LAST MNT TEST EVAR HOPEFULLY!

Question 1

What foods increase or decrease LES

Answer 1

increase -

decrease - peppermint,coffee,high fat

Question 2

Common medications-gerd

Answer 2

Proton pump inhibitors
. Histamine-r2eceptoarntagonists . Antacids
. Prokinetiacgents
. Fundoplica

Question 3

What is Fundoplication

Answer 3

, a procedure in which the fundus of the stomach is wrapped around the lower esophagus to limit reflux

Question 4

Esophagitis

Answer 4

Inflammation, ulceration, erosions, scarring
Acute from reflux, ingestion of a corrosive agent, infection, intubation, radiation, eosinophilic infiltration
Chronic from prolonged contact with gastric acid or other irritant (e.g., NSAIDs)
Barrett’s esophagus results in 5% to 15%

Question 5

Etiology of hiatal hernia

Answer 5

An outpouching of a portion of the stomach into the chest through the esophageal hiatus of the diaphragm
Epigastric discomfort after large, energy-dense meals

Question 6

MNT hiatal hernia

Answer 6

Medical nutrition therapy: weight reduction, decreasing meal size
May require surgery

Question 7

Difference between gastric and duodenal ulcers

Answer 7

Gastric ulcers: in stomach; normal or low acid secretion
Duodenal ulcers: in duodenum; high acid secretion
Gastric ulcer formation involves widespread gastritis, inflammation of oxyntic cells, and atrophy of acid- and pepsin-producing cells
Duodenal ulcers are associated with high acid and low bicarbonate secretion

Question 8

Medications – ulcers n stuff

Answer 8

H2 receptor blockers, antacids

Question 9

dumping syndrome Describe and– symptoms

Answer 9

Complex physiologic response to the rapid emptying of hypertonic contents into the duodenum and jejunum
Dumping syndrome occurs as a result of total or subtotal gastrectomy
Symptoms: abdominal fullness, nausea, flushing, rapid heartbeat, faintness, sweating, flatulence, abdominal cramps, diarrhea, alimentary hypoglycemia
Often causes weight loss

Question 10

dumping syndrome mnt

Answer 10

Small meals spread throughout the day are likely to result in improved net absorption and less dramatic fluid shifts.
High-protein, moderate-fat foods are recommended, with sufficient calories for weight maintenance or gain as needed. Complex carbohydrates are included as tolerated.
Intake of fibrous foods slows upper GI transit and increases viscosity. However, to avoid obstruction, caution should be used with large particles and fiber supplements, especially with esophageal or gastric outlet narrowing or dysmotility.
Lying down and avoiding activity an hour after eating may help slow gastric emptying.
Taking large amounts of liquids with meals is thought to hasten GI transit, but adequate amounts of liquid should be consumed throughout the day, small amounts at a time.
Only very small quantities of hypertonic, concentrated sweets should be ingested. These include soft drinks, juices, pies, cakes, cookies, and frozen desserts (unless made with sugar substitutes).
Lactose, especially in milk or ice cream, may be poorly tolerated because of rapid transit and thus may need to be avoided. Cheeses and yogurt are likely to be better tolerated.

Question 11

Hypoglycemia and gastrectomy

Answer 11

one causes the other

Question 12

types of diarrhea

Answer 12

Osmotic
Osmotic diarrheas occur when osmotically active solutes are present in the intestinal tract and are poorly absorbed.
Secretory
Secretory diarrhea the result of active intestinal secretion of electrolytes and water by the intestinal epithelium
Medication induced be caused by several medications, but especiallyantibiotics. Antibiotics can reduce the usual “salvage” by colonic bacteria of the small amounts of foods that escape digestion and absorption.
Malabsorptive
Malabsorptive diarrheais often complicated by steatorrhea (lipid malabsorption) and maldigestion of other macronutri- ents or micronutrients.

Question 13

mnt for diarrhea

Answer 13

Identify and treat underlying problem
Replace fluid and electrolytes; oral glucose electrolyte solutions with potassium, soups and broths, vegetable juices, and other isotonic liquids
Introduce starchy CHOs, low-fat meats, and small amounts of vegetables and fruits followed by lipids
Avoid sugar alcohols, lactose, fructose
Prebiotics and probiotics

Question 14

Steateorrhea

How is it diagnosed

Answer 14

Diagnosis is usually basedon a ratio offecal fat to ingested fat or a coeffrcient of absorption. A diet containing 75 to 100 g of fat is usually fed for 72hours,the amount of fat actually consumed is recorded, and the fecalfat content is analyzed.The upper limit of nor- mal fecal fat is usually in the range of 7%.

Question 15

MNT MCT oil – calories/rationale for using it,

Answer 15

The MCTs are available in some enteral formulas and also as MCT oil (8.3kcallkg).The oil is best used when it is incorporated into foods rather than administered by the spoonful.MCTs can be used to make salad dressings,sandwich spreads,or confections; and they can be substituted for fats in most recipes.Normally divided doses of less than 15 g of oil per feeding are better tolerated and absorbed than larger quantities. When steatorrhea is present, vitamin deficiencies may occur, especially of fat-soluble vitamins; calcium, zinc, and magnesium losses are increased as a result of the formation of insoluble soaps.

Question 16

Constipation

High fiber/water – know recommended amounts

Answer 16

individuals it is a large departure from their normal intake. Reaching the recommended levels of fiber may be sufficient to achieve normal laxation in many individuals, but a high-fiber therapeutic diet may need to exceed25 to 38 g. However, amounts greater than 50 g/day are not likely to be necessary and may increase abdominal distention and excessive flatulence in some persons. Appendix 41 provides a list of the fiber content of foods
Consumption of at least eight 8-oz glasses(2 L) of fluids daily is recommended to facilitate t}le effectiveness of a high-fiber intake.

Question 17

Celiac Disease

MNT

Answer 17

Omit sources of gluten: wheat, rye, barley
Label reading is critical

Oats are questionable
Cross-contamination must be considered

Question 18

Gluten Free Grains

Answer 18

Use uncontaminated corn, potato, rice, soybean, tapioca, arrowroot, amaranth, quinoa, millet, and buckwheat

Question 19

Lactose Intolerance and MNT

Lactose content of dairy products

Answer 19

Many adults with intolerance to moderate amounts of milk can ultimately adapt to and tolerate 12 g or more of lactose in milk (equivalent to 240 ml of full lactose milk)

Question 20

Inflammatory Bowel Disease
Know the difference between Crohn’s disease and Ulcerative Colitis,
and common signs for both

Answer 20

Crohn’s disease or ulcerative colitis
Both cause diarrhea, fever, weight loss, anemia, food intolerances, malnutrition, growth failure, and extraintestinal manifestations (arthritic, dermatologic, and hepatic); associated with malignancy
Crohn’s disease: may involve any part of the GIT; most in distal ileum and colon; segments of inflamed bowel; transmural
Ulcerative colitis: is a mucosal disease of the large intestine, including the rectum

Question 21

mnt for ibd

Answer 21

Fears and misconceptions; individualize
Nutrition support with parenteral or enteral nutrition to bring clinical remission
“Complete bowel rest” using PN not necessarily required
Enteral nutrition may temper inflammatory process and be steroid sparing and is preferred over PN
Children benefit from enteral nutrition to maintain growth and reduce steroid dependence
Vitamins, folate, vitamin B6, and vitamin B12 may require supplementation

Question 22

Irritable Bowel Syndrome

MNT,

Answer 22

Common syndrome involving abdominal discomfort and altered intestinal motility, bloating, feelings of incomplete evacuation, mucus in stool, straining or increased urgency, GI distress with psychosocial distress
Ensure adequate nutrient intake, tailor diet for specific pattern of IBS, management of symptoms, adequate fiber, prebiotics

Question 23

Pathophysiology of ibs

Answer 23

he normal enteric nervous system is sensitive to the presence, chemical composition, and volume of foods and also responds to a variety of inputs from the central nervous system(seeChapter1).Increasedawarenesasndsensitivity of the GI tract to internal and externalstimuli and altered modlity appearto be primary featuresof IBS

Question 24

Diverticulitis/Diverticulosis

MNT for both conditions including for acute flare of diverticulitis and long term diet after inflammation is over

Answer 24

Herniations of the colon, chronic diverticulosis, acute diverticulitis
Diverticulosis: high-fiber diet, increase gradually, supplements if necessary, adequate fluid intake
Diverticulitis: low-residue or elemental diet, possibly low-fat diet
Seeds, nuts, or skins unresolved

Question 25

Diagnosing of SBS

Answer 25

Loss of 70% to 75% of the small bowel usually results in SBS:
- 100 to 120 cm of small bowel without a colon
- 50 cm of small bowel with the colon intact
Causes weight loss; diarrhea; decreased transit time; malabsorption; dehydration; loss of electrolytes; hypokalemia

Question 26

MNT sbs

Answer 26

Step 1
Parenteral only for most patients
Step 2
Gradually introduce enteral nutrition; start early
Glutamine, nucleotides, SCFAs, are important nutrients for the gut
Narcotic drugs for pain cause GI problems and should be evaluated

Question 27

Explain Blind Loop Syndrome

Answer 27

Bacterial overgrowth from stasis in the intestine, obstruction, radiation enteritis, fistula, or surgical repair

Question 28

Ileostomy/Colostomy : Description and MNT (odor-causing foods to avoid

Answer 28

Surgical Opening of Intestine to Outside
Causes: ulcerative colitis, Crohn’s disease, colon cancer, trauma
Treatment
Nutrition needs vary with location and individual
Avoid gas- and odor-forming foods
Fluid and electrolyte needs
Vitamin B12 if loss of terminal ileum
Foods that tend to cause odor from a colostomy are legumes,onions, garlic, cabbage,eggs, fish, some medications, and some vitamin and mineral supplement

Question 29

Review the principles of low residue diet

Answer 29

Lactose(in lactosemalabsorbers)
Fiber (quantities >20 g)
Resistantstarch(especiallyrafifinoseandstachyose found in legumes)
Sorbitol, mannitol, and rylitol (excess,>10 g/day) Fructose (excess,20-25 g/meal)
Sucrose(excess>, 25-50 g/meal)
Caffeine
Alcoholic beverages(especiallywine and beer)
Comments
6-12g normally toleratedin healthylactase-deficientindividuals,but may not be in someindividuals
Modest amounts(10-15 g) may help maintain normal consistenryof gastrointestinal(GD contents and normal colonic mucosain healthy statesandGI disease
Well toleratedin moderateamounts;largeamountsmaycause hlryerosmolardiarrheaor decreasedfecalpH with fermentation to short-chain fatty acids
lncreasesGI secretions,colonic motility
fncreaseGI secretions

Question 30

Liver

Functions of the Liver,

Answer 30

Integral to most body functions
Performs more than 500 tasks
You cannot survive without a liver, but only 10% to 20% of function is needed to sustain life
The liver has the ability to regenerate
the main functions of the liver include metabolism of carbohydrate,protein, and fat; storage and activation of vitamins and minerals; formation and excretion of bile; conversion of ammonia to urea; metabolism of steroids;and action asa filter and flood chamber.

Question 31

Explain development of varices and ascites when a person has portal HTN

Answer 31

Portal hypertension increasescollateral blood flow and can result in varices in the gastrointestinal tract. These varices often bleed, causing a medical emergency High pressure in vessels supplying the liver may cause ruptured varicesand accumulation of fluid in the abdominal cavity.

Question 32

What is the common antibiotic that lowers ammonia

Answer 32

Neomycin is a non absorbable antibiotic that helps decrease colonic ammonia production.

Question 33

MNT and medical tx for Cirrhosis with and without hepatic encephalopathy

Answer 33

In general, energy requirements for patients with ESLD and without ascitesare about l20o/oto l40o/” of the REE. Requirements increase to 150% to l7 5o/oof REE if ascites,infection, or malabsorption is present or if nutritional repletion is necessary.This equatesto about 25 to 35 calories per kilogram body weight; estimated dry body weight should be used in calculations to prevent overfeed- ing.
Therefore, in uncomplicated hepatitis or cirrhosis without encephalopathy,protein requirements range from 0.8 to I g/kg of dry weight per day to achieve nitrogen balance.
To promote nitrogen accumulation or positive balance,at least1.2to 1.3glkg daily is neededQ’{ielsenetal.,1995).In situations of stresssuch as alcoholic hepatitis or decompen- sated disease (sepsis, infection, gastrointestinal bleeding, severeascites),at least 1.5g ofprotein per kilogram per day should be provided.
Therefore, in uncomplicated hepatitis or cirrhosis without encephalopathy,protein requirements range from 0.8 to I g/kg of dry weight per day to achieve nitrogen balance.
To promote nitrogen accumulation or positive balance,at least1.2to 1.3glkg dailyisneededQ’{ielsenetal.,1995).In situations of stresssuch as alcoholic hepatitis or decompen- sated disease (sepsis, infection, gastrointestinal bleeding, severeascites),at least 1.5g ofprotein per kilogram per day should be provided.

Question 34

When BCAA can be used and rationale

Answer 34

The BCAAs furnish as much as 30% of energy require- ments for skeletalmuscle,heart, and brain when gluconeo- genesis and ketogenesis are depressed (Latifi et al., l99l). This causessemm BCAA levels to fall. At the same rime, plasma AAfu and methionine are released into circulation by muscle proteolysis, but the slmthesis into protein and liver clearanceof AAAs is depressed

Question 35

Functions of the Gallbladder

Answer 35

The main function of the gallbladder is to concentrate,store, and excretebile, which is produced by thelive

Question 36

MNT for cholecystitis; what is the rationale for using a low fat diet

Answer 36

Cholelithiasis: avoid obesity and fasting; follow a low-fat diet
Acute cholecystitis: hold feedings or PN; then low-fat diet
Chronic cholecystitis: low-fat diet
Acute cholangitis
Sclerosing cholangitis
Cholestasis: occurs when no enteral feedings
High dietary fat intake over a prolonged period may predispose a person to gallstone formation because of the constant stimulus to produce more cholesterol for bile synthesis required in fat digestion.

Question 37

Pancreatitis Acute and Chronic and MNT,

What happens when there is not sufficient pancreatic lipase?

Answer 37

Acute pancreatitis
Withhold oral feeding; maintain hydration intravenously
Progress diet as tolerated; low-fat diet, six small meals
Nutrition support as needed
Chronic pancreatitis
High risk for PEM
Antioxidants, pancreatic enzymes, MCT
Glucose intolerance

fat malabsorbtion

Question 38

Know the nutrients that are absorbed in each part of the GI tract

Answer 38

stomach- intrinsic factor, pepsin to protein
duodenum - triglycerides, amino acids, cho,iron
jejunum - calcium,folate,a,d,e,k, water, b12

Question 39

Cholelithiasis

Answer 39

presence or formation of gallstone

Question 40

steatosis

Answer 40

fat deposition

Question 41

choledocholithiasis

Answer 41

develops when stones slip into the bile ducts, producing obstruction, pain, and cramp

Question 42

fistula

Answer 42

abnormal connection between an organ

Question 43

Nutrition Care Process

Answer 43

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