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Integrative Nutrition and Pathophysiology > GI 2 > Flashcards

GI 2 Flashcards

1
Q

what are the 2 types of IBD

A

Crohn’s disease
Ulcerative Colitis (UC)

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2
Q

genetics of IBD

A

genetic predisposition
ATG16L1
NOD2
IL23R

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3
Q

environmental factors of IBD

A

smoking
environment
hygiene
diet

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4
Q

secondary insult/trigger of IBD

A

infections
drugs

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5
Q

disease initiation of IBD characterized by

A
  1. loss of epithelial barrier integrity
  2. loss of tolerance to enteric commensal bacteria
  3. dysbiosis
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6
Q

IBD has __ inflammation

A

IBD has sub-clinical inflammation

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7
Q

what is sub-clinical inflammation overview

A

has to do with hyperglycemia and insulin resistance

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8
Q

sub-clinical inflammation specific to IBD

A
  1. expansion of auto-inflammatory process
  2. activated innate and acquired immune responses
  3. circulating antimicrobial antibodies
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9
Q

5 factors IBD is diagnosed based on

A
  1. symptoms
  2. lab data
  3. imaging studies
  4. endoscopic evaluation
  5. histology
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10
Q

IBD diagnosis requires (2)

A
  1. uncontrolled immune response
  2. bowel damage/tissue remodeling
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11
Q

Crohn’s symptoms are very __

A

Crohn’s symptoms are very variable, depends on location

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12
Q

constitutional symptom of Crohn’s

A

weight loss

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13
Q

symptoms more common in Crohn’s than UC

A

abdominal pain
fever
growth retardation

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14
Q

Crohn’s may present with

A

small bowel obstruction

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15
Q

UC symptoms

A

diarrhea
rectal bleeding
tenesmus
urgency

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16
Q

what is tenesmus

A

feeling that you need to pass stools even when your bowels are empty

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17
Q

__ and __ are only seen in severe UC

A

fever and weight loss are only seen in severe UC

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18
Q

goal of endoscopy

A

guide treatment by looking into body

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19
Q

what type of endoscopy used to looke at disease extent in Crohn’s

A

capsule endoscopy

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20
Q

goal of treatment

A

mucosal healing (absence of ulcerations and erosions)

21
Q

mucosal healing in IBD associated with
decreased need for __
decreased __ rates
sustained __
decreased risk of __

A

mucosal healing in IBD associated with
decreased need for corticosteroids
decreased hospitalization rates
sustained clinical remission
decreased risk of colorectal cancer

22
Q

histology of UC
inflammation limited to __ and __
__ often compromised
epitheloid granulomas __

A

histology of UC
inflammation limited to mucosa and submucosa
submucosa often compromised
epitheloid granulomas absent

23
Q

histology of Crohn’s disease
__ inflammation with __ aggregates
__ expanded by __ and __
epitheliod granulomas __

A

histology of Crohn’s disease
transmural inflammation with lymphoid aggregates expanded by **inflammation ** and fibrosis
epitheliod granulomas present

24
Q

complication of Crohn’s

A
  1. incidence of enterocutaneous or perianal fistulas (35%)
  2. internal fistulas (35%)
  3. rectovaginal fistulas (5-10% of females)
  4. strictures
25
Q

2 types of strictures in Crohn’s
1. __ (__) at areas of acute inflammation
2. __ at areas of long-standing inflammation and at anastomotic areas

A
  1. edematous (inflammatory) at areas of acute inflammation
  2. fibrotic at areas of long-standing inflammation and at anastomotic areas
26
Q

indications for surgery in Crohn’s

A
  1. abcess
  2. fistula
  3. fibrotic stricture causing obstruction
  4. toxic megacolon
  5. hemorrhage
  6. cancer
  7. symptoms refractory to medical therapy
27
Q

indications for surgery in UC

A
  1. toxic megacolon
  2. uncontrolled colonic bleeding
  3. perforation
  4. obstruction and stricture with suspicion for cancer
28
Q

main nutritional issue in IBD

A

weight loss

29
Q

how common is weight loss
IBD:
Crohn’s:

A

how common is weight loss
IBD: 70-80% of hospitalized patients
Crohn’s: 20-40% of outpatients

30
Q

4 causes of weight loss in IBD

A
  1. decreased food intake
  2. nutrient malabsorption
  3. increased intestinal loss
  4. drug interactions
31
Q

diarrhea causes increased loss of

A

Zn
K
Mg

32
Q

IBD causes Steatorrhea which is

A

increased loss of fat from stools

33
Q

Steatorrhea causes increased malabsoption of __ and loss of __

A

fat soluble vitamins
Zn, Mg, Ca, Cu

34
Q

drug interactions causing weight loss in IBD

A

drugs interacting with absorption of foods/nutrients

35
Q

parenteral nutrition in IBD pros

A
  1. remission! (short-lived though, ususally only 3 months)
  2. fistula healing
36
Q

risks of parenteral nutrition in IBD

A

bacteremia
thrombosis

37
Q

when is parenteral nutrition used in IBD

A

severe malnutrition
nutritional support pre- and post-op

38
Q

EEN in IBD pros

A

reduces remission in 85% of newly diagnosed patients

39
Q

in IBD, EEN has similar efficacy to

A

corticosteroids

40
Q

Rome IV definition of IBS

A
  • Recurrent Abdominal pain on average at least 1 day per week in the last 3 months associated with 2 or more of the following criteria:
  • Associated with defecation
  • Change in Stool Frequency
  • Change in Form of Stool
    *Criteria should be fulfilled for last 3 months with symptoms onset at least 6 months prior to diagnosis
41
Q

who is most likely to have IBS?

A

females
<50

42
Q

who is most likely to have IBS?

A

females
< 50

43
Q

3 subtypes of IBS

A

IBS-C (constipation)
IBS-M (mixed bowel habits)
IBS-D (diarrhea)

44
Q

parenteral vs enteral nutrition

A

parenteral = through IV
enteral = tube that goes into stomach/small intestine (bypasses digestive system)

45
Q

Bristol stool form scale (BSFS)

A

Type 1: separate hard lumps (hard to pass)
Type 2: sausage-shaped, but lumpy
Type 3: sausage with cracks
Type 4: sausage/snake, smooth and soft
Type 5: soft blobs with clear-cut edges (passed easily)
Type 6: fluffy pieces with ragged edges, mushy
Type 7: entirely liquid

46
Q

IBS-C
> 25% type:
< 25% type:

A

IBS-C
> 25% type: 1 or 2
< 25% type: 6 or 7

47
Q

IBS-M
> 25% type:
> 25% type:

A

IBS-M
> 25% type: 1 or 2
> 25% type:

48
Q

IBS-D
> 25% type:
< 25% type:

A

IBS-D
> 25% type: 6 or 7
< 25% type: 1 or 2

49
Q

predominant bowel habits are based on stool form on days with

A

at least 1 abnormal bowel movement

Integrative Nutrition and Pathophysiology (22 decks)

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