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What is the sm. intestine physio?
- villi/microvilli increase surface area, 600x abs (influence by malnutrition/dz)
- duodenum/jejunum
- ileum seperate sm. bowel from large
- duodenum, jejunum, ileum
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what happens in the sm. intestine (gateholder)?
- motility churns food
- makes: cholecystokinin, gastrin, secretin (release bile +pancreatic enzym) to stimulate pancreas + gallbladder
- 1.5 L water sol. secretions/ day made
- abs food via active transport (na/k) (glc, gal, aa)
- lipid turn into chylomicrons, then enter with passive abs>> to lymphatic systm (thyroid function)
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What are important things about the large intestine?
- absorb H20, electrolytes, vitamins (no enzymes here)
- form/store poop
- intestine flora balance w/ fiber fermentation
- make vit K and biotin
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what is the etiology of diarrhea?
- osmotic/acute (less than 2 weeks): high conc, then high water secretion
- secreatory(common)/ chronic (2 + weeks): hyper/undersecrete
- foul-smell/frothy, have blood (bright red = upper GI, dark red=lower), mucus (light), leukocytes (immune/white)
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what is the Tx for diarrhea?
- correct dehydration, electro, acid/base balance
- pectin (fiber) sources
- low residue diet = low insoluble, high soluble
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what is constipation and some important things about it?
- less than 3 bowel movements a week
- straining, hard stool, sense of fullness more than 25% of time
- had IBD manifestation
- pain medications relax muscle in colon so can poop
- motility/secretion dysfuncton?
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what is the recommended fiber intake for constipation?
- 20-35 g soluble fiber
- age + 5g for over 2 yrs old
- always drink water
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what is the etiology of malabsorption and the macromolecules absorption?
- impaired absorptive surface (crohn's, celiac's), protein cal malnutrition (PCM)
- lipids: have blockage/barrier so fat sol vitamin not abs, have to do fecal fat test
- pro: protein-loss enteropathy, might need 2-3 kg more if loss
- CHO: lactose (lg. intestine cant break down)
- all loose weight
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What is celiac's disease (gluten sensitive enteropathy) and some important things about it?
- it is immune response to gliadin (infants, type I dm, auto imm. disorders)
- result in flattening of GI villi and malabs of all nutrients
- cureent use antibodies for gliadin
- need gluten free diet quick
- full recovery can take years =(
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what are the clinical manifestations of celiacs?
- steatorhhea/diarrhea
- FTT (failure to thrive) in kids
- lactase deficient
- electrolyte disturbance
- osteomalacia (bone soften because no vit D)
- rickets
- night blindness
- micro/macro anemias
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what is the Tx for celiacs?
- avoid gluten food (because gliadin causes)!
- eiminate: buckwheat, rye, oats, wheat, barley
- be aware of hidden sources: medicine, malt, makeup, veggie gum, grain vinegar, startch, hydrolyzed things?
- get vitamin supplements
- once gluten is free from system there can be repairs
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what is difficult about the symptoms of celiacs dz?
- there is no classic profile for it- no set symp or manifestation
- it is often mistaken for crohns dz, parasites, skin disorders, etc
- usually comes after trauma(physical or emotional)
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what does genetics play a part in with celiacs?
it has a strong dispsition to genetics: pale, irritable(mood swings), fail to grow(cant gain lbs), flat butt ( low muscle), potbelly(has fat), stiny stool (malabs of stool)
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what are general symptoms of celiacs?
diarrhea, low constipaton, gas, bloating, irritable, depressed, joint/bone pain, muscle cramp, skin rash, mouth sores, anemia, bone disorders, neuropathy (loss of touch, poor sight, veins damaged)
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What testing can be done for celiac's and what is better testing method?
- ***biopsy: main test of stool (atrophy of villi checked)
- Antibody test/blood test:
- IgG (starting): immune disorders( usually false neg.
- IgA : food sensitivities (usually false positive)
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what is important about villi?
- they are the mop/broom of the stomach linning
- they have digestive enzymes
- foods pass thru and dont get abs or digested
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what are associated conditions with celiacs?
- Fe deficientcy anemia
- osteoporosis
- vit k deficient>> hemorrage
- CNS and PNS disorder because of no nutrients
- (always recommend vit D and ca)
- not work pancreas (type I dm)
- cancers
- lactose intolerance
- neurological manifestations
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What gets malnourished from celiacs?
- vitamins A,D,E,K
- vit. B12
- folate (not common)
- Fe
- severe for kids may lead to FTT
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what results from lack of Ca and vit D in celiacs?
- osteomalacia, rickets, kidney stones
- secondary lactose intolerance (vili can grow back)
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What are additional medical consequences of celiacs?
- intestinal lymphoma
- bowel cancer
- seizures
- peripheral neuropathy
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what ingredients does one avoid with celiacs?
- grains, barley, wheat, rye, farina, triticale, graham, durum,semolina, kamut, bulgur, kasha, spelt, matzo meal, oats?
- WORB= controversial because does not contain, but made on same machines
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what foods do celiac pateints aviod?
breads, cereals, crackers, pasta, cookies, cake, pie, gravy, sauces, medicine, snack food
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what cosmetics should celiac patients avoid or be weary of?
- makeup or skin care products
- gluten free- toothpate, mouthwash, lip balms, lotions (for kids)
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what foods are allowed for celiacs patients?
corn, potatoes, arrowroot, tapioca, rice, amarath, nut flours, quinoa
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What should you do if u have celiacs?
- sit with and RD annually
- check ingredients and prep methods
- have vitamin/mineral supplements (vit D and Ca at least)
- be proactive
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What is IBS ?
- irritable bowel syndrome (cluster of symptoms)
- alternating constipation and diarrhea (gas, bloating, abnormal bowel contractions)
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How is IBS diagnosed and how much of the poop does it affect?
- affects 20% of pop
- Dx: 12 wks with abdominal pain in 1 year and 1 of 3:
- pain relief with pooping, change in poop frequently
- (high or low), change on form of poop (dry, wet, lose,
- etc.)
- may be motility disorder, stress worsens
- similar to celiacs dz in symptoms
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what is the Tx for IBS?
- SSRI's (antidepressants) decrease anxiety
- food diary
- probiotics
- increase fiber : FOMAP (ferm. oligo,disac, mono, poly olig = decrease symptoms in 2 wks)
- increase sol, decrease insol.
- try stress mgmt 1st (related to IBS flares)
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what is IBD?
- inflammatory bowel dz- with other autoimmune dz
- includes crohns and ulcerative colitis
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What are causes, Tx, and other important things about IBD?
- effects both sexes (15-30 yrs)
- causes: unknown- genetic or autoimmune
- at risk for malnutrition (crohns)
- increase risk for malignant dz's
- Tx: surger, antibioti, immunosuppress.
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What is crohns dz?
- it is chronic/ intermittent abdominal pain, nausea, vomiting, diarrhea
- it causes malabs from bacterial overgroth, inflamm, or bowel ressection
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what are the deficiencies of crohns?
protein, folate Fe, kcal, Vit A,D,C,E, B12
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What are symptoms and causes of crohns dz?
- weight loss, fever, low albumin (increase enerrgy needs)
- unknown causes: genetic, infectous, immune
also diferent from others because can have active infection!
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what is UC and in causes +symptoms?
- it is ulcerative colitis ( in the colon)
- it usually comes and goes (remmision/exascerbations)
symp: bloody diarrhea/stomach pain, increase bowel movmt, decrease appetitie, rectal mucus with ulcer, fever, dehydration, anemia, protein loss, low albumin
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how would you treat UC?
- with surgery, getting colon removed
- get fiber and fluid too
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what are the differences between crohns and UC?
- Crohns: any part of GI (mouth to anus)
- segmented involvment
- all mucosa layers
- surgery not cured
- resections result in malabs
- UC: only in colon
- continuos dz
- rectal bleed/blood diarrhea
- colon need removal
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what is medical mgmt of IBD?
- corticosteriods, anti-inflammatory, immunosupre, antibio
- surgery: smll bowel resection, illeostomy, colonostomy
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what is nutritional mgmt of IBD?
- low residue/fiber diet to reduce diarrhea
- supplements to replenish
- enteral nutrition (elemental)
- PN for severe cases (TPN good for fluid)
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what micro/macro nutrients are needed for IBD?
- energy not greatly increased
- protein increase up 50%, 1.3-1.5 g/kg
- supplement vitamin +min
- fat malabs (crohns)
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What is SBS?
- short bowel syndrome (75% gut removed)
- decreased GI surface and increase transient time
- the more colon removed to more the malabs
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what doe the consequences of SBS?
- depend on:
- extent/site of bowel loss
- present/absent ileocecal valve
- function of remain GI
- degree of bowel adaption
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what do illeal resections decrease?
- abs of B12, bile salts, fat, fat sol vitamins
- availability of cations (mg, ca, zn)
- increase oxylate abs
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what is the Tx for SBS?
- IV with electrolyte +fluid
- TPN in early phase
- slow intro to enteral feed
- aa/'s glutamine + arginine help heal gut
- transition to oral diet (sm/frequent meal, low fiber/lactose, fat vitamin +min supple)
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what is specific for SBS?
- typical from gun shoot wound
- cells migrate and go to colon
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what is diverticulosis?
- hemiations in colonic wall (pouches) due to chronice increased colon pressure
- associated with constipation
- contain polops (bacterial ball)
- have high fiber diet to soften stool(white bread, rice etc.)
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What is diverticulitis?
- acute inflammatory flare-up (occur in 10-25% patients)
- low-residue/insoluble fiber diet
- possible elemental or TPN for short time
- avoid seed/nuts
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what are high fiber food choices?
- over 25 g/day
- to prevent diverticulosis, and manage IBS
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what are the low fiber/residue diets?
- less than 10 g/day
- use to reduce poop output (diarrhea, recovery from bowel surg.)
- can be used for people with maldigestion, absorption, diarrh.
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what is residue?
- total amount of poop mass: water, bacteria, fiber, GI cells,
- mucous, sugars, pectin, minerals
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what are the food choices for minimal fiber?
refined bread, cereal, fruit/veggies (no skin, nuts, seeds) milk, meat, egg, fat,
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what are food choices for low residue diets?
- limit dairy to 2 c/day
- limit meat, seafood
- no whole fruit/veggie, nut, seeds, legumes, potatoe, peas
- refined bread +cereal
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What is an illeostomy?
- surgical opening from distal ielum through abdominal wall
- that bypass colon, rectum, and anus
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why would someone have an ileostomy?
because massive lower GI surgery that render tissue unused
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what should a patient be weary of and consume if they have a ileostomy?
- that adjustments should be made to prevent obstruction, watery dischareg, smell, gas
- make sure to chew all food well so dont get stuck
- start on clear liquid and then eat reg. food
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how would a patient prevent obstruction of ileotomy?
increase fluid, avoid high insoluble fiber (seeds), chew!
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how would a patient prevent watery discharge?
avoid: spinach, broccoli, beans, prune juice,raw fruit, spicy food, beer/wine
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how would a patient avoid flatulance with pain and odor?
- eliminate gassy foods (cabbage)
- dont chew gum/ use a straw
- yogurt/probiotics may reduce smell
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what is the nutritional mgmt of an ileostomy?
gradual progression to regular diet (6 wks)
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what are some improtant factora about colostomy?
- mgmt depend on location
- constipation, diarrhea, flatus, odor, may require diet change
- collection bag attached to stoma need changing (2 days)
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how many people are lactose intolerant?
less than 70% world pop. is lactase deficient
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