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KIN 424 - Medical Aspects of Sport > Module 9 - GI Issues in Athletes > Flashcards

Module 9 - GI Issues in Athletes Flashcards

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1
Q

How many runners experience Gastrointestinal Distress?

A
  • 30-90% of runners
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2
Q

What are the symptoms of Gastrointestinal Distress?

A
  • Heartburn
  • Nausea
  • Vomiting
  • Abdominal Cramping
  • Bloody Diarrhoea
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3
Q

What is the GI tract divided into?

A
  • Upper GI tract
  • Lower GI tract
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4
Q

What is the beginning and end of the upper GI tract?

A

Begins
- Mouth
Ends
- Ileum

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5
Q

What is the beginning and end of the lower GI tract?

A

Begins
- Cecum
Ends
- Anus

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6
Q

How many parts make up the GI tract?

A
  • 11
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7
Q

What part of the GI tract breaks down food and prepares it for ingestion?

A
  • Mouth
  • Salivary Glands
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8
Q

What does the Esophagus do?

A
  • Transports food to stomach
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9
Q

How does food travel down the esophagus?

A
  • Peristalsis
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10
Q

Describe the Stomach

A
  • Hollow Organ
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11
Q

What does the Stomach do?

A
  • Stores food while its being processed
  • Food is broken down
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12
Q

What causes the food to be broken down in the stomach?

A
  • A series of enzymatic and chemical reactions
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13
Q

What does the liver do in the GI tract?

A
  • PRocesses nutrients absorbed from SI
  • Produces Bile
  • Major role in detoxification
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14
Q

What does bile do?

A
  • Breaks down fat
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15
Q

What does the pancreas do in the GI tract?

A
  • Secretes digestive enzymes into duodenum
  • Secretes Insulin into blood stream
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16
Q

What do the enzymes excreted by the pancreas do?

A
  • break down fat, carbohydrates, and protein
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17
Q

What does the gallbladder do in the GI tract?

A
  • Stores and concentrates bile
  • Releases it for fat digestion
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18
Q

Describe the structure of the Small intestine?

A
  • Approx 7m long
  • Composed of 3 parts
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19
Q

What 3 parts make of the small intestine? (in order)

A
  • Duodenum
  • Jejunum
  • Ilium
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20
Q

What happens in the Small Intestine of the GI tract?

A
  • Water, bile (liver), and enzymes (pancreas) are added to the food bolus
  • nutrient absorption
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21
Q

Describe the Structure of the Large intestine?

A
  • 5 Parts
  • Approx 2m long
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22
Q

What are the 5 parts of the large intestine? (in order)

A
  • Cecum
  • Ascending Colon
  • Transverse Colon
  • Descending Colon
  • Sigmoid Colon
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23
Q

What happens in the LArge Intestine of the GI tract?

A
  • Waste Product remains
  • Water is absorbed
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24
Q

What is mostly absorbed from waste when it reaches the large intestine?

A
  • Most nutrients
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25
Q

What is the Appendix? What is its function?

A
  • 4 inch pouch shape
  • Function unclear
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26
Q

Describe the Rectum

A
  • Approx. 20cm
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27
Q

What does the Rectum do?

A
  • connects the colon and anus
  • Holds waste until evacuation
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28
Q

Describe the Anus

A
  • Final Part of GI Tract
  • Approx 5cm
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29
Q

What does the Anus do?

A
  • Release waste
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30
Q

How is waste held in the GI tract until excretion?

A
  • A series of sphincters
  • Pelvic floor muscles
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31
Q

What is it called when waste is held?

A
  • Continence
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32
Q

What happens to the GI tract during exercise?

A

Blood is Directed to Working Muscles away from GI tract
- GI tract becomes ischaemic
- GI distress may also be induced

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33
Q

Why might GI distress occur from exercise?

A
  • Aggressive diaphragm movement
  • Abdominal contractions
  • Intestinal Jarring
  • Intestinal Bleeding
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34
Q

How does exercise affect the gut?

A
  • Splanchnic Hypoperfusion
  • Motility
  • Possible Increased Intestinal Permeability and Exercise
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35
Q

What does Splanchnic Hypoperfusion of the Gut during exercise entail?

A
  • Reduced blood flow to the gut: splanchnic vasoconstriction
  • Steal of blood flow to exercising muscles
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36
Q

What happens to the motility of the gut due to exercise?

A
  • Reduced esophageal motility and pyloric sphincter tone
  • Reduced gastric emptying during severe exercise
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37
Q

What are the differing mechanical factors that impact the GI Tract?

A
  • high-impact exercise
  • Runners: pounding
  • Cyclists: Positioning
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38
Q

What can the pounding of running do to the GI tract?

A

Cause Lower GI Tract Issues:
- Flatulence
- Diarrhoea
- Urgency

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39
Q

What can the positioning of cycling do to the GI tract?

A

Cause Upper GI issues
- Pressure on the abdomen
- Horizontal Esophagus

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40
Q

What are some nutritional causes for GI Issues?

A
  • Fibre
  • Fat
  • Protein
  • Carbohydrates, especially Fructose
  • Beverages with high osmolalities (>500 mOsm/L)
  • Delay Gastric Emptying
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41
Q

What are some nutritional solutions to GI issues?

A
  • Mix of glucose/fructose better than single sugar alone
  • Or Maltodextrin/Fructose
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42
Q

What is the recommendation for nutrition with GI Issues?

A
  • Individual Variations
  • Regular Fiber Intake
  • Stay Hydrated
  • Avoid Trigger Foods
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43
Q

What is the recommendation for managing individual variation for GI Issues and Nutrition?

A
  • Athletes keep track of trigger food
  • Dont introduce new food before a competition
  • Time meals appropriately
  • Inadequate pre-event feeding can also cause issues
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44
Q

Should you have fiber right before intense exercise?

A
  • NO
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45
Q

When should you experiment with new food?

A
  • before competition
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46
Q

What does NSAID stand for?

A

Non-steroidal anti-inflammatory drug

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47
Q

When do athletes use NSAIDs?

A
  • Prior and during sport for pain relief
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48
Q

What are some examples of NSAIDs?

A
  • Advil (ibuprofen)
  • Aleve (naproxen sodium)
  • Bayer (aspirin)
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49
Q

What are NSAIDs associated with in regards to the GI tract?

A
  • Upper GI Issues: 3-5x risk
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50
Q

What is unique about advil’s effect on the GI tract?

A
  • increase risk for intestine bleeding during exercise: especially when taken prophylactically
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51
Q

Where are GI Issues mostly seen with NSAIDs?

A
  • Esophagus
  • Stomach
  • Duodenum
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52
Q

Where are GI Issues rarely seen with NSAIDs?

A
  • Small Intestine
53
Q

Where are GI Issues uncommonly seen with NSAIDs?

A
  • Large Intestine
54
Q

What can NSAIDs do to the esophagus?

A
  • reflux
  • Upper GI bleeding
55
Q

What can NSAIDs do to the stomach and duodenum?

A
  • Gastritis
  • Upper GI bleeding
  • Perforation
56
Q

What, while rarely, do NSAIDs do to the small intestine?

A
  • Increase permeability
57
Q

What, while uncommon, can NSAIDs do to the large intestine?

A
  • Increase Permeability
  • Lower GI Bleeding
58
Q

What are some Upper GI TRact Issues that NSAIDs can cause?

A
  • Heartburn
  • Reflux
  • Nausea
  • Vomiting
  • Bloating
  • Epigastric Pain
59
Q

What is GERD?

A
  • Gastroesophageal Reflux Disease
60
Q

What is the likely causes of GERD?

A

Decrease
- esophageal peristaltic activity
- lower esophageal sphincter tone
Increase
- Transient lower sphincter relaxation

61
Q

What are some non-exercise causes of GERD?

A
  • Smoking
  • Obesity
  • Pregnancy
  • Overeating
62
Q

What are some trigger foods for GERD?

A
  • High fat foods
  • chocolate
  • onions
  • coffee
  • tea
  • alcohol
  • tomatoes
  • cheese
  • juice
  • ## carbonated bevies
63
Q

What should an athlete do if they start experiencing GERD?

A
  • start keeping a food log to track symptoms and identify trigger foods
64
Q

Describe the relationship between GERD and athletes

A
  • Exercise is a common cause
  • May mimic symptoms of EILO
  • the mechanism by which GERD occurs during exercise is not well understood
65
Q

What symptoms of GERD should be addressed immediately?

A
  • Chest pain: eliminate other causes
66
Q

What are the symptoms of GERD?

A
  • Heartburn
  • Reflux
  • Epigastric Pain
67
Q

What is the treatment for GERD?

A
  • Antacid Medication (Tums, Rolaids)
  • Histamine Blocking Drugs
68
Q

What is a suggested preventative method for GERD?

A
  • No solid foods before training/competition
69
Q

What are some Lower GI Tract Issues from Exercise?

A
  • Cramping
  • Urge to defecate
  • Diarrhea
  • Rectal Bleeding
  • Flatulence
70
Q

What is the ‘stitch’?

A
  • Sharp pain in UL or UR quadrant during exercise
71
Q

What are the mechanisms of the ‘Stitch’?

A

Unclear
- likely spasm of diaphragm or gas trapped in colon

72
Q

What is a suggestion for preventing the ‘stitch’?

A
  • Avoid solid food prior to exercise
73
Q

What is runners diarrhoea also known as?

A
  • Runner’s Trots
74
Q

Describe Runner’s Trots

A
  • Diarrhoea while running
  • Frequency increases with intensity and duration of exercise
  • More prevalent in competition than in practice
75
Q

Why might runner’s trots be more frequent during the competition than training?

A
  • Anxiety
76
Q

What seems to be linked with runners’ diarrhea?

A
  • Anxiety
  • Caffein
  • Artificial Sweeteners
77
Q

What are the causes of runners diarrhoea?

A

Unclear
- ischemia
- Increased motility

78
Q

What is the treatment for runners diarrhoea?

A
  • Individualized
  • Try to isolate the specific causes for the athlete
79
Q

What is suggested to limit risk of runners diarrhea?

A
  • Reduce fiber consumption 24hr prior competition
  • Avoid trigger foods
  • Anti-diarrheals may be used occasionally
80
Q

What is suggested if there is persistent or long-term diarrhea?

A
  • Investigate it further
81
Q

What might runners find in their stool following endurance events?

A
  • Blood in stool
82
Q

Why might runners find blood in their stool following endurance events?

A

Unclear: Likely
- lack of blood flow
- Dehydration
- Mechanical jarring

83
Q

What may recurrent bleeding do to an athlete?

A
  • risk of iron-deficiency anaemia
84
Q

What is the treatment for rectal bleeding following endurance events?

A
  • Assure proper hydration
  • Reduce mechanical jarring
  • change technique/shoes/surface
85
Q

What is unexplained GI bleeding a cause for?

A
  • Medical Intervention
86
Q

What is Irritable Bowel Syndrome (IBS)?

A
  • Common non-malignant condition of the colon
87
Q

What are the symptoms of IBS?

A
  • Cramping
  • Abdominal Pain
  • Bloating
  • Constipation
  • Diarrhoea
88
Q

What is FODMAPS?

A

Short Chain Carbohydrates

89
Q

What does FODMAPS stand for?

A
  • Fermentable Oligosaccharides
  • Disaccharides
  • Monosaccharides
  • And Polyols
90
Q

What is the pre-event protocol for avoiding GI Issues?

A
  • Don’t experiment during an event
  • Reduce: fiber, caffeine, and specific intolerance
  • Train in similar environment (heat/cold)
91
Q

What should you be cautious with during the event to avoid GI Issues?

A
  • Caffeine and other Stimulants
  • Fiber
  • Simple Sugars (fructose)
  • Specific Intolerances: lactose, gluten
  • Dehydration
  • NSAIDs
92
Q

What is Infectious Diarrhoea?

A
  • Not the same as exercise-induced diarrhoea
93
Q

What is Traveler’s Diarrhea caused by?

A
  • Bacteria: e.g. salmonella, E. Coli
  • Virus: Norovirus or Rotavirus
  • Parasites: Giardia, Cyclospora
94
Q

What is the most common cause of traveler’s diarrhoea?

A
  • Bacteria
95
Q

What is traveler’s diarrhea associated with?

A
  • Frequent bowel movements
  • Potential fever
  • potentially bloody stool
96
Q

What is the general treatment for traveler’s diarrhea?

A
  • Hydration
  • Track Weight
  • Restricted Diet
  • Clear Fluids
  • Gradual Progression back to normal diet
97
Q

What is the BRAT diet?

A
  • Bananas
  • Rice
  • Apples/apple sauce
  • Tea/toast
98
Q

What is another treatment for traveler’s diarrhea?

A
  • anti-diarrheal medication: imodium
99
Q

What does Imodium do?

A
  • Slows gut motility
  • Reduces frequency of stool
100
Q

What should you know about Imodium?

A
  • NOT A CURE
  • does not treat infection
  • Used when limited access to a toilet
101
Q

What is Protozoal Diarrhea?

A

Type of Traveler’s Diarrhea

102
Q

What percentage of traveler’s diarrhea is due to protozoa/parasites?

A
  • 5-10%
103
Q

How is Protozoa Diarrhea acquired?

A
  • Unclean drinking water
  • Person-to-person contact
104
Q

What are frequent symptoms of protozoa diarrhea?

A
  • Diarrhea: initially watery
  • Malaise: discomfort
  • Foul-smelling and fatty stool
  • Abdominal Cramps/bloating
  • Flatulence
  • Nausea
  • Weight loss
  • Vomiting
105
Q

What are some examples of parasites that can cause protozoa diarrhea?

A
  • Giardia
  • Cyclospora
106
Q

What is the treatment protocol for Protozoa Diarrhea?

A
  • Supportive Care: Hydration and Rest
  • Antiprotozoal Medication: prescription
107
Q

What is the difference between bacterial and protozoa diarrhea?

A

Bacterial
- sudden
- uncomfortable diarrhoea
Protozoa
- Gradual
- Tolerable diarrhea

108
Q

Where does much of the risk occur for bacterial traveler’s diarrhea?

A
  • Restaurant
109
Q

What is the suggestion for prevention of bacterial traveler’s diarrhea?

A
  • Boil
  • Peel
  • Cook
110
Q

What are some food recommendations to avoid traveler’s diarrhea?

A
  • Avoid ice
  • Alcohol does not sterilize water
  • Carbonation is good when bottle opened
  • Avoid Fruit salads, lettuce, chicken salads
  • condiments usually bad
  • steam table buffets bad
111
Q

What are some water recommnedations to avoid traveler’s diarrhea?

A
  • Boil 3 minutes, then let cool
  • No ice
112
Q

What can you add to water to kill bacteria?

A
  • 5% sodium hypochlorite (bleach)
  • Tincture of Idoine
113
Q

How much sodium hypochlorite should you add to water to kill bacteria?

A
  • 2 drops to a quart
114
Q

How much tincture of iodine should you add to water to kill bacteria?

A
  • 5 drops to a quart
115
Q

How long does it take sodium hypochlorite or tincture of iodine to kill bacteria in water?

A
  • about 30 minutes
116
Q

What is the pharmaceutical treatment/prevention for traveler’s diarrhea?

A
  • Antibacterial
  • Dukoral Vaccine
117
Q

What are antibacterials effective/not effective for treating?

A

Effective
- bacterial traveler’s diarrhea
Not Effective
- Viral Diarrhea

118
Q

What is the Dukoral Vaccine Used for?

A

Prevention
- Cholera
- E. Coli

119
Q

What is Viral Gastroenteritis?

A

“Stomach Flu” - not the same as influenza
- Spreads Rapidly

120
Q

What are some types of Viral Gastroenteritis?

A
  • Norwalk (norovirus)
  • Rotavirus
121
Q

What is the treatment for Viral Gastroenteritis?

A
  • Oral Rehydration
  • Symptomatic
122
Q

How do you get Norovirus?

A
  • Providing Care
  • Changing Diapers
  • Shaking Hands
  • Touching Contaminated Surfaces
  • All of above: then touch mouth
123
Q

What are the symptoms of Viral Gastroenteritis?

A

Inflammation of Stomach/Intestines
- Stomach Pain
- Nausea
- Diarrhea
- Vomiting

124
Q

What are some less common symptoms of Viral Gastroenteritis?

A
  • Body Aches
  • Headaches
  • Fever
125
Q

What is key for athletes with viral gastroenteritis?

A
  • Early Diagnosis
  • Rapid Isolation
126
Q

What should you do when an athlete has viral gastroenteritis?

A

Isolate
- Hand-washing
- Barriers
- Disinfection with chlorine

127
Q

Is there a vaccine for norovirus?

A
  • NO
128
Q

When should a physician be involved for an athlete with viral gastroenteritis?

A
  • 24HRs: unable to keep liquid down
  • Vomiting more than 2 days
  • Blood in Vomit
  • Severe Dehydration
  • Blood in the Bowel
  • Fever above (40C)

KIN 424 - Medical Aspects of Sport (11 decks)

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