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Medical Nutrition Therapy > LGI Small Intestine > Flashcards

LGI Small Intestine Flashcards

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USMLE® Step 1 flashcards
1
Q

edible plant material that are not digested by enzymes in the small intestine

A

dietary fiber

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2
Q

fiber DRI

A

women - 25 g
men - 38 g

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3
Q

soluble fiber sources

A

oats
legumes
barley
carrots
citrus
Fruits

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4
Q

insoluble fiber diet

A

whole-wheat products
Bran
Vegetables
Fruit
Seeds

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5
Q

functions and benefits of insoluble fiber

A

increases fecal bulk
promotes bowel regularity
takes some bile out of the body, and liver has to make more (from LDL I think)

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6
Q

soluble fiber benefits

A

normalize intestinal transit time and can decrease diarrhea
delays gastric emptying time
decreases serum LDL
may delay glucose absorption

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7
Q

purpose of a high fiber diet

A

promote normal bowel function
prevent and treat chronic diseases

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8
Q

indications of a high fiber diet

A

constipation
diverticulitis
hypercholesterolemia
to decrease colon cancer risk

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9
Q

goal of a high fiber diet

A

≥ 25-38 grams per day
6-11 servings of whole grains per day
5-8 servings of veggies, legumes, fruits, nuts, and seeds
2 L of fluid for day

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10
Q

how to start higher fiber diet

A

increase SLOWLY to avoid gas and cramps

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11
Q

what is residue

A

end result of digestive, secretory, absorptive, and fermentative process (fecal contents)

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12
Q

purpose of low fiber or low residue diet

A

reduce fecal output temporarily

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13
Q

indications of low fiber or low residue diet

A

ACUTE intestinal inflammation
- Caron’s disease, diverticulitis

intestinal strictures leading to partial obstruction
s/p (after) intestinal surgery (1 or 2 weeks)

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14
Q

guidelines for a low fiber diet

A

10-15 grams per day
avoid whole grains, seeds, nuts, legumes, popcorn, raw fruits and veggies, cooked corn, potato skins

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15
Q

parts of a low residue diet include

A

low fiber diet plus…

avoid excessive sorbitol, mannitol, and xylitol (sugar alcohols attract water leading to osmotic diarrhea)

avoid excessive fructose and sucrose

avoid caffeine and alcohol

limit dairy products if lactose and intolerant

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16
Q

nutritional adequacy of low residue diet or low fiber diet

A

short term use only
Rx MVI with minerals

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17
Q

sources of excessive intestinal gas / flatulence

A

aerophagia
bacterial fermentation in GIT

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18
Q

excess flatulence can lead to

A

abdominal distention
cramping pain

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19
Q

factors that contribute to excess flatulence

A

decrease GI motility
Physical inactivity
Aerophagia
Dietary factors
Certain GI disorders

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20
Q

MNT for excess flatulence (what foods to avoid?)

A

avoid foods that increase gas
- legumes
- vegetables: broccoli, cauliflower, cabbage, Brussel sprouts, onions, mushrooms, artichokes, asparagus
- carbonated beverages and beer
- sugar alcohols
- large amounts of fructose: apples, pears, peaches, fruit juice, HFCS
- whole grains
- Dairy if lactose intolerant

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21
Q

Other MNT for flatulence

A

limit aerophagia
- eat slowly, chew with mouth close, avoid carbonated beverages

recommend mild exercise

keep a food and symptom diary to identify problem foods

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22
Q

difficult or infrequent passage of stool

A

constipation

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23
Q

constipation is sometimes defined as _____ stools per week or no BM for _____, however everybody’s normal is different

A

<3
3 days

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24
Q

causes of constipation

A

inadequate fiber intake
insufficient fluid intake
lack of PA
inadequate kcal intake
iron supplements
laxative abuse
habitually ignoring the urge to defecate

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25
Q

medications that cause constipation

A

opiates

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26
Q

diseases or conditions that can cause constipation

A

GI disorders
- hemorrhoids, IBS, colonic obstruction

Pregnancy

Hypothyroidism

Neuromuscular diseases
- amyotrophic lateral sclerosis (ALS)
- multiple sclerosis (MS)
- spinal cord injury

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27
Q

medical management of constipation

A

identify the cause

medications
- evaluate current meds as a cause
- laxatives
- bulking agents/fiber supplements

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28
Q

MNT for constipation

A

High fiber diet increased gradually to 25-38 g/day

Regular eating pattern

Increase fluid to at least 2 L

increase PA

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29
Q

if total obstruction

A

NPO until it is resolved

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30
Q

Diarrhea is defined as

A

passage of ≥3 loose or liquid stools per day

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31
Q

diarrhea occurs when there is …

A

accelerated transit of intestinal contents through the small intestine

decreased enzymatic digestion of foodstuffs

decreased absorption of fluids and nutrients

increased secretion of fluids into the GI tract

exudative losses

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32
Q

diarrhea can be caused by … (types of diarrhea)

A

medications
food allergies
osmotic diarrhea
secretory diarrhea
motility disorders
exudative diarrhea
malabsorption diarrheas

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33
Q

medications that cause diarrhea

A

antibiotics
chemotherapy

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34
Q

osmotic diarrhea cause by

A

lactose intolerance
excessive sorbitol consumption
dumping syndrom

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35
Q

secretory diarrhea cause by

A

viral and bacterial infections
- E. coli
- C. difficile

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36
Q

motility disorders that cause diarrhea

A

dumping syndrome
IBS
surgical resections of the small intestine

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37
Q

exudative diarrhea

A

mucosal damage caused by inflammatory disease leading to an outpouring of mucus, fluid, blood, and plasma proteins

  • ulcerative colitis
  • crohn’s disease
  • radiation enteritis
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38
Q

malabsorption diarrhea causes

A

disease process impairs digestion or absorption
- pancreatic insufficiency
- celiac disease

insufficient absorptive surface area
- short bowel syndrome
- causes steatorrhea

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39
Q

clinical manifestations of diarrhea

A

dehydration
electrolyte imbalances: losses of Na & K+
metabolic acidosis (bicarb absorbed in blood)
micronutrient deficiencies (Zn)
weight loss
fever (if bacterial or viral etiology)
Bloody stools (if exudative)

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40
Q

MNT for acute diarrhea

A
  • identify & treat cause
  • restore fluid and electrolyte balance (ORS if needed)
  • limit simple sugars & sugar alcohols (lactose, fructose, sucrose, sorbitol, HFCS)
  • limit insoluble fiber sources
  • moderate intake of of soluble fiber sources
  • avoid caffeine & alcohol
  • avoid high fat foods
  • micronutrient replacement if needed
41
Q

symptoms of zinc deficiency

A

loss of taste
hairloss
poor wound healing

42
Q

MNT for acute SEVERE diarrhea

A

IV fluid & electrolyte replacement
May require NPO with parenteral nutrition if prolonged

43
Q

MNT for chronic diarrhea

A

diet modification based on cause of diarrhea

If UKO (UNKOWN ORIGIN) , systematically restrict lactose, fat, insoluble fiber and monitor symptoms

Assess for micronutrient deficiencies
- MVI w/minerals if needed

44
Q

oral rehydration solutions (ORS) are different because

A

have higher ratio of sodium to glucose which is ideal to absorb water and electrolytes

45
Q

live microorganisms (bacteria or yeast) that are the same or similar to those found naturally in intestinal tract that are used to restore beneficial gut flora

A

probiotics

46
Q

examples of probiotics

A

lactobacillus
bifidobacteria
Saccharomyces boulardii

47
Q

sources of probiotics

A

yogurt (with live active cultures)
acidophilus milk
kefir
probiotic supplements

48
Q

probiotics are modestly successful in _________

A

preventing certain types of diarrhea

49
Q

Dietary substrates used to promote the growth of beneficial intestinal bacteria and lead to the production of short-chain fatty acids (SCFA)

A

Prebiotics

50
Q

______ inhibit the growth of some harmful bacteria, energy source for colonocytes, enhance water and electrolyte consumption.

A

SCFA

51
Q

prebiotics may help _________

A

control diarrhea

52
Q

examples of prebiotics

A

pectin
fructooligosaccharides (FOS)
oats
bananas
artichokes

53
Q

lactose intolerant is a deficiency in ______ which leads to inability to digest lactose

A

lactase

54
Q

lactose is the __________ in dairy milk

A

disaccharide

55
Q

types of lactase deficiency

A

congenital
primary or genetic
secondary

56
Q

congenital lactase deficiency

A

present at birth, rare

57
Q

primary or genetic lactase deficiency

A

declines in lactase over time

58
Q

secondary lactase deficiency

A

infections of small intestine
intestinal inflammatory disorders
AIDS
intestinal surgery
malnutrition

59
Q

___% of the world population is lactase deficient

higher prevalence in __________________

A

65%
Asian, Native American, African, Latino

60
Q

symptoms of lactose intolerance

A

after consumption of lactose, indigested lactose enter the colon
- osmotic diarrhea
- chronic bacteria ferment lactose leading to cramps, flatulence, and bloating

severity varies from person to person

61
Q

Diagnosis of lactose intolerance

A

history of GI symptoms, especially following milk ingestion
elimination diet
abnormal hydrogen breath test
abnormal lactose tolerance test

62
Q

MNT for lactose intolerance

A

limit dairy products based on individual tolerance

63
Q

_________ of milk consumption in small increments can increase tolerance.

A

gradual increases

64
Q

Most people can tolerate up to _____ lactose per day
milk tolerAted better as a ______

A

12 g
meal

65
Q

lactose restricted diet

A

additional sources - standard infant formulas, baked goods, processed fats sauces, salad dressings, medications

label reading - milk solids, why, curds, cheese flavors, nonfat milk power

66
Q

for lactose intolerant infants, _________

A

reduce lactose formulas or soy formulas

67
Q

reduced lactose foods/products

A

aged cheese
yogurt
lactase hydrolyzed milk
lactation milk
enzyme supplement

68
Q

lactase hydrolyzed milk of _____

A

70 % reduced lactose - Lactaid

69
Q

MNT for those who strictly avoid diary products:

A

educate on other dietary sources of
- calcium
- vitamin D

  • if needed, MVI with minerals
70
Q

ways for lactose intolerant person to increase calcium

A

fortified OJ
cereals
soy milk
tofu

71
Q

ways for lactose intolerant person to increase vitamin D

A

egg yolks
fatty fish (salmon, tuna, mackerel, sardines, catfish)
mushrooms
fortifies soy milk and OJ

72
Q

celiac disease…, AKA __________ is an autoimmune enteropathy characterized by sensitivity to ________

A

gluten-sensitive enteropathy
prolamins

73
Q

when celiac disease individual ingests prolamins, leads to chronic ____________ mediated inflammatory response

A

T-lymphocyte mediated inflammatory response

74
Q

celiac disease response results in ______ and ______ to the __________

A

inflammation and damage
mucosa of the small intestine

75
Q

1 in every _____ persons in the US have celiac disease

This is _______ and primarily affects ________ race.

onset can occur anytime from ________ through _______

A

133

hereditary
caucasian

infancy
adulthood

76
Q

pathophysiology of celiac disease includes a combination of these factors

A

genetic susceptibility
exposure to gluten
an environmental trigger
an autoimmune response

77
Q

gluten refers to specific storage proteins (prolamin) found in _____, _____, and ______

A

Wheat
Rye
Barley

78
Q

wheat protein

A

glutenin
gliadin

79
Q

rye protein

A

secalin

80
Q

barley protein

A

hordein

81
Q

ingestion of gluten leads to an immune response that cause ______&_____ of the ____ in the ______&______ of the small intestine

A

atrophy & flattening
villi
duodenum & jejunum

82
Q

wiping out of villi results in a reduced __________ which can cause ____________

causes malabsorption in all nutrients except maybe ____ which is absorbed in ileum

A

absorptive surface area
deficiency of disaccharidases & peptidases

B12

83
Q

classic symptoms of celiac disease

A

diarrhea
steatorrhea
abdominal bloating & cramps
nausea
anorexia
poor weight gain
fatigue
apathy

84
Q

additional symptoms that are not classic in celiac disease

A

iron or folate deficiency anemia
fatigue
diarrhea
constipation
weight loss

85
Q

additional manifestations that may occur from celiac

A

osteomalacia
osteopenia
dermatitis herpetiformis (rash)
coagulopathies (problem with blood clotting, vit K def)
infertility
neurological: ataxia (unstable gate), seizures, polyneuropathy

86
Q

autoimmune diseases that are associated with celiac disease

A

type 1 DM
autoimmune thyoiditis
autoimmune hepatitis
increased risk for small bowel cancer

87
Q

how does Celiac get diagnosed

A

clinical manifestations
blood tests (antibodies)
definitive diagnosis (intestinal biopsy)

88
Q

treatment for celiac disease

A

MNT ONLY

complete withdrawal of gluten/prolamins

initially may require a 40 gram low fat diet and a low lactose diet to control diarrhea

fluid & electrolyte replacement

89
Q

celiac treatment goals

A

relieve symptoms
heal intestine
improve nutritional status

90
Q

biopsy requires eating gluten. Will not show if you didn’t eat gluten for _____

A

6 weeks

91
Q

Celiac Disease

consider the need for a ________ to meet the DRIs

additional supplements include
_____ or _____ for anemia
______ for prolonged bleeding
_____ and ____ for osteopenia/osteomalacia
__________ if experiencing steatorrhea

A

MVI w/minerals

iron or folate
vitamin K
Ca and Vitamin D
fat-soluble vitamin supplement in water-soluble form

92
Q

gluten free diet for celiac is life long and requires strict compliance to avoid all sources of

A

wheat
rye
barley
malt

93
Q

some grains that are allowed

A

corn
potato
rice
soybean
tapioca
arrowroot
amaranth
buckwheat
flax
legumes
sorghum
quinoa
millet
nuts and seeds

94
Q

Oats is controversial for celiac
The prolamin in oats (______) is not thought to be harmful, however, contamination with wheat or barley is of concern, so only use ___________ or ___________.

A

avenin

pure, uncontaminated
gluten-free oats

95
Q

examples of gluten-containing additives

A

hydrolyzed vegetable or plant protein (HVP or HPP)
Flour
Malt or malt flavoring
Malt vinegar
Modified food starch
Dextrin
Soy sauce

96
Q

gluten free diet education including…

A

reviewing foods to avoid and alternatives
gluten containing additives
issue of cross contamination
dining out
label reading
where to purchase gluten free foods
food prep (grill, toaster, cutting boards)

97
Q

for gluten free labeling, FDA published a regulation in 2013 that. to be labeled as gluten-free, a food must contain <______ of gluten

A

<20 ppm of gluten

98
Q
A

Medical Nutrition Therapy (12 decks)

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