Lecture 12

Question 1

common nutrient deficiencies seen in adult IBD

Answer 1

energy, protein, fluid/lytes, iron, mg, zn, ca, vit D, B12, folate, water sol vits, fat sol vits

Question 2

ab pain or discomfort occurs in association with altered bowel habits for at least 3 months, fxnal disorder, cause unknown

Answer 2

IBS

Question 3

common symptoms of IBS

Answer 3

gas, bloating, diarrhea, constipation, increased GI distress associated with psychosocial distress

Question 4

what is functional disorder?

Answer 4

tests show no diagnostic abnormalities so diagnosis depends on symptoms

Question 5

the ____ criteria for IBS and its subtypes are used to define diagnosis based on presence of GI symptoms and exclusion of other disease

Answer 5

Rome 3

Question 6

factors that play a role in etiology of IBS:

Answer 6

nervous sys alterations(abnormal motility, visceral hypersensitivity), gut flora alterations, genes, psychosocial stress

Question 7

low serotonin associated with ____ IBS, high serotonin with ___ IBS

Answer 7

constipation/sluggish gut; diarrhea/increased peristalsis

Question 8

what are the Rome 3 criteria for IBS?

Answer 8

recent ab pain/discomfort for at least 3 days/month in last 3 months with onset at least 6 months before diagnosis, plus 2+ of following: 1) pain improvement with defecation 2) change in stool frequency at onset 3) change in stool form or appearance at onset

Question 9

initial steps for nutrition counseling for IBS should include:

Answer 9

1) review current meds 2) review GI symptoms 3) assess nutr status and food intake 4) review supplements 5) review mind-body therapies

Question 10

what are FODMAPs?

Answer 10

short chain cho (poorly absorbed, highly osmotic, rapidly fermented by bacteria of large intestine)

Question 11

low FODMAP diet phases:

Answer 11

elimination 6-8 wks, challenge

Question 12

nutr deficiencies common in low FODMAP

Answer 12

folate, thiamin, vitamin B6 (cereals/breads), Ca, Vit D (dairy)

Question 13

what does FODMAPs stand for?

Answer 13

fermentable oligosaccharides disaccharids monosaccharides and polyols

Question 14

autoimmune, chronic inflammatory condition of GIT

Answer 14

IBD

Question 15

2 branches of IBD?

Answer 15

crohn’s, ulcerative colitis

Question 16

diff between ulcerative colitis and crohn’s?

Answer 16

ulcerative: limited to colon, always extends from rectum, continuous, young to middle aged, steatorrhea, loss of haustra; crohn’s: can involve any part of GIT from mouth to anus, disease often skips areas of intestine, young, slowly progressive, fistulas and abscesses, inflammatory mass, thickened wall and fissures, cobble-stoning, fat-wrapping

Question 17

enviro factors for pathogenesis of IBD:

Answer 17

diet, infections, antibiotics, smoking, geography, socioeconomic, development, sanitation

Question 18

these factors interact in the pathogenesis of IBD

Answer 18

enviro, genetic, epigenetic, gut microbiota dysbiosis, altered innate and adaptive immunity

Question 19

extraintestinal manifestations of IBD

Answer 19

osteopenia, osteoporosis, dermatitis, ocular symptoms, hepatobiliary complications

Question 20

similarities between crohn’s and colitis?

Answer 20

diarrhea, fever, wt loss, anemia, food intolerances, malnutrition, growth failure, arthritic, dematologic, hepatic, associated with malignancy

Question 21

lab markers of IBD:

Answer 21

inflammatory markers, antiglycan antibodies, wbc, albumin decreased; stool (calprotectin, lactoferrin, PMN)

Question 22

montreal classification of disease activity in ulcerative colitis

Answer 22

stools/day, blood, pulse, temp, hemoglobin, ESR

Question 23

IBD treatment pharm:

Answer 23

aminosalicylates, corticosteroids, immunomodulators, biologics

Question 24

what is step up vs top down approach?

Answer 24

mild to stronger vs early aggressive therapies

Question 25

common nutr diagnosis in IBD

Answer 25

chronic disease or condition related malnutrition, underweight/unintended wt loss, inadequate energy intake, inadequate vit/min intake, impaired nutr utilization, altered GI function, food med interaction, altered nutr related lab values

Question 26

nutrition therapy:

Answer 26

maintain fluid/lyte balace, low residue, lactose free, small frequent meals, assess for micronutr deficiencies, v fat if steatorrhea (maybe MCT oil benefit?)

Question 27

nutrition therapy in exacerbations:

Answer 27

maintain fluid/lyte balace, low residue, lactose free, small frequent meals, assess for micronutr deficiencies, v fat if steatorrhea (maybe MCT oil benefit?)

Question 28

nutr therapy in rehab:

Answer 28

primary goal to maximize protein and energy intake to promote rehab

Question 29

no IBD diet, but consider:

Answer 29

^ omega 3, antioxidants, MVT/mineral, lactose free as needed

Question 30

UC and Crohn's characterized by ___ interspersed with ____

Answer 30

exacerbations; periods of remission

Question 31

significant nutr implications of corticosteroids:

Answer 31

wt gain, loss of BMD, sodium and fluid retention, become hyperphagic, increased breakdown/losses, decrease in ca absorption, increased cholesterol/lipids, increased BG

Question 32

3 nutr goals of care for IBD:

Answer 32

prevent malnutrition and restore nutr status, prevent/minimize GI symptoms, normalize bowel function

Question 33

Crohn's has increased ___ but normal ____

Answer 33

REE; TEE

Question 34

why is PEM less common in UC?

Answer 34

only colon affected and small bowel is where absorption happens

Question 35

why would crohn's pro needs be increased?

Answer 35

losses related to intestinal inflammation/fistulas

Question 36

EN may temper ___ and be __ sparing

Answer 36

inflammatory process; steroidal

Question 37

for EN, is polymetric or elemental more effective?

Answer 37

polymetric