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Medical Nutrition Therapy > LGI Small Intestine > Flashcards

LGI Small Intestine Flashcards

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1
Q

edible plant material that are not digested by enzymes in the small intestine

A

dietary fiber

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2
Q

fiber DRI

A

women - 25 g
men - 38 g

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3
Q

soluble fiber sources

A

oats
legumes
barley
carrots
citrus
Fruits

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4
Q

insoluble fiber diet

A

whole-wheat products
Bran
Vegetables
Fruit
Seeds

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5
Q

functions and benefits of insoluble fiber

A

increases fecal bulk
promotes bowel regularity
takes some bile out of the body, and liver has to make more (from LDL I think)

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6
Q

soluble fiber benefits

A

normalize intestinal transit time and can decrease diarrhea
delays gastric emptying time
decreases serum LDL
may delay glucose absorption

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7
Q

purpose of a high fiber diet

A

promote normal bowel function
prevent and treat chronic diseases

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8
Q

indications of a high fiber diet

A

constipation
diverticulitis
hypercholesterolemia
to decrease colon cancer risk

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9
Q

goal of a high fiber diet

A

≥ 25-38 grams per day
6-11 servings of whole grains per day
5-8 servings of veggies, legumes, fruits, nuts, and seeds
2 L of fluid for day

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10
Q

how to start higher fiber diet

A

increase SLOWLY to avoid gas and cramps

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11
Q

what is residue

A

end result of digestive, secretory, absorptive, and fermentative process (fecal contents)

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12
Q

purpose of low fiber or low residue diet

A

reduce fecal output temporarily

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13
Q

indications of low fiber or low residue diet

A

ACUTE intestinal inflammation
- Caron’s disease, diverticulitis

intestinal strictures leading to partial obstruction
s/p (after) intestinal surgery (1 or 2 weeks)

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14
Q

guidelines for a low fiber diet

A

10-15 grams per day
avoid whole grains, seeds, nuts, legumes, popcorn, raw fruits and veggies, cooked corn, potato skins

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15
Q

parts of a low residue diet include

A

low fiber diet plus…

avoid excessive sorbitol, mannitol, and xylitol (sugar alcohols attract water leading to osmotic diarrhea)

avoid excessive fructose and sucrose

avoid caffeine and alcohol

limit dairy products if lactose and intolerant

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16
Q

nutritional adequacy of low residue diet or low fiber diet

A

short term use only
Rx MVI with minerals

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17
Q

sources of excessive intestinal gas / flatulence

A

aerophagia
bacterial fermentation in GIT

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18
Q

excess flatulence can lead to

A

abdominal distention
cramping pain

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19
Q

factors that contribute to excess flatulence

A

decrease GI motility
Physical inactivity
Aerophagia
Dietary factors
Certain GI disorders

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20
Q

MNT for excess flatulence (what foods to avoid?)

A

avoid foods that increase gas
- legumes
- vegetables: broccoli, cauliflower, cabbage, Brussel sprouts, onions, mushrooms, artichokes, asparagus
- carbonated beverages and beer
- sugar alcohols
- large amounts of fructose: apples, pears, peaches, fruit juice, HFCS
- whole grains
- Dairy if lactose intolerant

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21
Q

Other MNT for flatulence

A

limit aerophagia
- eat slowly, chew with mouth close, avoid carbonated beverages

recommend mild exercise

keep a food and symptom diary to identify problem foods

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22
Q

difficult or infrequent passage of stool

A

constipation

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23
Q

constipation is sometimes defined as _____ stools per week or no BM for _____, however everybody’s normal is different

A

<3
3 days

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24
Q

causes of constipation

A

inadequate fiber intake
insufficient fluid intake
lack of PA
inadequate kcal intake
iron supplements
laxative abuse
habitually ignoring the urge to defecate

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25
medications that cause constipation
opiates
26
diseases or conditions that can cause constipation
GI disorders - hemorrhoids, IBS, colonic obstruction Pregnancy Hypothyroidism Neuromuscular diseases - amyotrophic lateral sclerosis (ALS) - multiple sclerosis (MS) - spinal cord injury
27
medical management of constipation
identify the cause medications - evaluate current meds as a cause - laxatives - bulking agents/fiber supplements
28
MNT for constipation
High fiber diet increased gradually to 25-38 g/day Regular eating pattern Increase fluid to at least 2 L increase PA
29
if total obstruction
NPO until it is resolved
30
Diarrhea is defined as
passage of ≥3 loose or liquid stools per day
31
diarrhea occurs when there is ...
accelerated transit of intestinal contents through the small intestine decreased enzymatic digestion of foodstuffs decreased absorption of fluids and nutrients increased secretion of fluids into the GI tract exudative losses
32
diarrhea can be caused by ... (types of diarrhea)
medications food allergies osmotic diarrhea secretory diarrhea motility disorders exudative diarrhea malabsorption diarrheas
33
medications that cause diarrhea
antibiotics chemotherapy
34
osmotic diarrhea cause by
lactose intolerance excessive sorbitol consumption dumping syndrom
35
secretory diarrhea cause by
viral and bacterial infections - E. coli - C. difficile
36
motility disorders that cause diarrhea
dumping syndrome IBS surgical resections of the small intestine
37
exudative diarrhea
mucosal damage caused by inflammatory disease leading to an outpouring of mucus, fluid, blood, and plasma proteins - ulcerative colitis - crohn's disease - radiation enteritis
38
malabsorption diarrhea causes
disease process impairs digestion or absorption - pancreatic insufficiency - celiac disease insufficient absorptive surface area - short bowel syndrome - causes steatorrhea
39
clinical manifestations of diarrhea
dehydration electrolyte imbalances: losses of Na & K+ metabolic acidosis (bicarb absorbed in blood) micronutrient deficiencies (Zn) weight loss fever (if bacterial or viral etiology) Bloody stools (if exudative)
40
MNT for acute diarrhea
- identify & treat cause - restore fluid and electrolyte balance (ORS if needed) - limit simple sugars & sugar alcohols (lactose, fructose, sucrose, sorbitol, HFCS) - limit insoluble fiber sources - moderate intake of of soluble fiber sources - avoid caffeine & alcohol - avoid high fat foods - micronutrient replacement if needed
41
symptoms of zinc deficiency
loss of taste hairloss poor wound healing
42
MNT for acute SEVERE diarrhea
IV fluid & electrolyte replacement May require NPO with parenteral nutrition if prolonged
43
MNT for chronic diarrhea
diet modification based on cause of diarrhea If UKO (UNKOWN ORIGIN) , systematically restrict lactose, fat, insoluble fiber and monitor symptoms Assess for micronutrient deficiencies - MVI w/minerals if needed
44
oral rehydration solutions (ORS) are different because
have higher ratio of sodium to glucose which is ideal to absorb water and electrolytes
45
live microorganisms (bacteria or yeast) that are the same or similar to those found naturally in intestinal tract that are used to restore beneficial gut flora
probiotics
46
examples of probiotics
lactobacillus bifidobacteria Saccharomyces boulardii
47
sources of probiotics
yogurt (with live active cultures) acidophilus milk kefir probiotic supplements
48
probiotics are modestly successful in _________
preventing certain types of diarrhea
49
Dietary substrates used to promote the growth of beneficial intestinal bacteria and lead to the production of short-chain fatty acids (SCFA)
Prebiotics
50
______ inhibit the growth of some harmful bacteria, energy source for colonocytes, enhance water and electrolyte consumption.
SCFA
51
prebiotics may help _________
control diarrhea
52
examples of prebiotics
pectin fructooligosaccharides (FOS) oats bananas artichokes
53
lactose intolerant is a deficiency in ______ which leads to inability to digest lactose
lactase
54
lactose is the __________ in dairy milk
disaccharide
55
types of lactase deficiency
congenital primary or genetic secondary
56
congenital lactase deficiency
present at birth, rare
57
primary or genetic lactase deficiency
declines in lactase over time
58
secondary lactase deficiency
infections of small intestine intestinal inflammatory disorders AIDS intestinal surgery malnutrition
59
___% of the world population is lactase deficient higher prevalence in __________________
65% Asian, Native American, African, Latino
60
symptoms of lactose intolerance
after consumption of lactose, indigested lactose enter the colon - osmotic diarrhea - chronic bacteria ferment lactose leading to cramps, flatulence, and bloating severity varies from person to person
61
Diagnosis of lactose intolerance
history of GI symptoms, especially following milk ingestion elimination diet abnormal hydrogen breath test abnormal lactose tolerance test
62
MNT for lactose intolerance
limit dairy products based on individual tolerance
63
_________ of milk consumption in small increments can increase tolerance.
gradual increases
64
Most people can tolerate up to _____ lactose per day milk tolerAted better as a ______
12 g meal
65
lactose restricted diet
additional sources - standard infant formulas, baked goods, processed fats sauces, salad dressings, medications label reading - milk solids, why, curds, cheese flavors, nonfat milk power
66
for lactose intolerant infants, _________
reduce lactose formulas or soy formulas
67
reduced lactose foods/products
aged cheese yogurt lactase hydrolyzed milk lactation milk enzyme supplement
68
lactase hydrolyzed milk of _____
70 % reduced lactose - Lactaid
69
MNT for those who strictly avoid diary products:
educate on other dietary sources of - calcium - vitamin D * if needed, MVI with minerals
70
ways for lactose intolerant person to increase calcium
fortified OJ cereals soy milk tofu
71
ways for lactose intolerant person to increase vitamin D
egg yolks fatty fish (salmon, tuna, mackerel, sardines, catfish) mushrooms fortifies soy milk and OJ
72
celiac disease..., AKA __________ is an autoimmune enteropathy characterized by sensitivity to ________
gluten-sensitive enteropathy prolamins
73
when celiac disease individual ingests prolamins, leads to chronic ____________ mediated inflammatory response
T-lymphocyte mediated inflammatory response
74
celiac disease response results in ______ and ______ to the __________
inflammation and damage mucosa of the small intestine
75
1 in every _____ persons in the US have celiac disease This is _______ and primarily affects ________ race. onset can occur anytime from ________ through _______
133 hereditary caucasian infancy adulthood
76
pathophysiology of celiac disease includes a combination of these factors
genetic susceptibility exposure to gluten an environmental trigger an autoimmune response
77
gluten refers to specific storage proteins (prolamin) found in _____, _____, and ______
Wheat Rye Barley
78
wheat protein
glutenin gliadin
79
rye protein
secalin
80
barley protein
hordein
81
ingestion of gluten leads to an immune response that cause ______&_____ of the ____ in the ______&______ of the small intestine
atrophy & flattening villi duodenum & jejunum
82
wiping out of villi results in a reduced __________ which can cause ____________ causes malabsorption in all nutrients except maybe ____ which is absorbed in ileum
absorptive surface area deficiency of disaccharidases & peptidases B12
83
classic symptoms of celiac disease
diarrhea steatorrhea abdominal bloating & cramps nausea anorexia poor weight gain fatigue apathy
84
additional symptoms that are not classic in celiac disease
iron or folate deficiency anemia fatigue diarrhea constipation weight loss
85
additional manifestations that may occur from celiac
osteomalacia osteopenia dermatitis herpetiformis (rash) coagulopathies (problem with blood clotting, vit K def) infertility neurological: ataxia (unstable gate), seizures, polyneuropathy
86
autoimmune diseases that are associated with celiac disease
type 1 DM autoimmune thyoiditis autoimmune hepatitis increased risk for small bowel cancer
87
how does Celiac get diagnosed
clinical manifestations blood tests (antibodies) definitive diagnosis (intestinal biopsy)
88
treatment for celiac disease
MNT ONLY complete withdrawal of gluten/prolamins initially may require a 40 gram low fat diet and a low lactose diet to control diarrhea fluid & electrolyte replacement
89
celiac treatment goals
relieve symptoms heal intestine improve nutritional status
90
biopsy requires eating gluten. Will not show if you didn't eat gluten for _____
6 weeks
91
Celiac Disease consider the need for a ________ to meet the DRIs additional supplements include _____ or _____ for anemia ______ for prolonged bleeding _____ and ____ for osteopenia/osteomalacia __________ if experiencing steatorrhea
MVI w/minerals iron or folate vitamin K Ca and Vitamin D fat-soluble vitamin supplement in water-soluble form
92
gluten free diet for celiac is life long and requires strict compliance to avoid all sources of
wheat rye barley malt
93
some grains that are allowed
corn potato rice soybean tapioca arrowroot amaranth buckwheat flax legumes sorghum quinoa millet nuts and seeds
94
Oats is controversial for celiac The prolamin in oats (______) is not thought to be harmful, however, contamination with wheat or barley is of concern, so only use ___________ or ___________.
avenin pure, uncontaminated gluten-free oats
95
examples of gluten-containing additives
hydrolyzed vegetable or plant protein (HVP or HPP) Flour Malt or malt flavoring Malt vinegar Modified food starch Dextrin Soy sauce
96
gluten free diet education including...
reviewing foods to avoid and alternatives gluten containing additives issue of cross contamination dining out label reading where to purchase gluten free foods food prep (grill, toaster, cutting boards)
97
for gluten free labeling, FDA published a regulation in 2013 that. to be labeled as gluten-free, a food must contain <______ of gluten
<20 ppm of gluten
98

Medical Nutrition Therapy (12 decks)

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