NHM 365- Final Exam

What tract are these the functions of :

• Motility

• Secretion of enzymes, hormones, etc.

• Digestion & absorption

• Protection (physiologic barrier and immune function)

• Excretion

Intestinal track

What are gut associated lymphoid tissues and peyers patches used for in the intestinal track

protection

what are unencapsulated lymphatic cells that protect the mucous membranes of the small intestines (the ileum) from infection.

peyers patches

what is celiac disease also known as

glute-sensitivity enteropathy or non-tropical sprue

what is the etiology of celiac disease

unknown

what is the prevalence of celiac disease

1/133 people in the US

does celiac disease have a genetic component

yes - HLA-DQA1 and HLA-DQB1 genes

what is celiac disease

adverse autoimmune response to a protein in gluten (prolamin protein portion)

what is gluten

storage protein found in certain grains (wheat, barley, rye); a complex of 2 types of proteins called prolamins and glutelins

what does celiac disease do to the intestinal mucosa

damages it and causes inflammation, scarring, an dvillus atrophy

what is the primary manifestation of celiac disease

malabsorption and secondary malnutrition

what are the prolamins that cause problems for celiac disease

gliadin (wheat), secalin (rye), and hordein (barley)

what do villi look like in a normal human duodenal mucosa

long and thin what

do the villi look like in someone with celiac disease

loss of villi and the heavy infiltrate of white blood cells in the lamina propria

what are these presenting symptoms related to:

– Weight loss

– Increased appetite
– Generalized fatigue
– Abdominal bloating
– Symptoms associated with micronutrient deficiency
– Diarrhea, steatorrhea
– Children: Growth failure, projectile vomiting
– Occasionally, skin rash/itching (Dermatitis Herpetiformis)

celiac disease

T/F: Some people may be “gluten-intolerant” without having frank celiac disease.

true

is there a wide or short range of sensitivity with celiac disease

wide

is celiac disease more commonly diagnosed in adultood or infancy

adulthood

why are there delayed in the diagnosis of celiac disease

wide variety of symptoms or silent presentation

T/F: Triggering event or stressor often leads to s/s of celiac disease

true

what is the treatment for celiac disease

gluten free diet

can any tiny amount of gluten cause relapse of celiac disease

yes

what are these treatment goals for:

-Relieve symptoms; diet education

– Prevent (or treat) nutritional deficiencies

celiac disease

what would the MNT be for celiac disease

GFD

what should you mainly eliminate in a celiac diet

gluten: wheat, rye, barley c

can people with non-celiac gluten sensitivity tolerate small amount of gluten

yes, but if you have celiac disease, it should strictly be avoided

do you have to watch out for cross contamination with celiac disease

yes

what is another version of MNT for celiac disease

gliadin-free diet

when can people with celiac disease include gluten free oats in their meals

as tolerated

is gluten in a lot of food you wouldn’t suspect

yes

what ingredient may these foods have:

• modified food starch - stabilizing agent for ketchup, ice cream, and salad dressings

• MSG

• textured vegetable protein or seiten

• emulsifiers/lecithins

• soy sauce (most of it contains wheat; you have to use wheat-free tamari instead)

• prescription and over-the-counter drugs, even some vitamins

• “natural flavorings”

• Beer, ale, lager

• Malt vinegar

gluten

“Eat simply” is an MNT for what disease

celiac

what substitute should someone with celiac disease use for potato, rice, corn, soy, and tapioca

uncontaminated

T/F: Lifelong compliance required to maintain remission for celiac disease

true

If a food says “gluten free” it must contain less than. how. much gluten

<20 ppm. gluten

what types of biochemical data should an. RD assess in. someone with. celiac. disease

• Nutritional anemia profile (e.g., folate, ferritin and vitamin B-12) • Vitamin profile (e.g., thiamin, vitamin B-6 and 25-hydroxy

vitamin D)
• Mineral profile (e.g., copper and zinc)

what does untreated celiac disease result in

villous atrophy and malabsorption

what screening should an. RD recommend for adults with celiac disease within the. first year and why

bone density scan because there has been reports on reduced bone mineral content and bone mineral density in untreated adults with celiac disease

what medications are these side effects for:

• Hypercalciuria

• Sodium and fluid retention

• Other electrolyte imbalances (e.g., potassium loss in urine)

• Must be taken with food

• Hyperphagia

• Hyperglycemia

corticosteroid medications

what intolerance may occur secondary to celiac disease as a result of villus atrophy and insufficient brush border enzymes

lactose and fructose

what are the. 2 major forms of inflammatory bowl disease

crohn’s disease and. ulcerative colitis

T/F: Etiology and pathogenesis of IBD remains poorly understood

true

what is the chronic and progressive GI ulceration

crohn’s disease

what does transmural mean

affects the mucosa and submucosa

T/F: Crohn’s disease is incurable

true: resection to remove affected sections can provide relief

what sections of the GI tract does crohn’s disease involve

any

what parts are the GI tract are 50% of people with. crohn’s disease affected by

distal ileum and colon (LI)

what are these symptoms of

– ulceration
– weight loss
– anorexia
– fatigue
– abdominal pain – diarrhea

crohn’s disease

what disease are these complications of

• –  stricture or obstruction 2° scar tissue formation and inflammation

• –  malabsorption

• –  deficiencies and anemias related to malabsorption

• –  fistula - depending on location, can produce significant nutrient/fluid losses

• –  Increased risk of cancer

crohn’s disease

what disease can a variety of of immunologically related systemic complications can occur in

crohn’s disease

Ulcerations of the tongue, skin, rashes, or joint problems can bee complications of what disease

crohn’s disease

what diagnosis is the Chronic inflammation & ulceration of intestinal mucosa

ulcerative colitis

where does ulcerative colitis start

rectum

what diagnosis in limited to the LI and inflammation is generally limited to the mucosal and submucosal layers

ulcerative colitis

what is the only cure for ulcerative colitis

colectomy

what diagnosis are these symptoms for

– Bloody diarrhea
– Weight loss
– Ulcerative lesions of large bowel mucosa – Anemia

ulcerative colitis

what diagnosis are these complications for

• Malabsorption of nutrients isn’t as much of an issue as with Crohn’s, but UC pts may have significant water/electrolyte losses

• Primary Sclerosing Cholangitis- chronic liver disease characterized by inflammation, destruction and fibrosis of the bile ducts that leads to cirrhosis of the liver.

• Toxic colitis/Toxic megacolon

• Cancer

• Rarely-stricture formation or fistulas

ulcerative colitis

what is a rare but serious complication of ulcerative colitis where the inflamed colon becomes immobilized and distended

toxic megacolon

what irritation can anti-inflammatories cause

GI

what pharmacology Suppresses immune response and inflammation. Side effects: ↑ susceptibility to infection, electrolyte imbalances, weight gain, hypercalciuria.

corticosteroids

what pharmacology block the immune reaction that contributes to inflammation. Side effects: N/V/D and ↓ immune function

immunosuppressants

what is the pharmacology for IBD

• Anti-inflammatories

• Corticosteriods

• Immunosuppressants

• Possibly methotrexate

  • Anti-diarrheal medications

• Fluid/electrolyte replacement

when are anti-diarrheal medications prescribed for someone with IBD

after inflammation subsides

what is the goals of MNT for someone with IBD

to induce and maintain remission and to improve nutrition status.

what is ONE of the environmental factors that triggers relapses of IBD

diet

what should someone do when they relapse with IBDd

1. Identify food intolerances

   1. Eliminate the foods identified as triggers

what is the MNT for an acute flare up of IBD

• Low-residue diet

  • Limit lactose, excessive fructose, greasy/fatty foods

to prevent malabsorption deficiency for someone with IBD what should they supplement

• Ca, Vit D, folate, Fe, B12, Mg, Zn as needed

what are the energy needs of someone with IBD

• not greatly increased, unless patient is malnourished and weight gain is desired.

what are the protein requirements for someone with IBD

• ↑ support tissue healing. Typically 1-1.5 g pro/kg, depending on severity of illness.

what should fiber be for MNT with someone with IBD

acutely restricted during inflammation, but individualized addition during remission what

what may be beneficial in remission for someone with IBD

probiotics

what resection for IBD requires individualized evaluation

bowel

to determine probable deficiencies for someone who had a bowel resection, they should base it on what

sections removed and how much functional area is left wha

what has recent evidence shown that may reduce acute inflammation and maintain remission of crohn’s disease

omega 3 fatty acid supplements

what are these MNT for

• Prevent malabsorption deficiency

• Monitor food/drug interactions

• Energy needs

• Protein requirements.

• Monitor for lactose intolerance with Crohn’s

  -Fiber
  

  For steatorrhea

  Probiotics???

  For bowel resection

• -omega 3 supplements

• mediterranean diet pattern

  • support groups

IBD

what diagnosis is this PES statement for

P: Unintended weight loss
• E: related to poor PO intake and

malabsorption

• S: as evidenced by 10# weight loss in 2 months, steatorrhea, and pt report of abdominal pain and cramping after meals

IBD

What syndrome Could be from a congenital birth defect resulting in reduced small intestine or more likely a surgical removal of a large part of the small intestine

Short bowel syndrome (SBS)

what syndrome is Associated with severe metabolic alteration and malnutrition

SBS

what syndrome is more symptomatic with removal of ileocecal valve: risk of small intestinal bacterial overgrowth (SIBO)

SBS

what is small intestinal bacterial overgrowth (SIBO)

abnormally large numbers of bacteria present in the small intestine

what are these symptoms correlated with

• –  Malabsorption (macro- and micronutrients)

• –  Diarrhea

• –  Steatorrhea

• –  Acidic diarrhea secondary to gastric acid hypersecretion

• –  Dehydration

• –  Electrolyte imbalance

• –  Weight loss

• –  Growth failure (children)

SBS

What symptoms of SBS is 2 degrees malabsorption/hyperosmolar intestinal contents

diarrhea

what does diarrhea do to CCK and secretin

increases GI motility due to decreased CCK and secretin

what syndrome is this post- op care for

• Duration of parenteral nutrition following resection depends on extent of removal. Can require total bowel rest for weeks.

• Start enteral feeds as soon as tolerated but introduce gradually. Continue parenteral nutrition for nutritional adequacy.

• Begin oral feeds with clear liquids

• Initial refeeding of solids should be bland, low residue, low fat, lactose-free. Progress in volume and concentration as tolerated.

• Average recovery time 3-4 months.

• Supportive parenteral nutrition may be required for life.

SBS

what kinds of drugs may improve absorption with someone with SBS

• Drugs to slow gastric emptying ,slow motility, and decrease secretions

loss of terminal iluem for people with SBS requires what kind of injections

B12

what kinds of GI supplements may not me tolerable for up to a year after surgery for someone with SBS

Alcohol and caffeiene

Are IBS and IBD the same thing

no

What is a Common gastrointestinal disorder involving an abnormal condition of gut contractions (motility)

IBS

what syndrome are these symptoms for

– abdominal pain

– bloating / flatulence

– mucous in stools

– irregular bowel habits with alternating diarrhea and constipation

IBS

what syndrome causes symptoms to be chronic and wax/wane over years

IBS

what syndrome Can cause chronic recurrent discomfort but does not lead to any serious organ or tissue damage.

IBS

is IBS a function GI disorder

yes

what are possible contributors to IBS

0. – stress; inadequate rest

   – caffeine, alcohol, FODMAPs – laxative abuse
   – low fiber/low water intake
   – Heredity / genetics

is IBS more common in men or women

women

what is the typical age onset for IBS

20-30 years old

what is the etiology of IBS

unknown

what is the first step in diagnosing IBS

ruling out other illnesses

what syndrome is this the criteria to meet for diagnosing

Recurrent abdominal pain, on average, at least one day/week in the last 3 months, associated with two or more of the following criteria:

• Related to defecation
• Associated with a change in frequency of stool
• Associated with a change in form (appearance) of stool.

Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis.

IBS