FNN 401 Midterm Flashcards
1
Q
this is a motility disorder characterized by an absence of or weakened peristalsis within the esophagus
A
achalasia
2
Q
this is a complication of severe chronic GERD involving changines in the cells of the issue that line the bottom of the esophagus
A
barrett’s esophagus
3
Q
vague upper ad symptoms that may include upper ab pain, bloating, early satiety, nausea, belching
A
dyspepsia
4
Q
difficulty swallowing
A
dysphasia
5
Q
chronic or reccurent gastric pain due to reflux of gastric seretions into the lower esophagus
A
gerd
6
Q
profusion of part of the stomach through the diaphragm into the space normally occupied by the esophagus, heart, lungs
A
hiatal hernia
7
Q
if osmolality is > 300 mosm/kg, this is
A
hyperosmolar
8
Q
ulceration or perforation in the lining of the stomach, duodenum or esophagus
A
peptic ulcer disease
9
Q
for this disease, nutrition therapy is the only treatment
A
celiac
10
Q
the upper gi tract is composed of these 4 organs:
A
mouth
pharynx
esophagus
stomach
11
Q
the lower gi tract is composed of these:
A
large intestine
small intestine
12
Q
what are 4 functions of the stomach
A
motility
secretion
digestion
absorption
13
Q
what are gastric juices made up of
A
water
mucus
hcl
gastric juices
electrolytes
14
Q
these stomach cells secrete pepsinogen (which, when activated, begins protein digestion)
A
chief cells
15
Q
these stomach cells secrete hcl and intrinsic factor (activates pepsinogen, kills microorganisms, denatures proteins, and helps absorb b12)
A
parietal cells
16
Q
these cells secrete histamine
A
ECL cells
17
Q
these cells secrete gastrin
A
G cells
18
Q
these cells secrete somatostatin
A
D cells
19
Q
what is the role of chief cells in stomach
A
they secrete pepsinogen. when activsated, this begins protein digestion
20
Q
Which cells activate pepsinogen?
A
parietal cells
21
Q
which cells stimulate parietal cells?
A
ECL cells
g cells
d cells
22
Q
which are the 3 endocrine cells? the 3 exocrine cells?
A
endocrine:
- ecl
- g cells
- d cells
exocrine:
- mucous cells
- chief cells
- parietal cells
23
Q
what are the 3 phases of gastric sectetion?
A
cephalic phase - hcl and pepsinogen are released when we smell or taste food
gastric phase - when food enters stomach
intestinal phase
cephalic and gastric phase stimulate gastric juices, while intestinal phase slows gastric secretions and prepares small intestine
24
Q
what are the 5 different types of medications to treat GERD?
A
- PPIs
- histamine blocking agents
- prokinetic agents
- antacids
- foaming agents
25
what is the most common surgical procedure used for refractory gerd?
nissen fundoplication (fundus is wrapped around lower esophagus
other treatments: partial ffundoplication, roux-en-y for obese patients, LINX
26
common nutrition diagnoses related to GERD:
overweight/obesity, impaired nutrient utilization, inadequate vitamin/mineral intake, swallowing difficulty, altered GI function
27
nutrition recommendations for GERD
1. eat small, frequent meals
2. restrict foods that lower LES pressure
3. weight loss (if overweight)
28
how to diagnose GERD?
1. look at symptoms
2. hthere is relief after PPI use
29
what are the 2 types of hiatal hernias?
1. sliding (type 1) - most common - GE junction slides up (95%)
2. paraesophageal/rolling (type 2) - part of fundus goes through hiatus rather than junction
incidence increase with age
30
causes of hiatal hernia
obesity
pregnancy
decreased muscle elasticity
trauma (seatbelt injury)
previous surgeries
31
signs and symptoms of hiatla hernia
heartburn
regurgitation
acidic taste
burping
nausea
persisten nighttime cough
chest pain (mistaken for heart attack)
32
a person who has food and fluids accumulating in the lower esophagus may have
achalasia
33
what are some causes of acute gastritis?
nsaids
food poisoning
alcohol
34
causes of chronic gastritis (type a and type b)
type a - less common. the development of antibidoies against parietal cells
type b - h pylori infection
35
epigastric pain is most commonly associated with
PUD
36
nutrition diagnosis associated with PUD:
- inadequate beverage intake
- altered GI function
- involuntary weight loss
- food and nutrition related knowledge deficit
37
historically milk was used to treat:
PUD
38
metalic taste and helltosis are symptoms of
GERD
39
Names 5 causes of GERD
1. smoking
2. obesity
3. pregnancy (increased estrogen and progesterone)
4. meds (calcium channel blockers)
5. hiatal hernia
40
What are 5 symptoms of GERD?
1. nausea/vomiting
2. hoars voice, cough
3. halletosis
4. shortness of breath
5. heartburn
6. burping/hiccuping
41
opera singers often present with
GERD
42
what are 5 conditions related to reflux?
1. esophagitis
2. cancer
3. dental caries
4. barrets esophagus
5. sleep apnea
6. astha
43
if GERD goes untreated, it can progress to:
Barrett's esophagus
Erosive esophagitis
44
What % of GERD cases end with barrett's esophagus?
10% (but has no specific symptoms outside of GERD)
45
how do you diagnose GERD?
symptom description
medical trial
lifestyle modification
Tests:
- esophagael manometry
- barium swallow with contrast
- ambulatory esophagel pH monitoring
- screener for Barrett's esophagus
there is potential for endoscopy
Response to PPIs does not necessarily correlate with objective measures of GERD
46
what are 5 treatments for GERD?
1. meds that decrease gastric acidity
2. behaviour modification - weight loss, stop smoking, loose clothing
3. nissen fundoplication for refractory gerd
4. bariatric surgery for refractory gerd
47
what are the 3 goals of GERD treatment?
1. increase LES competence
2. decrease acid secretion
3. protect esophageal mucosa
48
Give one example of a PPI
omeprazole
49
give one example of a histamine2-receptor antagonist
ranitidine
50
give one example of a prokinetic agent
domperidone
51
when should PPIs be taken for GERD and why?
in the mornign, because the amount of H-K-ATPase in parietal cells is highest after a prolonged fast
52
what are the lab recommendations for PPI use?
1. check magnesium before starting PPO for patients on it over 1 year
2. check B12 levels yearly
3. check CBC and ferritin (because there is decreased iron absorption)
53
safety concerns of long term PPI use include:
c diff
microscopic colitis
atrophic gastritis
54
antacids, for treatment of GERD, combine 3 basic salts with bicarbonate:
1. magnesium
2. calcium
3. aluminum
55
Antacids (or is it foaming agents?) may decrease absorption of:
iron
folate
phosphorous
56
the use of H2 antagonists decreases absorption of:
calcium
iron
b12
57
which GERD medication are available OTC (vs. prescription)?
antacids
foaming agents
H2 antagonists
58
PPIs decrease absorption of:
calcium
iron
b12
magnesium
may also cause nausea/ab pain
59
What type of diet would help with reflux?
1. strict diet for at least 2 weeks
2. avoid foods below pH4
3. avoid foods that increase gastric pressure
4. avoids foods that relax the LES
5. avoid large meals before bed
60
Name 5 foods to avoid and 5 foods to have with GERD:
avoid:
- peppermint
-coffee
- fatty foods
- alcohol
- citrus
Have:
- herbs
- fish
- eggs
- low acid fruits like pear and banana
- oats
61
5 behaviour modifications that can help with GERD
1. wear loose clothes
2. small frequent meals
3. stop smoking
4. lose weight
5. dont lie down for 3 hours after meal
62
When would you do a fundoplication for GERD?
1. if there is a hiatus hernia bigger than 2 CM
2. if GERD is unresponsive to usual therapies
3. if there is GERD complication like erosive esophagitis and barret's esophagus
63
in severe cases of gerd, what is the nutrition protocol?
1. clear fluids first
2. pureed foods 1-2 weeks
3. soft/minced foods 2-4 weeks
4. avoid straws, gum, carb drinks
5. small volumes of food
64
Explain differences between acute and chronic gastritis
Acute gastritis
- related to infection
- associated with alcohol, food poisoning, NSAIDs
- short lived and resolves
Chronic gastritis
- Type A (pernicious anemia/autoimmunue) or Type B (H. pylori)
type a reuslts in achlorydia (low stomach acid), iron deficiency, b12 deficiency
65
What are symptoms of gastritis?
belching
anorexia
ab pain
vomiting
bleeding
hematemesis
melena - jet black stool
66
treatment for gastritis includes
antibiotics for h pylori
reduce acid secretion
anti-inflammatory meds other than NSAIDs
67
What is the definition of PUD?
ulcers in gastric mucosa or duodena mucosa. these ulcers pentetrate the submucosa
68
what are 5 causes of PUD?
1. h pyolri (50% of cases)
2. nsaids
3. alcohol
4. smoking
5. stress
6. genetics - 3x more common in 1st degree relative
69
what are 5 differences between gastric ulcers and duodenal ulcers
gastric ulcers
- least common
- food increases pain
- pain 1 hour after meal
- weight loss
- vomiting
duodenal ulcers
- most common
- food decreases pain
- well nourished
- pain 3 hours after meal
70
what are clinical manifestations of PUD?
epigastric pain, burning sensation
bloody stool
infection (WBC count)
71
how do you diagnose PUD?
endoscopy with biopsy
C-urea breath test
stool antigen test
72
how do you treat PUD?
3-4 meds to treat h. pylori
1-2 weeks of antibiotics + PPI
Refractory PUD requires surgery
73
what are nutrition implications of PUD?
1. impaired oral intake (anorexia)
2. malaise
3. weight loss
4. atrophic gastritis - b12 deficiency
5. nutrient imbalance
74
which foods cause PUD?
non, but spices and coffee increase acid secretion but no association with ulcer development. PH OF FOOD DOESNT HAVE THERAPEUTIC RELEVANCE
but alcohol and smoking do contribute to ulcers
75
milk and cream used to be used to treat
PUD
but it really increases gastrin and pepsin secretion
76
what are the micronutrients of concern in PUD?
iron
calcium
b12
77
____ helps prevent further ulcers in PUD
soluble fibre (chia, flaxseed
78
what are 3 complications of PUD?
1. hemmorage detetced in stool (melena) or hernatemesis (vomiting fresh blood)
2. perforation
3. gastric outlet obstruction
79
___ results from prgroessive degentation of ganfglion cells
achalasia
the LES can relax
80
symptoms of achalasia:
difficulty swallowing, regurgitation, belching, coughing at night
81
what is achlordydia?
stomach doesnt produce Hcl which helps digest food
82
How much of digestion and absorption occurs in the lower GI?
98%
83
how long is the SI
400 cm
84
what are the 3 parts of the SI? lengths?
duodenum - 25-30cm
jejenum - 160-200cm
ileum - 200-400m
85
_____ is an autoimmune disease caused by immunological reaction to gluten
celiac disease
86
how many canadians have celiac
1 in 133
87
what % of people worldwide have celiac?
1% - mostly in european countries
88
how does celiac disease work?
gliadin intake --> villous atrophy --> nutrient malabsorption, wasting, diarrhea
89
What are risk factors for celiac disease?
1. family history
2. type 1 diabetes
3. thyroid/liver disease
4. downs syndrome
Celiac often occurs in conjunction with other autoimmune disorders like T1DM
90
What happens when small intestine is exposed to gluten from wheat, rye, malt, barley?
1. inflammatory response
2. infiltration of WBC
3. production of IgA antibodies
91
What are 5 GI symptoms of celiac disease?
GI symptoms like:
1. chronic diarrhea
2. ab pain
3. ab distension
4. constipation
5. weight loss
7. vomiting
8. GERD
92
what are 5 extraintestinal symptoms of celiac disease?
1. fatigue
2. delayed puberty
3. joint pain
4. peripheral neuropathy
5. oral ulcers
93
How do you test for celiac disease?
1. serological screener test for TTG-Iga - if positive, proceed to diagnostic test
(accurate test, slight rise of false positive) - use ttg-iga to track progress
2. endoscopy/biopsy
3. genetics (if genetics are +, serology is -ve, do gluten challnge
94
how much goten can increase enteropathy
50 mg gluten
95
which nutrients are GFDs deficient in?
vitamins
calcium
iron
fibre
96
In addition to GFD, what secondary diet is helpful until the intestine has healed?
low residue diet
low fat diet
lactose free diet
97
how many gluten free oats is ok per day
40-100 g/day - only introduce them after all symptoms of CD have resolves
98
5 random foods that have gluten
1. dates?
2. frozen turkey based with hydrolyzed wheat protein
3. teriyake sauce
99
What is the definition of IBS?
RECURRENT ab pain ONCE PER WEEK for 3 MONTHS, with 2 or more of: related to defecation, change in stool frequency, change in stool form
100
What are the 4 subtypes of IBS?
IBS - D
IBS - C
IBS - Mixed
IBS - unspecified
101
what is the prevalence of IBS in North America?
10% (more in women), develops before 50%
102
what is a key identifier of IBS?
pain before passing bowel movement, relief of pain after passing bowel movement
103
What is the cause of IBS?
unknown - continued to be a diagnosis of exclusion
104
What are differential diagnoses for IBS?
1. bile acid diarrhea
2. pancreatic exocrine insufficiency
3. microscopic colitis
4. SIBO - small intestinal bacterial overgrowth
5. pelvic floor dysfunction - occurs in 50-70% of IBS patients
6. histamine intolerance
7. non-IGE and ige mediated allergic reactions
105
what is the pathophysiology of IBS?
1. genetic predisposion
2. environmental trigger (medication, hormonal change, oral contraceptives, infection)
foods DONT cause IBS. they just dont allow IBS to heal
106
what are 5 risk factors for IBS?
1. psych factors
2. genetic factors
3. environmental factors
4. chronic infections
5. antibiotics
6. age
107
What are 3 potential mechanisms of actions for IBS?
1. cephalic phase - gut receptors are stimulated and volume is added to the lumen
2. ingestion of poorly absorbably molecules (mono and disaccharides)
3. chemostimulation of gut receptors. - peptides release CK and motilin, which activate mast cells, which lead to low grade inflammation
108
Describe the gut brain axis
Our gut and brain are attached. Enteric nervous system - runs gums to bum - a complex mesh of neurons running throughout our digestive tract
the gut-brain axis plays a role in:
- nutrient metabolsim
- produce makes beneficial compounds
- immunity
-regulates hormones
109
______ is the freeway between the gut and the brain
vagus nerve
110
what is the ratio of bacteria to cells in the gut
10:1
111
What are the responsibilities of SCFAs?
1. provide main source of fuel to intestinal cells.
2. create protective barrier
3. help with muscular contraction
4. reduce brain inflammation
5. increase serotonin
6. regulate appetite
112
what is the classic characterization of ibs?
- diarrhea
- alternating constipating, gas, bloating
also mucous secretion, upper gi symptoms, feeling of incomplete elimination
ROME criteria
113
IBS involves:
1. abnormalities in brain-gut communication
2. small intestinal bacterial overgrowth
3. increased permeability of the mucosa
4. altered microbial environment
114
what are 5 non-pharmacological approaches to IBS?
1. CBT (hypnosis, relaxation techniques)
2. probiotics
3. low FODMAPs diet
4. pelvic floor physiotherapy
115
What supplements do people use for IBS?
1. probiotics
2. digestive enzymes
3. prebiotics
4. apple cider vinegar
5. IBgard (peppermint)
6. biocidin (herbal)
7. candibactin (herbal)
116
What does medical treatment for IBS look like?
1. antidiarrheal agents
2. antispasmodics (take 30 minutes before meal)
3. bulking agents, laxatives
4. seratonin 5-HT4 receptor agonsts, SSRIs
117
what are the 4 pillars of managing IBS?
diet
mental health
probiotics
exercise
118
What does a nutritional diagnosis of IBS include?
inadequate oral intake
altered GI function
undesirable food choices
food and nutrition related deficit
disordered eating pattern
119
FODMAPS diet is used for which GI issue
IBS
120
When doing a food symptom diary for IBS, need ot include:
date
time
food item
quantity
time of symptoms
symptoms
121
What are the types of carbs in FODMAP foods?
1. fructans/galactins
2. fructo-oligosaccharides/galacto-oligosaccharides
3. polyols
122
Give 5 examples of FODMAP foods, and 5 examples of foods ok to eat
5 FODMAP foods:
- apples, apricots, artichokes, brussel sprouts, broccoli
5 OK foods:
- carrot
- celery
- cereals
- cheese
- chilli (and other herbs)
123
what are 5 steps to decrease gas production
1. reduce fried/high fat foods
2. eat small meals
3. dont eat while anxious
4. avoid pop
5. exercise
6. nonprescription antigas
7. peppermint tea
8. probiotics
Boost fibre intake
reduce caffeine
124
_____ is an autoimmune, chronic inflammatory condition of the GI tract
IBD
125
_____ is higher in caucasians and ashkenazi jews and norther hemisphere
IBD
126
what are causes of IBD?
1. smoking
2. diet
3. microbiome
4. infectious agents
5. hygiene hypothesis
6. environment + genetics
127
IBD involves the release of cytokines and destruction of mucosa
128
What are similarities and differences between crohns and colitis?
Similarities:
- both are considered IBD
- all have pain, diarrhea, tenesmus (want to poo but bowel is empty)
Differences:
- Crohn's affects any part of GI tract (cobblestone pattern), colitis affects colon and rectum
- Crohns affects all layers of tissue, UC affects 1st and 2nd layer
- Crohns results in fistulas, strictures, obstructions, UC results in toxic megacolon
- Crohn's has muscle wasting and malnutrition, UC has bloody diarrhea
129
How do you diagnose IBD?
1. serology test for cytokines IL1, IL6, TNF and antigylcan antibodies
2. Blood work: high CRP, high WBC
3. stool test: calprotectin, lactoferrin under 200 ixs good
6. scope every 6 motnhs
130
What are 5 extraintestinal manifestations of IBD?
1. dermatitis
2. osteopenia
3. rheumatological diseases
4. ocular symptoms (uveitis)
5. spondylitis
6. gullstones
131
what are 5 treatments for IBD?
1. glucocorticoids (prednisone) - to calm everything down
2. immunosuppressants (imuran)
3. immunomodulators (methotrexate)
4. biological therapies (remicade)
5. antidarrheals
6. antibiotics (flagyl, cipro)
132
What are the most common surgeries for crohns and UC?
crohn's: ileostomy (large bowel removed)
UC: total colectomy (colon is removed)
133
____ is a surgically created artificial opening into the abdomen
stoma
134
____ is a surgical connection between 2 parts of the intestine
anastomosis
135
____ is the removal of the colon and rectum. the ileum gets attached to the stoma
ileostomy
136
____ is the removal of the ileum, colon, rectum. attach the jejunum to the stoma (RARE)
jejunostomy
137
_____ is the removal of the colon
colectomy
138
How much liquid is gathered when you have an ileostomy?
1-1.5 L/day of liquidy/pasty output
4-6 xper day
139
Hartmann's procedure is an example of:
a colostomy (rectum and anus disconnected from GI tract)
140
what are 4 surgical options for UC?
1. proctocolectomy
2. Brooke ileostomy
3. Kock pouch ileostomy
4. restorative proctocolectomy
141
how many americans are living with a stoma?
750,000
142
another name for an ileal pouch-anal anastomosis
J pouch (used for UC)
bowel function is NOT compltely normaal, but allows for more control. 5-8 stools per day
143
what can irritate a j pouch?
spicy foods
144
What are pros and cons of the J pouch?
Pros:
- no bag
- can go to bathroom
- dont need a stoma
- easier sanitation
- less social stigma
Cons
- might not take
- surgery
adhere to dietary restrictions
145
What are 5 nutrition concerns related to ileal resection?
1. decreases transit time
2. loss of fluids, electrolytes, vit/min deficiency
3. b12 malabsorption at terminal ileum
4. inadequate bile salts for fat digestion
5. malabsortion of calcium, magnesium, zinc due to formation of soaps
146
if your ostomy output is more than 1.5 L of stool per day, you may be at risk of poor nutrition and dehydration
add 1-2 litres of extra fluid each day
147
tips for people who have ileostompy
Avoid foods that block stoma:
1. coconut
2. dried fruit
3. fibrous fruit
4. peas, snow peas
5. veggie skins
6. popcorn
after 6-8 weeks, small amount of cooked foods
2. stay hydrated with water, milk, 100% fruit juice, weak tea
3. manage symptoms
148
what are nutritiong oals for ileostomy:
avoid stoma irritation/obstruction
manage stool output
reduce gas/odour
maintain normal fluid/electrolye diet
149
foods ot look out for during food history that may cause symptoms:
1. high fiber foods
2. caffeine
3. dairy
4. high sugar drinks
5. gas forming foods
6. carbonated drinks
150
what are some nutritional concerns with ostomies?
1. inadequate intake
2. inadequate absorption
3. medication side effects
4. severe anemia
5. incresased losses
151
Abnormal presence of sac-line herniations on wall of S.I or colon
diverticulosis
152
____ may result from:
- prolonged constipation
- chronic low fibre intake causing increased pressure in the colon
diverticular disease
153
diverticular disease is associated with the following factors:
1. obesity
2. low physical activity
3. steroid use
4. alcohol
5. caffeine
6. smoking
154
diverticulosis usually has no symptoms unless complications occur. resolves with stooling
155
diverticulitis affects ___ % of patients with diverticulosis
20%
156
in diverticulosis we recommend _____ fibre, whereas in diverticulitis we recommend _____ fibre
diverticulosis: increased fibre
diverticulitis: decreased fibre
157
