pancreas/liver

61
Q

intestinal adaptation evidenced by:

A

hyperplasia of intestinal cells, ^ villus height, deepening of crypts, ^ transporter proteins

62
Q

hormones to help intestinal adaptation?

A

recombinant human growth hormone, glucagon-like peptide 2

63
Q

syndrome characterized by overproliferation of bacteria normally found in large intestine within small intestine

A

SIBO

64
Q

causes of SIBO?

A

chronic use of meds suppressing gastric acid, liver disease/chronic pancreatitis, gastroparesis, bowel dysmotility, surgical resection of distal ileum and ileocecal valve

65
Q

one of the most common symptoms of SIBO

A

chronic diarrhea (fat maldigestion)

66
Q

what does bacteria in SIBO do?

A

toxic effects of bacterial products to brush border, use available vit B12 and make host deficient, produce folic acid, bloating/distention

67
Q

rare neurologic complication of SIBO:

A

d-lactic acidosis (malabsorption of large CHO load)

68
Q

treatment for SIBO?

A

therapeutic trial of antibiotics when suspicion is high (broad-spectrum)

69
Q

diet for SIBO?

A

limit readily fermented carbohydrates (refined starch/sugar), more vit B12, MCTs, fat sol vits

70
Q

abnormal passage of organ to another organ, skin, or wound called:

A

fistula

71
Q

what is enterocutaneous fistula?

A

abnormal passage from portion of intestinal tract to skin or to wound

72
Q

ECF classified how?

A

volume of output per day, cause (surgical vs spontaneous), site of origin, # fistula tracts

73
Q

majority of ECF develops cuz of __

A

surgery

74
Q

gold standard for identifying location and route of fistulous tract:

A

fistulogram

75
Q

surgically created opening between intestinal tract and skin

A

intestinal ostomy

76
Q

colostomies and ileostomies categorized either ___ or ___

A

loop (more temp); end

77
Q

output from ileostomy is termed ___ whereas output from colostomy is ___

A

effluent; stool

78
Q

stool from colostomy on __ side of colon is firmer than on ___ side

A

left; right

79
Q

should we wait to feed when bowel functions again?

A

no, can start early

80
Q

diet for ostomy:

A

low fibre diet

81
Q

controlling flatus/odour more concern for ____ pt than ___ pt

A

colostomy; ileostomy

82
Q

risk of ____ for ileostomy, so chew food well

A

blockage

83
Q

ostomy output may become elevated, more common with ___

A

ileostomy

84
Q

a high output stoma is output > ___ mL/day over 3 consecutive days

A

2000

85
Q

reasons for high output stoma?

A

c diff, meds, intraab sepsis, obstruction, drinking too much, IBD

86
Q

managing HOS?

A

correction of depleted electrolytes and minerals, initiate oral rehydration solution, avoid hypertonic/simple sugar, reduce insoluble fibre, separate solids and liquids at meals, small frequent meals

87
Q

two classes of meds recommended to reduce HOS:

A

antidiarrheal, antisecretory

88
Q

surgery of choice for pt with medically refractory UC and familial adenomatous polyposis

A

proctocolectomy with ileal pouch anal anastomosis

89
Q

what does proctocolectomy with IPAA involve?

A

removal of entire colon and rectum while preserving anal sphincter

90
Q

most common pouch in IPAA?

A

ileal J-pouch (two limbs of bowel)

91
Q

why J pouch preferred?

A

efficiency of construction and optimal functional results

92
Q

alternatives to J pouch:

A

S and W

93
Q

type of applianceless ileostomy that uses internal reservoir with one way valve, constructed from loop of intestine attached to ab wall with skin level stoma

A

koch pouch

94
Q

non specific inflamm of mucosal tissue forming ileal pouch and is most frequent long term complication of IPAA in pt with UC

A

pouchitis

95
Q

why pouchitis?

A

SIBO, unrecognized crohn’s, immun changes, bile salt malabsorb, insufficient SCFA production

96
Q

presenting symptoms pouchitis:

A

stool frequency/urgency, incontinence, nocturnal seepage, ab cramps, pelvic discomfort

97
Q

main treatment for pouchitis?

A

antibiotics

98
Q

IPAA people need supplement vit B12 cuz:

A

reduced absorb capacity cuz distal ileal resection, bacterial overgrowth, insufficient intake

NUTR 442 (34 decks)

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