LGI Small Intestine Flashcards
edible plant material that are not digested by enzymes in the small intestine
dietary fiber
fiber DRI
women - 25 g
men - 38 g
soluble fiber sources
oats
legumes
barley
carrots
citrus
Fruits
insoluble fiber diet
whole-wheat products
Bran
Vegetables
Fruit
Seeds
functions and benefits of insoluble fiber
increases fecal bulk
promotes bowel regularity
takes some bile out of the body, and liver has to make more (from LDL I think)
soluble fiber benefits
normalize intestinal transit time and can decrease diarrhea
delays gastric emptying time
decreases serum LDL
may delay glucose absorption
purpose of a high fiber diet
promote normal bowel function
prevent and treat chronic diseases
indications of a high fiber diet
constipation
diverticulitis
hypercholesterolemia
to decrease colon cancer risk
goal of a high fiber diet
≥ 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
how to start higher fiber diet
increase SLOWLY to avoid gas and cramps
what is residue
end result of digestive, secretory, absorptive, and fermentative process (fecal contents)
purpose of low fiber or low residue diet
reduce fecal output temporarily
indications of low fiber or low residue diet
ACUTE intestinal inflammation
- Caron’s disease, diverticulitis
intestinal strictures leading to partial obstruction
s/p (after) intestinal surgery (1 or 2 weeks)
guidelines for a low fiber diet
10-15 grams per day
avoid whole grains, seeds, nuts, legumes, popcorn, raw fruits and veggies, cooked corn, potato skins
parts of a low residue diet include
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
nutritional adequacy of low residue diet or low fiber diet
short term use only
Rx MVI with minerals
sources of excessive intestinal gas / flatulence
aerophagia
bacterial fermentation in GIT
excess flatulence can lead to
abdominal distention
cramping pain
factors that contribute to excess flatulence
decrease GI motility
Physical inactivity
Aerophagia
Dietary factors
Certain GI disorders
MNT for excess flatulence (what foods to avoid?)
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
Other MNT for flatulence
limit aerophagia
- eat slowly, chew with mouth close, avoid carbonated beverages
recommend mild exercise
keep a food and symptom diary to identify problem foods
difficult or infrequent passage of stool
constipation
constipation is sometimes defined as _____ stools per week or no BM for _____, however everybody’s normal is different
<3
3 days
causes of constipation
inadequate fiber intake
insufficient fluid intake
lack of PA
inadequate kcal intake
iron supplements
laxative abuse
habitually ignoring the urge to defecate
medications that cause constipation
opiates
diseases or conditions that can cause constipation
GI disorders
- hemorrhoids, IBS, colonic obstruction
Pregnancy
Hypothyroidism
Neuromuscular diseases
- amyotrophic lateral sclerosis (ALS)
- multiple sclerosis (MS)
- spinal cord injury
medical management of constipation
identify the cause
medications
- evaluate current meds as a cause
- laxatives
- bulking agents/fiber supplements
MNT for constipation
High fiber diet increased gradually to 25-38 g/day
Regular eating pattern
Increase fluid to at least 2 L
increase PA
if total obstruction
NPO until it is resolved
Diarrhea is defined as
passage of ≥3 loose or liquid stools per day
diarrhea occurs when there is …
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
diarrhea can be caused by … (types of diarrhea)
medications
food allergies
osmotic diarrhea
secretory diarrhea
motility disorders
exudative diarrhea
malabsorption diarrheas
medications that cause diarrhea
antibiotics
chemotherapy
osmotic diarrhea cause by
lactose intolerance
excessive sorbitol consumption
dumping syndrom
secretory diarrhea cause by
viral and bacterial infections
- E. coli
- C. difficile
motility disorders that cause diarrhea
dumping syndrome
IBS
surgical resections of the small intestine
exudative diarrhea
mucosal damage caused by inflammatory disease leading to an outpouring of mucus, fluid, blood, and plasma proteins
- ulcerative colitis
- crohn’s disease
- radiation enteritis
malabsorption diarrhea causes
disease process impairs digestion or absorption
- pancreatic insufficiency
- celiac disease
insufficient absorptive surface area
- short bowel syndrome
- causes steatorrhea
clinical manifestations of diarrhea
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)
MNT for acute diarrhea
- 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
symptoms of zinc deficiency
loss of taste
hairloss
poor wound healing
MNT for acute SEVERE diarrhea
IV fluid & electrolyte replacement
May require NPO with parenteral nutrition if prolonged
MNT for chronic diarrhea
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
oral rehydration solutions (ORS) are different because
have higher ratio of sodium to glucose which is ideal to absorb water and electrolytes
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
probiotics
examples of probiotics
lactobacillus
bifidobacteria
Saccharomyces boulardii
sources of probiotics
yogurt (with live active cultures)
acidophilus milk
kefir
probiotic supplements
probiotics are modestly successful in _________
preventing certain types of diarrhea
Dietary substrates used to promote the growth of beneficial intestinal bacteria and lead to the production of short-chain fatty acids (SCFA)
Prebiotics
______ inhibit the growth of some harmful bacteria, energy source for colonocytes, enhance water and electrolyte consumption.
SCFA
prebiotics may help _________
control diarrhea
examples of prebiotics
pectin
fructooligosaccharides (FOS)
oats
bananas
artichokes
lactose intolerant is a deficiency in ______ which leads to inability to digest lactose
lactase
lactose is the __________ in dairy milk
disaccharide
types of lactase deficiency
congenital
primary or genetic
secondary
congenital lactase deficiency
present at birth, rare
primary or genetic lactase deficiency
declines in lactase over time
secondary lactase deficiency
infections of small intestine
intestinal inflammatory disorders
AIDS
intestinal surgery
malnutrition
___% of the world population is lactase deficient
higher prevalence in __________________
65%
Asian, Native American, African, Latino
symptoms of lactose intolerance
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
Diagnosis of lactose intolerance
history of GI symptoms, especially following milk ingestion
elimination diet
abnormal hydrogen breath test
abnormal lactose tolerance test
MNT for lactose intolerance
limit dairy products based on individual tolerance
_________ of milk consumption in small increments can increase tolerance.
gradual increases
Most people can tolerate up to _____ lactose per day
milk tolerAted better as a ______
12 g
meal
lactose restricted diet
additional sources - standard infant formulas, baked goods, processed fats sauces, salad dressings, medications
label reading - milk solids, why, curds, cheese flavors, nonfat milk power
for lactose intolerant infants, _________
reduce lactose formulas or soy formulas
reduced lactose foods/products
aged cheese
yogurt
lactase hydrolyzed milk
lactation milk
enzyme supplement
lactase hydrolyzed milk of _____
70 % reduced lactose - Lactaid
MNT for those who strictly avoid diary products:
educate on other dietary sources of
- calcium
- vitamin D
- if needed, MVI with minerals
ways for lactose intolerant person to increase calcium
fortified OJ
cereals
soy milk
tofu
ways for lactose intolerant person to increase vitamin D
egg yolks
fatty fish (salmon, tuna, mackerel, sardines, catfish)
mushrooms
fortifies soy milk and OJ
celiac disease…, AKA __________ is an autoimmune enteropathy characterized by sensitivity to ________
gluten-sensitive enteropathy
prolamins
when celiac disease individual ingests prolamins, leads to chronic ____________ mediated inflammatory response
T-lymphocyte mediated inflammatory response
celiac disease response results in ______ and ______ to the __________
inflammation and damage
mucosa of the small intestine
1 in every _____ persons in the US have celiac disease
This is _______ and primarily affects ________ race.
onset can occur anytime from ________ through _______
133
hereditary
caucasian
infancy
adulthood
pathophysiology of celiac disease includes a combination of these factors
genetic susceptibility
exposure to gluten
an environmental trigger
an autoimmune response
gluten refers to specific storage proteins (prolamin) found in _____, _____, and ______
Wheat
Rye
Barley
wheat protein
glutenin
gliadin
rye protein
secalin
barley protein
hordein
ingestion of gluten leads to an immune response that cause ______&_____ of the ____ in the ______&______ of the small intestine
atrophy & flattening
villi
duodenum & jejunum
wiping out of villi results in a reduced __________ which can cause ____________
causes malabsorption in all nutrients except maybe ____ which is absorbed in ileum
absorptive surface area
deficiency of disaccharidases & peptidases
B12
classic symptoms of celiac disease
diarrhea
steatorrhea
abdominal bloating & cramps
nausea
anorexia
poor weight gain
fatigue
apathy
additional symptoms that are not classic in celiac disease
iron or folate deficiency anemia
fatigue
diarrhea
constipation
weight loss
additional manifestations that may occur from celiac
osteomalacia
osteopenia
dermatitis herpetiformis (rash)
coagulopathies (problem with blood clotting, vit K def)
infertility
neurological: ataxia (unstable gate), seizures, polyneuropathy
autoimmune diseases that are associated with celiac disease
type 1 DM
autoimmune thyoiditis
autoimmune hepatitis
increased risk for small bowel cancer
how does Celiac get diagnosed
clinical manifestations
blood tests (antibodies)
definitive diagnosis (intestinal biopsy)
treatment for celiac disease
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
celiac treatment goals
relieve symptoms
heal intestine
improve nutritional status
biopsy requires eating gluten. Will not show if you didn’t eat gluten for _____
6 weeks
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
MVI w/minerals
iron or folate
vitamin K
Ca and Vitamin D
fat-soluble vitamin supplement in water-soluble form
gluten free diet for celiac is life long and requires strict compliance to avoid all sources of
wheat
rye
barley
malt
some grains that are allowed
corn
potato
rice
soybean
tapioca
arrowroot
amaranth
buckwheat
flax
legumes
sorghum
quinoa
millet
nuts and seeds
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 ___________.
avenin
pure, uncontaminated
gluten-free oats
examples of gluten-containing additives
hydrolyzed vegetable or plant protein (HVP or HPP)
Flour
Malt or malt flavoring
Malt vinegar
Modified food starch
Dextrin
Soy sauce
gluten free diet education including…
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)
for gluten free labeling, FDA published a regulation in 2013 that. to be labeled as gluten-free, a food must contain <______ of gluten
<20 ppm of gluten
