Nutrition in GI disease Flashcards
Dietary carbohydrates are digested when ______ changes starches to disaccharides and then intestinal enzymes hydrolyze disaccharides to monosaccharides prior to absorption
amylase
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
lipases
bile acids
Dietary protein digestion requires acidity to denature proteins and activate pepsin, and proteases to complete the breakdown into amino acids.
Absorption occurs via:
carrier-mediated process through the intestinal wall.
List impairments of mechanical digestion that could cause malabsorption
abnormal dentition
gastrectomy
gastroparesis
vagotomy
List impairments of chemical digestion that could cause malabsorption
pancreatic disease
impaired acid release due to vagotomy
How can impaired solubilization lead to malabsorption?
inadequate bile acids–> malabsorption
List mechanisms that decrease absorption surface area and thus cause pathological impairment in absorption
IBD ex Crohn’s
short bowel syndrome
List mechanisms that impair fatty acid digestion/ esterification and thus cause pathological impairment in absorption
pancreatic disease
intestinal bypass
Celiac disease
Carbohydrate malabsorption causes _______ diarrhea
osmotic
The most common form of carbohydrate malabsorption is due to
lactase deficiency- genetic or acquired
Describe ways to treat or eliminate lactose intolerance
reduce dairy
use lactase treated dairy products
use lactase supplements
avoid medications that contain lactose
How does diarrhea or inflammatory bowel disease lead to secondary lactose intolerance?
“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
In secondary lactose intolerance, avoidance of lactose until the inflammation is controlled is vital to allow the _____ to return to normal
brush border
List agents that can be malabsorbed, leading to “carbohydrate intolerance”
fructose
sorbitol
fructans and glucans
Symptoms of carbohydrate intolerance include bloating, abdominal discomfort, and flatulence and can easily be confused with ______
IBS- irritable bowel syndrome
Absorption of fructose usually improves when an equal amount of ______ is present
glucose
List foods high in fructose
HFCS, honey, fruit juice, apples, pears, mango
Fructose intolerance can be assessed using a _________test
hydrogen breath test
_______ is a sugar alcohol used as an artificial sweetener in diet foods and also found in some fruits and beers
sorbitol
Why do oligosaccharides with fructose or galactose chains cause carbohydrate intolerance?
mammalian small intestine does not contain hydrolases to split the bonds so these oligosaccharides are almost completely malabsorbed
List foods high in fructans and glucans
legumes, wheat, onions, garlic, artichokes, cabbage, some fruits
Commercial _______ is available to help with fructan and glucan malabsorption
galactosidases
List complications of fat malabsorption
weight loss, muscle wasting failure to thrive fatigue infertility, menstrual disorders Vitamin ADEK oxalate kidney stones
List complications of vitamin D malabsorption
hypocalcemia, osteomalacia with bone pain and fractures
List complications of vitamin A malabsorption
blindness and skin changes
List complications of vitamin K malabsorption
prolonged bleeding time, ostopenia
List complications of vitamin E malabsorption
neuropathy, hemolytic anemia
Pancreatitis leads to a reduction in ________, reducing fat digestion and leading to malabsorption, and thus steatorrhea.
pancreatic lipase
How does fat malabsorption lead to formation of oxalate kidneys stones?
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
_________ malabsorption is relatively rare
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.
The most common cause of protein malabsorption is _______
celiac disease
In celiac disease, due to inflammation and villus flattening, there is a reduced ability to absorb nutrients and patients may be deficient in:
iron calcium vitamin K B vitamins macronutrients
List recommendations for management of GERD and nutrition
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
List substances that stimulate gastrin (hormone that causes gastric acid secretion)
caffeine, alkaloids, alcohol, cigarette smoking
Peptic ulcer disease is highly associated with:
NSAIDs and H pylori
List nutritional recommendations for patients with hepatic cirrhosis
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
List nutrient deficiencies commonly seen in inflammatory bowel disease
B12- absorbed in ileum, inflammedi n Crohn’s
calcium, vitamin D- due to fat malabsorption
iron- inflammation, chronic low grade bleeding
Crohn’s disease patients may need ______ diets to decrease steatorrhea (loose, fatty stools), and to decrease risk of calcium oxalate nephrolithiasis.
low fat
In IBD, frequent intake of low volume, low fiber foods may be needed to decrease residue to avoid intestinal _________
strictures
The ileum is often inflamed or resected in Crohn’s, which can lead to malabsorption of:
B12, bile salts
List nutritional recommendations for IBD
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
Differentiate soluble vs involuble fiber
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
Differentiate probiotics vs prebiotics
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
