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Clinical Nutrition > Nutritional Disorders of GI > Flashcards

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
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2
Q

atrophic gastritis should be evaluated for?

A

B12, iron and calcium

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3
Q

natural eradication for H. Pylori?

A 
green tea
broccoli
black currant oil
kimchi
probiotics (lactobacillus, bifidobacterium)
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4
Q

peptic ulcer avoiders

A

alcoholc, spicy foods, triggers

limit coffee and caffeine

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5
Q

gas producing foods

A 
beans
cruciferous veggies
fruits
whole wheat and bran
high sugar beverages
dairy
sugar alcohols
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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
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7
Q

criteria for constipation

A
  1. 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
  2. loose stools are rarely present without use of laxitives
  3. there are insufficient criteria for diagnosis of IBS
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8
Q

separate hard lumps

A

severe constipation

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9
Q

lumpy and sausage like

A

mild constipation

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10
Q

a sausage shape with cracks in the surface

A

normal

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11
Q

smooth, soft sausage or snake

A

normal

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12
Q

soft blobs with clear cut edges

A

lacking fiber

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13
Q

mushy consistency with ragged edges

A

mild diarrhea

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14
Q

liquid consistency with no solid pieces

A

severe diarrhea

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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

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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
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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

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18
Q

bacteriodetes (seen in healthy patients)

A

bacteroides
prevotella
xylanibacter

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19
Q

firmicutes (seen in obese patients)

A 
clostridium
eubacterium
roseburia
blautia
ruminococcus
faecalibacterium
lactobacillus
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20
Q

actinobacteria

A

bifidobacterium

propionibacterium

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21
Q

proteobacteria

A

E. coli

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22
Q

verocomicrobia

A

akkermansia (none in autistic patients)

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23
Q

large intestine colonization can be affected by?

A 
mode of delivery
premature delivery
feeding
introduction of solid food
siblings
antibiotics
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24
Q

signs and symptoms of malabsorbed fat

A

pale, greasy, smelly stools, diarrhea without distention or gas

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25
Q

signs and symptoms of malabsorbed protein

A

edema

muscle atrophy

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26
Q

signs and symptoms of malabsorbed carbs

A

watery diarrhea, flatus, abdominal distention

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27
Q

signs and symptoms of malabsorbed fluid or electrolytes

A

tachycardia

dry mouth

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28
Q

signs and symptoms of malabsorbed bile salts

A

watery diarrhea

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29
Q

signs and symptoms of malabsorbed folic acid

A

macrocytic anemia

glossitis

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30
Q

signs and symptoms of malabsorbed B12

A

macrocytic anemia, glossitis, fatigue, nerve issues

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31
Q

signs and symptoms of malabsorbed B complex

A 
cheilosis
angular stomatitis
glossitis
dermatits
ataxia
sensory dysfunction
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32
Q

signs and symptoms of malabsorbed vitamin A

A

night blindness

follicular hyperkeratosis

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33
Q

signs and symptoms of malabsorbed vitamin D

A

muscle cramps

bone pain

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34
Q

signs and symptoms of malabsorbed vitamin E

A

decreased deep tendon reflex

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35
Q

signs and symptoms of malabsorbed iron

A

microcytic anemia
fatigue
koilonychia

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36
Q

signs and symptoms of malabsorbed zinc

A

taste atrophy
dermatits
hair loss

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37
Q

signs and symptoms of malabsorbed magnesium

A

tetany

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38
Q

signs and symptoms of malabsorbed selenium

A

muscle pain

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39
Q

signs and symptoms of malabsorbed copper

A

weakness

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40
Q

signs and symptoms of malabsorbed calcium

A

paresthesia
tetany
bone pain
trousseau sign

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41
Q

leaky gut

A

increated intestinal permeability

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42
Q

what could leaky gut be due to?

A

infections
medications
dysbiosis

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43
Q

who has leaky gut?

A 
celiac
chron's
MS
IBS
SIBO
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44
Q

most common test for diganosis of leaky gut

A

lactulose-mannitol test

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45
Q

pathyphysiology of celiac disease

A

genetic susceptibility (35% have it, small percent present with it)
exposure to gluten
environmental trigger
autoimmune response

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46
Q

nutritional symptoms of celiac disease

A 
anemia
increased fracture risk
clotting issues
delayed growth
lactase deficiency
47
Q

extraintestina celiac symptoms

A 
malaise
arthritis
dermatiits herpetiformis
infertility
hepatitis
ataia
psychiatric syndromes (depression, etc)
48
Q

associated disorders with celiac

A

autoimmune cluster: T1DM, thyroiditis, hepatits
GI malignancy
IgA deficiency

49
Q

celiac vs gluten sensitivity or intolerance

A

celiac: immune system involved, body attacks itself

gluten sensitivity/intolerance: no immune response, IBS, diagnose using elimination diet

50
Q

nutritonal therapy for those with celiac

A

gluten free for life, avoid wheat, rye, barley and malt

up to 50g/day of oats may be tolerated

51
Q

gluten free grains and flours

A 
amaranth
arrow root
bean flours
corn
rice
soybean
potato
quinoa
flax
tapioca
52
Q

gluten free desserts

A

sorbet

popsicles

53
Q

cheese, eggs, meat, fish, poultry for gluten free

A

all cheese
all eggs
all fresh untreated meat, fish or poultry

54
Q

beans, legumes, nuts, seeds, fruits, veggies for gluten free

A

can have all these things

55
Q

alcohol gluten free

A

wine
distilled liquor
gluten-free beer

56
Q

hidden exposure to gluten

A 
medications
communion wafter
toothpaste
mouthwash
lipstick
cross contamination
57
Q

nutritional defeicencies at diagnosis of celiac

A 
calorie/protein
fiber
iron
zinc, copper
calcium, magnesium, vitamin D
folate, niacin, riboflavin, B12
58
Q

gluten free diet started nutritional deficiencies

A

fiber
iron
calcium, magnesium, vitamin D
folate, niacin, riboflavin, B12

59
Q

long term gluten free diet

A

fiber

folate, niacin, riboflavin, B12

60
Q

refractory celiac disease

A

patients who don’t respond to a gluten free diet

present with severe malabsorptive diarrhea and weight loss

61
Q

gluten free diets are usually low in?

A

iron, fiber, folate
niacin
riboflavin

62
Q

gluten free diets are usually high in?

A

saturated fat
starch
sucrose

63
Q

nutritionally adequate gluten free diet

A

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
Q

intestinal brush border enzyme deficiencies

A

lactose intolerance

fructose malabsorption

65
Q

lactose intolerance

A

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
Q

fructose malabsorption

A

diagnosed with hydrogen breath test

75% of healthy people incompletely absorb large amounts of fructose

67
Q

IBD

A

inflammation increases protein requirement

68
Q

what supplements are necessary for IBD?

A

folate B6, B12, zinc, magnesium
if diarrhea: zinc, selenium, potassium
if steroids: vitamin D and calicum

69
Q

what can help reduce flareups for IBD?

A

omega 3s

70
Q

rome III criteria for IBS

A

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
Q

IBS with constipation (IBS-C)

A

<3 bowel movements per week
hard, lumpy stools
straining

72
Q

IBS w/ diarrhea (IBS-D)

A

> 3BM/d
fecal urcency
loose, watery stools

73
Q

mixed IBS (IBS-M)

A

mix of hard and loose stools over hours to days

74
Q

unsubtyped IBS

A

insufficient evidence to meet criteria for other types

75
Q

what should you check for those with IBS?

A 
meds they are taking
review of GIsymptoms
assessment of nutritonal staus and food intake
supplement intake
use of mind-body therapies
76
Q

IBS treatemnts for abdominal pain and discomfort

A

antispasmodic agent (antidepressants)

77
Q

IBS treatment options for constipation

A

fiber, fluid, laxatives

78
Q

IBS treatment options for diarrhea

A

antidiarrheals

79
Q

IBS treatment options for small intestinal bacterial growth

A

antibiotics/probiotics

80
Q

IBS treatment options for global symptoms

A

psychotherapy
peppermint oil
probiotics/prebiotics

81
Q

FODMAP diets

A

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
Q

diary foods to limit with FODMAP

A 
milk
cottage cheese
ice cream
sweetened condensed milk
evaporated milk
soft cheese
sour cream
whipped cream
yogurt
chocolate
83
Q

non dairy foods to avoid with FODMAP

A 
coconut milk
coconut cream
beans
black eyed peas
hummus
lentils
pistachios
soy
84
Q

grains to limit with FODMAP

A

wheat
chicory root
inulin
rye

85
Q

fruits to limit for FODMAP

A 
avocado
apples
apricots
dates
canned fruit
cherries
dried fruit
figs
guava
lychee
mango
nectarines
pears
papaya
peaches
plums
pprunes
watermelon
86
Q

vegetables to limit with FODMAP

A 
artichokes
asparagus
beets
leeks
broccoli
brussel sprouts
cabbage
cauliflower
green beans
mushrooms
summer squash
87
Q

sweetners/seasonings to limit with FODMAP

A 
agave
honey
high fructose corn syrup
coconut
jams
jelly
molasses
garlic
onions
pickles
relish
sugar alcohols
88
Q

diverticulosis

A

sac-like pouches that form within the colon due to weakeneed muscles
most often in sigmoid colon

89
Q

diverticulitis

A

inflammation fo diverticula

90
Q

etiology of diverticular disease

A 
associated with obesity
low fiber diet
vitamin D insufficiency
sedentary lifestyle
NSAID use
91
Q

nutritional therapy for diverticular disease

A

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
Q

SIBO

A

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
Q

what diet could be useful for SIBO?

A

FODMAP diet

94
Q

fat lab test

A

72 hour fecal fat test

95
Q

protein lab test

A

fecal nitrogen, serum albumin

96
Q

carb lab test

A

hydrogen breath test

97
Q

fluid/electrolyte lab tests

A

serum electrolyte panel, creatinine, urea nitrogen

98
Q

bile salt lab test

A

serum 7alpha-hydroxy-4-cholesten-3-1

99
Q

folic acid lab test

A

hemoglobin, MCV, serum, RBC folate

100
Q

B12 lab tests

A

hemoglobin, MCV, serum, RBC B12

101
Q

B complex lab test

A

serum vitamin levels

102
Q

vitamin A lab tests

A

serum retinol, retainal esters

103
Q

vitamin D lab test

A

serum 25-hydroxyvitamin D

104
Q

vitamin E lab test

A

serum tocopherol

105
Q

vitamin k lab test

A

prothrombin clotting time

106
Q

iron lab tests

A

hemoglobin, MCV, serum ferritin, serum iron-binding capacity, total iron

107
Q

zinc lab test

A

serum zinc

108
Q

magnesium lab tests

A

serum magnesium, 24hr urinary Mg

109
Q

selenium lab test

A

serum selenium

110
Q

copper lab test

A

serum copper, cerulopalsmin

111
Q

calcium lab tests

A

serum calcium, phsophorus, alkaline phosphatase, PTH

112
Q

lactulose

A

non-absorbable disaccharide (leaky gut)

113
Q

mannnitol

A

sugar alcohol (lack of indicates malabsorption)

114
Q

is chron’s or ulcerative colitis more likely to show with malabsorption

A

chron’s because it involves the ileum

which is used to absorb B12 and bile

Clinical Nutrition (19 decks)

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