Module 9 - GI Issues in Athletes Flashcards

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
What is the Appendix? What is its function?
- 4 inch pouch shape - Function unclear
26
Describe the Rectum
- Approx. 20cm
27
What does the Rectum do?
- connects the colon and anus - Holds waste until evacuation
28
Describe the Anus
- Final Part of GI Tract - Approx 5cm
29
What does the Anus do?
- Release waste
30
How is waste held in the GI tract until excretion?
- A series of sphincters - Pelvic floor muscles
31
What is it called when waste is held?
- Continence
32
What happens to the GI tract during exercise?
Blood is Directed to Working Muscles away from GI tract - GI tract becomes ischaemic - GI distress may also be induced
33
Why might GI distress occur from exercise?
- Aggressive diaphragm movement - Abdominal contractions - Intestinal Jarring - Intestinal Bleeding
34
How does exercise affect the gut?
- Splanchnic Hypoperfusion - Motility - Possible Increased Intestinal Permeability and Exercise
35
What does Splanchnic Hypoperfusion of the Gut during exercise entail?
- Reduced blood flow to the gut: splanchnic vasoconstriction - Steal of blood flow to exercising muscles
36
What happens to the motility of the gut due to exercise?
- Reduced esophageal motility and pyloric sphincter tone - Reduced gastric emptying during severe exercise
37
What are the differing mechanical factors that impact the GI Tract?
- high-impact exercise - Runners: pounding - Cyclists: Positioning
38
What can the pounding of running do to the GI tract?
Cause Lower GI Tract Issues: - Flatulence - Diarrhoea - Urgency
39
What can the positioning of cycling do to the GI tract?
Cause Upper GI issues - Pressure on the abdomen - Horizontal Esophagus
40
What are some nutritional causes for GI Issues?
- Fibre - Fat - Protein - Carbohydrates, especially Fructose - Beverages with high osmolalities (>500 mOsm/L) - Delay Gastric Emptying
41
What are some nutritional solutions to GI issues?
- Mix of glucose/fructose better than single sugar alone - Or Maltodextrin/Fructose
42
What is the recommendation for nutrition with GI Issues?
- Individual Variations - Regular Fiber Intake - Stay Hydrated - Avoid Trigger Foods
43
What is the recommendation for managing individual variation for GI Issues and Nutrition?
- Athletes keep track of trigger food - Dont introduce new food before a competition - Time meals appropriately - Inadequate pre-event feeding can also cause issues
44
Should you have fiber right before intense exercise?
- NO
45
When should you experiment with new food?
- before competition
46
What does NSAID stand for?
Non-steroidal anti-inflammatory drug
47
When do athletes use NSAIDs?
- Prior and during sport for pain relief
48
What are some examples of NSAIDs?
- Advil (ibuprofen) - Aleve (naproxen sodium) - Bayer (aspirin)
49
What are NSAIDs associated with in regards to the GI tract?
- Upper GI Issues: 3-5x risk
50
What is unique about advil's effect on the GI tract?
- increase risk for intestine bleeding during exercise: especially when taken prophylactically
51
Where are GI Issues mostly seen with NSAIDs?
- Esophagus - Stomach - Duodenum
52
Where are GI Issues rarely seen with NSAIDs?
- Small Intestine
53
Where are GI Issues uncommonly seen with NSAIDs?
- Large Intestine
54
What can NSAIDs do to the esophagus?
- reflux - Upper GI bleeding
55
What can NSAIDs do to the stomach and duodenum?
- Gastritis - Upper GI bleeding - Perforation
56
What, while rarely, do NSAIDs do to the small intestine?
- Increase permeability
57
What, while uncommon, can NSAIDs do to the large intestine?
- Increase Permeability - Lower GI Bleeding
58
What are some Upper GI TRact Issues that NSAIDs can cause?
- Heartburn - Reflux - Nausea - Vomiting - Bloating - Epigastric Pain
59
What is GERD?
- Gastroesophageal Reflux Disease
60
What is the likely causes of GERD?
Decrease - esophageal peristaltic activity - lower esophageal sphincter tone Increase - Transient lower sphincter relaxation
61
What are some non-exercise causes of GERD?
- Smoking - Obesity - Pregnancy - Overeating
62
What are some trigger foods for GERD?
- High fat foods - chocolate - onions - coffee - tea - alcohol - tomatoes - cheese - juice - carbonated bevies -
63
What should an athlete do if they start experiencing GERD?
- start keeping a food log to track symptoms and identify trigger foods
64
Describe the relationship between GERD and athletes
- Exercise is a common cause - May mimic symptoms of EILO - the mechanism by which GERD occurs during exercise is not well understood
65
What symptoms of GERD should be addressed immediately?
- Chest pain: eliminate other causes
66
What are the symptoms of GERD?
- Heartburn - Reflux - Epigastric Pain
67
What is the treatment for GERD?
- Antacid Medication (Tums, Rolaids) - Histamine Blocking Drugs
68
What is a suggested preventative method for GERD?
- No solid foods before training/competition
69
What are some Lower GI Tract Issues from Exercise?
- Cramping - Urge to defecate - Diarrhea - Rectal Bleeding - Flatulence
70
What is the 'stitch'?
- Sharp pain in UL or UR quadrant during exercise
71
What are the mechanisms of the 'Stitch'?
Unclear - likely spasm of diaphragm or gas trapped in colon
72
What is a suggestion for preventing the 'stitch'?
- Avoid solid food prior to exercise
73
What is runners diarrhoea also known as?
- Runner's Trots
74
Describe Runner's Trots
- Diarrhoea while running - Frequency increases with intensity and duration of exercise - More prevalent in competition than in practice
75
Why might runner's trots be more frequent during the competition than training?
- Anxiety
76
What seems to be linked with runners' diarrhea?
- Anxiety - Caffein - Artificial Sweeteners
77
What are the causes of runners diarrhoea?
Unclear - ischemia - Increased motility
78
What is the treatment for runners diarrhoea?
- Individualized - Try to isolate the specific causes for the athlete
79
What is suggested to limit risk of runners diarrhea?
- Reduce fiber consumption 24hr prior competition - Avoid trigger foods - Anti-diarrheals may be used occasionally
80
What is suggested if there is persistent or long-term diarrhea?
- Investigate it further
81
What might runners find in their stool following endurance events?
- Blood in stool
82
Why might runners find blood in their stool following endurance events?
Unclear: Likely - lack of blood flow - Dehydration - Mechanical jarring
83
What may recurrent bleeding do to an athlete?
- risk of iron-deficiency anaemia
84
What is the treatment for rectal bleeding following endurance events?
- Assure proper hydration - Reduce mechanical jarring - change technique/shoes/surface
85
What is unexplained GI bleeding a cause for?
- Medical Intervention
86
What is Irritable Bowel Syndrome (IBS)?
- Common non-malignant condition of the colon
87
What are the symptoms of IBS?
- Cramping - Abdominal Pain - Bloating - Constipation - Diarrhoea
88
What is FODMAPS?
Short Chain Carbohydrates
89
What does FODMAPS stand for?
- Fermentable Oligosaccharides - Disaccharides - Monosaccharides - And Polyols
90
What is the pre-event protocol for avoiding GI Issues?
- Don't experiment during an event - Reduce: fiber, caffeine, and specific intolerance - Train in similar environment (heat/cold)
91
What should you be cautious with during the event to avoid GI Issues?
- Caffeine and other Stimulants - Fiber - Simple Sugars (fructose) - Specific Intolerances: lactose, gluten - Dehydration - NSAIDs
92
What is Infectious Diarrhoea?
- Not the same as exercise-induced diarrhoea
93
What is Traveler's Diarrhea caused by?
- Bacteria: e.g. salmonella, E. Coli - Virus: Norovirus or Rotavirus - Parasites: Giardia, Cyclospora
94
What is the most common cause of traveler's diarrhoea?
- Bacteria
95
What is traveler's diarrhea associated with?
- Frequent bowel movements - Potential fever - potentially bloody stool
96
What is the general treatment for traveler's diarrhea?
- Hydration - Track Weight - Restricted Diet - Clear Fluids - Gradual Progression back to normal diet
97
What is the BRAT diet?
- Bananas - Rice - Apples/apple sauce - Tea/toast
98
What is another treatment for traveler's diarrhea?
- anti-diarrheal medication: imodium
99
What does Imodium do?
- Slows gut motility - Reduces frequency of stool
100
What should you know about Imodium?
- NOT A CURE - does not treat infection - Used when limited access to a toilet
101
What is Protozoal Diarrhea?
Type of Traveler's Diarrhea
102
What percentage of traveler's diarrhea is due to protozoa/parasites?
- 5-10%
103
How is Protozoa Diarrhea acquired?
- Unclean drinking water - Person-to-person contact
104
What are frequent symptoms of protozoa diarrhea?
- Diarrhea: initially watery - Malaise: discomfort - Foul-smelling and fatty stool - Abdominal Cramps/bloating - Flatulence - Nausea - Weight loss - Vomiting
105
What are some examples of parasites that can cause protozoa diarrhea?
- Giardia - Cyclospora
106
What is the treatment protocol for Protozoa Diarrhea?
- Supportive Care: Hydration and Rest - Antiprotozoal Medication: prescription
107
What is the difference between bacterial and protozoa diarrhea?
Bacterial - sudden - uncomfortable diarrhoea Protozoa - Gradual - Tolerable diarrhea
108
Where does much of the risk occur for bacterial traveler's diarrhea?
- Restaurant
109
What is the suggestion for prevention of bacterial traveler's diarrhea?
- Boil - Peel - Cook
110
What are some food recommendations to avoid traveler's diarrhea?
- 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
What are some water recommnedations to avoid traveler's diarrhea?
- Boil 3 minutes, then let cool - No ice
112
What can you add to water to kill bacteria?
- 5% sodium hypochlorite (bleach) - Tincture of Idoine
113
How much sodium hypochlorite should you add to water to kill bacteria?
- 2 drops to a quart
114
How much tincture of iodine should you add to water to kill bacteria?
- 5 drops to a quart
115
How long does it take sodium hypochlorite or tincture of iodine to kill bacteria in water?
- about 30 minutes
116
What is the pharmaceutical treatment/prevention for traveler's diarrhea?
- Antibacterial - Dukoral Vaccine
117
What are antibacterials effective/not effective for treating?
Effective - bacterial traveler's diarrhea Not Effective - Viral Diarrhea
118
What is the Dukoral Vaccine Used for?
Prevention - Cholera - E. Coli
119
What is Viral Gastroenteritis?
"Stomach Flu" - not the same as influenza - Spreads Rapidly
120
What are some types of Viral Gastroenteritis?
- Norwalk (norovirus) - Rotavirus
121
What is the treatment for Viral Gastroenteritis?
- Oral Rehydration - Symptomatic
122
How do you get Norovirus?
- Providing Care - Changing Diapers - Shaking Hands - Touching Contaminated Surfaces - All of above: then touch mouth
123
What are the symptoms of Viral Gastroenteritis?
Inflammation of Stomach/Intestines - Stomach Pain - Nausea - Diarrhea - Vomiting
124
What are some less common symptoms of Viral Gastroenteritis?
- Body Aches - Headaches - Fever
125
What is key for athletes with viral gastroenteritis?
- Early Diagnosis - Rapid Isolation
126
What should you do when an athlete has viral gastroenteritis?
Isolate - Hand-washing - Barriers - Disinfection with chlorine
127
Is there a vaccine for norovirus?
- NO
128
When should a physician be involved for an athlete with viral gastroenteritis?
- 24HRs: unable to keep liquid down - Vomiting more than 2 days - Blood in Vomit - Severe Dehydration - Blood in the Bowel - Fever above (40C)