Lecture 11

Question 1

common nutr diagnoses with PUD

Answer 1

inadequate oral intake, inadequate energy intake, altered GI fxn, unintended wt loss, food and nutrition related knowledge deficit

Question 2

management of PUD pharmacotherapy:

Answer 2

antacids, PPI, prostaglandin analogs, mucosal barrier fortifiers, H2 receptor agonists

Question 3

this med causes black stool

Answer 3

peptobismal

Question 4

what is h pylori triple therapy?

Answer 4

7-14 day course 2 antibiotics + PPI (cause nausea, vomiting, ab pain)

Question 5

management of PUD nutrition:

Answer 5

prevent wt loss and restore nutrient interactions, support med therapies and v symptoms, trial restriction of foods increasing acid secretion, avoid foods not tolerated, avoid lying down after eating, avoid larger meals close to bedtime, small/frequent meals, omega 3 and 6 f.a.?

Question 6

historical diet treatment of PUD:

Answer 6

milk and cream (but now know that they increase gastrin and pepsin secretion so don’t recommend)

Question 7

one of major diffs between GERD and PUD nutrition management:

Answer 7

don’t restrict acid foods/juices for PUD

Question 8

acute symptomology of PUD:

Answer 8

sharp, sudden, persistent, severe pain; melena (bloody/black stools), hematemesis (vomiting blood, coffee ground emesis)

Question 9

acute symptomology of PUD indicative of serious complications like:

Answer 9

acute/chronic GI bleed, perforation, obstruction (big drops in Hb)

Question 10

when use surgery for PUD?

Answer 10

when severe, refractory to treatment, complications

Question 11

types of surgery for PUD:

Answer 11

vagotomy, gastroenterostomy

Question 12

what is vagotomy?

Answer 12

interruption of impulses carried by vagus nerve to parietal cells (v acid production, v response to gastrin)

Question 13

preferred vagotomy for treating PUD

Answer 13

highly selective vagotomy (preserves antral motility)

Question 14

what is truncal vagotomy with pyloroplasty?

Answer 14

vagus nerve cut at distal esophagus to decrease antral contraction, delay emptying of solids, v pylorus relaxation; pyloroplasty is surgical revision to widen pyloric canal that creates leaky pylorus to enhance emptying (can cause dumping, less control of food flow)

Question 15

what is a gastrectomy?

Answer 15

resection of stomach (partial or total) –>used in gastric CA, more aggressive

Question 16

alternative to pyloroplasty:

Answer 16

gastric remnant of partial gastrectomy anastomosed to small intestine

Question 17

primary gastric surgeries for PUD:

Answer 17

gastroduodenostomy (billroth 1), gastrojejunostomy (Billroth 2) , roux-en-Y anastomosis

Question 18

what is billroth 1?

Answer 18

removal of pylorus and/or antrum of stomach, anastomosis of proximal end of duodenum to distal end of remnant stomach

Question 19

what is billroth 2?

Answer 19

removal of antrum, anastomosis of remnant stomach to side of jejunum, blind duodenal loop (stapled) to allow for bile and pancreatic secretions to flow into intestine (aid in digest and absorb) –>it is more distal and lower down than billroth 1

Question 20

what is roux-en-Y

Answer 20

close to total gastrectomy, jejunum pulled up and anastamosed at distal end of esophagus or gastric remant, duodenum then connected to small bowel to allow bile and pancreatic secretions to flow into intestine

Question 21

potential complications of vagotomy:

Answer 21

impaired motor fxn of stomach

Question 22

potential complications of total gastric and truncal vagotomy

Answer 22

gastric stasis and poor emptying

Question 23

potential complications of subtotal gastrectomy with vagotomy

Answer 23

early satiety, delayed gastric emptying, rapid emptying of hypertonic fluids

Question 24

potential complications of total gastrectomy

Answer 24

early satiety, nausea, vomiting, wt loss, poor availability bile acids and pancreatic enzymes cuz anastomotic changes, malabsorption, PEM, anemia, dumping, B12 deficiency

Question 25

what is dumping syndrome?

Answer 25

physio response to presence of larger than normal amts of food/liquid in small intestine

Question 26

healthy individual digestion:

Answer 26

food partially digests in 1-3 hr, enters duodenum slowly via pyloric sphincter, acidic chyme is neutralized by pancreatic bicarbonate

Question 27

why are refined/simple sugars particularly problematic for dumping syndrome?

Answer 27

highly osmotic so rapidly absorb water from body

Question 28

post-gastrectomy nutr goals of care

Answer 28

Adequate cals and nutr (promote healing, attenuate wt loss, correct micronutrient deficiencies), symptom management (reflux, early satiety, dumping syndrome)

Question 29

nutr interventions post-gastrectomy:

Answer 29

dependent on goals of care, reason for surgery (PUD with acute complication, gastric carcinoma, neoadjuvant treatment pre-op, bariatric surgery), post op considerations (anastomosis, EN, PN

Question 30

98% of digestion and absorption occurs in ___

Answer 30

lower GIT

Question 31

3 parts of small intestine:

Answer 31

duodenum, jejunum, ileum

Question 32

autoimmune disease caused by immunological rxn to gluten

Answer 32

celiac disease

Question 33

peptide fractions (storage proteins) found in wheat, barley, rye to give shape and elasticity

Answer 33

gluten

Question 34

this type of gluten appears to be particularly problematic

Answer 34

gliadin

Question 35

exposure to gliadin cause:

Answer 35

inappropriate T cell mediated inflamm response

Question 36

etiology of celiac?

Answer 36

unknown, but strong gene component, several other disorders associated with it

Question 37

pathophysio of celiac?

Answer 37

absorptive surface of small intestine damaged by inflamm response/rxn to gluten proteins-->damage to enterocytes (less absorptive SA, loss of digestive enzymes), villi have ht reduced and are flattened

Question 38

GI symptoms of celiac

Answer 38

diarrhea, ab pain, cramping, bloating , gas production

Question 39

extraintestinal symptoms of celiac:

Answer 39

bone and joint pain, muscle cramping, fatigue, peripheral neuropathy, seizures, skin rash, mouth ulcers, depression, infertility

Question 40

other clincal features encountered in celiac?

Answer 40

vit and min deficiencies (iron, B12, fat sol vits, Zn, Mg, Folate), secondary lactase deficiency, metabolic bone disease

Question 41

treatment of celiac:

Answer 41

lifelong elimination of gluten (improve symptoms after 2 wks in most pt, histological improvement not seen for years)

Question 42

considerations for gluten free diets:

Answer 42

beware cross contamination (ie. oats)

Question 43

what does CELIAC stand for?

Answer 43

consultation with dietitian skilled in celiac, education, lifelong adherence to GED, identification and treatment of nutr deficiencies, access to advocacy group, continuous long term follow up by multidisciplinary team

Question 44

what is non-celiac gluten sensitivity

Answer 44

clinical state in which pt develop symptoms related to celiac disease when consume gluten and feel better on GFD but do NOT have celiac (no biomarkers, autoantibodies absent, no villous atrophy)

Question 45

packaged GF foods are higher in __ and lower in __

Answer 45

fat, CHO; protein, Fe, folate