Nutrition in GI disease

Question 1

Dietary carbohydrates are digested when ______ changes starches to disaccharides and then intestinal enzymes hydrolyze disaccharides to monosaccharides prior to absorption

Answer 1

amylase

Question 2

Dietary fats require the action of ______ to
hydrolyze fatty acids from the glycerol structure of triglycerides.
______ emulsify the fatty acids, glycerol, monoglycerides, and fat-soluble vitamins to allow them to diffuse through the intestinal wall via enterocytes

Answer 2

lipases

bile acids

Question 3

Dietary protein digestion requires acidity to denature proteins and activate pepsin, and proteases to complete the breakdown into amino acids.
Absorption occurs via:

Answer 3

carrier-mediated process through the intestinal wall.

Question 4

List impairments of mechanical digestion that could cause malabsorption

Answer 4

abnormal dentition
gastrectomy
gastroparesis
vagotomy

Question 5

List impairments of chemical digestion that could cause malabsorption

Answer 5

pancreatic disease

impaired acid release due to vagotomy

Question 6

How can impaired solubilization lead to malabsorption?

Answer 6

inadequate bile acids–> malabsorption

Question 7

List mechanisms that decrease absorption surface area and thus cause pathological impairment in absorption

Answer 7

IBD ex Crohn’s

short bowel syndrome

Question 8

List mechanisms that impair fatty acid digestion/ esterification and thus cause pathological impairment in absorption

Answer 8

pancreatic disease
intestinal bypass
Celiac disease

Question 9

Carbohydrate malabsorption causes _______ diarrhea

Answer 9

osmotic

Question 10

The most common form of carbohydrate malabsorption is due to

Answer 10

lactase deficiency- genetic or acquired

Question 11

Describe ways to treat or eliminate lactose intolerance

Answer 11

reduce dairy
use lactase treated dairy products
use lactase supplements
avoid medications that contain lactose

Question 12

How does diarrhea or inflammatory bowel disease lead to secondary lactose intolerance?

Answer 12

“carbohydrases” needed to absorb carbohydrates are present on the brush border of enterocytes and can thus be lost when enterocytes are sloughed off during inflammatory processes

Question 13

In secondary lactose intolerance, avoidance of lactose until the inflammation is controlled is vital to allow the _____ to return to normal

Answer 13

brush border

Question 14

List agents that can be malabsorbed, leading to “carbohydrate intolerance”

Answer 14

fructose
sorbitol
fructans and glucans

Question 15

Symptoms of carbohydrate intolerance include bloating, abdominal discomfort, and flatulence and can easily be confused with ______

Answer 15

IBS- irritable bowel syndrome

Question 16

Absorption of fructose usually improves when an equal amount of ______ is present

Answer 16

glucose

Question 17

List foods high in fructose

Answer 17

HFCS, honey, fruit juice, apples, pears, mango

Question 18

Fructose intolerance can be assessed using a _________test

Answer 18

hydrogen breath test

Question 19

_______ is a sugar alcohol used as an artificial sweetener in diet foods and also found in some fruits and beers

Answer 19

sorbitol

Question 20

Why do oligosaccharides with fructose or galactose chains cause carbohydrate intolerance?

Answer 20

mammalian small intestine does not contain hydrolases to split the bonds so these oligosaccharides are almost completely malabsorbed

Question 21

List foods high in fructans and glucans

Answer 21

legumes, wheat, onions, garlic, artichokes, cabbage, some fruits

Question 22

Commercial _______ is available to help with fructan and glucan malabsorption

Answer 22

galactosidases

Question 23

List complications of fat malabsorption

Answer 23

weight loss, muscle wasting
failure to thrive
fatigue
infertility, menstrual disorders
Vitamin ADEK 
oxalate kidney stones

Question 24

List complications of vitamin D malabsorption

Answer 24

hypocalcemia, osteomalacia with bone pain and fractures

Question 25

List complications of vitamin A malabsorption

Answer 25

blindness and skin changes

Question 26

List complications of vitamin K malabsorption

Answer 26

prolonged bleeding time, ostopenia

Question 27

List complications of vitamin E malabsorption

Answer 27

neuropathy, hemolytic anemia

Question 28

Pancreatitis leads to a reduction in ________, reducing fat digestion and leading to malabsorption, and thus steatorrhea.

Answer 28

pancreatic lipase

Question 29

How does fat malabsorption lead to formation of oxalate kidneys stones?

Answer 29

dietary oxalate is normally bound to calcium in the intestines, preventing its absorption. With steatorrhea, excess fat in intestines binds calcium, so oxalate binds with sodium instead, and is thus readily absorbed. The oxalate goes to kidney for waste and forms oxalate stones

Question 30

_________ malabsorption is relatively rare

Answer 30

protein
**If a person cannot digest the protein in a food, the entire food will not be adequately digested and the nutrient content of that food will be lost.

Question 31

The most common cause of protein malabsorption is _______

Answer 31

celiac disease

Question 32

In celiac disease, due to inflammation and villus flattening, there is a reduced ability to absorb nutrients and patients may be deficient in:

Answer 32

iron
calcium
vitamin K
B vitamins
macronutrients

Question 33

List recommendations for management of GERD and nutrition

Answer 33

eat smaller meals
less fluid with meals
don't eat soon before laying down
reduce acidic food
avoid caffeine, coffee, chocolate, alcohol- decrease LES tone
control dietary fat- decreases LES tone
lose weight

Question 34

List substances that stimulate gastrin (hormone that causes gastric acid secretion)

Answer 34

caffeine, alkaloids, alcohol, cigarette smoking

Question 35

Peptic ulcer disease is highly associated with:

Answer 35

NSAIDs and H pylori

Question 36

List nutritional recommendations for patients with hepatic cirrhosis

Answer 36

avoid all alcohol
high caloric intake for malnutrition
sodium restriction-based on diuresis capability and ascites
fluid restriction if significant hyponatremia or ascites
vitamin supplementation

Question 37

List nutrient deficiencies commonly seen in inflammatory bowel disease

Answer 37

B12- absorbed in ileum, inflammedi n Crohn’s
calcium, vitamin D- due to fat malabsorption
iron- inflammation, chronic low grade bleeding

Question 38

Crohn’s disease patients may need ______ diets to decrease steatorrhea (loose, fatty stools), and to decrease risk of calcium oxalate nephrolithiasis.

Answer 38

low fat

Question 39

In IBD, frequent intake of low volume, low fiber foods may be needed to decrease residue to avoid intestinal _________

Answer 39

strictures

Question 40

The ileum is often inflamed or resected in Crohn’s, which can lead to malabsorption of:

Answer 40

B12, bile salts

Question 41

List nutritional recommendations for IBD

Answer 41

treat underlying disease
reduce symptoms associated with malabsorption
correct or prevent nutritional deficiencies including high dose vitamin and mineral supplements (2-5x normal)
low fat, low fiber, low lactose diet
small frequent meals

Question 42

Differentiate soluble vs involuble fiber

Answer 42

soluble fiber: helps maintain normal blood sugar levels, lowers cholesterol moderately. ex oats, barley, vegetables, beans

insoluble fiber: bulks up stool, may reduce risk of diverticulosis. ex whole wheat, vegetables, fruits

Question 43

Differentiate probiotics vs prebiotics

Answer 43

Prebiotics are non-digestible (by the host) food ingredients that have a beneficial effect through their selective metabolism in the intestinal tract. ex some dietary fibers

Probiotics are live microorganisms that, when administered in adequate amounts, confer
a health benefit on the host