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Medical Nutrition Therapy > UGI > Flashcards

UGI Flashcards

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USMLE® Step 1 flashcards
1
Q

Impaired neuromuscular coordination of the lower esophagus due to disrupted
innervation is called _________

  • Impaired swallowing due to:
  • Decreased ________ in the ______ esophagus
  • _____________ maintains an excessively high tone and fails to open properly during swallowing
  • Food is prevented from entering the _______, causing esophageal distention
A

Achalasia

peristalsis
middle

Lower esophageal sphincter (LES)

stomach

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2
Q

Symptoms of Achalasia

A

Esophageal pain after swallowing
Feeling of fullness in the chest
Dysphagia
Frequent regurgitation
Aspiration
Poor intake & weight loss

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3
Q

Medical Treatment of Achalasia

A

Anticholinergic drugs (e.g. Bentyl)
Intrasphincteric botulism injection
Mechanical dilation of esophageal sphincter
Myotomy

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4
Q

MNT for Achalasia

Eat ______ & _____ thoroughly
_________ meals
Take ______ with meals
Altered texture based on tolerance=> _____________
High _________ nutrition supplements

A

slowly & chew
Small, frequent
fluids
easy to chew diet or blenderized liquid diet
calorie/protein

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5
Q

Reflux of gastric acid through the lower esophageal sphincter (LES) into the esophagus

A

GERD

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6
Q

GERD is caused by ______

Primarily due to spontaneous and transient _______

A

LES Pressure

relaxation of LES

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7
Q

LES pressure is decreased by:

A
  • Smoking
  • Certain foods
  • Distention of the proximal stomach
  • Hormone changes=> pregnancy, oral contraceptives
  • Smooth muscle relaxants
  • Scleroderma
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8
Q

Intragastric pressure can be increased by:

A
  • Large meals
  • Lifting/bending
  • Obesity
  • Tight fitting clothes
  • Hiatal hernia
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9
Q
A

Hiatal Hernia

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10
Q

Symptoms of GERD

A

Heartburn
Odynophagia
Chronic cough, hoarseness, asthma

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11
Q

Complications of GERD

A

Esophagitis
Esophageal stricture=> dysphagia
Dental erosion
Respiratory problems
* asthma
* aspiration pneumonia
Barrett’s esophagus=> precancerous cells

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12
Q

goal of GERD medications

A

decrease gastric acid secretion

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13
Q

types of GERD medication

A

H2 receptor antagonists
proton pump inhibitors
FMI of meds that decrease acid secretion
Antacids

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14
Q

H2 receptor antagonists examples

A

fomotidine (Pepcid)
cimetidine (Tagamet)

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15
Q

Proton pump inhibitors are used for _______
examples?

A

more severe GERD

omeprazole (Prilosec)
pantoprazole (Protonix)

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16
Q

FMI of meds that decrease acid secretion

A

lower absorption of Fe, vitamin B12, Ca2+, and Mg2+

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17
Q

Antacids will _________

Examples?

A

neutralize gastric acids

Mylanta
Maalox
Tums

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18
Q

Lifestyle modifications to do for GERD

A

sleep with HOB elevated 6-8 inches
weight loss if overweight
stress management

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19
Q

lifestyle modifications to avoid for GERD

A

eating within 2-3 hours of bed
tobacco products
lying down, bending over, or straining immediately after eating
Tight fitting clothing

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20
Q

for GERD, a trial of the restriction of these foods that decrease LES pressure

A

coffee
chocolate
peppermint and spearmint
food with a high fat content

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21
Q

for GERD, a trial of the restriction of these foods that increase gastric secretion

A

black and red pepper
alcohol
coffee (reg or decaf)
tea (reg or decaf)
caffeinated beverages

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22
Q

For GERD avoid eating ____ meals or meals high in ____
also limit _____ beverages

A

large
high fat
carbonated

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23
Q

surgical treatment for GERD

A

Nissen fundoplication where funds of the stomach is wrapped around the lower esophagus to prevent reflux

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24
Q

problems that may occur after Nissen Fundoplication

A

esophageal swelling (dysphagia)
gas pain
dumping syndrome

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25
Q

Post-op MNT: Nissen Diet
* Follow a “_________” diet for ~ ________

  • Avoid _____________________
  • Avoid ______ foods=> peanut butter, untoasted white bread
  • Consume small frequent meals to avoid distention
  • No gassy foods; Limit aerophagia
  • ____________________
A

Easy-to-Chew
2 months

nuts, seeds, tough meats, raw fruits & veg, and sharp edges
sticky

no drinking through a straw, no gum, no carbonated beverages, dried beans, cabbage family veg

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26
Q

MNT: Nissen Diet
* Avoid spicy foods
* Eat slowly, take small bites, & chew thoroughly

  • Anti-dumping diet guidelines:
  • Drink fluids ____________
  • Limit fluid with meals to _____
  • Limit ________
A

between meals
½ cup
concentrated sweets

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27
Q

Acute esophagitis is caused by:

  • Viral or bacterial ______
  • _____
  • Ingestion of a _______
  • ________ therapy
  • Acute ________
  • ___________ esophagitis
A

infection
GERD
corrosive agent
Radiation
vomiting
Eosinophilic

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28
Q

Chronic esophagitis is caused by:
* Chronic _____
* Recurrent _______

A

GERD
vomiting

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29
Q

Esophagitis

Symptoms=> __________

Complications:
___________
__________
____________

A

odynophagia

Hemorrhage
Stricture
Dysphagia

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30
Q

Goals of MNT for esophagitis

Prevent ____________

Prevent _____ to decrease exposure of esophagus to gastric contents

A

pain and irritation
GERD

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31
Q

MNT for Esophagitis
Avoid any foods that exacerbates symptoms:

  • _________ foods=> citrus fruit & juice, tomatoes & tomato products, carbonated beverages
  • ______ foods
  • ______ foods
A

acidic
rough
spicy

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32
Q

MNT to prevent GERD for ppl with esophagitis
* Avoid ______ meals
* Limit dietary ____
* Avoid _____
* Avoid _____

A

large
fat
alcohol
coffee

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33
Q

Indications for Esophageal Surgery

A
  • Cancer
  • Barrett’s esophagus
  • GERD
  • Achalasia
  • Trauma
  • Fistula
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34
Q

Esophagectomy Variations

A

Gastric pull-up
Colonic interposition

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35
Q

Complications of Esophagectomy

A
  • Dysphagia
  • Dumping syndrome
  • Early satiety
  • GERD
  • Aspiration
  • Weight loss & malnutrition
  • Stricture
  • Fistula (rare)
  • Chylothorax (rare)
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36
Q

Injury to the thoracic duct is called ________ and its when _____________ into the ________

A

chylothorax
chyle leaks into the thoracic cavity

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37
Q

examples of Chyle

A

WBC
chylomicrons (LCT & Fat soluble vitamins)
proteins
fluid
electrolytes

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38
Q

consequences of chylothorax

A

pain
pleural effusion
anorexia
hypoalbuminemia
decreased electrolytes
fat soluble vit depletion
EFAD

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39
Q

Goal of MNT for Chylothorax

A

reduce chyle flow by decreasing LCT intake to <10 g/day

40
Q

MNT for Chylothorax options

A

very low fat oral diet with MCT oil supplementation

NPO with TF using a very low fat elemental formula

NPO with TPN

41
Q

MNT for Partial Esophagectomy
Oral diet:
- Begin with _____ and progress to _______ diet
- Avoid tough, sticky, or abrasive foods
- ________ meals per day
- Take small bites, chew thoroughly, eat slowly
- MNT to prevent ______
- MNT for dumping syndrome if needed
- MNT for _______ if needed

A

liquids
easy-to-chew
6 small
reflux
dumping syndrome

42
Q

MNT for Total Esophagectomy

A
  • NPO with JT feedings
  • When approved by surgeon, begin esophagectomy diet and follow for ~3 months
43
Q

Nonspecific, persistent upper abdominal discomfort

A

Dyspepsia

44
Q

Symptoms of Dyspepsia

A

vague abdominal pain
bloating
belching
nausea

45
Q

Dyspepsia Caused by:

A
  • GERD
  • Peptic ulcer disease
  • Gastritis
  • Gallbladder disease
  • Emotional stress
  • Eating habits=> eating too much, too
    fast, high-fat foods
46
Q

MNT for Dyspepsia

A
  • Eat slowly & chew thoroughly
  • Smaller size meals
  • Decrease dietary fat
  • Limit aerophagia=> eat slowly, chew with mouth closed, avoid straws, no chewing gum
  • Limit alcohol
47
Q

inflammation of the gastric mucosa

A

gastritis

48
Q

acute gastritis is _______ of inflammation and symptoms

A

rapid onset

49
Q

chronic gastritis is a ______ problem with periods of __________
more common in __________

A

long term
exacerbation and remission
older adults

50
Q

symptoms of gastritis

A

epigastric pain
N/V
anorexia
GI bleeding (GIB)

51
Q

causes of gastritis come from disruption of the _______ through…

Bacteria ?
Drugs ?
Excessive use of ?
acute, severe _______
_______ therapy
___________ (condition)
___________ (condition)

A

mucosal integrity

helicobacter pylori (H. pylori)

non-steroidal anti-inflammatory drugs (NSAIDS)
aspirin
corticosteroids

alcohol and tobacco

metabolic stress

radiation

pernicious anemia

bile reflux

52
Q

rare complication of chronic gastritis that results in extensive degeneration of the gastric mucosa

A

atrophic gastritis

53
Q

atrophic gastritis results in _______ and loss of ______ resulting in _________ __________

A

atrophy & loss of parietal cells

Achlorhydria (not enough acid secretion)

Decreased secretion of intrinsic factor (possible B12 deficiency)

54
Q

medical treatment for gastritis

A

antibiotics for H. pylori

proton pump inhibitors; H2 receptor antagonists for Acid

discontinuing injurious drugs, alcohol, smoking

55
Q

MNT for Acute Gastritis

A

follow bland diet and avoid gastric irritants
- pepper, chili powder, alcohol

avoid foods that increase acid secretion
- coffee, tea, caffeine, alcohol, pepper

56
Q

if acute gastritis is severe, individual might need to follow __________ to decrease inflammation with _____, then later follow the ______

A

NPO 24-48 hours
IVF
bland diet

57
Q

MNT for chronic gastritis

A

well balanced bland diet for healing
monitor for iron deficiency anemia
IM or sublingual vit B12 supplementation for atrophic gastritis

58
Q

an ulceration in the mucosal lining of the ______, _____, ______, or ______ is called _________

A

duodenum
stomach
esophagus
jejunum

peptic ulcer disease (PUD)

59
Q

peptic ulcer disease. exposes the ______ to ________ and _______

PUD can be acute or chronic with _____ erosions or _____ ulcers

A

submucosa
gastric secretions
auto digestion

superficial
deep

60
Q

risk factors for PUD include…

_______ infection
habitual use of _______ or ________
excessive ________
high dose _______
use of ______
_____________

A

H. pylori infection
aspirin or NSAIDS
Excessive alcohol
high dose corticosteroids
tabacco
metabolic stress

61
Q

PUD is a ______, ______, or ______ abnormalities that disrupt the factors that normally maintain mucosal integrity

it results in ___ and ____ penetrating the mucosal barrier creating ulceration

A

microbial
chemical
neural

acid and pepsin

62
Q

clinical manifestations of PUD

A

epigastric pain
dyspepsia, N/V
anorexia and wt loss

63
Q

epigastric pain can become worse when stomach is _______
may be relieved by ___________

_______ pain is common
pain may disappear and then return in a few _______

A

empty
ingestion of food or antacid

nocturnal
days or weeks

64
Q

complications of PUD

A

Hemorrhage
gastric outlet obstruction
perforation

65
Q

Medical management for PUD should be to eliminate the cause and decrease risk factors

_______ for H. pylori
reduce use of ______, quit ________, avoid ________
Decrease gastric secretion with ______ and ______
neutralize gastric acid with ________
_____________ may be required for PUD complications

A

antibiotics
NSAIDS, smoking, alcohol
proton pump inhibitors and H2 receptor antagonists
antacids
surgical resection

66
Q

proton pump inhibitor examples

A

Omeprazole (Prilosec)
Pantoprazole (Protonix)

67
Q

H2 receptor antagonists example

A

famotidine (Pepcid)

68
Q

examples of antacids

A

Mylanta
Maalox
Tums

69
Q

MNT for PUD

A

well balanced bland diet

avoid alcohol, red and black pepper, coffee, tea, and caffeine

smaller frequent meals

avoid food not individually tolerated

70
Q

why would someone need gastric surgery

A

gastric cancer
complications of PUD

71
Q

surgical widening of the pylorus

A

pyloroplasty

72
Q

why does some one need pyloroplasty

A

gastric outlet obstruction
enhance gastric emptying

73
Q

removal of part of the stomach is _______
removal of whole stomach is _______

A

partial gastrectomy
total gastrectomy

74
Q

reconstructive procedures that accompany partial gastrectomy

A

billroth operations

75
Q

reattachment of remaining stomach to the duodenum

A

billroth I (gastroduodenostomy)

76
Q

reattachment of the remaining stomach to the jejunum

A

Billionth II (gastrojejunostomy)

77
Q

Nutritional Consequences of Gastric Surgery

Early ________; inadequate ______
Malabsorption due to ___________
Fluid & electrolyte imbalances due to ______
___________; Malnutrition
_________ deficiencies
Nutritional ________

A

satiety; intake
dumping syndrome
diarrhea
Micronutrient
anemias

78
Q

gastric surgeries can cause anemias
- _____ due to __________
- ______ due to __________

A

Iron deficiency due to lack of gastric acid
vitamin B12 deficiency dure to decreased IF

79
Q

what is dumping syndrome

A

rapid emptying of hypertonic chyme from the residual stomach into the small intestine 10-20 minutes after eating

80
Q

factors that promote dumping syndrome include
- loss of ______________
- loss of ________ control when ______ is removed
- loss of ________ control by the _______ when it is removed

A

gastric capacity

emptying
pylorus

feedback
duodenum

81
Q

dumping syndrome resulting in rapid gastric emptying results in __________ in small intestine so _____ shifts from __________ to ___________

A

high osmotic load
fluid
vasculature
intestinal lumen

82
Q

early dumping syndrome occurs ______ after eating

A

10-30 min

83
Q

dumping syndrome can cause ________, __________, and ____________.

Along with distention of the intestine which results in ______, _______, _______, and _______

A

weakness
dizziness
rapid heartbeat

cramping
diarrhea
nausea
bloating

84
Q

late stage during syndrome occurs ____ after eating and is _________. Often occurs after eating a _____ meal

A

1-3 hours
less common
high carb

85
Q

late dumping syndrome causes _________ due to rapid rise in ________ level

symptoms include _____, _______, _______, and _______.

A

reactive hypoglycemia
insulin

weakness
diaphoresis
shakiness
confusion

86
Q

what is the Post-Gastrectomy/ Anti-Dumping Syndrome Diet

A

5-6 small meals
limit simple sugars
high protein & moderate fat (every meal should have pro)
Avoid liquids with meals (drink >30-40 min after eating)

87
Q

for after gastric surgery consider ________ sources and eat slowly and chew well.

_______ after meals and avoid ________________(4)

A

soluble fiber

relax and recline
caffeine, alcohol, prunes, sorbitol

88
Q

after gastric surgery, patients should be prescribed ___________ and may need additional ____ and _____ supplements

advance to a regular diet within _____

if a total gastrectomy, diet should be____________

A

MVI with minerals
B12
iron

6-8 weeks

NPO with jejunal time feeding

89
Q

nausea and vomiting are caused by the stimulation of ___________ in the __________

A

chemoreceptor trigger zone
medulla

90
Q

nausea and vomiting zone can be triggered by …

A

Infections; Toxins
Diseases
Medications
Gastric or duodenal distention
Severe pain
Motion sickness; vertigo

91
Q

Nutritional Consequences of Vomiting (_________)

1.
2.
3.
4.
5.

A

Emesis

  • Dehydration
  • Electrolyte depletion
  • Poor intake and weight loss
  • Acid base imbalance (blood too basic)
  • Learned food aversions
92
Q

After vomiting stops, begin with ________ then small amounts of ____________ and then ______________ after _____ hours of not vomiting

A

ice chips
clear liquids
solid foods
8 hours

93
Q

for nausea and vomiting, eat _____, ______ meals

Avoid high _____ foods and high ____ foods
Also avoid ______ foods

Avoid ________ flavored, highly ______, or foods with strong ______

A

small, frequent

fat and fiber
gassy

strong
spiced
odors

94
Q

for N/V try to eat ____, _______ and/or _____ foods

A

dry, starchy, or salty foods

95
Q

for N/V sip ______ between meals, _______ may be helpful

avoid eating ________ when nauseous

replace _____ and _______, may consider oral _________

may require _____ status with ______ if severe and prolonged

A

cold liquids
ginger ale

favorite foods

fluid and electrolytes
rehydration solutions

NPO
parenteral nutrition

Medical Nutrition Therapy (12 decks)

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