IF Final

define enteral

The delivery of nutrients directly into the GI tract, usually through oral feeding or feeding tubes

define parenteral

giving nutrients or medications by routes that bypass the digestive system, most commonly through injections

define standard formulas and when should it be used

for patients with normal digestion, no malabsorption/GI upset

• protein: intact (milk/soy; casein, soy protein)

• Carbs: glucose polymers (2-9 units); sometimes hydrolyzed

• Fat: variety of oils (safflower, canola, corn, etc.)

• blenderized: whole foods; rarely clinical use (tube clog risk), more common at home

define hydrolyzed formulas and when should it be used

nutrients are partially or fully broken down (proteins → peptides/amino acids; carbs → simple sugars)

• use when: patient has malabsorption, GI dysfunction, or impaired digestion (ex. pancreatitis, short bowel, severe food allergies)

• Easier to absorb, less GI stress compared to standard formulas

define specialized formulas and when should it be used

designed for specific diseases/conditions (ex., diabetes, renal failure, liver disease, pulmonary disease)

• composition: tailored nutrients (modified protein, carb, fat, electrolytes, or micronutrients)

• use when: patient has a particular medical condition requiring targeted nutrition support beyond standard or hydrolyzed formulas

define modular formulas and when should it be used

contain single nutrient modules (protein, carb, fat, or micronutrient) rather than a complete formula

• Use when: patient needs customized nutrition support- to supplement or adjust a standard regimen (ex. add extra protein, calories, or specific nutrients)

• often combined with other formulas to meet individualized needs

What is the purpose of MCT oil in enteral formula?

• easily digested and absorbed (don’t require bile salts or pancreatic enzymes)

• provide quick energy for patients with fat malabsorption or GI dysfunction

Why can’t an enteral formula contain 100% of MCT oil as a fat source?

• MCTs lack essential fatty acids (EFAs) (linoleic, linolenic acids)

• Long-chain triglycerides (LCTs) are needed to supply EFAs and support cell membrane functions

• 100% MCT → risk of EFA deficiency

define intact formula

contain whole nutrients (intact proteins, complex carbs, long-chain fats)

• use when: patient has a functioning GI tract and can digest/absorb nutrients normally

• provide balanced nutrition similar to a regular diet

define gastric residual volume (GRV)

• fluid left in the stomach after tube feeding

• checks stomach emptying and feeding tolerances

• High CRV (.500 mL) → possible feeding intolerance, aspiration risk

define emesis

• vomiting; expulsion of stomach contents

• causes, infection, irritation, meds, motion, sickness, systemic illness

• Watch for dehydration/ electrolyte imbalance

define post-pyloric tube feeding

• delivery of enteral nutrition into the small intestine beyond the stomach

• use when: patient has high aspiration risk, delayed gastric emptying, reflux, or intolerance to gastric feeding

• bypasses stomach → improves safety and tolerance in compromised GI patients

How many calories/ml might a fluid restricted patient require?

• typically 1.5-2.0 kcal/ mL

• provides adequate nutrition in smaller fluid volumes for patients with fluid restrictions

• ex. TwoCal® HN = 2.0 kcal/mL

Define osmolality and know what hypo-, hyper-, and isotonic means.

• osmolality: measure of solute concentration in fluid (particles per kg of water)

• hypotonic: lower osmolality than body fluids → water moves into cells → cells swell

• hypertonic: higher osmolality than body fluids → water moves out of cells → cells shrink

• isotonic: same osmolality as body fluids → no net water movement, cells stay stable

Why would a hydrolyzed formula contain a higher osmolality?

• nutrients are broken down into smaller particles (peptides, amino acids, simple sugars)

• smaller molecules = more particles per unit of fluid → increases osmolality

• higher osmolality can cause GI intolerance (diarrhea, cramping) if not managed

List the conditions that indicate that a person will require an enteral tube feeding. In what situations is enteral feedings contraindicated?

indications: patient cannot eat enough orally but has functional GI tract

• Neurologic impairment (stroke, coma, dementia)

• Swallowing disorders (dysphagia, head/neck cancer)

• Critical illness with poor oral intake

• Mechanical ventilation

• Severe anorexia or malnutrition

• Major trauma, burns, or surgery with high nutritional needs

Contradictions: nonfunctional or unsafe GI tract

• Severe GI obstruction or ileus

• Intractable vomiting or diarrhea

• Severe GI bleeding

• High‑output fistula not bypassed by tube

• Hemodynamic instability or shock

• Peritonitis or severe ischemia

List and describe the different feeding routes and formula delivery methods and when/what situations these feeding routes and delivery methods are indicated.

Feeding routes

• Nasogastric (NG): tube through nose → stomach. Short-term use, functional stomach, low aspiration risk

• Nasoduodenal/Nasojejunal (ND/NJ): tube through nose → small intestine. Short-term, poor gastric emptying, high aspiration risk

• Gastrostomy (PEG/G-tube): tube directly into the stomach. Long-term, functional stomach, safe aspiration risk

• Jejunostomy (J-tube): tube directly into the jejunum. Long-term, severe reflux, gastroparesis, high aspiration risk

Formula delivery methods

• bolus feeding: large volume given quickly (via syringe). Home use, stable patients, intact stomach.

• Intermittent feeding: smaller volumes at set times. Mimics meals, used in rehab or home settings.

• continuous feeding: slow, steady via pump over 24 hours. Critically ill, poor tolerance, high aspiration risk.

• cyclic feeding: continuous but limited hours (ex., overnight). Allows daytime mobility, used in long-term care.

List the conditions that necessitate the use of PN.

PN= nutrition through veins when gut can’t be used

conditions requiring PN

• severe GI obstruction or ileus

• short bowel syndrome (insufficient absorptive surface)

• severe malabsorption (ex., Crohn’s flare, radiation enteritis)

• Intractable vomiting or diarrhea

• High-output fistula not bypassed by tube feeding

• Severe pancreatitis (when enteral feeding is not tolerated)

• Peritonitis, ischemic bowel, or severe GI bleeding

• Critical illness with contraindication to enteral feeding

Why is enteral nutrition preferred over parenteral nutrition if the GI tract is functional?

• maintains gut integrity and function (prevents atrophy of intestinal mucosa)

• supports immune function (reduces infection risk)

• fewer complications (lower risk of sepsis, catheter infections)

• More physiologic and cost-effective than PN

• promotes better nutrient utilization and outcomes

Explain the difference in the form of nutrients delivered in each of these types of nutrition support.

EN: delivers nutrients directly into GI tract

• Standard/Intact formulas: Whole proteins, complex carbs, long‑chain fats.

• Hydrolyzed formulas: Partially/fully broken down proteins (peptides, amino acids), simple sugars, easier absorption.

• Specialized formulas: Modified nutrients for specific diseases (renal, hepatic, pulmonary, diabetes).

• Modular formulas: Single nutrient modules (protein, carb, fat) for customization.

PN: delivers nutrients directly into bloodstream (bypasses GI tract)

• Protein: Free amino acids.

• Carbohydrate: Dextrose (simple sugar).

• Fat: IV lipid emulsions (soybean, safflower, MCT, olive oil, fish oil).

• Micronutrients: Electrolytes, vitamins, trace elements in soluble form.

EN = nutrients in food‑like form (intact or partially broken down). PN = nutrients in simplest chemical form for IV use.

List and describe the different delivery routes and delivery methods of PN. You should know the advanatages and disadvantages of these delivery routes and methods.  

Delivery routes

• central PN (TPN- Total Parenteral Nutrition): catheter into a large vein (ex., subclavian, jugular)

  • Advantages: can deliver high-concentration solutions → full nutrition support

  • disadvantages: higher infection risk, invasive, requires skilled placement

• peripheral PN (PPN-Peripheral Parenteral Nutrition): a catheter into a smaller peripheral vein

  • Advantages: easier placement, lower infection risk

  • disadvantages: limited nutrition (lower osmolarity), vein irritation, short-term, use only

Delivery Methods

• continuous PN: infused 24 hrs/day via pump.

  • advantages: stable blood glucose, steady nutrient delivery

  • disadvantages: limits mobility, higher infection risk with constant access

• cyclic PN: infused over part of the day (ex., 12-18 hrs, often overnight)

  • advantages: greater mobility, allows liver rest, better quality of life

  • disadvantages: risk of hypo/hyperglycemia during on/off cycles, requires monitoring

Define refeeding syndrome. Why does it occur, and how can it be prevented?

a potentially fatal shift in fluids and electrolytes that occurs when nutrition is reintroduced after prolonged starvation or severe malnutriton.

cause:

• Sudden carbohydrate intake → ↑ insulin release.

• Insulin drives electrolytes (especially phosphate, potassium, magnesium) into cells.

• Leads to dangerous drops in serum levels → arrhythmias, respiratory failure, neurologic issues.

prevention:

• Sudden carbohydrate intake → ↑ insulin release.

• Insulin drives electrolytes (especially phosphate, potassium, magnesium) into cells.

• Leads to dangerous drops in serum levels → arrhythmias, respiratory failure, neurologic issues.

Refeeding = insulin surge → electrolyte crash; prevent with slow feeding + electrolyte/thiamine support.

define sublingual

• administration of medication or substance under the tongue for absorption

• mechanism: rapid absorption into the bloodstream via a rich capillary network under the tongue

• advantages: fast onset, bypasses GI tract and first-pass liver metabolism

• ex. Nitroglycerin tablets, certain vitamins (e.g., B12).

define subcutaneous

• administration f medication or fluid into the fatty tissue layer beneath the skin

• mechanism: absorbed slowly into the bloodstream via capillaries in subcutaneous tissue

• advantages: easy to administer, steady absorption, less painful than intramuscular

• ex. insulin injections, heparin, some vaccines

define intramuscular

• administration of medication or fluid directly into a muscle tissue

• absorbed into bloodstream via rich blood supply in muscle

• advantages: faster absorption than subcutaneous, can deliver larger volumes

• ex. vaccines, antibiotics, epinephrine, certain hormones

define mucositis

• Painful inflammation and ulceration of the mucous membranes lining the mouth and gastrointestinal tract

• Cause: Common side effect of chemotherapy, radiation therapy, or stem cell transplants; treatments damage rapidly dividing mucosal cells

• Symptoms: Red, swollen mouth/gums, mouth sores, ulcers, difficulty swallowing, abdominal pain, diarrhea

• Complications: Infection risk, malnutrition, dehydration, treatment delays

• Prevention/Management: Good oral hygiene, salt/baking soda rinses, pain control, soft/bland diet, hydration

Mucositis = inflamed mucosa from cancer therapy → pain, sores, infection risk.

define NVDC

short for Nausea, Vomiting, Diarrhea, Constipation, common gastrointestinal symptoms

• often documented together in patient charts to summarize GI tolerance or side effects

• helps track feeding tolerance, medication reactions, or GI complications

define enterically coated

a medication tablet or capsule with a special coating that resists breakdown in the stomach

• coating dissolves only in the intestine (alkaline pH) no in the acidic stomach

• protects the stomach lining from irritation, prevents drug inactivation by stomach acid, and ensures absorption in the intestine

• ex. aspirin EC, certain proton pump inhibitors, some antibiotics

Enteric coating = stomach protection + intestinal release

describe an example of a drug-drug interaction

warfarin and aspirin. Taken together, they significantly increase the risk of bleeding because both interfere with clotting mechanisms

describe an example of a nutrient-drug interaction

Grapefruit Juice + Statins (e.g., simvastatin, atorvastatin)

• Mechanism: Grapefruit juice inhibits the intestinal enzyme CYP3A4, which normally breaks down statins before absorption.

• Result: Higher drug levels in the blood → increased risk of side effects (muscle pain, liver toxicity).

List the three major influences that drugs have on the body.

Pharmacokinetics – What the body does to the drug

• Absorption, distribution, metabolism, and excretion.

• Determines drug concentration in blood/tissues.

Pharmacodynamics – What the drug does to the body

• Mechanism of action at receptors, enzymes, or cells.

• Produces therapeutic effects or side effects.

Toxicology – Adverse or harmful effects of the drug

• Overdose, drug interactions, organ damage.

• Focuses on safety and limits of drug use.

Kinetics = body on drug; Dynamics = drug on body; Toxicology = harm potential.

How does grapefruit juice interfere with drug metabolism?

Grapefruit juice interferes with drug metabolism by inhibiting the intestinal enzyme CYP3A4, which normally breaks down many medications during first‑pass metabolism. This inhibition leads to higher drug levels in the bloodstream and increases the risk of toxicity

What is tyramine? Where is it found? How does it affect MAOI’s?

Tyramine is a naturally occurring amino acid that helps regulate blood pressure. It is found in aged, fermented, or cured foods (like aged cheeses, cured meats, soy products, and certain alcoholic beverages). In people taking monoamine oxidase inhibitors (MAOIs), tyramine can build up to dangerous levels and trigger a hypertensive crisis because MAOIs block the enzyme that normally breaks tyramine down

Know the 10 most commonly used herbs in the US and their common use.

• basil: Popular in Mediterranean cuisine; used in salads, pasta, pesto, and tomato dishes. Known for antioxidant and anti-inflammatory properties

• thyme: Adds earthy flavor to soups, stews, and roasted meats. Traditionally used for respiratory health

• Bay (bay leaf): Used in soups, sauces, and braises for subtle flavor. Removed before serving

• Sage: Common in stuffing, sausages, and poultry dishes. Traditionally linked to digestive and memory support

• Oregano: Staple in Italian and Greek cooking (pizza, pasta sauces). Contains antimicrobial compounds

• Chives: Mild onion flavor; used fresh in salads, baked potatoes, and egg dishes

• Dill: Classic in pickling, fish dishes, and yogurt sauces. Traditionally used for digestion

• Parsley: Fresh garnish, flavor enhancer in soups, sauces, and salads. Rich in vitamin K and antioxidants

• Rosemary: Strong pine-like flavor; used in roasted meats, potatoes, and breads. Traditionally linked to memory and circulation

• Lavender: Used in teas, baked goods, and aromatherapy. Known for calming and relaxation effects

How can metabolism and excretion be affected in relation to diet-drug interactions? Give examples.

• Metabolism: Diet can inhibit or induce enzymes, altering drug breakdown.

• Excretion: Diet can change urinary pH or electrolyte balance, affecting how quickly drugs leave the body.

Food can either “block the breakdown” or “speed the clearance” of drugs.

What are the safety concerns associated with the use of herbal products?

Herbal products can cause serious risks through interactions, contamination, toxicity, and inconsistent potency. Always evaluate them with the same caution as prescription drugs.

Define metabolic stress. What conditions or causes are associated with it?

Metabolic stress is a state where the body’s normal metabolic processes are disrupted or overwhelmed, leading to cellular dysfunction. It is commonly associated with critical illness, trauma, obesity, diabetes, poor diet, chronic inflammation, sleep deprivation, and oxidative stress

What List the hormones responsible for the metabolic stress response. How do these hormones produce the energy required to “fight or flight”?

epinephrine (adrenaline), norepinephrine, cortisol, and glucagon

• together they mobilize stored energy by increasing blood glucose and fatty acid availability, fueling muscles and the rain for rapid action in a “fight-or-flight” situationbrain

define anabolic

The metabolic processes that build complex molecules from simpler ones, such as proteins from amino acids or glycogen from glucose. These processes require energy and are essential for growth, repair, and tissue building

define catabolic

• metabolic processes that break down complex molecules into simpler ones

• release energy (usually captured at ATP)

define counterregulatory

• hormones that oppose the action of insulin

• raise blood glucose by stimulating glycogen breakdown, gluconeogenesis, and lipolysis

• prevents hypoglycemia by mobilizing stored energy

define glycogenolysis

• The breakdown of glycogen into glucose

• occurs mainly in the liver and skeletal muscle

• provides rapid glucose for energy during fasting, exercise, or stress

• maintain blood glucose (liver) and fuel muscle contraction (muscle)

How do omega-3 and omega-6 fatty acids relate to inflammation? What compounds are these fatty acids derived from?

omega-3: derived froom alpha-linolenic acid

• converted into EPA (eicosatetraenoic acid) and DHA (docosahexaenoic acid)

• produce resolvins and protectins → anti-inflammatory, pro-solving

• found in fish oils, flaxseed, chia, and walnuts

omega-6 fatty acids

• derived from linoleic acid (LA)

• converted into arachidonic acid (AA)

• produce prostaglandins, leukotrienes, thromboxanes → pro-inflammatory

• found in vegetable oils (corn, soybean, sunflower)

What is the typical ratio of omega-6 to omega-3 fatty acids Americans typically consume

• 10:1 to 20:1 (15:1)

• cause high intake of omega-6 vegetable oils, low intake of omega-3-rich foods

• effect: promotes chronic inflammation and related diseases

what should the eomega-6 and omega-3 ratio be for optimal health

• Recommended ratio: 1:1 to 4:1

• closer to 1:1 supports anti-inflammatory balance

• helps reduce the risk of cardiovascular and inflammatory diseases

Which foods contain omega-3

• animal sources: salmon, mackerel, sardines, anchovies, herring, oysters, cod liver oil, caviar

• plant sources: flaxseed, chia seeds, walnuts, soybeans, algae oils

What are cytokines?

• small signaling proteins released by immune cells

• regulate immune response, inflammation, and cell communication

• can be pro-inflammatory or anti-inflammatory

• act like “messenger molecules” coordinating defense and repair

define chemokines

• a subclass of cytokines specialized in directing cell movement (chemotaxis)

  • guide immune cells (neutrophils, lymphocytes) to sites of infection or injury

  • ex. CCL2 (MCP-1), CXCL8 (IL-8)

  • act like “GPS signals” for immune cells

Give an example of an acute phase protein. What is the purpose of acute phase proteins?

• ex. C-reactive protein (CRP)

• purpose: Acute-phase proteins are produced by the liver during inflammation

  • they enhance immune defense by opsonizing pathogens, activating complement, and modulating the inflammatory response

  • they help restore homeostasis and promote healing after infection, injury or stress

What are the 3 phases of the stress response

1. alarm phase: immediate “flight-or-flight” response

2. Resistance phase: body adapts, mobilizes energy reserves

3. exhaustion phase: energy stores depleted, risk of breakdown

what is the nutrition therapy goal durin the alrm phas

• support rapid energy availability

• maintain blood glucose with easily digestible carbs

• prevent hypoglycemia during acute stress

what is the nutrition therapy goal during the resistance phase

• provide balanced macronutrients to sustain energy

• ensure adequate protein for tissue repair

• support immune function with vitamins/minerals (ex. vitamin C, zinc)

what is the nutrition therapy goal during the exhaustion phase

• Focus on recovery and replenishment

• restore glycogen and nutrient stores

• prevent malnutrition and support healing with nutrient-dense foods

Review the definitions of respiratory distress listed in the module.

Discuss the complications of dysphagia

• Aspiration pneumonia: food/liquid enters the lungs, causing infection

• malnutrition: inadequate nutrient intake due to difficulty swallowing

• dehydration: reduced fluid intake

• weight loss: from poor oral intake

• airway obstruction/choking: risk during swallowing

• reduced quality of life: anxiety, social isolation,, depression

discuss professionals responsible for identifying and providing education about dysphagia,

• SLPs are the lead professionals

• Evaluate swallowing function (bedside, instrumental tests)

• provide therapy and safe swallowing strategies

• educate patients, families, and staff

what is the role of dietitians in dysphagia care

• ensure adequate nutrition and hydration

• design texture-modified diets (ex., IDDSI levels)

• educate caregivers on safe food preparation

explain how dietary interventions can help with dysphagia management.

• texture modification: foods are altered (pureed, minced, soft) to reduce choking risk

• liquid thickening: fluids are thickened (nectar, honey, pudding consistency to slow flow and prevent aspiration)

• nutrient density: meals are fortified with protein, calories, and micronutrients to prevent malnutrition

• hydration strategies: thickened liquids or alternative fluids ensure adequate hydration

• individualization: diet tailored to swallowing ability, medical condition, and patient preference

• education: patients and caregivers learn safe food preparation and feeding techniques

Define GERD

• GERD: gastroesophageal reflux disease

• chronic condition where stomach acid flows back into the esophagus due to a weak LES (lower esophageal sphincter)

• causes irritation and symptoms like heartburn, regurgitation, and dysphagia

what are the complications of GERD

• esophagitis: inflammation of the esophagus

• esophageal strictures: narrowing from scar tissue, causing swallowing difficulty

• Barrett’s esophagus: precancerous changes increasing risk of esophageal adenocarcinoma

• ulcers and bleeding: acid erosion leading to sores and anemia

• respiratory issues: chronic cough, asthma, laryngitis, dental erosion

What are the dietary treatments used to manage GERD.

• avoid: high-fat foods, spicy foods, acidic foods, chocolate, caffeine, alcohol, peppermint, carbonated beverages

• recommended: lean proteins, non-citrus fruits, vegetables, whole grains, low fat dairy

what eating habits help manage GERD

• eat smaller, frequent meals

• avoid eating 2-3 hours before bedtime

• chew food thoroughly and eat slowly

• stay upright after meals

• maintain healthy weight

How do protein pump inhibitors control symptoms of GERD?

• PPIs black gastric H+/K+ ATPase (proton pumps) in parietal cells

• This reduces stomach acid secretion

• less acid = reduced reflux, heartburn relief, healing of esophagitis, prevention of complications

what nutrient deficiencies can long-term PPI use cause

• Vitamin B12: impaired release from food proteins

• Magnesium: reduced absorption → cramps, arrhythmias

• Calcium: decreased solubility → osteoporosis, fractures

• Iron: impaired conversion to absorbable form → anemia

• Occasionally vitamin C and D

define dyspepsia

indigestion

upper abdominal pain/ burning, early satiety, bloating, nausea, prolonged fullness

can be organic (GERD, ulcers, gastritis) or functional (no clear cause)

define gastritis

inflammation of the stomach lining

can be acute or chronic, erosive or non-erosive

causes: H. pylori, NSAIDS, alcohol, smoking, stress, autoimmune disease

symptoms: epigastric pain, nausea, vomiting, bloating, loss of appetite,

complications: ulcers, bleeding, anemia, obstruction, cancer risk

define hypochlorhydria

low stomach acid production

results from reduced secretion of hydrochloric acid (HCl) in gastric parietal cells

causes: aging, chronic use of PPIs/ H2 blockers, H. pylori infection, autoimmune gastritis

symptoms: bloating, indigestion, nutrient malabsorption

complications: deficiencies in B12, iron, calcium, magnesium, increased infection risk

define atrophic gastritis

chronic inflammation of the stomach lining that leads to thinning (atrophy) of the mucosa

causes: H. pylori infection or autoimmune destruction of gastric parietal cells

results: loss of acid-secreting cells and reduced intrinsic factor

complications: hypochlorhydria, vitamin B12 deficiency → pernicious anemia, iron deficiency, increased risk of gastric cancer

define fistula

an abnormal connection or passageway between two epithelialized surfaces (organs, vessels, or structures) that do not normally connect

causes: trauma, surgery, infection, inflammation (ex. Crohn’s disease), cancer

Types

• enterocutaneous fistula: intestine to skin\

• arteriovenous fistula: artery to vein

• rectovaginal fistula:

complications: infection, leakage of fluids, malnutrition, impaired organ function

define ostomy

surgically created opening (stoma) in the body that allows waste (stool, urine, or other bodily fluids) to exit into an external pouch or bag

types

• colostomy: opening from colon to abdominal wall

• Ileostomy: opening from ileum (small intestine)

• Urostomy: opening for urinary diverson

purpose: used when normal elimination routes are impaired by disease, injury or surgery (ex. cancer, IBD, trauma)

complications: skin irritation, infection, dehydration (especially with ileostomy), psychosocial adjustment)

define idiopathic

a condition or disease with no identifiable cause

term often used when the origin is unknown despite medical evaluation

ex. idiopathic pulmonary fibrosis → scarring of lungs without a known trigger

Describe how H. pylori can be both beneficial and dangerous to health.

dangerous effects:

• causes gastritis and peptic ulcers by damaging the stomach lining

• chronic infection increases risk of gastric cancer (adenocarcinoma, MALT lymphoma)

• can lead to abdominal pain, nausea, anemia, and bleeding

Benefits

• may reduce risk of GERD and esophageal adenocarcinoma by lowering stomach acid

• associated with lower rates of asthma and allergies, possibly due to immune modulation

• contributed to microbiome diversity in the stomach

what are the causes of peptic ulcer disease (PUD)?

• H. pylori infection (most common)

• NSAID use (aspirin, ibuprofen, naproxen)

• excessive alcohol and smoking

• severe stress/illness (burns, trauma, ICU)

• rare: Zollinger Ellison syndrome (gastrin-secreting tumor)

what are the symptoms of peptic ulcer disease

• burning/ gnawing epigastric pain (often relieved or worsened by food)

• nausea, vomiting, bloating, belching

• loss of appetite, weight loss

• severe cases: perforation→ sharp abdominal pain

how is peptic ulcer disease treated

• eradicate H. pylori: antibiotics + PPI (“triple therapy”)

• Stop NSAIDs, use alternatives if possible

• PPIs or H2 blockers reduce acid, promote healing

• lifestyle changes: avoid alcohol, smoking, irritant foods

• surgery: rare, for complications (bleeding, perforation, obstruction)

what is the Bristol stool chart

• a clinical tool developed in 1997 to classify stool from into 7 types

• Type 1-2: hard, lumpy → constipation

• Type 3-4: sausage-like, smooth → normal/ideal

• Type 5-7: soft blobs to water → diarrhea

• used to monitor bowel health, diagnose GI disorders, and track treatment effectiveness

Besides poor diet, what are some other causes of constipation?

• medications: opioids, antacids (calcium/aluminum), iron supplements, antidepressants, antihypertensives

• Medical conditions: hypothyroidism, diabetes, irritable bowel syndrome (IBS), neurological disorders (Parkinson’s, MS, spinal cord injury)

• Lifestyle factors: physical inactivity, dehydration, ignoring the urge to defecate

• Psychological factors: stress, anxiety, depression

• Structural issues: colorectal cancer, strictures, anal fissures, pelvic floor dysfunction

• age-related changes: slower gut motility in older adults

How do bulking agents, stimulants, osmotic and stool surfactant laxatives work (basically, what is their method of action)?

bulking agents (fiber supplements)

• add bulk and water to stool → increase stool size and softness

• stimulate intestinal peristalsis naturally

• ex. psyllium, methylcellulose, bran

stimulant laxatives

• directly stimulate intestinal nerve plexus → increase peristaltic contractions

• speed up bowel movement

• ex. senna, bisacodyl

osmotic laxatives

• draw water into the intestine via osmotic action → soften stool and increase volume

• promote bowel movement by distension

• ex. lactulose, polyethylene glycol, magnesium hydroxide

stool surfactant (emollient) laxatives

• lower surface tension of stool → allow water and fats to penetrate

• soften stook, making it easier to pass

• ex. docusate sodium

Describe the three types of diarrhea

osmotic diarrhea

• cause: non-absorbed solutes in the intestine draw water into the lumen

• ex. lactose intolerance, sorbitol ingestion, malabsorption syndromes

• improves with fasting

secretory diarrhea

• cause: intestinal cells actively secrete electrolytes and water into the lumen

• ex. cholera, certain toxins, hormone-secreting tumors, bile acid malabsorption,

• persists even during fasting

exudative (inflammatory) diarrhea

• cause: mucosal damage leads to leakage of blood, mucus, and protein into stool

• ex. ulcerative colitis, Crohn’s disease, infections (shigella, salmonella)

• often associated with fever, abdominal pain, and bloody stools

What are the complications caused by severe diarrhea?

• dehydration → loss of water and electrolytes

• electrolyte imbalances → hypokalemia, hyponatremia, metabolic acidosis

• malnutrition → poor absorption of nutrients

• weight loss → due to fluid and nutrient depletion

• kidney injury → from severe dehydration and low blood volume

• shock → in extreme fluid loss cases

• death → if untreated, especially in infants, elderly, or immunocompromised

Define SIBO, the causes of SIBO

small intestinal bacterial overgrowth

condition where excessive bacteria grow in the small intestine, disrupting normal digestion and absorption

causes:

• motility disorders: impaired peristalsis (ex., scleroderma, diabetic neuropathy,)

• structural abnormalities: strictures, adhesions, diverticula, surgical blind loops

• reduced gastric acid secretion: hypochlorhydria, chronic PPI use

• Immune dysfunction: weakened immune defenses

• ileocecal valve dysfunction: allows colonic bacteria to reflux into small intestine

• other risk factors: aging, chronic pancreatitis, liver disease, IBS

discuss how SIBO impacts digestive function and integrity.

• Nutrient Malabsorption:

  • Bacteria consume nutrients (esp. vitamin B12, iron, fat).

  • Leads to deficiencies, anemia, weight loss.

• Fat Malabsorption:

  • Bacterial deconjugation of bile salts → poor fat digestion.

  • Results in steatorrhea (fatty stools) and fat-soluble vitamin deficiencies (A, D, E, K).

• Carbohydrate Fermentation:

  • Excess bacteria ferment carbs → gas, bloating, abdominal pain, diarrhea.

• Mucosal Damage:

  • Bacterial toxins and inflammation injure intestinal lining.

  • Increased intestinal permeability (“leaky gut”).

• Immune Activation:

  • Chronic exposure to bacterial antigens → low-grade inflammation.

  • May worsen IBS-like symptoms.

• Overall Integrity:

• Disrupts normal microbiome balance.

• Weakens gut barrier, increasing risk of systemic effects (nutrient loss, immune dysregulation).

Define and give examples of probiotics and prebiotics.

probiotics

• live beneficial microorganisms (bacteria or yeasts) that, when consumed in adequate amounts, support gut health and balance the microbiome

• ex. yogurt, kefir, sauerkraut, kimchi, miso, kombucha

prebiotics

• non-digestible food components (usually fibers) that stimulate the growth and activity of beneficial gut bacteria

• ex. garlic, onions, leeks, asparagus, bananas, whole grains, chicory root

What is gluten and what foods contain gluten?

Gluten is a group of proteins (gliadin + glutenin) that gives dough elasticity and bread its chewy texture

foods containing gluten include bread, pasta, cereals, baked goods, beer, and many processed foods

How does celiac disease effect the intestinal mucosa?

• Gluten triggers an autoimmune response in genetically predisposed individuals (HLA-DQ2/DQ8).

• Villi flatten and atrophy, reducing surface area for nutrient absorption.

• Leads to malabsorption of iron, calcium, vitamin D, folate, B12, and fats.

• Results in diarrhea, weight loss, anemia, osteoporosis, growth delays in children.

• Damage can extend to microvilli and brush border enzymes, worsening nutrient loss.

What are the possible environmental causes of celiac disease?

• Infant feeding practices → early gluten introduction, formula vs. breastfeeding.

• Gut infections → viral or bacterial triggers that alter immune response.

• Gut microbiome changes → imbalance in early life linked to immune dysfunction.

• Stressful events → surgery, pregnancy, childbirth, severe emotional stress.

• Antibiotic exposure → disrupts microbiome balance.

• Environmental toxins → pesticides, nonstick cookware chemicals, fire retardants (possible links).

• High gluten intake in childhood → may increase risk in genetically predisposed children.

Describe the two types of inflammatory bowel disease. How do they differ from each other?

• Crohn’s Disease:

  • Can affect any part of the GI tract (mouth → anus).

  • Inflammation is patchy (“skip lesions”) with healthy tissue between diseased areas.

  • Involves all layers of the bowel wall (transmural).

  • Complications: strictures (narrowing), fistulas (abnormal connections), abscesses, malnutrition.

  • Symptoms: abdominal pain, diarrhea (often non-bloody), weight loss, perianal disease, mouth sores.

• Ulcerative Colitis (UC):

• Limited to the colon and rectum.

• Inflammation is continuous, starting at the rectum and extending upward.

• Affects only the mucosal layer (inner lining).

• Complications: toxic megacolon, perforation, higher colon cancer risk.

• Symptoms: bloody diarrhea, urgency, rectal pain, abdominal cramps.

What does “diagnosis of exclusion” mean and what disorder is diagnosed by this method?

It refers to a medical diagnosis made only after ruling out all other possible conditions that could explain the patient’s symptoms. In other words, the disorder is identified when no other cause can be found.

Irritable Bowel Syndrome (IBS) — it is diagnosed by exclusion because there are no specific biomarkers, and other gastrointestinal diseases (like celiac disease, inflammatory bowel disease, infections, etc.) must first be ruled out.

Describe the difference in diet treatment between diverticulosis and diverticulitis (also, define these conditions).

Diverticulosis = small pouches (diverticula) in the colon wall, usually without symptoms. Diet treatment: emphasize a high‑fiber diet (whole grains, fruits, vegetables, legumes) with plenty of fluids to keep stool soft and prevent complications.

Diverticulitis = inflammation or infection of those pouches. Diet treatment: during a flare, start with clear liquids or low‑fiber foods to rest the bowel, then gradually reintroduce fiber once symptoms resolve

Describe the functions of the liver.

The liver is the body’s chemical processing plant—detoxifying, digesting, storing, and producing substances essential for survival. Without it, life is not possible

define hepatocyte

A hepatocyte is the main functional cell of the liver, making up about 80% of its mass. These cells are responsible for protein synthesis, nutrient storage, bile production, and detoxification

define steatosis

Steatosis is the abnormal accumulation of fat within cells, most commonly in the liver (hepatic steatosis, or “fatty liver”). It becomes clinically significant when fat makes up more than 5–10% of the liver’s weight

define hepatomegaly

means an enlarged liver—the liver is swollen beyond its normal size. It is not a disease itself but a symptom of underlying conditions such as fatty liver disease, hepatitis, heart failure, or cancer

define steatohepatitis

Steatohepatitis is a liver condition where fat buildup in the liver leads to inflammation and damage. It is an advanced stage of fatty liver disease and can progress to fibrosis, cirrhosis, or even liver cancer if untreated

define jaundice

Jaundice is a condition where the skin, whites of the eyes, and mucous membranes turn yellow due to a buildup of bilirubin in the blood. It is a symptom, not a disease, and usually signals an underlying issue with the liver, gallbladder, or red blood cell

define bilirubin

Describe cirrhosis of the liver and the medical manifestations caused by cirrhosis. 

What is the most common type of diabetes 

define autoimmune

define insulin resistance