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FN 125 LE2 > LOWER GIT > Flashcards

LOWER GIT Flashcards

1
Q

Neurotransmitter that relaxes lower esophageal sphincter

A

GABA (Gamma-amino butyric acid)

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2
Q

Neurotransmitter that decreases motility

A

Norepinephrine

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3
Q

Sites of release for the norepinephrine

A

CNS, spinal cord, sympathetic nerves

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4
Q

Neurotransmitter that increases contraction of sphincters

A

Norepinephrine

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5
Q

Neurotransmitter that inhibits secretions

A

Norepinephrine

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6
Q

Neurotransmitter that inhibits secretions

A

Norepinephrine

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7
Q

Site of release of acetylcholine

A

Central nervous system, autonomic system, other tissues

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8
Q

Neurotransmitter that increases motility

A

Acetylcholine

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9
Q

Neurotransmitter that relaxes sphincters

A

Acetylcholine

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10
Q

Neurotransmitter that stimulates secretion

A

Acetylcholine

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11
Q

Neurotransmitter that stimulates secretion

A

Acetylcholine

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12
Q

Differentiate acetylcholine and norepinephrine

A

Norepinephrine decreases motility, increases contraction of sphincters, inhibits secretion and is released at the CNS, spinal cord, and sympathetic nerves

Acetylcholine increases motility, relaxes sphincters, stimulates secretion and is released at the CNS, autonomic system, and other tissues

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13
Q

Neurotransmitter that inhibits release of gastric emptying and acid secretion

A

Neurotensin

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14
Q

Neurotransmitters that inhibits acid secretion

A

Neurotensin

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15
Q

Primary action of neurotensin

A

Inhibits release of gastric emptying and acid secretion

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16
Q

Neurotransmitter that facilitates secretion and peristalsis

A

Serotonin (5-HT)

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17
Q

Site of Release of GABA

A

CNS

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18
Q

Site of release of serotonin (5-HT)

A

GI tract and spinal cord

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19
Q

Site of release of neurotensin

A

GI tract and CNS

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20
Q

Neurotransmitter that released at the CNS and GI tract

A

Nitric oxide, neurotensin

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21
Q

Primary actions of nitric oxide (3)

A

Regulates blood flow
Maintains muscle tone
Maintains gastric motor activity

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22
Q

Neurotransmitter that increases sensory awareness

A

Substance P

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23
Q

Primary actions of substance P

A

Increases sensory awareness (mainly pain)

Peristalsis

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24
Q

Site of release of substance P

A

Gut, CNS, skin

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25
Q

7 examples of neurotransmitters

A

GABA (Gamma Amino Butyric Acid)
Norepinephrine
Acetylcholine
Neurotensin
Serotonin (5-HT)
Nitric Oxide
Substance P

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26
Q

Major Gastrointestinal Hormones (7)

A

Gastrin
Secretin
CCK (Cholecystokinin)
GIP (Gastric Inhibitory Polypeptide)
Motilin
GLP-1 (Glucagon-like peptide-1)
GLP-2 (Glucagon-like peptide-2)

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27
Q

Site of release of gastrin

A

G cells of gastric mucosa and duodenum

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28
Q

Hormone that is released due to stimulants like interdigestive periods and alkaline pH in the duodenum

A

Motilin

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29
Q

Hormone and its stimulant that affects the stomach, small bowel, and colon

A

Hormone: Motilin

Stimulant:
Interdigestive periods, alkaline pH in duodenum

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30
Q

Primary action of motilin on the stomach, small bowel, and colon

A

Promotes gastric emptying and GI motility

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31
Q

Site of release of motilin

A

M cells of duodenum and jejunum

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32
Q

Hormone released at the site of L cells of small intestine and colon (density increases in distal GIT)

A

GLP-1 and GLP-2

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33
Q

Hormone stimulated by presence of glucose, fat, and SCFA

A

GLP-1 and GLP-2

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34
Q

Hormone that affects the stomach and pancreas

A

GLP-1

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35
Q

Hormone that affects the small intestine and colon

A

GLP-2

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36
Q

Hormone that affects stomach such that it promotes gastric emptying

A

GLP-1

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37
Q

Hormone that affects the pancreas by inhibiting glucagon release and stimulating insulin release

A

GLP-1

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38
Q

Primary action of GLP-2 in the intestine and colon

A

Stimulates intestinal growth and nutrient digestion and absorption

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39
Q

Site of release of Gastrin

A

G cells of gastric mucosa and duodenum

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40
Q

Stimulants of gastrin that can affect the stomach, esophagus, and GIT in general

A

peptides, amino acids, and caffeine

distention in antrum

some alcoholic beverages and vagus nerve

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41
Q

Organs that are affected when gastrin is stimulated by alcoholic beverages

A

stomach, esophagus, and GIT in general

gallbladder

pancreas

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42
Q

primary action of gastrin to the stomach, esophagus, and GIT in general when stimulated by peptides amino acids and caffeine

A

stimulates secretion of HCl and pepsinogen

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43
Q

primary action of gastrin to the stomach, esophagus, and GIT in general when stimulated by antrum distention

A

Increase in gastric antral motility

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44
Q

primary action of gastrin to the stomach, esophagus, and GIT in general when stimulated by alcoholic beverages and vagus nerve

A

increases lower esophageal sphincter tone

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45
Q

primary action of gastrin in the gallbladder

A

weakly stimulates contraction of gallbladder

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46
Q

primary action of gastrin in pancreas

A

weakly stimulates secretion of bicarbonate

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47
Q

affected organs of secretin

A

pancreas and duodenum

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48
Q

primary action of secretin in pancreas

A

increase in water and bicarbonate production

increase in pancreatic enzyme and insulin production

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49
Q

hormone whose site of release is the S cells of the duodenum

A

secretin

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50
Q

Hormone that is released due to a stimulant such as acid in small intestine

A

secretin

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51
Q

primary action of secretin in the duodenum

A

decreases it motility and increases mucus output

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52
Q

site of release of CCK

A

I cells of duodenum

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53
Q

organs affected by CCK when stimulated by peptides, amino acids, fat, and HCl

A

pancreas, gallbladder, stomach, colon

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54
Q

CCK effect on pancreas

A

stimulates secretion of pancreatic enzymes

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55
Q

CCK primary action on stomach

A

slows gastric emptying

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56
Q

CCK primary action on gallbladder

A

causes gallbladder contraction

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57
Q

CCK primary action on colon

A

increases motility and may mediate feeding behavior

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58
Q

Hormone whose site of release is K cells of duodenum and jejunum

A

GIP

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59
Q

stimulants for GIP release

A

glucose and fat

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60
Q

Organ affected by the GIP

A

Stomach

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61
Q

primary action of GIP

A

reduce intestinal motility

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62
Q

symptoms in the cognitive area as an effect of enteroimmune disease

A

Mental log, poor concentration, learning difficulties, poor memory, lethargy, apathy, rage, restlessness, hyperactivity

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63
Q

symptoms in the sensory area as an effect of enteroimmune disease

A

Vertigo, lightheadedness, tinnitus

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64
Q

symptoms in emotionally as an effect of enteroimmune disease

A

Anxiety, moodiness, depression, aggressiveness, irritability

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65
Q

symptoms experienced somatically as an effect of enteroimmune disease

A

Headaches, insomnia, fatigue, joint pain, muscle pain, stiffness, weakness, weight gain, fluid retention, non-ischemic chest pain

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66
Q

symptoms experienced in the gastrointestinal tract as an effect of enteroimmune disease

A

Dyspepsia, bloating, belching, constipation, abdominal cramping, nausea, excessive flatulence

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67
Q

symptoms experienced in respiratory system as an effect of enteroimmune disease

A

Congestion, excessive phlegm and mucous, dyspnea, chronic cough, gagging

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68
Q

Neurologic Diseases associated with enteroimmunopathies

A

Autism
Alzheimer’s disease
Parkinson’s disease
Multiple sclerosis
Depression
Bipolar disorder
Schizophrenia
Migraine headaches
Cerebellar ataxia
Certain seizure disorders

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69
Q

Diseases associated with inflammation

A

Cancer
Diabetes
Cardiovascular Disease
Neurological Diseases
Alzheimer’s Disease
Autoimmune Disease
Arthritis
Pulmonary Diseases

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70
Q

Factors that affect the microbiome

A

Geography
Birth route
Genetics
Hygiene
Diet/Nutrition
Stress
Drugs

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71
Q

What happens if there is healthy microbiome complexity and stability?

A

Protection against pathogens
Immune function is traned/stimulated
Nutrients, Energy, Vitamin, SCFA are supplied

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72
Q

What happens if there is perturbation in microbiome complexity and stability

A

Inflammation (local>systemic)
Oxidative stress
Increase in Gram-negative bacteria
Infection (opportunistic/pathogenic)
Altered metabolite production

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73
Q

These are considered parameters in the nutrition assessment for the lower GIT

A

medical history
medications

74
Q

The 4 Nutrient Assessment for Lower GIT

A

Food/Nutrient Intake
Anthropometrics
Laboratory
Physical Signs

75
Q

appetite, intolerance to milk and gluten, fiber, fluid and calcium intake are associated with what aspect of the nutritional assessment for lower GIT?

A

Food/Nutrient intake

76
Q

Laboratory data associated with the nutritional assessment for lower GIT

A

fecal fat, malabsorption, anemia

77
Q

Physical signs associated with the nutritional assessment of the lower GIT

A

dehydration, PEM, B12 deficiency

78
Q

7 tests for malabsorption

A

Stool examination
Chemical analysis of fecal fat
Fecal nitrogen
D-xylose
Serum calcium
Serum carotene
Schilling test

79
Q

Fecal fat results that would indicate malaborption

A

> 5-7 g when given 100 g of fat or
7 g when given 100 g fat

80
Q

Fecal nitrogen results that would indicate malaborption

A

> 2 g/day

81
Q

D-xylose is used to test the malabsorption of?

A

Carbohydrates

82
Q

Schilling test is used to test the malabsorption of?

A

B12

83
Q

How many types of stool are there based on the Bristol Stool Chart?

A

7

84
Q

What type of stool based on the Bristol Stool chart is characterized by separate hard lumps?

A

Type 1

85
Q

What does seperate hard lumps of stool indicate based on the Bristol Stool Chart?

A

Severe constipation?

86
Q

What type of stool based on the Bristol Stool chart is characterized by lumpy and sausage-like?

A

Type 2

87
Q

What does seperate lumpy and sausage-like indicate based on the Bristol Stool Chart?

A

Mild constipation

88
Q

What does stool that is characterized by a sausage-shape with cracks in the surface indicate based on the Bristol Stool Chart?

A

Normal

89
Q

What type of stool is characterized by a sausage-shape with cracks in the surface based on the Bristol Stool Chart?

A

Type 3

90
Q

What type of stool is characterized by its similarity to a smooth, soft sausage or snake based on the Bristol Stool Chart?

A

Type 4

91
Q

What does stool that is characterized by its similarity to a smooth soft sausage or snake indicate based on the Bristol Stool Chart?

A

Normal

92
Q

What does stool that is characterized by soft bulbs with clear cut edges indicate based on the Bristol Stool Chart?

A

Lacking fiber

93
Q

What type of stool is characterized by separate hard lumps based on the Bristol Stool Chart?

A

Type 5

94
Q

What type of stool is characterized by mushy consistency with ragged edges based on the Bristol Stool Chart?

A

Type 6

95
Q

What does stool that is characterized by mushy consistency with ragged edges indicate based on the Bristol Stool Chart?

A

Mild diarrhea

96
Q

What does stool that is characterized by liquid consistency with no solid pieces based on the Bristol Stool Chart?

A

Severe diarrhea

97
Q

What type of stool is characterized by liquid consistency with no solid pieces based on the Bristol Stool Chart?

A

Type 7

98
Q

Diagnostic criteria used to assess functional constipation

A

Rome IV Diagnostic Criteria for Functional Constipation

99
Q

How long is the period of fulfillment for the Rome IV Diagnostic Criteria for Functional Constipation

A

the last 3 months

100
Q

What are the three criterias of the Rome IV Diagnostic Criteria for Functional Constipation?

A
  1. Must include two or more of the following:
    - Straining during more than 25% of defecations
    - Lumpy or hard stools (Bristol stool scale 1 to 2) in more than 25% of defecations
    - Sensation of incomplete evacuation for more than 25% of defecations
    - Manual maneuvers to facilitate more than 25% of defecations (i.e., digital evacuation, support of the pelvic floor)
    - fewer than three defecations per week
  2. Loose stools are rarely present without the use of laxatives
  3. There are insufficient criteria for irritable bowel syndrome
101
Q

What is a treatment for constipation?

A

Adding fiber to the diet slowly and adding fluids

102
Q

How does fiber treat constipation?

A

It adds volume and weight to the stool which normalizes the transit of undigested materials and minimizes pressure

103
Q

Infection & inflammation of the membrane lining of the abdominal cavity caused by leakage of infectious organisms through a perforation

A

Peritonitis

104
Q

Food component that comes from plant foods and are not digestible by human enzymes

A

Fiber or roughage

105
Q

Component that pertains to fecal contents

A

Residue

106
Q

What are included in the fecal contents in residue

A

Bacteria and net remains after ingestion of food, secretions into GI tract, and absorption

107
Q

Treatement for diarrhea

A
  • drink plenty of fluids
  • adequate salt in food
  • food with soluble fibers
  • eat small frequent meals
  • avoid insoluble fiber
  • avoid caffeine and lactose
  • avoid highly seasoned food
  • avoid high fat food
  • avoid foods that cause gas
108
Q

Treatment for diarrhea for adults

A
  • repopulate GI tract with microorganisms (prebiotics in modest amounts and probiotics)
109
Q

examples of prebiotics

A
  • pectin
  • oligosaccharides
  • inulin
  • oats
  • banana flakes
110
Q

examples of probiotics

A
  • cultured food
111
Q

what type of food is a source of beneficial gut flora

A

probiotics

112
Q

What diet is characterized by foods completely digested, well absorbed

A

Low- or minimum residue diets

113
Q

What diet is characterized by foods that do not increase GI secretions

A

Low- or minimum residue diets

114
Q

When (or in what conditions) is low- or minimum residue diet used?

A
  • maldigestion
  • malabsorption
  • diarrgea
  • temporarity after some surgeris like hemorrhoidectomy
115
Q

Foods to Limit in a Low- or Minimum Residue Diet

A
  • Lactose
  • Fiber that is > 20 g/day
  • Resistant starches
    —Raffinose, stachyose in legumes
  • Sorbitol, mannitol, xylitol that are > 10 g / day
  • Caffeine
  • Alcohol (esp. wine and beer)
116
Q

When to use restricted-fiber diets

A
  • When reduced fecal output is necessary
  • When GI tract is restricted or obstructed
  • When reduced fecal residue is desired
117
Q

Foods restricted in restricted-fiber diets

A
  • fruits
  • vegetables
  • coarse grains
118
Q

How much fiber intake a day is allowed in a restricted-fiber diet?

A

< 10 g fiber/day

119
Q

What are obstructions in the stomach lining that result from ingestion of plant foods?

A

Phytobezoars

120
Q

In which individuals are phytobezoars common in?

A
  • Edentulous patients
  • Patients w/ poor dentition
  • Patients w/ dentures
121
Q

What are examples of foods associated with phytobezoars

A

Potato skins, oranges, grapefruit

122
Q

Intestinal Disorders that need MNT

A
  • Irritable Bowel Syndrome
  • Lactose Intolerance
  • Fat Malabsorption
  • Steatorrhea (>5 g / day based on fecal exam)
  • Flatus (intestinal gas)
123
Q

pertains to a functional GI disorder

A

Irritable Bowel Syndrome (IBS)

124
Q

Characterized by unexplained abdominal discomfort or pain that is associated with changes in bowel habits

A

Irritable Bowel Syndrome (IBS)

125
Q

Symptoms of IBS

A

Gas
Bloating
Diarrhea
Constipation
Increased GI distress associated with psychosocial distress

126
Q

What disorder does this pertain to?
ROME IV criteria is recurrent abdominal pain at least 1 day/week in the last 3 months and associated with two or more of the following conditions:

  • related to defecation
  • associated with a change in stool frequency
  • associated with a change in stool form or appearance
A

IBS

127
Q

What are the FODMAP sugars

A
  • fermentable sugars
  • oligosaccharides
  • disaccharides
  • monosaccharides
  • polyol sweeteners
128
Q

Foods that may cause flatulence

A

apples, beer, broccoli, cabbage, corn, cucumber, fructose, high-fat meats, legumes, nuts, peppers (green), radishes, sorbitol wheat, milk products, asparagus, bran, brussel sprouts, cauliflower, cream sauces, fried foods, gravy, honey, mannitol, onions, punces, raisins, soybeans, soda

129
Q

Diseases of the small intestine

A

Celiac Disease
Brush Border Enzyme Deficiencies
Crohn’s Disease

130
Q

other names for the celiac disease

A

Gluten-sensitive enteropathy
Non-tropical sprue

131
Q

Where is gliadin found

A

in the gluten

132
Q

the celiac disease has a negative reaction to what?

A

gliadin

133
Q

this is caused by inappropriate autoimmune reaction to gliadin

A

celiac disease

134
Q

prevalence of celiac disease

A

1 in 133 persons in the US

135
Q

T or F: celiac disease is not as common as peoplpe think

A

False; it is much more common than formerly believed

136
Q

T or F: celiac disease is easy to diagnose

A

False; celiac disease frequently goes undiagnosed

137
Q

What does the damaged villi of intestinal mucosa with celiac disease cause?

A
  • atrophy
  • flattening
138
Q

T or F: the celiac disease involves potential or actual malabsorption of all nutrients

A

True

139
Q

List down the conditions that may accompany celiac disease

A
  • Dermatitis herpetiformis
  • anemia
  • bone loss
  • muscle weakness
  • polyneuropathy
  • follicular hyperkeratosis
140
Q

Individuals are in greater risk of what malignancies if they have celiac disease?

A
  • type 1 diabetes
  • lymphomas
  • other malignancies
141
Q

T or F: fatigue is an early presentation (symptom) of celiac disease

A

False; it is a later presentation (symptom)

142
Q

List down the early presentation symptoms of celiac disease

A
  • diarrhea
  • steatorrhea
  • malodorous stools
  • abdominal bloating
  • poor weight gain
143
Q

List down the later presentation (symptoms) of celiac disease

A

Other autoimmune disorders
Failure to maintain weight
Fatigue
Consequences of malabsorption
- Anemia
- Osteoporosis
- Coagulopathy

144
Q

This is often misdiagnosed as IBD or other disorders

A

celiac disease

145
Q

Gold standard in diagnosing the celiac disease

A

intestinal mucosa biopsy

146
Q

What are used for the diagnosis of celiac disease?

A
  • positive family history
  • pattern of symptoms
  • serologic tests
  • intestinal mucosa biopsy
147
Q

what are serologic tests use for celiac disease diagnosis?

A
  • Antiendomysial antibodies(AEAs)
  • Immunoglobulin A (IgA)
  • Antigliadin antibodies (AgG-AGA)
  • IgA tissue transglutaminase
148
Q

T or F: In celiac disease therapy, diet is not included

A

False; diet IS the therapy

149
Q

how is diet utilized in the acute phase of the celiac disease

A

electrolyte and fluid replacement

150
Q

what vitamin and mineral supplementation may be needed during celiac disease?

A
  • fat-soluble vitamins (ADEK)
  • calcium
  • iron
  • folate
  • B12
151
Q

How to use diet therapy in celiac disease?

A
  • electrolyte and fluid replacement (acute phase)
  • vitamin and mineral supplementation
  • delete gluten sources
  • substitute some food (rice, corn, potato)
  • see dietitian familiar with this disease
  • read labels carefully
152
Q

what are the common problem additives that may contain gliadin?

A
  • fillers
  • thikeners
  • seasonings
  • sauces
  • gravies
  • vegetable protein
  • coatings
153
Q

List down ailments wherein medicine practitioners may recommend gluten-free diets.

A
  • fatigue
  • depression
  • schizophrenia
  • arthritis
  • digsestive upsets
154
Q

this disorder has an unknown cause

A

tropical sprue

155
Q

this imitates celiac disease

A

tropical sprue

156
Q

what disorder results in the atrophy and inflammation of villi but is not necessarily characterized by gluten sensitivity

A

tropical sprue

157
Q

Sx of tropical sprue

A
  • diarrhea
  • anorexia
  • abdominal distention
158
Q

Rx of tropical sprue

A
  • tetracycline
  • folate 5 mg/day
  • B12 IM
159
Q

characterized by deficiency of brush border disaccharides

A

intestinal brush border enzyme deficiencies

160
Q

Disaccharides not hydrolyzed at mucosal cell membrane

A

Intestinal Brush Border Enzyme Deficiencies

161
Q

Intestinal Brush Border Enzyme Deficiencies can occur as:

A
  • rare congenital defects
  • effects of diseases that damage intestinal epithelium
  • genetic form
162
Q

list down rare congenital defects that the intestinal brush border enzyme deficiencies can manifest as:

A

lack of sucrase, isomaltase, and lactase in newborns

163
Q

List down diseases that damage the intestinal epithelium that intestinal brush border enzyme deficiencies occur secondary to.

A
  • Chron’s disease
  • Celiac disease
164
Q

Give an example of a genetic form that the deficiency of intestinal brush border enzymes can occur as:

A

lactas deficiency

165
Q

How many adults (in percentage) worldwide are lactase deficient?

A

70%

166
Q

From what regions are lactase deficiencies most prevalent

A

South America, Africa, Asia

167
Q

This is diagnosed based on the history of GI tolerance to dairy products

A

lactase deficiency

168
Q

What test is used as lactose intolerance diagnostics?

A

Lactose breath hydrogen test

169
Q

Explain the lactose breath hydrogen test mechanism.

A
  1. the baseline breath hydrogen is measured
  2. patient consumes 25 to 50 g lactose
  3. breath hydrogen is remeasured in 3-8 hours
  4. increase greater than 200 ppm indicates lactose malabsorption (90% sensitivity)
170
Q

What test is used as lactose deficiency diagnostics?

A

lactose tolerance test

171
Q

Explain the lactose tolerance test mechanism.

A
  1. Baseline serum glucose is measured after an 8-hour fast
  2. Patient consumes 50-100 g lactose
  3. Remeasurement of serum glucose is done 30, 60, and 90 minutes after
  4. No increase in blood glucose levels suggests lactose malabsorption
172
Q

T or F: lactase-deficient individuals cannot tolerate even small amounts of lactose without symptoms

A

False; most lactase-deficient individuals can tolerate small amounts of lactose without symptoms, particularly with cultured products (yogurt or cheese)

173
Q

How is lactose intolerance distinct from protein allergy?

A
  • allergy would require a milk-free diet
174
Q

What are the inflammatory bowel diseases (IBD)

A
  • ulcerative colitis
  • chron’s disease
  • autoimmune diseases with unknown origin
175
Q

is characterized by inflammation and ulceration of the colon

A

ulcerative colitis

176
Q

characterized by inflammation and ulceration of the GIT with granulomas

A

Chron’s disease

177
Q

T or F: IBDs can be linked with genetic and environmental factors

A

True

178
Q

what age rage is usual onset of IBDs

A

15 to 30 years old

179
Q

Clinical features of IBDs

A

Food intolerances
Diarrhea
Fever
Weight loss
Malnutrition
Growth failure
Extraintestinal manifestations
- Arthritic
- Dermatologic
- Hepatic

180
Q

Tests used for initial diagnosis of IBD

A
  • Colonoscopy
  • Lower gastrointestinal (GI) series with barium enema
  • ASCA (Antisacchromyces Antibodies)
    (Dubinsky, 2003)
  • ANCA (Antineutrophil Cytoplasmic Antibodies)
    (Dubinsky, 2003)
  • Biopsy
181
Q

Tests for Diagnosis, Exacerbation, and Response to Therapy

A
  • C-reactive protein
  • Erythrocyte Sedimentation Rate (ESR)
  • Lactoferrin
  • White blood count and differential
  • Stool assessment for presence of leukocytes
182
Q
A

FN 125 LE2 (8 decks)

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