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FN 125 LE2 > Upper GIT > Flashcards

Upper GIT Flashcards

1
Q

Body’s initial response to stress, trauma, or injury

A

Inflammation

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2
Q

Adverse physical effects of undernutrition and their consequences

A
  • impaired immune response: predisposes to infection
  • reduced muscle strength and fatigue: Inactivity, inability to work effectively, and poor self-care
  • reduced respiratory muscle strength: poor cough pressure, delay recovery from chest infection
  • Inactivity, especially in bed-bound patient: predisposed to pressure, sores, thrmboembolism
  • impaired thermoregulation: hypothermia
  • Impaired wound-healing: failure of fistulae to close, un-united fractures, increased wound infection, prolonged recovery, increased hospital stay
  • fetal and infant programming: predisposed to common chronic illness
  • growth failure: stunting, delayed sexuao devlopment, reduced muscle mass
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3
Q

Adverse psychosocial effects of undernutrition

A
  • impaired psychosocial function: even when uncomplicated by disease, undernutrition causes apathy, depression, self-neglect, hypochondriasis, loss of libido, social interaction deterioration; effects in personality and impairment in mother-child bonding
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4
Q

organs used for ingestion (4) and their functions

A
  • oral cavity: mechanical breakdown,
    moistening, and mixing of food with saliva
  • salivary glands: release a mixture of water, mucus, and enzymes
  • pharynx: propels food from the back of the cavity to the esophagus
  • esophagus: unique because transport system from external source to internal system
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5
Q

organs used in digestion and their functions

A
  • small intestine: can help digestion and utilization (main character); major site of enzymatic nutrient digestion and absorption
  • stomach: (more main character than intestine); muscular contractions mix food w/ acid and enzymes –> physical and chemical breakdown of food
  • liver: produces bile (important secretion for lipid digestion)
  • gall bladder: stores and releases bile (needed for lipid digestion)
  • pancreas: releases pancreatic juice to neutralize acidic chyme; contains enzymes for CHO, CHON, and fat digestion
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6
Q

organs used in utilization and their functions

A

small intestine: nutrient absorption
large intestine: undigested food to be eliminated by body as feces

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7
Q

What happens in secretion of the IDU?

A

enzymes and digestive fluids secreted by the digestive tract and its accessory organs facilitate chemical digestion

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8
Q

What happens in the elimination of the IDU?

A

undigested material will be released through the rectum and anus by defecation

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9
Q

What happens in the absorption of the IDU?

A

passage of end-products (nutrients) of chemical digestion from digestive tract into blood or lymph for distribution to tissue cells

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10
Q

Common Symptoms of Gastrointestinal Disease

A
  • ingestion of solid food causes distress but liquids do not
  • difficulty swallong; food sticks in throat
  • epigastric pain when eating
  • pain 2-5 hours after a meal; pain relief after eating
  • abdominal pain several hours after ingesting fatty meal
  • cramps, distention, flatulence 18-24 hours after drinking milk
  • heartburn after large or fatty meal
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11
Q

possible disorder for the symptom: ingestion of solid food causes distress, but liquids do not

A

esophageal stricture or tumor

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12
Q

possible disorder of the symptom: difficulty swallowing; food sticks in throat

A

esophageal spasm; achalasia

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13
Q

possible disorder of the symptom: epigastric pain when eating

A

gastric ulcer

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14
Q

possible disorder of the symptom: pain 2-5 hours after a meal; pain relief after eating

A

duodenal ulcer

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15
Q

possible disorder of symptom: abdominal pain several hours after ingesting a fatty meal

A

pancreatic or biliary tract disease

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16
Q

possible disorder of the symptom: cramps, distention, and flatulence 18-24 hours after drinking milk

A

lactose intolerance
- due to lactase deficiency or rapid transit time

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17
Q

possible disorder of the symptom: heartburn after eating a large or fatty meal

A

esophageal reflux

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18
Q

term for prolonged vomiting

A

hyperemesis

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19
Q

effects of prolonged vomiting

A
  • loss of nutrients, fluids, electrolytes
  • dehyration, electrolyte imbalance, weight loss
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20
Q

medications for nausea and vomiting

A
  • antinauseants
  • antiemetics
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21
Q

goals of MNT in nausea/vomiting

A
  • decrease frequency and severity of nausea and/or vomiting
  • maintain optimal fluid balance and nutritional status
  • prevent development of anticipatory nausea, vomiting, and learned food aversions
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22
Q

MNT for Nausea/Vomiting

A

● When vomiting stops, introduce ice chips if older than 3 years of age. If tolerated, start with rehydration beverage or clear liquids
- 1tsp every 10 minutes.
- Increase to 1 Tbsp every 20 minutes.
- Double amount of fluid every hour.

If diarrhea is present, use only rehydration beverage.
○ Apple juice
○ Sports drink
○ Warm or cold tea
○ Lemonade

● When there has been no vomiting for at least 8 hours, initiate oral intake slowly with adding one solid food at a time in very small increments.

● Choose the following types of foods;
1. Without odor
2. Low in fat
3. Low in fiber
4. Take prescribed antiemetics and other medications on a regular schedule to assist in prevention of nausea and vomiting. Take all other medications after eating.

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23
Q

Food and Feeding Issues of Vomiting and Nausea

A

● Keep patient away from strong food odors

● Provide assistance in food preparation to avoid cooking odors

● Eat foods at room temperature

● Keep patient’s mouth clean and perform oral hygiene tasks after each episode of vomiting

● Offer fluids between meals

● Patient should sip liquids throughout the day

● Cold beverages may be more easily
tolerated

● Keep low-fat crackers or dry cereal by the bed to eat before getting out of bed

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24
Q

Lifestyle issues of Nausea and vomiting

A

● Relax after meals instead of moving around

● Sit up for 1 hour after eating

● Wear loose-fitting clothes

● Provide fresh air with a fan or open window

● Limit sounds, sights, and smells that may trigger nausea and vomiting

● Other complementary and alternative medicine interventions that have anecdotal evidence (though clinical trials have not been conducted):
○ Relaxation techniques
○ Acupuncture
○ Hypnosis

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25
Q

causes of eating difficulties associated with cancer in the oral cavity, pharynx, esophagus

A
  • tumor mass
  • obstruction
  • oral infection
  • ulceration
  • alcoholism
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26
Q

T or F: Cancer in the Oral Cavity, Pharynx, Esophagus affects the chewing, swallowing, salivation, and taste acuity

A

TRUE

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27
Q

T or F: weight gain is common in Cancer in the Oral Cavity, Pharynx, Esophagus

A

FALSE; weight loss is common

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28
Q

this refers to the inability to safely transfer food and liquid from the oral cavity to the esophagus

A

dysphagia

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28
Q

occurence (in percentage) of dysphagia in the ICU

A

3 to 62% of those patients who have been intubated

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29
Q

percentage of mortality

A

9.2%

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30
Q

Risks associated with dysphagia

A

● Increases risk of aspiration pneumonia
● Increased likelihood of malnutrition
● Prolongs ICU stay
● Prolongs hospital stay
● Still present on discharge in 60% of cases
● Increased morbidity and mortality

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30
Q

how is dysphagia assessed on the ICU?

A
  1. bedside swallowing assessment
  2. Flexible Endoscopic Evaluation of Swallowing (FEES)
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31
Q

Explain the graph on consequences of dysphagia

A

  • aspiration pneumonia –> immuno-compromise
  • aspiration pneumonia –> malnutrition & dehydration
  • immunocompromise –> poor wound healing
  • immunocompromise –> increased risk of infections
  • immunocompromise –> malnutrition & dehydration
  • increased risk of infections –> increased risk of skin breakdown
  • increased risk of infections –> immunocompromise
  • ## increased risk of skin breakdown –> poor wound healing
  • malnutrition & dehydration –> poor wound healing –> immunocompromise (refer to previously mentioned effects of immunocompromise)
  • malnutrition & dehydration –> muscle breakdown
  • muscle breakdown –> decreased functional status
  • muscle breakdown –> decreased swallowing ability
  • decreased swallowing ability –> malnutrition & dehydration
  • decreased swallowing ability –> dysphagia

[refer to the actual graph for better comprehension]

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32
Q

This diet is of different levels of allowable consistencies and modified according to the capacity of the patient to swallow

A

Diets for Patients with Dysphagia

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33
Q

this established standard terminology and practice applications of dietary texture
modification in dysphagia management

A

The National Dysphagia Diets, published in 2002 by the American Dietetic Association

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34
Q

Objectives of MNT for dysphagia

A
  1. To attain and maintain optimal nutritional status for patients with dysphagia
  2. To provide adequate calories and nutrients by a variety of food items included in the meals
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35
Q

this can affect any part of the head and neck area

A

head and neck cancers

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36
Q

this disease finds surgical treatment to have a profound effect on ability to take food orally

A

head and neck cancers

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37
Q

what are utilized to aid patients with head and neck cancers in obtaining nutritional needs at the time of surgery

A

feeding tubes

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38
Q

where should tube be connected for immediate nutrition if with neck cancer

A

stomach

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39
Q

where should tube be connected for immediate nutrition if with stomach cancer

A

jejunum intestine

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40
Q

MNT in head and neck cancers (7)

A

● Address nutritional consequences of
disease and treatments (radiation therapy, surgery)

● Radiation therapy can alter taste sensation, result in dry mouth, loss of appetite, mucositis and dysphagia

● Malnutrition is reported to affect 30 to 50% of patients with head and neck cancers.

● Goal is to maintain adequate intake to promote healing and allow aggressive treatment

● May involve enteral feedings, liquid oral supplements, dietary changes (liquid, moist, soft-textured foods and smalll, frequent meals)

● Artificial saliva solutions, increased fluids, topical anaesthetics to relieve pain

● Aggressive oral hygiene, fluoride, treatment of fungal infections

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41
Q

Steps in the Malnutrition Universal Screening Tool (MUST)

A

Step 1: BMI score
Step 2: Weight loss score
Step 3: Acute disease effect score
Step 4: Overall risk of malnutrition
Step 5: Management guidelines

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42
Q

Etiology of acute esophagitis

A
  • viral infection
  • ingestion of irritating agents
  • intubation
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43
Q

etiology of chronic esophagitis

A
  • increased abdominal pressure
  • reduced lower esophageal sphincter (LES) pressure
  • recurrent vomiting
  • delayed gastric emptying
  • hiatal hernia
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44
Q

Pathophysiology of esophagitis

A

reflux of gastric acid and/or intestinal contents through the lower esophageal sphincter and into the esophagus

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45
Q

Management of esophagitis

A

behavioral modification
*avoid:
- eating within 3-4 hours of bedtime
- lying down after meals
- tight-fitting clothing
- cigarrete smoking
- excess stress

medical/surgical management
- proton pump inhibitors
- histamin-2 receptor antagonists
- antacids
-
-

nutrition management
goal: decrease exposure of esophagus to gastric contents
avoid: large meals, excess intake of dietary fat, alcohol, mint, coffee, chocolate

goal: decrease acidity of gastric secretions
avoid: coffee, alcohol

goal: prevent pain and irritation
avoid: any food that the patient feels exacerbates symptoms, especially hot and spicy foods

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46
Q

this chemical relaxes both upper and lower esophageal sphincters

A

nicotine

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47
Q

tube from pharynx to stomach

A

esophagus

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48
Q

this part of the esophagus is closed except when swallowing

A

upper esophageal sphincter (UES or cardial sphincter)

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49
Q

this part of the esophagus closes entrance to stomach

A

lower esophageal sphincter (LES)

50
Q

part of the esophagus that prevents reflux of stomach contents back into esophagus

A

lower esophageal sphincter (LES)

51
Q

Defined as symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus

A

Gastroesophageal Reflux Disease (GERD)

52
Q

Symptoms of GERD

A

Symptoms: Burning sensation after meals; heartburn, regurgitation or both, especially after meals

53
Q

what actions can aggravate symptoms of GERD

A

recumbency or bending over

54
Q

what relieves symptoms of GERD

A

antacids

55
Q

An outpouching of a portion of the stomach into the chest through the esophageal
hiatus of the diaphragm

A

Hiatal hernia

56
Q

Symptom of hiatal hernia

A

Heartburn after heavy meals or with
reclining after meals

57
Q

this condition may worsen GERD symptoms

A

hiatal hernia

58
Q

Complications of GERD

A

● Esophagitis, stricture or ulcer
● Barrett’s Esophagus (premalignant state)

59
Q

a precancerous condition in which the
normal squamous epithelium of the
esophagus is replaced by abnormal
columnar-lined epithelium known as
specialized intestinal metaplasia (similar to the intestinal lining)

A

Barrett’s Esophagus

60
Q

what replaces the normal squamous epithelium in Barrett’s Esophagus

A

abnormal columnar-lined epithelium

61
Q

what is the abnormal columnar-lined epithelium called in BE

A

specialized intestinal metaplasia

62
Q

How is GERD diagnosed?

A

● Empirically, via symptoms (symptoms don’t always correlate with the degree of damage)
● Endoscopy - to confirm Barrett’s Esophagus and dysplasia (a negative endoscopy does not rule out the presence of GERD)
● Ambulatory reflux monitoring

63
Q

what are the clinical symptoms associated with GERD?

A
  • dental corrosion
  • dysphagia
  • heartburn (pyrosis)
  • odynophagia
  • regurgitation
  • noncardiac chest pain
  • extraesophageal symptoms
64
Q

slow, progressive tooth surface loss associated with acid regurgitation

A

dental corrosion

65
Q

difficulty initiating a swallow (oropharyngeal dysphagia) or sensation of food being hindered or “sticks” after swallowed

A

dysphagia

66
Q

difficulty initiating a swallow

A

oropharyngeal dysphagia

67
Q

painful, burning sensation that radiates up behind the sternum of fairly short duration

A

heatburn (pyrosis)

68
Q

another word for heartburn

A

pyrosis

69
Q

painful swallowing

A

odynophagia

70
Q

backflow of gastric content into the mouth not associated with nausea or retching

A

regurgitation

71
Q

unexplained substernal chest pain resembling a myocardial infarction without evidence of coronary artery disease

A

noncardiac chest pain

72
Q

chronic cough, hoarsness, reflux-induced laryngitis, asthma

A

extraesophageal symptoms

73
Q

Goals of Nutrition Intervention in GERD

A

● Increasing lower esophageal sphincter competence
● Decreasing gastric acidity, which results in decreasing severity of symptoms
● Improving clearance of contents from the esophagus
● Identification of drug-nutrient interaction
● Prevention of obstruction if esophageal stricture present
● Improvement of nutritional intake if appropriate

73
Q

Nutrition Prescription for GERD

A

● Initiate weight-reduction program if
overweight

● Initiate smoking cessation (lowers LES pressure)

● Improve clearing of materials from
esophagus

● Remain upright after eating

● Avoid eating within 3 hours of bedtime

● Wear loose-fitting clothing

● Raise the head of bed for sleeping

● Reduce gastric acidity by eliminating the following:
○ Black and red pepper
○ Coffee (caffeinated and
decaffeinated)
○ Alcohol

● Substitute smaller more frequent meals

● Restrict foods that lessen lower esophageal sphincter pressure by eliminating the
following:
○ Chocolate
○ Mint
○ Foods with a high fat content

● Spicy, acidic foods may be irritating if esophagitis is present

● Limitation of these foods should be based on individual tolerance

74
Q

T or F: Evidence reflecting the true efficacy of the Nutritional Care for Patients with Reflux and Esophagitis is almost completely lacking

A

True; Evidence reflecting the true efficacy of these maneuvers in patients is almost completely lacking
- American College of Gastroenterology Guidelines, 2005

75
Q

What are Nutrition Recommendations based on the Nutrition Care Guidelines for Reducing Gastroesophageal Reflux and Esophagitis

A
  • avoid large, high-fat meals and decrease greasy foods
  • avoid eating 2 to 3 hours before lying down
  • avoid chocolate, mint, tomatoes, and tomato products
  • avoid caffeine-containing foods and beverages
  • avoid acidic and highly spiced foods
  • consume a well-balanced diet with adequate fiber
  • consider weight loss if overweight or obese
  • choose smaller, more frequent meals rather than three larger meals each day
76
Q

What are Lifestyle Recommendations based on the Nutrition Care Guidelines for Reducing Gastroesophageal Reflux and Esophagitis

A
  • elevate head of bed by 6-8 inches for individuals who have reflux episodes at night
  • quit smoking and avoid secondhand smoke and alcoholic beverages
  • reduce overall stress levels when possible
  • wear losse-fitting clothing around the stomach area, as tight or constricting clothing can worsen reflux
77
Q

Drugs Commonly Used to Treat Gastrointestinal Disorders

A
  • antibiotics
  • antacids
  • proton pump inhibitors
  • histamine-2 receptor antagonists (cimetidine, ranitidine)
  • sucralfate
78
Q

this drug eradicates Helicobacter pylori and prevents or treats infection after abdominal wounds or surgery

A

Antibiotics

79
Q

this drug neutralizes gastric acid in acid reflux, peptic ulcer

A

antacids

80
Q

this drug decrease gastric acid secretion

A

Proton pump inhibitors

81
Q

this drug inhibits gastric acid
secretion

A

Histamine-2 receptor antagonists
(cimetidine, ranitidine)

82
Q

this drug protects stomach lining and may increase mucosal resistance to acid or enzyme damage

A

Sucralfate (sulfated disaccharide)

83
Q

Medications Used to Tx GERD

A
  • antacids
  • gaviscon
  • H2 receptor antagonists
  • proton pump inhibitors
  • promotility agents
84
Q

examples of antacids as medications for GERD

A
  • mylanta
  • maalox
85
Q

a medication for GERD that functions as a barrier between gastric contents and esophageal mucosa

A

Gaviscon

86
Q

examples of H2 receptor antagonists as medications for GERD

A
  • cimetadine
  • ranitidine
  • famotidine
  • nizatidine
87
Q

examples of proton pump inhibitors as medications for GERD

A
  • Omeprazole (Prilosec)
  • lansoprazole
  • rabeprazole
  • pantoprazole
  • esomeprazole
88
Q

examples of promotility agents as medications used to treat GERD

A
  • cisapride
  • bethanechol
89
Q

this drug enhances esophageal clearing and gastric emptying

A

promotility agents

90
Q

what is the mainstay therapy for GERD? (main goal of medication)

A

acid suppression

91
Q

drug that provide the most rapid symptomatic relief and heal esophagitis in the highest percentage of patients

A

PPI

92
Q

less effective than PPIs but effective in divided doses for persons with less severe GERD

A

Histamin-2 receptor

93
Q

may be used in selected patients, especially as an adjunct to acid suppression BUT not ideal monotherapy for most patients with GERD

A

Promotility agents

94
Q

Fundus of stomach is wrapped around lower esophagus to limit reflux

A

Fundoplication

95
Q

this surgical procedure requires that there be another conduit in place to transport food from the oropharynx to the rest of the GIT for digestion and absorption

A

esophagectomy

96
Q

this procedure is usually indicated for patients with esophageal cancer

A

esophagectomy

96
Q
A
97
Q

Diseases of the Stomach

A
  • Indigestion/Dyspepsia
  • Acute gastritis
98
Q

causes of acute gastritis

A
  • H. pylori
  • tobacco
  • chronic use of drugs (alcohol, aspirin, nonsteroidal anti-inflammatory agents)
99
Q

symptoms of dyspepsia

A
  • Abdominal pain
  • Bloating
  • Nausea
  • Regurgitation
  • Belching
100
Q

Dyspepsia Treatment

A
  • Avoid offending foods
  • Eat slowly
  • Chew thoroughly
  • Do not overindulge
101
Q

What protects the gastric and duodenal mucosa in gastritis?

A
  • mucus
  • bicarbonate
  • rapid removal of excess acid
  • rapid repair of tissue
102
Q

pertains to the erosion of mucosal layer

A

gastritis

103
Q

pertains to the exposure of cells to gastric acid secretions and bacteria

A

gastritis

104
Q

pertains to inflammation and tissue damage

A

gastritis

105
Q

what is the full scientific name of H. pylori and its four characteristics

A

Helicobacter Pylori
- Bacteria; resistant to acid
- Damages mucosa
- Treat with bismuth, antibiotics, antisecretory agents
- Causes ~92% duodenal ulcers; 70% gastric ulcers

106
Q

characterized by loss of parietal cells in the stomach

A

atrophic gastritis

107
Q

characterized by gastric or duodenal ulcers

A

peptic ulcer disease (PUD)

108
Q

this disease can be asymptomatic or may cause symptoms similar to gastritis and dyspepsia

A

Peptic Ulcer Disease

109
Q

Danger of hemorrhage, perforation, penetration into adjacent organ or space

A

Peptic Ulcer Disease (PUD)

110
Q

characterized by melena

A

peptic ulcer disease (PUD)

111
Q

black tarry stools from GI bleeding

A

melena

112
Q

differentiate gastric ulcers and duodenal ulcers

A

Gastric ulcer
- inflammatory involvement of acid-producing cells
- usually occurs with low acid secretion

Duodenal ulcers
- high acid and low bicarbonate secretion

113
Q

T or F: Duodenal ulcers are associated with increased mortality and hemorrhage

A

False; Increased mortality and hemorrhage are associated with gastric ulcers

114
Q

Etiology of Petic Ulcer

A
  • H. pylori infection
  • aspirin
  • stress
  • gastritis
115
Q

pathophysiology of peptic ulcer

A

erosion through muscularis mucosa into submucosa or muscularis propria

116
Q

Medical management of peptic ulcer

A
  • if H. pylori is positive, use antibiotics
  • reduce or withdraw use of NSAIDs
  • use sulcrafate antacids
  • suppress acid secretion with PPIs or H2 receptor antagonists
117
Q

behavioral management of peptic ulcer

A
  • avoid tobacco products
118
Q

nutrition management of peptic ulcer

A

decrease consumption of:
- alcohol
- spices (red and black peppers when inflammed)
- coffee and caffeine

increase consumption of:
- omega-3 and omega-6 fatty acids which may have a protective effect

119
Q

T or F: Nutrition cannot prevent H. pylori complications

A

False; Good nutrition helps defend against H. pylori complications

120
Q
A
121
Q

Surgical treatment of GERD

A

Fundoplication

FN 125 LE2 (8 decks)

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