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Clinical I > Lecture 5 - Part 2 > Flashcards

Lecture 5 - Part 2 Flashcards

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1
Q

How do we diagnose allergies?

A

Patient History
Skin prick test
Blood test (test for serum antibodies)
Oral food challenge

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2
Q

What is the oral food challenge test?

A

Medically supervised feeding
Allergist gives increasing amounts of allergen- containing foods
Timed intervals
Risk of allergic reaction
Be prepared for emergency Tx of reactions

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3
Q

How do we treat allergies?

A

Elimination of allergen

Food allergen immunotherap

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4
Q

How can we tell if a product has an allergen in it?

A

Label reading, recipes, special products
Food processing errors Cross-contamination
Dining out
Treating reactions
Epipen, Allerject

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5
Q

What are the different kinds of desensitization?

A

Oral immunotherapy: the allergen is eaten

Sublingual immunotherapy: the allergen is placed under the tongue (research setting)

Epicutaneous immunotherapy: an allergen patch is applied to the skin (research setting)

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6
Q

What are the health Canada requirements for food labels in terms of allergens?

A

Food allergens and gluten must be declared for top food allergens in

Priority allergens are clearly labeled

Food allergen precautionary statements

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7
Q

Do non food items have to abide by the same rules?

A

Noon food items don’t have to follow these food labellling guidlinges

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8
Q

What are the top allergens?

A 
 Eggs
 Milk
 Mustard
 Peanuts
 Tree Nuts
 Fish
 Shellfish (Crustaceans and molluscs) 
 Sesame
 Soy
 Wheat and triticale
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9
Q

What are sulphites?

A

Food additive and also found naturally in some foods
-considered a priority allergen

Sulphites do not cause true allergic reactions, and are generally grouped with the priority food allergens because sulphite-sensitive individuals may react to sulphites with allergy-like symptoms.

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10
Q

Where can you fine sulphites?

A 
 Beer, wine, cider
 Deli meats
 Vinegar
 Fruit and vegetable juices, fresh grapes 
 Soy products
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11
Q

If mom has an allergy will baby?

A

Not necessarily, can use breastfeeding treatment for high risk infants

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12
Q

Are high risk infants to an allergy breastfed?

A

No, formula given

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13
Q

When should allergen foods be introduced to children?

A

actively offer non-choking forms of foods containing common allergens (e.g. peanuts, egg) around 6 months of age

No advantage of delaying highly allergenic foods (May actually increase risk

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14
Q

What is pollen food allergy syndrome?

A

Direct contact with food allergens; previously sensitized to a specific pollen (primary
sensitization)

Proteins are simlar and can casue a rxn to the item that is not normally an allergen to them

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15
Q

What is. latex food syndrome?

A

Natural rubber latex contains many proteins that can be allergenic

 Cross-reaction with antigens from foods

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16
Q

In non IgE mediated responses, what are the most common symptoms?

A

involve the gastrointestinal/digestive tract (N&V) but are not life-threatening.

 Symptoms can take longer to develop and last longer than IgE mediated allergy symptoms

 Epinephrine is usually not needed.

 Treatment = avoidance

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17
Q

What is a food intolerance?

A

Adverse reactions to foods (ARFs) that result in clinical symptoms but are not caused by a reaction from the immune system.

Intolerances do not cause anaphylaxis

More common than allergies

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18
Q

What does lactase break down and where is it found?

A

Brush border on luminal side

Glucose and galactose aka lactose

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19
Q

What is congenital lactase deficiency?

A

people born with deficiency of lactase activity or no lactase present

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20
Q

What is primary lactase deficiency?

A

age-related, genetic decrease activity of lactase
Lactase non-persistence
-expereience as we age

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21
Q

Want is secondary lactase deficiency?

A

temporary decrease activity of lactase due to illness Celiac disease

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22
Q

How can we test for lactose intolerance?

A

Hydrogen breath test

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23
Q

What is the treatment for lactose intolerance ?

A

Low/No lactose
Small amounts throughout the day
Exogenous lactase

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24
Q

What is beneficial to consume for people who have a lactose intolerance?

A

Fermented dairy products beneficial

Lactose free products

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25
What is celiac disease?
Autoimmune disorder characterized by genetically-based sensitivity to amino acids found in the prolamin fraction of wheat, barley and rye
26
What does the consumption of gluten do to the GI?
Consumption damages mucosa of small intestine, decrease absorptive surface and nutrient absorption
27
Who is most likely to have celiac disease?
Caucasian
28
Can you genetically test for celiac disease?
HLA DQ2 & HLA DQ8 genetic markers
29
Is celiac disease and allergy?
No
30
What is the pathophysiology of celiac disease?
Inflammatory and innate immune responses damage the villi Lead to reduced height and flattened villi Damage to the enterocytes results in decreased enzyme function and surface area Occurs with other autoimmune disorders
31
What are the symptoms?
Classic symptoms: Diarrhea, abdominal pain, cramping, bloating, and gas
32
What are screening for when determining celiac disease?
Serum antibodies anti-gliadin, anti- endomysium, and anti-tissue transglutaminase (IgA, TTG) A biopsy of the proximal small bowel (duodenum) remains the gold standard for diagnosing celiac disease. -Too be diagnosed you have too be consuming gluten to have the antibodies in the blood
33
What is dermatitis herpetiformis?
Form of gluten-sensitive enteropathy ~ 15-25% those with celiac will develop Skin symptoms: Bilateral blister-like papules Severe itchiness & burning  Arms, back, buttocks Mouth ulcers
34
What are the nutrition implications of celiac?
Protein-energy malnutrition (PEM) Lactose intolerance. Iron-deficiency anemia Other nutrient deficiencies
35
What are the nutrition therapy goals for celiac?
Promote healing of small intestine, allow normal nutrient digestion and absorption decrease symptoms caused by sensitivity to gluten Nutrition primary treatment
36
What happens to the GI when celiacs dont eat gluten?
Results in more normal mucosal architecture within 2-3 months; could take up to 2 years Even if small amount of gluten tolerated, damage continues with consumption
37
What should celiac people avoid eating?
Wheat Rye Barley Oats (unless pure and uncontaminated)
38
What is diarrhea?
Frequent and/or unusually liquid bowel movements Acute vs. chronic Osmotic vs. Secretory
39
What is osmotic diarrhea?
osmolality >300 mOsm/kg; H2O pulled into lumen caused by maldigestion of nutrients, excessive sorbitol or fructose intake
40
What is secretary diarrhea?
excessive fluid and electrolytes into intestine caused by bacterial infections does not resolve when patient is NPO Bacteria causes this
41
What is steatorrhea?
Foul-smelling, frothy stools | -malabsorbing fat causes this
42
What are the different kinds of blood found in stool?
“Frank”: red and fresh, indicating bleeding from rectum or anus. “Occult”: not visible, detected by testing stool; usually occurs from bleeding in lower GI tract. “Melena” is dark stool caused by bleeding in the upper GI tract -Hgb from blood contributes to dark colour.
43
How do you treat secretory diarrhea?
Treat underlying disorder Antibiotics 1st line of treatment Restore normal fluid, electrolyte and acid-base balance Meds to decrease motility or thicken consistency of stool
44
What are the nutritional implications and management of secretory diarrhea?
Will depend on volume and duration Oral rehydration solutions Feed patient – stimulates recovery Also use foods with probiotics and prebiotics
45
What is clostridium difficile?
Major cause of antibiotic-related diarrhea When patients st are on antibiotics frequenctly or for a long time and allows C diff to grow and increase to produce the endotoxins
46
What is the ethology of constipation?
Slowed colonic transit time  Rectal outlet obstruction, fecal impaction, adhesions, tumor  Pelvic floor dysfunction  Irritable bowel syndrome (IBS)  Other medical conditions; i.e. MS, Parkinson’s  Side effect of medications, supplements
47
How do you manage constipation?
Treat underlying condition Treat symptoms  Nutrition: focus on fluid and fibre  Bulking agents  Soluble fibre forms gel and increases peristalsis  meds
48
What is diverticular disease?
Includes Diverticulosis, diverticular bleeding & diverticulitis  Presence of sac-like herniations on wall of colon  May result from prolonged constipation and increased pressure in the colon
49
What is diverticulosis?
Sacs present
50
What is diverticulitis?
Flare up of sacs | -inflammation and infection
51
What are the S&S of diverticulitis?
Alternating diarrhea & constipation, abdominal pain, tenderness, chills and fever bleeding, abscess, obstruction, or perforations
52
What is the nutritional therapy for diverticulosis?
Emphasis to increase fibre Food and supplements (ie Metamucil, Benefibre) Fluid Some recommendations suggest avoiding seeds & nuts but not supported by research
53
What is the nutritional therapy for diverticulitis?
Low fibre diet along with oral antibiotics More severe, bowel rest (NPO), IV fluids and antibiotics Progress to clear fluids then low fibre
54
What are the effects of fibre with diverticulosis?
High-fibre diet (in non-acute phase) aids in: Preventing exacerbation  decrease postprandial intra-luminal pressure Increase insoluble fibre (in non-acute phase) - decrease need for pressure when passing stools - decrease segmentation of colon
55
What is IBS?
Abdominal pain or discomfort that occurs in association with altered bowel habits at least 1 day per week on average over the preceding month
56
What are the 4 subtypes of IBS?
IBS-D (diarrhea) IBS-C (constipation) IBS-M (mixed) IBS-U (unspecified)
57
What is IBS considered?
functional disorder
58
What is the pathophysiology of IBS?
Increased sensitivity to stimulation of GI tract Resulting in abdominal pain, urgency, diarrhea, constipation Infectious and inflammatory components Stress
59
What are the clinical manifestations of IBS?
Abdominal pain, alterations in bowel habits, gas, flatulence Sensitivity to certain foods; lactose, wheat, high-fibre
60
What is the nutrition therapy for IBS?
Correct/prevent underweight, malnutrition  Decrease anxiety, normalize dietary patterns  Assess diet hx; offending foods  Assess nutritional adequacy  Fibre intake to 25 g/day (for some); adequate fluid  Pre and probiotics  Avoid foods that produce gas and swallowed air  limit fodmaps
61
What is the nutrition intervention of IBS?
 Exclusion diet  Fermentable oligo-, di-, and monosaccharides and polyols (F O D M A P) approach  Relieve symptoms associated with gas and flatulence
62
What is fodmaps?
Fermentable oligo di monosaccharides and polyols
63
What are the proposed effects of FODMAPS on IBS symptoms?
Fast transit time nutrients arent goiogn too be absorbed Fermented by bacteria in colon to produce gas and water
64
What is the problem with foods that fit within a low FODMAP diet?
They are usually really healthy like fruits veg and legumes

Clinical I (17 decks)

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