Nutritional Disorders of GI Flashcards Preview

Clinical Nutrition > Nutritional Disorders of GI > Flashcards

Flashcards in Nutritional Disorders of GI Deck (114):
1

GERD nutritional therapy

avoid large, high fat meals
avoid eating 2-3 hours befor lying down
elevate head 6-8 inches while sleeping
avoid smoking
avoid alcohol
avoid caffeine and carbonate beverages
avoid acidic or spicy foods
consume a healthy, nutritionally balanced diet with adequate fiber
lose weight, if indicated

2

atrophic gastritis should be evaluated for?

B12, iron and calcium

3

natural eradication for H. Pylori?

green tea
broccoli
black currant oil
kimchi
probiotics (lactobacillus, bifidobacterium)

4

peptic ulcer avoiders

alcoholc, spicy foods, triggers
limit coffee and caffeine

5

gas producing foods

beans
cruciferous veggies
fruits
whole wheat and bran
high sugar beverages
dairy
sugar alcohols

6

constipation, how do we get it?

lack of fiber
inadequate fluid
low energy intake
iron and calcium supplements
lack of exercise
immobility
laxative abuse
postponing urge to defecate

7

criteria for constipation

1. must include or more of these for last 3 months
straining during 25% defecations
lumpy or hard stools in 25%
sensation of incomplete evacuations in 25%
sensation of anorectal obstruction for at least 25%
manual maneuvers to facilitate at least 25%
<3 defecations per week
2. loose stools are rarely present without use of laxitives
3. there are insufficient criteria for diagnosis of IBS

8

separate hard lumps

severe constipation

9

lumpy and sausage like

mild constipation

10

a sausage shape with cracks in the surface

normal

11

smooth, soft sausage or snake

normal

12

soft blobs with clear cut edges

lacking fiber

13

mushy consistency with ragged edges

mild diarrhea

14

liquid consistency with no solid pieces

severe diarrhea

15

how can we help people with constipation?

increase consumption of whole grain products to 6-11 servings/d
increase veggies to5-8 servings/d
consume high fiber cereals to get at least 25 g of fiber/d for females and 38 g/d for males
increased fluid consumption to at least 2L/d

16

what could cause malabsorptive diarrhea

pancreatic insufficiency
gastric acid hypersecretion
imparied bile production or secretion
bacterial overgrowth
enzymatic deficiency
celiac disease
chron's disease
allergy

17

what should you so for those with diarrhea?

replenish fluids
limit lactose, sugar alcohols, fructose and large amounts of sucrose
soluble fiber, like pectin, can slow GI motility
try probiotics

18

bacteriodetes (seen in healthy patients)

bacteroides
prevotella
xylanibacter

19

firmicutes (seen in obese patients)

clostridium
eubacterium
roseburia
blautia
ruminococcus
faecalibacterium
lactobacillus

20

actinobacteria

bifidobacterium
propionibacterium

21

proteobacteria

E. coli

22

verocomicrobia

akkermansia (none in autistic patients)

23

large intestine colonization can be affected by?

mode of delivery
premature delivery
feeding
introduction of solid food
siblings
antibiotics

24

signs and symptoms of malabsorbed fat

pale, greasy, smelly stools, diarrhea without distention or gas

25

signs and symptoms of malabsorbed protein

edema
muscle atrophy

26

signs and symptoms of malabsorbed carbs

watery diarrhea, flatus, abdominal distention

27

signs and symptoms of malabsorbed fluid or electrolytes

tachycardia
dry mouth

28

signs and symptoms of malabsorbed bile salts

watery diarrhea

29

signs and symptoms of malabsorbed folic acid

macrocytic anemia
glossitis

30

signs and symptoms of malabsorbed B12

macrocytic anemia, glossitis, fatigue, nerve issues

31

signs and symptoms of malabsorbed B complex

cheilosis
angular stomatitis
glossitis
dermatits
ataxia
sensory dysfunction

32

signs and symptoms of malabsorbed vitamin A

night blindness
follicular hyperkeratosis

33

signs and symptoms of malabsorbed vitamin D

muscle cramps
bone pain

34

signs and symptoms of malabsorbed vitamin E

decreased deep tendon reflex

35

signs and symptoms of malabsorbed iron

microcytic anemia
fatigue
koilonychia

36

signs and symptoms of malabsorbed zinc

taste atrophy
dermatits
hair loss

37

signs and symptoms of malabsorbed magnesium

tetany

38

signs and symptoms of malabsorbed selenium

muscle pain

39

signs and symptoms of malabsorbed copper

weakness

40

signs and symptoms of malabsorbed calcium

paresthesia
tetany
bone pain
trousseau sign

41

leaky gut

increated intestinal permeability

42

what could leaky gut be due to?

infections
medications
dysbiosis

43

who has leaky gut?

celiac
chron's
MS
IBS
SIBO

44

most common test for diganosis of leaky gut

lactulose-mannitol test

45

pathyphysiology of celiac disease

genetic susceptibility (35% have it, small percent present with it)
exposure to gluten
environmental trigger
autoimmune response

46

nutritional symptoms of celiac disease

anemia
increased fracture risk
clotting issues
delayed growth
lactase deficiency

47

extraintestina celiac symptoms

malaise
arthritis
dermatiits herpetiformis
infertility
hepatitis
ataia
psychiatric syndromes (depression, etc)

48

associated disorders with celiac

autoimmune cluster: T1DM, thyroiditis, hepatits
GI malignancy
IgA deficiency

49

celiac vs gluten sensitivity or intolerance

celiac: immune system involved, body attacks itself
gluten sensitivity/intolerance: no immune response, IBS, diagnose using elimination diet

50

nutritonal therapy for those with celiac

gluten free for life, avoid wheat, rye, barley and malt
up to 50g/day of oats may be tolerated

51

gluten free grains and flours

amaranth
arrow root
bean flours
corn
rice
soybean
potato
quinoa
flax
tapioca

52

gluten free desserts

sorbet
popsicles

53

cheese, eggs, meat, fish, poultry for gluten free

all cheese
all eggs
all fresh untreated meat, fish or poultry

54

beans, legumes, nuts, seeds, fruits, veggies for gluten free

can have all these things

55

alcohol gluten free

wine
distilled liquor
gluten-free beer

56

hidden exposure to gluten

medications
communion wafter
toothpaste
mouthwash
lipstick
cross contamination

57

nutritional defeicencies at diagnosis of celiac

calorie/protein
fiber
iron
zinc, copper
calcium, magnesium, vitamin D
folate, niacin, riboflavin, B12

58

gluten free diet started nutritional deficiencies

fiber
iron
calcium, magnesium, vitamin D
folate, niacin, riboflavin, B12

59

long term gluten free diet

fiber
folate, niacin, riboflavin, B12

60

refractory celiac disease

patients who don't respond to a gluten free diet
present with severe malabsorptive diarrhea and weight loss

61

gluten free diets are usually low in?

iron, fiber, folate
niacin
riboflavin

62

gluten free diets are usually high in?

saturated fat
starch
sucrose

63

nutritionally adequate gluten free diet

focus on foods taht are natrually gluten free
get at least 5 servings of fruits and veggies/day
add amaranth, quinoa and buckwheat
meat, fish and dairy

64

intestinal brush border enzyme deficiencies

lactose intolerance
fructose malabsorption

65

lactose intolerance

most common form of carb malabsorption
diagnosi with hydrogen breath test or a lactose tolerance test
most can consume up to 12 g of lactose a day without symptoms (=1 cup of milk)

66

fructose malabsorption

diagnosed with hydrogen breath test
75% of healthy people incompletely absorb large amounts of fructose

67

IBD

inflammation increases protein requirement

68

what supplements are necessary for IBD?

folate B6, B12, zinc, magnesium
if diarrhea: zinc, selenium, potassium
if steroids: vitamin D and calicum

69

what can help reduce flareups for IBD?

omega 3s

70

rome III criteria for IBS

recurrent abdominal pain or discomfort at elast 3 days/month in the last 3 months associated with 2 or more of the following:
improvement with defecation
onset associated with a change in frequency of stool
onset associated with chagne in appearance of stool

71

IBS with constipation (IBS-C)

<3 bowel movements per week
hard, lumpy stools
straining

72

IBS w/ diarrhea (IBS-D)

>3BM/d
fecal urcency
loose, watery stools

73

mixed IBS (IBS-M)

mix of hard and loose stools over hours to days

74

unsubtyped IBS

insufficient evidence to meet criteria for other types

75

what should you check for those with IBS?

meds they are taking
review of GIsymptoms
assessment of nutritonal staus and food intake
supplement intake
use of mind-body therapies

76

IBS treatemnts for abdominal pain and discomfort

antispasmodic agent (antidepressants)

77

IBS treatment options for constipation

fiber, fluid, laxatives

78

IBS treatment options for diarrhea

antidiarrheals

79

IBS treatment options for small intestinal bacterial growth

antibiotics/probiotics

80

IBS treatment options for global symptoms

psychotherapy
peppermint oil
probiotics/prebiotics

81

FODMAP diets

limit fermentable foods (sugars, oligosacharides,sugar alcohols)
use as a guide to start with a very restictive diet and slowly add back foods to determine trigger
emerging as a useful diet for IBS peitnts

82

diary foods to limit with FODMAP

milk
cottage cheese
ice cream
sweetened condensed milk
evaporated milk
soft cheese
sour cream
whipped cream
yogurt
chocolate

83

non dairy foods to avoid with FODMAP

coconut milk
coconut cream
beans
black eyed peas
hummus
lentils
pistachios
soy

84

grains to limit with FODMAP

wheat
chicory root
inulin
rye

85

fruits to limit for FODMAP

avocado
apples
apricots
dates
canned fruit
cherries
dried fruit
figs
guava
lychee
mango
nectarines
pears
papaya
peaches
plums
pprunes
watermelon

86

vegetables to limit with FODMAP

artichokes
asparagus
beets
leeks
broccoli
brussel sprouts
cabbage
cauliflower
green beans
mushrooms
summer squash

87

sweetners/seasonings to limit with FODMAP

agave
honey
high fructose corn syrup
coconut
jams
jelly
molasses
garlic
onions
pickles
relish
sugar alcohols

88

diverticulosis

sac-like pouches that form within the colon due to weakeneed muscles
most often in sigmoid colon

89

diverticulitis

inflammation fo diverticula

90

etiology of diverticular disease

associated with obesity
low fiber diet
vitamin D insufficiency
sedentary lifestyle
NSAID use

91

nutritional therapy for diverticular disease

no longer recommended to avoid nuts, seeds, corn, popcorn or berries
high fiber diet can improve symptoms
probiotic studies suggest improvement with certain bacteria

92

SIBO

overproliferation of bacteria in the SI that are normally only found in LI
could be due to low stomach acidity, liver or gallbladder disease or pancreatitis
if probiotics are recommended, avoid lactobacillus acidophilus and ferminti
carbs serve as fuel for bacteria

93

what diet could be useful for SIBO?

FODMAP diet

94

fat lab test

72 hour fecal fat test

95

protein lab test

fecal nitrogen, serum albumin

96

carb lab test

hydrogen breath test

97

fluid/electrolyte lab tests

serum electrolyte panel, creatinine, urea nitrogen

98

bile salt lab test

serum 7alpha-hydroxy-4-cholesten-3-1

99

folic acid lab test

hemoglobin, MCV, serum, RBC folate

100

B12 lab tests

hemoglobin, MCV, serum, RBC B12

101

B complex lab test

serum vitamin levels

102

vitamin A lab tests

serum retinol, retainal esters

103

vitamin D lab test

serum 25-hydroxyvitamin D

104

vitamin E lab test

serum tocopherol

105

vitamin k lab test

prothrombin clotting time

106

iron lab tests

hemoglobin, MCV, serum ferritin, serum iron-binding capacity, total iron

107

zinc lab test

serum zinc

108

magnesium lab tests

serum magnesium, 24hr urinary Mg

109

selenium lab test

serum selenium

110

copper lab test

serum copper, cerulopalsmin

111

calcium lab tests

serum calcium, phsophorus, alkaline phosphatase, PTH

112

lactulose

non-absorbable disaccharide (leaky gut)

113

mannnitol

sugar alcohol (lack of indicates malabsorption)

114

is chron's or ulcerative colitis more likely to show with malabsorption

chron's because it involves the ileum
which is used to absorb B12 and bile