Lower GI Flashcards
______ is a disease of the intestines, caused by a sensitivity to gluten.
Celiacs
T/F: Celiacs is also known as gluten sensitive enteropathy.
True
____ is a protein found in wheat, barely, and rye.
Gluten
T/F: It’s believed that most people with celiacs have a genetic disposition, but not everyone with a genetic disposition will develop celiacs.
True
A _____ is the gold standard when diagnosing celiacs disease because it can examine any damage to small intestine (inflammation, microvilli, change in cells).
Biopsy
T/F: Biopsies of the small intestine are challenging because small intestine is very long, meaning there can be patches of inflammation and some patches that are normal.
True
T/F: People with celiacs produce antibodies when they consume gluten. Continuing to consume gluten during an antibody test (serologic test) is essential in order to properly diagnose a patient with celiacs.
True
T/F: Normally the lining of the small intestine has tight junctions, which prevents intact gluten proteins from entering the barrier. These tight junctions become loose with celiacs disease so gluten protiens can enter and cause an immune/inflammatory response.
True
Complications of celiacs disease include: malabsorption, anemia, _____, and other autoimmune diseases.
Osteoporosis
T/F: Lactase is an enzyme at the brush border of the small intestine, it breaks lactose down into glucose and galactose, but if this enzyme is missing, lactose doesn’t get absorbed and moves into the colon to be fermented, resulting in uncomfortable GI symptoms.
True
T/F: Hydrogen breath tests help diagnose lactose intolerance because lactose fermentation in the colon creates a gas that is exhaled in the breath. If hydrogen is higher than normal, the patient may have lactose intolerance.
True
T/F: Lactose intolerance would create a spike in blood sugar.
False, blood sugar stays the same because lactose isn’t being digested so glucose is not absorbed into the blood stream, thus having no effect on blood sugar
T/F: The MNT for lactose intolerance is lactose- free.
False, lactose- restricted
T/F: The MNT for celiacs disease is gluten-restricted.
False, gluten- free
T/F: Similar to celiacs disease and IBD, lactose intolerance and IBS also damage the bowels.
False
T/F: Crohn’s may involve any part of the GI tract while ulcerative colitis affects only the large intestine and rectum.
True
Crohn’s affects ___ mucosal layers, while ulcerative colitis only affects the ___ - most layer.
All, inner
T/F: In ulcerative colitis, inflammation is seen in segments of the bowel, whereas with Crohn’s inflammation is continuous.
False, the opposite
T/F: The probiotic VSL#3 has been shown to improve symptoms in Crohn’s disease patient’s.
False, Ulcerative colitis only
T/F: MNT for Crohns and Colitis patients includes MCT’s only if they are having fat malabsorption.
True
Gut- ____ psychotherapy has been shown as a valuable treatment for IBS patients.
Directed
T/F: To diagnose IBS, you must first rule out other GI disorders such as IBD and celiacs, then diagnose with Rome 4 Criteria
True
T/F: IBS is a functional GI disorder because nothing is structurally, anatomically or physiology wrong, rather a disorder of the gut-brain connection.
True
_____ fiber (psyllium, fruit, oats, and barely) has been shown to improve symptoms in IBS patients through fermentation, because it produces SCFA’s such as butyric acid which acts as a fuel source for intestinal cells.
Soluble
Accessory organs of the lower GI tract include ______, ______, and ________. They aren’t part of the GI tract because food contents don’t pass through them, rather, they produce secretions that aid in digestion.
Pancreas
Liver
Gallbladder
The large intestine includes the ascending, transverse, descending and sigmoid colon, as well as the _____.
Rectum
Pancreas secretes pancreatic enzymes and _________ to help neutralize the chyme that leaves the stomach.
Bicarbonate
T/F: Digestion does not occur in the small intestine, only absorption.
False
Ignoring the urge to defecate causes the large intestine to keep absorbing _____ creating harder stool and constipation.
Water
Colace is a stool softener that ____ the water content of the stool.
Increases
Excessive fat consumption ____ stomach emptying, resulting in constipation.
Delays
Hypothyroidism causes ______ because the thyroid produces hormones that regulate digestion.
Constipation
Lactulose is an osmotic agent that draws water into the ____.
Bowels
Dulcolax and Senna are bowel _____ that stimulate peristaltic contractions and helps the stool move through the GI tract.
Stimulants
Iron causes constipation while ______ relieves constipation.
Magnesium
Antibiotics and anti-_______ cause diarrhea.
Neoplastics
MNT for diarrhea is _____ fiber, fluids diluted juice, and electrolytes. As well as antidiarrheal medicine such as Immodium.
Soluble
T/F: The primary function of the large intestine is nutrient absorption.
False (It primarily absorbs water and electrolytes).
T/F: Diverticulosis commonly leads to the formation of pockets in the colon wall that can become inflamed, resulting in diverticulitis.
True
Evaluate ____ and potassium in patients with diarrhea as those minerals can be lost in the stool.
Zinc
_____ is a yeast based probiotic, usually recommended for patient’s with C. diff.
Florastor (made from Saccharomyces)
T/F: Crohn’s disease can affect any part of the gastrointestinal (GI) tract from mouth to anus.
True
T/F: The ileum is the final part of the small intestine and primarily responsible for absorbing bile acids and vitamin B12.
True
T/F: Irritable Bowel Syndrome (IBS) often causes physical damage to the colon wall.
False (IBS typically does not cause structural damage to the GI tract).
T/F: Ulcerative colitis typically affects only the rectum and colon.
True
T/F: Someone with diverticulosis can develop diverticulitis, but someone with diverticulitis also has diverticulosis.
True
If diverticular become inflamed it is know as ______ and causes acute inflammation.
Diverticulitis
Diverticula are formed by increased _____ pressure, which may be a result of aging (kinetic movement of stool decreases), genetics, obesity, IBS.
Intracolonic
T/F: Lactose intolerance occurs due to an autoimmune response to dairy proteins.
False (It is due to a deficiency in lactase enzyme)
Which part of the GI tract is primarily involved in water and electrolyte absorption?
A) Stomach
B) Small intestine
C) Large intestine
D) Esophagus
C) Large intestine
The primary function of the small intestine is:
A) Storing waste
B) Absorbing nutrients
C) Breaking down proteins
D) Absorbing water
B) Absorbing nutrients
Diverticulitis is most commonly associated with which part of the GI tract?
A) Rectum
B) Stomach
C) Small intestine
D) Large intestine
D) Large intestine, primarily the lower part (descending and sigmoid colon)
Which of the following tests is often used to diagnose celiac disease?
A) Fecal occult blood test
B) Colonoscopy
C) Blood tests for antibodies
D) Upper GI series
C) Blood tests for antibodies
Which part of the small intestine is primarily responsible for nutrient absorption?
A) Duodenum
B) Jejunum
C) Ileum
D) Colon
B) Jejunum
Which nutritional therapy is often recommended for patients with IBS?
A) Gluten-free diet
B) High-protein diet
C) Low-FODMAP diet
D) Vegan diet
C) Low-FODMAP diet
The presence of small pouches in the colon, called diverticula, is a condition known as:
A) Diverticulitis
B) Crohn’s disease
C) Diverticulosis
D) Ulcerative colitis
C) Diverticulosis
Which disorder is characterized by a hypersensitivity to gluten, leading to damage in the small intestine?
A) IBS
B) Lactose intolerance
C) Celiac disease
D) Diverticulitis
C) Celiac disease
The Rome IV criteria are commonly used in the diagnosis of which GI disorder?
A) Crohn’s disease
B) Ulcerative colitis
C) Irritable Bowel Syndrome (IBS)
D) Celiac disease
C) Irritable Bowel Syndrome (IBS)
Colonoscopies diagnose diverticulosis, but examining for diverticulitis includes assessing fevers, infection, ____ ____ quadrant pain, ultrasound, CT scan and CRP levels to diagnose diverticulitis.
Left lower
What is the main reason for avoiding gluten in patients with celiac disease?
A) Gluten irritates the stomach lining.
B) Gluten triggers an immune response that damages the small intestine.
C) Gluten causes excessive acid production.
D) Gluten prevents the absorption of protein.
B) Gluten triggers an immune response that damages the small intestine.
Which of the following conditions is likely to benefit from increased fiber intake?
A) Celiac disease
B) Diverticulosis
C) Crohn’s disease
D) Ulcerative colitis
B) Diverticulosis, mixed evidence but fluids and fiber may help contents move through the GI tract and result in regular bowel movements and decreased intracolonic pressure.
Diverticulitis is usually associated with an infection, meaning patients would have to be treated with _____ first, then possibly a resection.
Antibotics
T/F: Patients with both diverticulosis and diverticulitis must consume a high fiber diet.
False, patients with diverticulitis need to consume a low fiber diet temporarily until inflammation/infection is resolved.
People with ___ are more at risk to develop diverticula due to difficulty defecating, increasing pressure in the colon.
IBS
Short bowel syndrome is defined as inadequate absorptive capacity resulting from reduced length or decreased functional bowel after resection, usually after ____ - _____ % loss
70-75
B12 is only absorbed in the ____, also where bile salts are reabsorbed.
Ileum
T/F: A patient with 100-120 cm of small bowel without the colon or 50 cm of small bowel w/colon is likely to develop short bowel syndrome.
True
T/F: After duodenal resection, malabsorption of iron (Fe), zinc (Zn), calcium (Ca), and magnesium (Mg) is common.
True
T/F: Ileal resection does not affect the absorption of vitamin B12, bile salts, or fat-soluble vitamins.
False
T/F: Antidiarrheals are not used in the treatment of short bowel syndrome.
False
T/F: A trophic tube feeding (TF) or oral diet may be used in short bowel syndrome for gratification.
True
T/F: For short bowel syndrome, glutamine and medium-chain triglycerides (MCT) supplements are commonly recommended, regardless of the type of resection.
False (supplements depend on the type of resection)
T/F: Liver, gallbladder, and pancreatic diseases are not associated with the development of SIBO.
False, they are associated with SIBO because bile and digestive enzymes are not secreted into the small intestines to digest contents, the undigested content then becomes fuel for bacteria
Acid suppressing medicine such as PPI, H2 blockers and antacids may cause SIBO because they kill acid in the stomach, resulting in more ____ in the intestines.
Bacteria
Gastroparesis and narcotics can cause SIBO due to the ____ of gastric emptying.
Delay
Ileal resections (ileocecal valve specifically) acts as a ______ to prevent the contents from the colon from traveling back up and entering the small intestines.
Sphincter
_____ (fatty stools) are a common symptom of SIBO due decreased fat metabolism.
Steatorrhea
SIBO is diagnosed by direct culture (culture from inside the small intestine to see excessive bacteria), or a _____ test, where patient’s are fed ______ and the amount of methane is measured from the breath 1 hr after consumption.
Breath, lactulose
T/F: To diagnose both SIBO and lactose intolerance, patients are given lactose for a breath test.
False, breath tests for SIBO consist of feeding the patient lactulose
T/F: Patients with SIBO may be given elemental formulas, where macronutrients are already digested (AA, simple sugars and MCTs), which may help “starve” the bacteria.
True
T/F: SIBO patients should try a low FODMAP diet, MCT supplementation, and avoid snacks between meals in order to “push” bacteria towards the colon.
True
In SIBO patients, bacteria binds to vitamin ___ in the small intestine, preventing absorption.
B12
A ________ is an abnormal passage between two organs or between an organ and the skin or wound. They are common after a GI surgery.
Fistula
RD’s are more concerned with Enterocutaneous fistula (ECF) because it is an abnormal passage between the skin and the _________.
Intestines
What is an Enterocutaneous Fistula (ECF)?
A) An abnormal passage between the trachea and esophagus
B) An abnormal connection between the intestine and the skin
C) A normal opening in the digestive tract
D) A type of ostomy
B) An abnormal connection between the intestine and the skin
What is a common cause of Enterocutaneous Fistulas?
A) Infections
B) Surgery
C) Trauma
D) All of the above
D) All of the above
Why is it important to maintain fluid and electrolyte balance in patients with fistulas?
A) It prevents dehydration and electrolyte imbalances.
B) It has no significant impact on recovery.
C) It is only necessary for ostomy patients.
D) It is a standard practice for all patients.
A) It prevents dehydration and electrolyte imbalances.
Ileostomies may remove the entire colon and an opening from the ___ to the skin is created.
Ileum
What is a common dietary recommendation for patients after an ileostomy or colostomy?
A) High-fiber diet immediately after surgery
B) Low-fiber diet for 6-8 weeks after surgery
C) No dietary restrictions
D) Only liquid diet for life
B) Low-fiber diet for 6-8 weeks after surgery
Why might patients with an ileostomy need B12 supplementation?
A) They do not absorb B12 effectively due to changes in the intestine.
B) B12 is unnecessary for ostomy patients.
C) They consume too much B12 in their diet.
D) B12 is primarily absorbed in the stomach.
A) They do not absorb B12 effectively due to changes in the intestine.
Which of the following foods should be limited for patients with ostomies?
A) High-fiber fruits and vegetables
B) Protein-rich foods
C) Whole grains
D) All of the above
A) High-fiber fruits and vegetables
- unless they’re really well cooked or else they could block the stoma site
What is an important practice for patients with an ileostomy or colostomy regarding food?
A) Chew food well
B) Avoid chewing food
C) Eat quickly
D) Only consume liquid foods
A) Chew food well
What is an ileostomy?
A) A connection between the stomach and the skin
B) A connection between the colon and the skin
C) A surgically created opening between the small intestine and the skin
D) An abnormal passage between two organs
C) A surgically created opening between the small intestine and the skin
T/F: It is advisable for patients with ostomies to avoid odor-causing foods to minimize odor.
True
T/F: A colostomy is a type of ostomy that connects the colon to the abdominal wall.
True
Pouches restructure the ileum and leave the anal sphincter intact so patients can eliminate normally without a bag. _______ fiber should be limited, SFM should be consumed and B12 should be supplemented.
Insoluble
C. diff infection (CDI) can lead to _____. Its spores are not killed by antibiotics so patients may have to be treated with a fecal microbiota transplant or florastor (a probiotic made from yeast).
Diarrhea
_____ fiber increases the water holding capacity, making stool softer for constipated patients.
Soluble
_____ fiber helps patients with diarrhea by absorbing excess fluid in the intestines, potentially slowing down transit time and reducing diarrhea.
Soluble
______ fiber is not dissolved in water, but it regulates bowel movements by increasing stool bulk and accelerates fecal transit time through the intestines.
Insoluble
What is the recommended fluid intake for individuals on a high fiber diet?
A) 1 liter daily
B) 2 liters daily
C) 3 liters daily
D) 4 liters daily
B) 2 liters daily
Why should fiber dietary guidelines be implemented slowly over 1 to 2 weeks?
A) To reduce costs
B) To give the gastrointestinal tract time to adjust and minimize discomfort or gas
C) To avoid weight gain
D) To ensure a varied diet
B) To give the gastrointestinal tract time to adjust and minimize discomfort or gas
What is the recommended daily fiber intake for women?
A) 30 grams or more
B) 25 grams or more
C) 38 grams or more
D) 15 grams or more
B) 25 grams or more
What is the recommended daily intake of fruits, vegetables, legumes, nuts, and edible seeds on a high fiber diet?
A) 3 to 6 servings
B) 5 to 8 servings
C) 8 to 10 servings
D) 2 to 4 servings
B) 5 to 8 servings
How many servings of whole-grain products are recommended daily for a high fiber diet?
A) 3 to 5 servings
B) 6 to 11 servings
C) 2 to 4 servings
D) 8 to 10 servings
B) 6 to 11 servings
T/F: Following guidelines for a high-fiber diet may cause an increase in stool weight, fecal water, and gas, and should be implemented gradually over 1 to 2 weeks.
True
T/F: C Diff infection is an antibiotic associated diarrhea because antibiotics kill bacteria in the GI tract, allowing pathogens to grow, specifically the overgrowth of Clostridium Difficile bacterium, which is resistant to antibiotics.
True
T/F: Chronic suppression of stomach acid with proton pump inhibitor medications during broad-spectrum antibiotic therapy also may increase susceptibility to C Diff Infection (CDI).
True
