Elimination and Nutrition

Question 1

is the degenerative loss of skeletal muscle mass that usually occurs with aging.

Answer 1

Sarcopenia

Question 2

is a condition of too little protein in the blood; the normal range for albumin in a healthy adult is 3.5 – 5.0 g/dL

Answer 2

Hypoalbuminemia

Question 3

is the failure of the chemical processes of digestion that take place in the intestines

Answer 3

Maldigestion

Question 4

is the lack of a desire to eat despite physiologic stimuli that would normally produce hunger; this may occur as a side effect to drugs or as a result of disease process
a. Symptoms may include nausea, abdominal pain, and diarrhea

Answer 4

Anorexia

Question 5

is the forceful emptying of the stomach and intestinal contents through the mouth

a. Stimuli – severe pain, distention of the stomach, presence of ipecac or copper salts, drugs, motion
b. Usually preceded by nausea and retching
c. *Spontaneous vomiting not preceded by nausea or retching is called projectile vomiting = it is caused by direct stimulation of the vomiting center by neurologic lesions
d. Symptoms include tachycardia, tachypnea, diaphoresis, increased gastric motility
e. May cause a metabolic alkalosis, hyponatremia, hypochloremia, and hypokalemia

Answer 5

Vomiting (emesis)

Question 6

is difficult or infrequent defecation

a. Affected by activity, diet, and drugs!
i. Decreased activity, low residue diet, opiates, antacids, anticholinergics, and iron all could cause decreased motility/bowel movements

Answer 6

Constipation

Question 7

_______ constipation can be:

i. Normal transit: normal rate of passage but evacuation issue
ii. Slow transit: impaired colon activity so defecation is infrequent and difficult; there is distention
iii. Pelvic floor dysfunction: inability or difficulty expelling because the pelvic floor muscles or sphincter do not work

Answer 7

Primary

Question 8

__________ constipation could be due to neurogenic disorders like strokes and Parkinson’s that cause altered neural pathways to the colon

Answer 8

Secondary

Question 9

Fecal _________ may occur and be manifested by bleeding, abdominal cramping and pain, and nausea and vomiting

Answer 9

impactions

Question 10

is the increase in frequency of defecation and in the fluid content and volume of stools

Types:
i.	\_\_\_\_\_ Volume: increased volume 
caused specifically by:
a.	E. coli or C. diff
b.	rotavirus

ii. _____ Volume: volume not changed
1. Often a result of inflammation of the intestine associated with ulcerative colitis or Crohn’s
2. Also results from fecal impaction

Answer 10

Diarrhea

Large

Small

Question 11

(Diarrhea)

a non-absorbable substance in the intestine that draws excess water into the intestine and increases stool weight and volume, producing large volume stool

Specific Causes:

a. Lactase or pancreatic enzyme deficiency
b. Excessive ingestion of non-absorbable sugars
c. Full-strength tube feedings

Answer 11

Osmotic

Question 12

(Diarrhea)

Excessive mucosal secretion of fluid and electrolytes produces large-volume diarrhea

1. Specific Causes:
   a. Bacteria like E. coli or C. diff
   b. Viruses like rotavirus

Answer 12

Secretory

Question 13

(Diarrhea)

food is not mixed properly, digestion and absorption are impaired and motility is increased

1. Specific Causes:
   a. Resection of the small intestine (short bowel syndrome)
   b. Surgical bypass of an area of the intestine
   c. Fistula formation between the loops of the intestine
   d. Irritable bowel syndrome

Answer 13

Motility

Question 14

Gastrointestinal bleeding

a. Frank bleeding is bleeding that is seen

i. Bright ___ means the blood has not been digested
1. This would be blood from the esophagus if it is in vomit (_________)
2. May be blood from the rectum if it is in the stool (____________) - can also be caused if an upper GI bleed is rapid enough

ii. Dark and grainy means the blood has been digested/affected by stomach ____
1. Also known as coffee ground blood
2. Coffee ground emesis means it is blood from the stomach (so think a gastric ulcer)

iii. ______ is black or tarry stools that are foul smelling and indicate that the blood has been digested
1. This is blood that has been digested in the intestines

Answer 14

red
(hematemesis)
(hematochezia)

acid

Melena

Question 15

Gastrointestinal bleeding

bleeding is bleeding that is not seen; it is usually from a slow, chronic blood loss and results in iron deficiency anemia

Answer 15

Occult

Question 16

Gastrointestinal bleeding

_____ __ Bleeding

i. Usually due to varices in the esophagus or ulcers in the stomach or duodenum
ii. Characterized by the bright red bleeding if it is unaffected by stomach acid or coffee ground emesis if it has been affected by stomach acid

Answer 16

Upper GI

Question 17

Gastrointestinal bleeding

_____ __ Bleeding is bleeding from the jejunum, ileum, colon, or rectum due to polyps, inflammatory disease (ulcerative colitis or Crohn’s), diverticulitis, hemorrhoids, or cancer

Answer 17

Lower GI

Question 18

is difficulty swallowing

Due to:

i. Mechanical obstructions like tumors or strictures
ii. Functional issues that interfere with voluntary swallowing
iii. _________, which is a rare form caused by an autoimmune issue; esophageal peristalsis is absent and the lower esophageal sphincter does not relax

Characterized by:

i. Distention and spasm of the esophageal muscles
ii. Pain at the site of obstruction

Treatment

i. Eat small meals and include fluids
ii. Elevate bed when sleeping
iii. Mechanical dilation of esophageal sphincter
iv. Surgical separation of lower esophageal muscles

Answer 18

Dysphagia

Achalasia

Question 19

is reflux of chyme from the stomach through the lower esophageal sphincter to the esophagus

Causes:

i. Decreased pressure of the lower esophageal sphincter
ii. Spontaneous relaxation of the lower esophageal sphincter
iii. Increased abdominal pressure

Manifestations:

i. Heartburn
ii. Dysphagia
iii. Laryngitis
iv. Upper abdominal pain within 1 hour of eating
v. Worse symptoms when layin down

In newborns, _________ ______ is normal because the gastroesophageal sphincter is not fully developed; they should grow out of this but we call it ____ once there have been complications such as bleeding, dysphagia, or failure to thrive

i. Concerned about aspiration pneumonia
ii. May see a chronic cough, wheezing, esophagitis, and pain
iii. Evaluate with a pH probe and treat with small, frequent feedings and burping

Answer 19

Gastroesophageal reflux disorder (GERD)

Question 20

______ hernia is protrusion of the upper part of the stomach through the diaphragm into the thorax
a. Symptoms include GERD, dysphagia, heartburn, vomiting, and epigastric pain

Answer 20

Hiatal Hernia

Question 21

_______ obstruction is the narrowing or blocking of the opening between the stomach and the duodenum

a. May be congenital
b. Could be caused by ulceration the causes inflammation, edema, spasms, fibrosis, and scarring > obstruction
i. Manifestations: epigastric fullness and weight loss

Answer 21

Pyloric Obstruction

Question 22

Infantile _______ stenosis is caused by hypertrophy of the pyloric sphincter; this may lead to hypertrophy of the stomach muscles

a. Manifestations: _________ vomiting after having fed well, constipation, fluid and electrolyte imbalances
b. Treatment: pyloromyotomy

Answer 22

Infantile pyloric stenosis

Projectile

Question 23

Intestinal __________ is caused by any condition that prevents the normal flow of chyme through the intestinal lumen of the small or large intestine

Answer 23

obstruction

Question 24

is a functional obstruction in which there is failure of intestinal motility
a. Often occurs after abdominal surgery as a result of inflammatory mediators and the influence of exogenous (meperidine) and endogenous opioids (endorphins)

Answer 24

Paralytic ileus

Question 25

is the inflammation of the gastric mucosa

Answer 25

Gastritis

Question 26

Gastritis _____ gastritis erodes the surface epithelium in a diffuse or localized pattern i. Usually the result of injury to the mucosal barrier by drugs or chemicals 1. NSAIDs 2. Alcohol

Answer 26

Acute

Question 27

Gastritis ______ gastritis tends to occur in elderly individuals and causes thinning and degeneration (atrophy) of the gastric mucosa

Answer 27

Chronic

Question 28

_______ intolerance is due to a lactase deficiency; there is an inability to break lactose (milk sugar) into monosaccharides a. Lactose is not digested or absorbed so it remains in the intestine, where bacterial fermentation causes gases to form b. Manifestations: *bloating, *cramping, diarrhea, and flatulence

Answer 28

Lactose

Question 29

______ Disease is an *autoimmune disease that damages the epithelium of the small intestinal when there is ingestion of gluten (barely, wheat, oats, rye) a. *There is atrophy and flattening of villi that leads to malabsorption of nutrients b. Damage to the mucosa of the duodenum and jejunum exacerbates *malabsorption c. Manifestations: diarrhea, *failure to thrive, anemia, stools are pale, bulky, greasy and foul smelling, anorexia, electrolytes deficiency

Answer 29

Celiac

Question 30

__________ _______ is a chronic inflammatory disease that causes ulceration of colonic mucosa Characteristics: 1. Most common in the sigmoid colon and rectum; begins in the rectum and may extend proximally to the entire colon 2. Edema and thickening of the mucosa may narrow the lumen of the involved lumen 3. Mucosal destruction and inflammation causes bleeding, cramping pain, and an urge to defecate 4. *Frequent diarrhea with passage of small amounts of blood and purulent mucus is common Evaluation – *colonoscopy with biopsy is used in addition to laboratory data Treatment: 1. Mesalamine products, steroids and aminosalicylates 2. Surgical resection of the colon may be performed if other forms of therapy are unsuccessful

Answer 30

a. Ulcerative colitis

Question 31

are herniation or saclike outpouchings of the mucosa and submucosa that can occur anywhere in the GI tract but are most commonly in the left sigmoid colon a. Forms from increases in intraluminal pressure, particularly at weak points in the colon b. Symptoms: cramping, constipation, distention, flatulence c. Treatment – increase in dietary fiber, probiotics and mesalazine d. Diverticul____ – asymptomatic diverticular disease e. Diverticul____ – inflammation of the outpouchings i. Uncomplicated diverticulitis is usually treated with non-absorbable antibiotics, bowel rest, and analgesia

Answer 31

Diverticula Diverticulosis Diverticulitis

Question 32

is a functional GI disorder without specific structural or biochemical alterations Manifestations: i. Lower abdominal discomfort ii. *Diarrhea predominant, or alternating diarrhea/constipation b. Evaluation – based upon s/s; may include endoscopy, CT or abdominal u/s *Treatment: no cure but we can give laxatives and fiber

Answer 32

Irritable bowel syndrome (IBS)

Question 33

_______ is an increase in body fat mass and a metabolic disorder where the BMI exceeds 30 a. Associated with Cushing’s syndrome, polycystic ovary syndrome (PCOS), and hypothyroidism

Answer 33

Obesity

Question 34

Obesity _____ is a product of the obesity gene and expressed primarily by adipocytes; it acts on the hypothalamus to *suppress *appetite and functions to regulate body weight within a fairly normal range

Answer 34

Leptin

Question 35

Obesity Leptin ________ occurs when there are increased adipocytes, which lead to *increased levels of leptin; this disrupts hypothalamic satiety and promotes* *overeating, and *excessive weight gain i. Associated with insulin resistance and the cardiovascular complications of obesity

Answer 35

resistance

Question 36

Obesity Manifestations: i. ________ obesity – occurs when the distribution of body fat is localized around the abdomen and upper body ii. __________ obesity – occurs when the distribution not fat is extra-peritoneal and distributed around the thighs and buttocks

Answer 36

Visceral Peripheral

Question 37

Obesity Evaluation – CT, MRI, underwater weighing, skinfold thickness i. _ _ _ and waist-to- hip ratios are most commonly used because they are the easiest to measure

Answer 37

BMI

Question 38

Obesity diet and exercise, psychotherapy, behavioral modifications, medication and weight loss therapy

Answer 38

Treatment