chapter 18 - GI

Question 1

dyspepsia

Answer 1

indigestion

discomfort in digest tract (physical or psych in origin)

heartburn, bloating, pain, sometimes regurgitiation

phycial cause: overeating or spicy foods or symptom of another problwem like appendicitis or a kidney, gallbladder or colon disease ,or possibly cancer (if organic problem then tratment of underlyic cause)

psychological: find relief from underlying stress, allow sufficient time to relax and enjoy meals, learn to improve eating habits

Question 2

esophagitis

Answer 2

irritating effect of acid reflux on the mucosa of the esophagus

heartburn, regurigtaiton, and dysphagia

acute could be irritating agent or GERD or hiatal hernia, reduced lower esophageal sphincter (LES) pressure, abd pressure, recurrent vomiting, alc use, overweight, or smoking

cancer of esophagus and silent aspiration may be life threatening for those w GERD

Question 3

hiatal hernia

Answer 3

• condition in which a part of stomach protureds through the diaphragm into the thoarci cavity

hernia prevents food from movigng normally along diestive tract although food does somewhat mix w gastric juices

food might move back into esophagus, creating heartburm or regureigiation into mouth

Question 4

medical nutrition therapy for dyspepsia, esophagitis and hiatal hernia

Answer 4

• small, frequent meals so amount of food in stomach is never large
• avoid irritatns to esophagus like carbonated becerages, chocolate, citurs fruits and uices, tomato products, spicy foods, coffee, pepper, and some herbs

some food can cause lower esophageal sphincter to relax like fatty and fried foods, spicy foods, cirtrus foods, tomato products, onions, chocolate, mint candy, caffeinated beverages, and alc so they should be avoided

if obese, wt loss

avoid late-night dinners and lyign down for 2-3 hours after eating (sleep w heads and upper toros somewhat elevated and wearning loose-fitting clothing)

may need sugery

Question 5

peptic ulcers

Answer 5

erosion of mucous membranes

gastric ulcer in stomach or duodenal ulcer in duodenum

cause is unclear but could be genetic predisposition, abn high secretion of HCL in stomach, stress, excessive use of aspirin or ib uprofen, cig smoking, bacterium H. pylori

symptom is gastric pain and maybe hemorrhage

Question 6

treatment for ulcers

Answer 6

treat gastric pain w food or antacids
hemorrhage traeated w surgery

ulcers treated w drugs such as antibiotics and cimetidine

antibiotics kill bacteria and cimetidine inhibits acidsecretion in stomach and thus helps ulcer hal

antacids contain calcium carbonate which neutraizes any excess acid

stress managemtnt

Question 7

diet for ulcers

Answer 7

sufficient low-fat sources of protein but not in excess as it stimulates gastric acid secretion

(no more than 9,8g protein per kg body wt; if blood loss inc to 1-1.5 g per kg)

vitamin and mineral suppplements (esp uron if hemorrhage)

increased intake of fat as fat delayed emptying stomach in moderation as ppl w peptic ulcers are more prone to atherscleroris

spicy foods as tolerated; avoid coffee, tea, or caffeine, alc, aspirin as irritate mucous membrane; cig smokng decrease secretion of pancrease that buffers gastric acid in duodenum

Question 8

diverticulosis/ diverticulitis

Answer 8

diverticulosis - intenstinal disorder charcteriszed by little pickets n side of large intenstine

diverticulitis - fecal matter collect in pockets, breeding bacteria, and infalammation and pain may reulst

deverticulum rupture = surgery

thought to be caused by diet lacking in fiber so high-fiber diet recommendnet

treatment for diverticulitis is antibotics, clear-liquid diet, low-residue diet to allow bowel to rest and heal, then high fiber diet to increase stool volume, reduce pressure in colon, and shorten time food is in intestine

Question 9

irritable bowel syndrome

Answer 9

function gi disorder

gi tract not functioning properly

previously known as spastic colon or colitis

abn pain or discomfort for the last 3 months, at least 3x during those months

some indv may exp diarrhea, constipiation, mixutre of both, cramping, bloatin g

cause not welknown but may be genetics, food sensitivity, bacterial inection or overgrowht, motility issues, altered neurotransmitters, GI hormones, psych issues

treated by changes in diet, med, probiotics, therpaies for mental health

Question 10

avoid food for IBS

Answer 10

• foods high in fat
• milk products
• alc or caffeine drinks
• drinks w large amoutns of artifical sweenters
• beans, cabbage, other gas-producing foods

Question 11

FODMAP Diet

Answer 11

(feremtnable oligo-, di-, mono-saccharides and polyols)

• restirct fodos w constituents such as honey, high fructose corn syrup, fruits w pits or seeds, milk, wheat, onions, and garlic, starchy beans, and sugar alc

Question 12

inflammatory bowel disease

Answer 12

chronic conditions causing inflammation in GI tract
- cause malabsorption that often leads to malnurition
- acute phase is irregular and are followed by symptom free preiod
- ex are ulcerative colitis and Crohns Disease

Question 13

ulcertive colitis

Answer 13

inflammation and ulceration of the colon, rectum, and smoetmies entire large intstine

Question 14

crohns disease

Answer 14

autoimmune disease

chronic progressive disorder that can affect both small and large intestine

ulcers can penetrate entire intestinal wall
chronic inflammation can thicken the intestinal wall causing obstruction

Question 15

IBD symptoms

Answer 15

bloody diarrhea
cramps
fatigue
nausea
anorexia
malnutrition
wt loss

electroylte, fluids, vitamins, anod other minerals are lost in diarrhea, and bleeding can cuase loss of iron and protein

clients w crohsn are often thin and may be malnoursihed due to malabsorption of nutrients

Question 16

treatments for IBD

Answer 16

anti-inflammatory drugs + med nutrition therapy

low-resideu diet to avoid irritating inflamed area and avoid danger of obstruction

when tolerated include abt 100g protein, addition cal, vitamins, and minerals

in severe cases total parenteral nutrition

Question 17

ileostomy or colostomy

Answer 17

severe IBD may need stoma for defectation (size of nickel)

ileostomy if entire colon, rectum and anus msy be removed

colostomy - enterance to colon if rectum and anus are removed (temp or permanent)

Question 18

short bowel syndrome

Answer 18

after surgical removal of small intstine (at least half) and/or dysfunction or removal of colon

patient lacks sufficient bowel length or function to support nutrient neesd

reduced intestinal lenght and decreased transit results in nutrient malabsorption and fluid losses

may need parenteral or specialized enteral formula after surgery, need food asap as nuteints from food are the most potent stimuli to foster bowel adaptation

successful adaption more liekely in pt whose colons reamin

Question 19

treatment for short bowel syndrome

Answer 19

anti-diarrheal and anti-secretory medication + pancreatic enzumes, oral rehydration solutions and soluble fibers

larger instutuets have intesitnal rehab programs devoted to weaning idn off parenteral nutritio nand IV fluids

Question 20

diet for short bowel syndrome

Answer 20

diet focus on six small meals per day and low fat, no concetrated swee emphasis

w ilesotaomtes hve greater need for salt and water

vitamin C and B12 supplement as well as fat-soluble vitamins

liquid or cheweable multivitmain

Question 21

celiac disease

Answer 21

gluten-sensitive enteropathy or sprue

chronic autoimmune disorder caused by interolanerce to gluten (protein wheat, barley and rye)

produce antibodies that attack intestine when they ingest gluten

1/3 ppl have genes for celiac but unknown environemntal factors determine who get celiac dsease or glyen sensitivity

Question 22

celiac disease symptoms

Answer 22

diarrhea
constpiation
wt loss or gain
abd cramping and bloating
malnutrition
joint pain
anemia
fatigue

growht compromised in children with untreated celiac

Question 23

1 in ___ americans have celiac

Answer 23

133

Question 24

celiac is _____ as common as crohns, ulcerticatives colitis, and CF. ombined and -__$ celiac indv remain undaginosed or misdaginsed

Answer 24

twice

83

Question 25

_____ year lapse before celiac diagnosis

Answer 25

6 to 10 year

Question 26

celiac diagnosis and treatment

Answer 26

celiac panel - blood tests that measure immune response to gluten which nust be done prior to start of glutenfree diet biopsy of intestine strict-gluten free diet

Question 27

---% of pop are neg for celiac but have gluten sensitivty

Answer 27

6%

Question 28

how to assess non celiac gluten intolerance

Answer 28

trial of 2 to 3 weeks of gluten free diet (elimination) and challenge of returningback to gluten then monitor synmptoms non-celiac gluten sensitivity dont have damange to intestinal villi compared to someone w celiac disease

Question 29

gluten-containing grains to avoid

Answer 29

barley (malt extract, beer, and ale), rye, wheat (all wheat flours and products made w wheat, bran, germ, starch), spelt, triticale, and farro

Question 30

gluten free grains and starches

Answer 30

rice wild rice millet amaranth arrowroot corn flax buckwheat soy teff flours made from ntus, beans, seeds, potato, tapioca, and sorghum

Question 31

most nutritious high giber gluten-free grains

Answer 31

brown rice wild rice quinoa amaranth buckwheat gluten-free steel cut oats rice bran

Question 32

liver function

Answer 32

all nutrients expect for a few fatty acids are absorbed in intestines and transported to liver liver then dismantles some of nutrients, stores others, anuses some to synthesize other substances liver determine where amino acids are needed, synthesizes some proteins, enzymes, and uera changes simple sugars to glycogen, provides glucse to body cells, sythesizes glucose from anio acids if needed converts fats to lipoproteins and syhtesizes cholesterol stores iron, copper, zinc, mangeiusm, fati-soluble vitmains, and b viitamin synehzies bile detoxifies many substances such as barbiturates and morphine

Question 33

cirrhosis

Answer 33

general term for all liver disease characteriszed by cell loss alc abuse is most common cause but could also be congential defects, infections, or other otxic chemicals replacement does not match loss of cells in cirrhosis also has fatty infilatration and fibrosis blood flow thorugh liver is upset, form of phyertension, anemia, and hemorrhage

Question 34

dietary treatment of cirrhosis

Answer 34

25-35 cal or more + 0.8-1g of protein per kg if hepatic coma is imminent then lower amt supplements of vitmains and minerals advanced chirrhosis: 50-60% of call from carb in some cirrhosis fat is not tolerated well so restricted if protein not toelrated well its restricted to 35-40g a day cirrhosis can cuase ascites sodium and fluids may be restricted fluid may be restircted if bleeding in esophagus smaller feedings no alc

Question 35

hepatitis

Answer 35

inflammation of the liver caused viruses or toxic agents sucha sdrugs and alc necrosis in mild cases cells can be replaced, in severe cases damage is extensive and then lver failure and dath and bile stasis, decreased blood albumin level,s nausea, heachae, fever, fatigue, tender and enerlaged liver, anorexia, and handice, wt loss

Question 36

types of hepatitis

Answer 36

hep A: contaminatd drinking water, food, and sweage vita fecal-oral route hep B and hep C: blood, blood products, semen and salivia (Hep b and C can lead to chronic active hep (CAH)) CAH can lead to liver failure and end stage liver disease

Question 37

treatment for hepatitsi

Answer 37

bed rest plenty of fluids med nutriton therapy 35-40 g cal per kg most of cal from carb, mod fat, and 70-80g protein if necrosis no severe limit protein if necrosis is not severe smal lfrequent meals clients w liver disease requre a great deal of encouargement bc anorexia and conseuqnet feelings of general malaise can be severe recovery take patience rest and time

Question 38

cholecystitis and cholelithiasis

Answer 38

may inhibits flow of bile and cause pain cholecystitis can cuase changes in gallbladder tissue which in turns affect cholesterol, causing it to harden and form stones thought chronic overindulgence in fats may contribute to gallstones bc fat stmiaultes liver to prodcue more cholesterol for bile which is necessary for digestion of fat

Question 39

etiology of gallbladder disease

Answer 39

heredity factors women develop gallbladder disease more oftne than men boesity, TPN, very-low-cal diet for rapid wt loss, use of estrogen, various small intestien disease

Question 40

function of gallbalder

Answer 40

dual function of gallbladder is concentration and storage of bile gallbaldder contecntates ble formed in liver fat in duodenum triggers gallbladder to cntract and release bile in common duct

Question 41

symptoms and treatment for gallbladder inflammation and sotnes

Answer 41

symtpoms: pain, indgiestion, vomiting (particularly after ingestion of fatty foods) treatment - mediciatio nto dissolve stones, diet therapy, cholescystectomy

Question 42

med nutritoin therapy for gallbladder stones

Answer 42

clear-liquid diet rgular but fat-restircted diet (40-45g fat daily) chronic cases: fat restricted on permanent basis wt loss if obsese water-misicle forms of fat-soluble vitmaisnp

Question 43

pancreas function

Answer 43

prodcues insulin and other hormones and enzymes essnetial to digetion of protein, fats, and carbs

Question 44

pancreatitis

Answer 44

inflammation of pancrease caused by infection, surgery, alcholism, biliary tract disease pr certain drugs

Question 45

symptoms of pancreatitis

Answer 45

abd pain, nausea, steatorrhea malabsopriton of fat-solube vitmains wt loss if islet of Langerhans are destroyed, diabetes mellitus

Question 46

diet therapy for pancreatitis

Answer 46

protein and HCL stimualte pancrease thus during acute pancreatitis client is noursihed stricly parenterally later liquid diet of mainly carb then small ,fdreuqnt feedings of carbs and proteins w little fat or fiber bc deficiency of pancreatic lipase vitamin supplements

Question 47

residue controlled diets

Answer 47

dietary fib er is mostly found in plant foods resude is solid part of feces reside made up of all undigested and unabsorbed parts of food, connective tissue in animal foods, dead cells, and inestinal bacteria and prodcts (mostly fiber) diets can be adjusted to increae or decrease fiber and residue

Question 48

high fiber diet

Answer 48

30g or more bleieved to help prevent diverticulosis, constipation, hemorrhoids, and colon cancer helpful in treatment of diabetes mellitus and athersclerosis normal diet in US contains about 15g of dietary fiber, rec is for 38g men and 25g women byt not to exceed 50g intrudce gradually 8 8-oz glasses of water must also be consumed

Question 49

recommendent foods for high fiber diet

Answer 49

coarse and hwole grain breads and cerea;s bran all fruits and veg (esp raw) and legumes

Question 50

low residue diet

Answer 50

5-10 g ietary fiber to reduce normal work of interstines by reduced amt of dietary fiber and thus residue may be used in cases of severe diarrhea, diverticultisi, ulcerative colitis, and intestinal blockage and in prep for and immeiatley after instential surgery no more than 3g of fiber in some facitlirs

Question 51

diarrhea

Answer 51

frequent expulsion of watery feces causes food to move through the digestive system too quickly for nutrients to be fully absorbed + loss of liquid may be caused by Food sensitivity, harmful bacteria, and stress

Question 52

constipation

Answer 52

- chyme moves v slow hrough large intestine so too much water is absorbed - feces become hard,bowel movement becomes painful - excess straining can lead to hemorrhoids - caused by erratic eating habits, low fiber, lack of physical activity, too little water, ignoring bowel movements

Question 53

indigestion

Answer 53

- abd discomfort after eating and relates to difficulty digesting food - caused by stress, eating too fast or much, particular foods - symptoms include gas, stomach cramps, nausea

Question 54

heartburn

Answer 54

burning sensation in middle of chest caused by stomach acid into esophagus; aka reflux prevent by avoiding certain foods or drinks, decrease fatty and spicy food intake, small frequent meals > large meals, no eating several hours before bed