Nutritional Disorders of GI Flashcards
1
Q
GERD nutritional therapy
A
avoid large, high fat meals avoid eating 2-3 hours befor lying down elevate head 6-8 inches while sleeping avoid smoking avoid alcohol avoid caffeine and carbonate beverages avoid acidic or spicy foods consume a healthy, nutritionally balanced diet with adequate fiber lose weight, if indicated
2
Q
atrophic gastritis should be evaluated for?
A
B12, iron and calcium
3
Q
natural eradication for H. Pylori?
A
green tea broccoli black currant oil kimchi probiotics (lactobacillus, bifidobacterium)
4
Q
peptic ulcer avoiders
A
alcoholc, spicy foods, triggers
limit coffee and caffeine
5
Q
gas producing foods
A
beans cruciferous veggies fruits whole wheat and bran high sugar beverages dairy sugar alcohols
6
Q
constipation, how do we get it?
A
lack of fiber inadequate fluid low energy intake iron and calcium supplements lack of exercise immobility laxative abuse postponing urge to defecate
7
Q
criteria for constipation
A
- must include or more of these for last 3 months
straining during 25% defecations
lumpy or hard stools in 25%
sensation of incomplete evacuations in 25%
sensation of anorectal obstruction for at least 25%
manual maneuvers to facilitate at least 25%
<3 defecations per week - loose stools are rarely present without use of laxitives
- there are insufficient criteria for diagnosis of IBS
8
Q
separate hard lumps
A
severe constipation
9
Q
lumpy and sausage like
A
mild constipation
10
Q
a sausage shape with cracks in the surface
A
normal
11
Q
smooth, soft sausage or snake
A
normal
12
Q
soft blobs with clear cut edges
A
lacking fiber
13
Q
mushy consistency with ragged edges
A
mild diarrhea
14
Q
liquid consistency with no solid pieces
A
severe diarrhea
15
Q
how can we help people with constipation?
A
increase consumption of whole grain products to 6-11 servings/d
increase veggies to5-8 servings/d
consume high fiber cereals to get at least 25 g of fiber/d for females and 38 g/d for males
increased fluid consumption to at least 2L/d
16
Q
what could cause malabsorptive diarrhea
A
pancreatic insufficiency gastric acid hypersecretion imparied bile production or secretion bacterial overgrowth enzymatic deficiency celiac disease chron's disease allergy
17
Q
what should you so for those with diarrhea?
A
replenish fluids
limit lactose, sugar alcohols, fructose and large amounts of sucrose
soluble fiber, like pectin, can slow GI motility
try probiotics
18
Q
bacteriodetes (seen in healthy patients)
A
bacteroides
prevotella
xylanibacter
19
Q
firmicutes (seen in obese patients)
A
clostridium eubacterium roseburia blautia ruminococcus faecalibacterium lactobacillus
20
Q
actinobacteria
A
bifidobacterium
propionibacterium
21
Q
proteobacteria
A
E. coli
22
Q
verocomicrobia
A
akkermansia (none in autistic patients)
23
Q
large intestine colonization can be affected by?
A
mode of delivery premature delivery feeding introduction of solid food siblings antibiotics
24
Q
signs and symptoms of malabsorbed fat
A
pale, greasy, smelly stools, diarrhea without distention or gas
25
signs and symptoms of malabsorbed protein
edema
| muscle atrophy
26
signs and symptoms of malabsorbed carbs
watery diarrhea, flatus, abdominal distention
27
signs and symptoms of malabsorbed fluid or electrolytes
tachycardia
| dry mouth
28
signs and symptoms of malabsorbed bile salts
watery diarrhea
29
signs and symptoms of malabsorbed folic acid
macrocytic anemia
| glossitis
30
signs and symptoms of malabsorbed B12
macrocytic anemia, glossitis, fatigue, nerve issues
31
signs and symptoms of malabsorbed B complex
```
cheilosis
angular stomatitis
glossitis
dermatits
ataxia
sensory dysfunction
```
32
signs and symptoms of malabsorbed vitamin A
night blindness
| follicular hyperkeratosis
33
signs and symptoms of malabsorbed vitamin D
muscle cramps
| bone pain
34
signs and symptoms of malabsorbed vitamin E
decreased deep tendon reflex
35
signs and symptoms of malabsorbed iron
microcytic anemia
fatigue
koilonychia
36
signs and symptoms of malabsorbed zinc
taste atrophy
dermatits
hair loss
37
signs and symptoms of malabsorbed magnesium
tetany
38
signs and symptoms of malabsorbed selenium
muscle pain
39
signs and symptoms of malabsorbed copper
weakness
40
signs and symptoms of malabsorbed calcium
paresthesia
tetany
bone pain
trousseau sign
41
leaky gut
increated intestinal permeability
42
what could leaky gut be due to?
infections
medications
dysbiosis
43
who has leaky gut?
```
celiac
chron's
MS
IBS
SIBO
```
44
most common test for diganosis of leaky gut
lactulose-mannitol test
45
pathyphysiology of celiac disease
genetic susceptibility (35% have it, small percent present with it)
exposure to gluten
environmental trigger
autoimmune response
46
nutritional symptoms of celiac disease
```
anemia
increased fracture risk
clotting issues
delayed growth
lactase deficiency
```
47
extraintestina celiac symptoms
```
malaise
arthritis
dermatiits herpetiformis
infertility
hepatitis
ataia
psychiatric syndromes (depression, etc)
```
48
associated disorders with celiac
autoimmune cluster: T1DM, thyroiditis, hepatits
GI malignancy
IgA deficiency
49
celiac vs gluten sensitivity or intolerance
celiac: immune system involved, body attacks itself
| gluten sensitivity/intolerance: no immune response, IBS, diagnose using elimination diet
50
nutritonal therapy for those with celiac
gluten free for life, avoid wheat, rye, barley and malt
| up to 50g/day of oats may be tolerated
51
gluten free grains and flours
```
amaranth
arrow root
bean flours
corn
rice
soybean
potato
quinoa
flax
tapioca
```
52
gluten free desserts
sorbet
| popsicles
53
cheese, eggs, meat, fish, poultry for gluten free
all cheese
all eggs
all fresh untreated meat, fish or poultry
54
beans, legumes, nuts, seeds, fruits, veggies for gluten free
can have all these things
55
alcohol gluten free
wine
distilled liquor
gluten-free beer
56
hidden exposure to gluten
```
medications
communion wafter
toothpaste
mouthwash
lipstick
cross contamination
```
57
nutritional defeicencies at diagnosis of celiac
```
calorie/protein
fiber
iron
zinc, copper
calcium, magnesium, vitamin D
folate, niacin, riboflavin, B12
```
58
gluten free diet started nutritional deficiencies
fiber
iron
calcium, magnesium, vitamin D
folate, niacin, riboflavin, B12
59
long term gluten free diet
fiber
| folate, niacin, riboflavin, B12
60
refractory celiac disease
patients who don't respond to a gluten free diet
| present with severe malabsorptive diarrhea and weight loss
61
gluten free diets are usually low in?
iron, fiber, folate
niacin
riboflavin
62
gluten free diets are usually high in?
saturated fat
starch
sucrose
63
nutritionally adequate gluten free diet
focus on foods taht are natrually gluten free
get at least 5 servings of fruits and veggies/day
add amaranth, quinoa and buckwheat
meat, fish and dairy
64
intestinal brush border enzyme deficiencies
lactose intolerance
| fructose malabsorption
65
lactose intolerance
most common form of carb malabsorption
diagnosi with hydrogen breath test or a lactose tolerance test
most can consume up to 12 g of lactose a day without symptoms (=1 cup of milk)
66
fructose malabsorption
diagnosed with hydrogen breath test
| 75% of healthy people incompletely absorb large amounts of fructose
67
IBD
inflammation increases protein requirement
68
what supplements are necessary for IBD?
folate B6, B12, zinc, magnesium
if diarrhea: zinc, selenium, potassium
if steroids: vitamin D and calicum
69
what can help reduce flareups for IBD?
omega 3s
70
rome III criteria for IBS
recurrent abdominal pain or discomfort at elast 3 days/month in the last 3 months associated with 2 or more of the following:
improvement with defecation
onset associated with a change in frequency of stool
onset associated with chagne in appearance of stool
71
IBS with constipation (IBS-C)
<3 bowel movements per week
hard, lumpy stools
straining
72
IBS w/ diarrhea (IBS-D)
>3BM/d
fecal urcency
loose, watery stools
73
mixed IBS (IBS-M)
mix of hard and loose stools over hours to days
74
unsubtyped IBS
insufficient evidence to meet criteria for other types
75
what should you check for those with IBS?
```
meds they are taking
review of GIsymptoms
assessment of nutritonal staus and food intake
supplement intake
use of mind-body therapies
```
76
IBS treatemnts for abdominal pain and discomfort
antispasmodic agent (antidepressants)
77
IBS treatment options for constipation
fiber, fluid, laxatives
78
IBS treatment options for diarrhea
antidiarrheals
79
IBS treatment options for small intestinal bacterial growth
antibiotics/probiotics
80
IBS treatment options for global symptoms
psychotherapy
peppermint oil
probiotics/prebiotics
81
FODMAP diets
limit fermentable foods (sugars, oligosacharides,sugar alcohols)
use as a guide to start with a very restictive diet and slowly add back foods to determine trigger
emerging as a useful diet for IBS peitnts
82
diary foods to limit with FODMAP
```
milk
cottage cheese
ice cream
sweetened condensed milk
evaporated milk
soft cheese
sour cream
whipped cream
yogurt
chocolate
```
83
non dairy foods to avoid with FODMAP
```
coconut milk
coconut cream
beans
black eyed peas
hummus
lentils
pistachios
soy
```
84
grains to limit with FODMAP
wheat
chicory root
inulin
rye
85
fruits to limit for FODMAP
```
avocado
apples
apricots
dates
canned fruit
cherries
dried fruit
figs
guava
lychee
mango
nectarines
pears
papaya
peaches
plums
pprunes
watermelon
```
86
vegetables to limit with FODMAP
```
artichokes
asparagus
beets
leeks
broccoli
brussel sprouts
cabbage
cauliflower
green beans
mushrooms
summer squash
```
87
sweetners/seasonings to limit with FODMAP
```
agave
honey
high fructose corn syrup
coconut
jams
jelly
molasses
garlic
onions
pickles
relish
sugar alcohols
```
88
diverticulosis
sac-like pouches that form within the colon due to weakeneed muscles
most often in sigmoid colon
89
diverticulitis
inflammation fo diverticula
90
etiology of diverticular disease
```
associated with obesity
low fiber diet
vitamin D insufficiency
sedentary lifestyle
NSAID use
```
91
nutritional therapy for diverticular disease
no longer recommended to avoid nuts, seeds, corn, popcorn or berries
high fiber diet can improve symptoms
probiotic studies suggest improvement with certain bacteria
92
SIBO
overproliferation of bacteria in the SI that are normally only found in LI
could be due to low stomach acidity, liver or gallbladder disease or pancreatitis
if probiotics are recommended, avoid lactobacillus acidophilus and ferminti
carbs serve as fuel for bacteria
93
what diet could be useful for SIBO?
FODMAP diet
94
fat lab test
72 hour fecal fat test
95
protein lab test
fecal nitrogen, serum albumin
96
carb lab test
hydrogen breath test
97
fluid/electrolyte lab tests
serum electrolyte panel, creatinine, urea nitrogen
98
bile salt lab test
serum 7alpha-hydroxy-4-cholesten-3-1
99
folic acid lab test
hemoglobin, MCV, serum, RBC folate
100
B12 lab tests
hemoglobin, MCV, serum, RBC B12
101
B complex lab test
serum vitamin levels
102
vitamin A lab tests
serum retinol, retainal esters
103
vitamin D lab test
serum 25-hydroxyvitamin D
104
vitamin E lab test
serum tocopherol
105
vitamin k lab test
prothrombin clotting time
106
iron lab tests
hemoglobin, MCV, serum ferritin, serum iron-binding capacity, total iron
107
zinc lab test
serum zinc
108
magnesium lab tests
serum magnesium, 24hr urinary Mg
109
selenium lab test
serum selenium
110
copper lab test
serum copper, cerulopalsmin
111
calcium lab tests
serum calcium, phsophorus, alkaline phosphatase, PTH
112
lactulose
non-absorbable disaccharide (leaky gut)
113
mannnitol
sugar alcohol (lack of indicates malabsorption)
114
is chron's or ulcerative colitis more likely to show with malabsorption
chron's because it involves the ileum
| which is used to absorb B12 and bile
