Week 5

Question 1

common causes of constipation in adults

Answer 1

• > 65 y/o
• Diet (↓ fiber)
• Medications
• Metabolic/neurologic disorders
• Psychosocial issues
• Pregnancy

Question 2

expected frequency of bowel movements in an adult

Answer 2

< 3 unassisted BM per week = abnormal

Question 3

current therapies used to manage constipation in adults

Answer 3

• lifestyle modification
  - increase fiber and fluid, decrease red meat and dairy
• medications
  - change medications possibly causing sxs
  - prescribe medications to help with symptoms (stool softener/laxative)

Question 4

Opioid induced constipaiton

Answer 4

• Opioids interfere w/normal GI motility by delaying transit (↑ contact time for absorption of fluids), stimulate non-propulsive motility, & stimulate sphincters (i.e. pylorus & ileocecal) through effects on enteric neurons
• Act on μ-receptors in GI tract

Question 5

Rationale for using fiber supplementation in the management of constipation

Answer 5

fiber is neither digested or absorbed—will ↑ stool volume and weight; ↓ stool transit time

Question 6

Correlate exercise frequency to bowel function.

Answer 6

↑ exercise causes ↑ bowel function

Question 7

Osteopathic structural examination findings in constipation

Answer 7

TART changes in T12-L2 paraspinal region

Question 8

Rationale for the use of OMT in patients with constipation

Answer 8

Treat viscerosomatic reflex associated with constipation

Question 9

Define lactose intolerance

Answer 9

clinical syndrome characterized by GI symptoms following lactose ingestion as a result of lactose malabsorption (↓ hydrolysis & digestion of lactose d/t lactase deficiency)

Question 10

physiological basis for lactose intolerance

Answer 10

-lactase is not present/not functioning properly so lactose is not able to be broken down

Question 11

Relate sxs of lactose intolerance to physiology

Answer 11

• Malabsorbed lactose generates osmotic load & draws fluid & electrolytes into intestinal lumen causing watery/lose stool
• Colonic bacteria ferments the unabsorbed lactose causing gas(methane, CO2, & hydrogen), abdominal pain, bloating

Question 12

How to increase calcium intake in patients with lactose intolerance

Answer 12

Calcium rich diet—leafy greens, oranges, calcium fortified juices, cereals, breads, etc., legumes + supplements

Question 13

Lactose Tolerance Test

Answer 13

Measures blood glucose 2 hrs after ingesting high levels of lactose—no/little rise in BG suggests person lacks lactase—not hydrolyzing lactose to glucose

Question 14

Hydrogen Breath Test

Answer 14

• Measures H in breath after ingesting large amount of lactose—should be very little H+, if H+ rises then indicative of lactose fermenting in intestine
• After 60 min. if H+ is < 20 ppm = diagnostic criteria for lactose intolerance

Question 15

Types of Lactose Intolerance

Answer 15

• Primary: deficiency/ absence of lactase—most common to develop in childhood
• Secondary: lactase deficiency caused by injury/damage to small intestine—transient
• Congenital: absolute absence of lactase present from birth—Rare

Question 16

coenzyme

Answer 16

organic-vitamin

Question 17

cofactor

Answer 17

inorganic