Common GI disease- Dx & Tx plans Flashcards Preview

Clinical Nutrition- Final > Common GI disease- Dx & Tx plans > Flashcards

Flashcards in Common GI disease- Dx & Tx plans Deck (70)
Loading flashcards...
1

common GI symptoms

--pain
QUAL: Burning, cramping
LOCATION: RUQ, LLQ, epigastric
--N/V/ loss of appetite
--swelling, bloating, excessive or prolonged "fullness" after eating
--air/gas
--diarrhea or constipation

2

1st: Rule out serious disease
--omnious signs

--acute, severe symptoms
--progressive worsening
--fever, inflammation
--palpable masses, difficulty swallowing
--bleeding, jaundice
--unexplained weight loss

3

1st: Rule out serious disease
--abnormal lab screening tests

--CBC
--SED rate
--liver function
etc

4

2nd: Try to find a Dx

--peptic ulcer?
--GERD?
--early gallbladder disease?
--IBS?
--Celiac?
NOTE*many GI complaints end up with no Dx*

5

Peptic ulcer =

--burning pain or ache in upper abdomen btw meals, relieved by eating

6

causes of peptic ulcer =

--60% assoc w/ H. Pylori
--NSAID
--Aggravated by stress, smoking, alcohol, diet

7

peptic ulcer Tx

--H. Pylori infection must be Tx medically
--avoid NSAIDs
--healthy diet (milk & bland food = no help// fiber = reduce recurrences)
--consider sensitivities: salt, spices, alcohol, caffeine, food allergy?
--supplements: chewable DGL licorice, zinc

8

DGL licorice actions

--inhibits irritating acid secretion
--increases protective mucus secretions
--inhibits H. pylori
--increases blood flow & growth

9

DGL licorice how to take it:

--2/day-chewed before meals
--relief from chronic ulcer pain w.in 5-7days
--usually as effective as ulcer meds

10

DGL preparation

1) deglycyrrizinated (DG) extract
--removal of glycyrrhizin eliminates undesirable side effects (high BP, water retention)
2) chewable tablets before each meal
--extract must mix with saliva for efficacy
--capsules don't work in ulcer research
--useful for other conditions (ex: mouth sores)

11

GERD what is it?

--a disorder of lower esophageal sphincter

12

GERD - symptoms?

Classic = chronic, recurrent retrosternal burning pain ("heartburn")

--not necessarily associated with hiatal hernia

13

GERD Tx

1) keep food in lower portion of stomach only: small frequent meals, avoid laying down after meals, no tight clothes!
2)obesity increases risk but effectiveness of weight loss is controversial
3) consider potential aggravators: smoking/alcohol/ caffeine/ spicy or acidic food/ chocolate/ mint

14

GERD Tx
(supplement specific)

1) chewable DGL licorice?
--helps mouth & peptic ulcers
--no clinical studies on DGL & GERD
--therapeutic trial makes sense if patient desires alternative/adjunct to antacid therapy
2) Digestive aids? (enzymes)
--might speed digestion to encourage more rapid emptying
--no clinical studies
--*caution d/t risk of worsening symptoms

15

early gall baldder disease

RUQ pain sometimes associated with high-fat meals
--stones may only be visible w. U/S
--ominous signs (severe pain, fever) suggest acute cholecystitis, which should be referred

16

who gets gall bladder disease?
6F's

Family Hx
Female
40's
Fat
Fair skin
Fertility

17

Strategy for early gall bladder disease

decrease biliary cholesterol, increase bile acids and phospholipids, increase bile flow

18

dietary approaches to prevent progression of gall bladder disease

1) weight loss (but not rapid)
2) low cholesterol, vegetarian, high fiber, longevity-type diet
--healthy diet improves hepatic cholesterol metabolism to reduce biliary cholesterol
--**COFFEE = reduce risk**
bcuz it increases bile flow

19

supplementation for gall bladder disease

agents that affect stone formation/dissolution by affecting bile flow or bile composition
--concentrated bile acids = good evidence in long-term (OTC ox bile salt has not been evaluated)
--concentrated lecithin
--Vit C (required for bile acid synthesis)
--Milk thistle
--artichoke extract
--curcumin (gall bladder contraction by 50%)

20

"lipotropic" formulas

--contains vitamins, minerals, amino acids, herbs, etc. thought to be important for optimum bile flow and composition
--mostly theoretical. no clinical studies for preventing or treating gallbladder disease

21

what do they say about Tx's that are designed to expel stones?

--not safe or effective
--"gall bladder flush" with olive oil is controversial. analysis of recovered "stones: show no chemical or structural resemblance to gall stones

22

for some reason she has a slide that says:
Dx-related supplements

1) peptic ulcer?
--zine & chewable DGL licorice
2) GERD?
--chewable DGL licorice
3) Early Gall bladder?
--artichoke leaf extract
4) Celiac?
--gluten-specific enzymes
5) IBS?
--enteric-coated peppermint
6) IBD?
--probiotics & fish oil (omega-3)

23

Celiac disease?

autoimmune disease triggered by dietary protein called gluten (aka gluten intolerance, celiac sprue)
--immune rxn damages intestinal villi, causing malabsorption & chronic GI distress

24

what if you suspect someone has celiacs disease?

screening test for unique antibodies, followed up by endoscopic biopsy

25

Celiac disease Symptoms

1) Malabsorption: weight loss, impaired growth in kids, anemia, fatigue, bone loss, infertility, dermatitis herpetiformis, aphthous stomatitis, peripheral neuropathy
2) GI distress: gas, recurring ab pain, chronic diarrhea/constipation, N/V, pale, foul-smelling, or fatty stool

26

Celiac disease Tx

1) gluten-free diet
(avoid: wheat, rye, barley; oat may be OK)
--also wheat relative: spelt, triticale, kamut
--initially avoid lactose
*recover of vili takes weeks--> months
2) multiple vitamin-mineral supplement to help reverse malnutrition
3) generic digestive enzyme supplements may speed recovery

27

Gluten-specific digestive enzymes

one RCT showed DPP-IV activity may help celiac patients by breaking down gluten metabolites

28

IBS

a disorder of gut motility or microflora imbalance

29

symptoms of IBS

--recurrent cramping pain
--bloating
--soreness
--gas
--diarrhea, constipation
--NO BLEEDING/ signs of inflammation

**symptoms are often flora, stress or food-related

30

IBS possible triggers

1)over eating
2)gas-forming foods: legumes, crucifers, onion, bran
3)stress