MNT Exam 1- Lower GI, Celiacs
Card Set Information
MNT Exam 1- Lower GI, Celiacs
Lower GI Celiacs
Lower GI, Celiacs
What is the sm. intestine physio?
villi/microvilli increase surface area, 600x abs (influence by malnutrition/dz)
ileum seperate sm. bowel from large
duodenum, jejunum, ileum
what happens in the sm. intestine (gateholder)?
motility churns food
: 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)
What are important things about the large intestine?
absorb H20, electrolytes, vitamins (no enzymes here)
intestine flora balance w/ fiber fermentation
make vit K and biotin
what is the etiology of diarrhea?
osmotic/acute (less than 2 weeks)
: high conc, then high water secretion
secreatory(common)/ chronic (2 + weeks)
foul-smell/frothy, have blood (bright red = upper GI, dark red=lower), mucus (light), leukocytes (immune/white)
what is the Tx for diarrhea?
correct dehydration, electro, acid/base balance
pectin (fiber) sources
low residue diet = low insoluble, high soluble
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
what is the recommended fiber intake for constipation?
20-35 g soluble fiber
age + 5g for over 2 yrs old
always drink water
what is the etiology of malabsorption and the macromolecules absorption?
impaired absorptive surface (crohn's, celiac's), protein cal malnutrition (PCM)
: have blockage/barrier so fat sol vitamin not abs, have to do fecal fat test
: protein-loss enteropathy, might need 2-3 kg more if loss
: lactose (lg. intestine cant break down)
all loose weight
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 =(
what are the clinical manifestations of celiacs?
FTT (failure to thrive) in kids
osteomalacia (bone soften because no vit D)
what is the Tx for celiacs?
avoid gluten food (because gliadin causes)!
: 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
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)
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)
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)
What testing can be done for celiac's and what is better testing method?
: main test of stool (atrophy of villi checked)
Antibody test/blood test
: immune disorders( usually false neg.
: food sensitivities (usually false positive)
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
what are associated conditions with celiacs?
Fe deficientcy anemia
vit k deficient>> hemorrage
CNS and PNS disorder because of no nutrients
(always recommend vit D and ca)
not work pancreas (type I dm)
What gets malnourished from celiacs?
folate (not common)
severe for kids may lead to FTT
what results from lack of Ca and vit D in celiacs?
osteomalacia, rickets, kidney stones
secondary lactose intolerance (vili can grow back)
What are additional medical consequences of celiacs?
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
what foods do celiac pateints aviod?
breads, cereals, crackers, pasta, cookies, cake, pie, gravy, sauces, medicine, snack food
what cosmetics should celiac patients avoid or be weary of?
makeup or skin care products
gluten free- toothpate, mouthwash, lip balms, lotions (for kids)
what foods are allowed for celiacs patients?
corn, potatoes, arrowroot, tapioca, rice, amarath, nut flours, quinoa
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)
What is IBS ?
irritable bowel syndrome (cluster of symptoms)
alternating constipation and diarrhea (gas, bloating, abnormal bowel contractions)
How is IBS diagnosed and how much of the poop does it affect?
affects 20% of pop
: 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,
may be motility disorder, stress worsens
similar to celiacs dz in symptoms
what is the Tx for IBS?
SSRI's (antidepressants) decrease anxiety
: FOMAP (ferm. oligo,disac, mono, poly olig = decrease symptoms in 2 wks)
increase sol, decrease insol.
try stress mgmt 1st (related to IBS flares)
what is IBD?
inflammatory bowel dz- with other autoimmune dz
includes crohns and ulcerative colitis
What are causes, Tx, and other important things about IBD?
effects both sexes (15-30 yrs)
: unknown- genetic or autoimmune
at risk for malnutrition (crohns)
increase risk for malignant dz's
: surger, antibioti, immunosuppress.
What is crohns dz?
it is chronic/ intermittent abdominal pain, nausea, vomiting, diarrhea
it causes malabs from bacterial overgroth, inflamm, or bowel ressection
what are the deficiencies of crohns?
protein, folate Fe, kcal, Vit A,D,C,E, B12
What are symptoms and causes of crohns dz?
weight loss, fever, low albumin (increase enerrgy needs)
: genetic, infectous, immune
also diferent from others because can have active infection!
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
how would you treat UC?
with surgery, getting colon removed
get fiber and fluid too
what are the differences between crohns and UC?
: any part of GI (mouth to anus)
all mucosa layers
surgery not cured
resections result in malabs
: only in colon
rectal bleed/blood diarrhea
colon need removal
what is medical mgmt of IBD?
corticosteriods, anti-inflammatory, immunosupre, antibio
: smll bowel resection, illeostomy, colonostomy
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)
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)
What is SBS?
short bowel syndrome (75% gut removed)
decreased GI surface and increase transient time
the more colon removed to more the malabs
what doe the consequences of SBS?
extent/site of bowel loss
present/absent ileocecal valve
function of remain GI
degree of bowel adaption
what do illeal resections decrease?
abs of B12, bile salts, fat, fat sol vitamins
availability of cations (mg, ca, zn)
increase oxylate abs
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)
what is specific for SBS?
typical from gun shoot wound
cells migrate and go to colon
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.)
What is diverticulitis?
acute inflammatory flare-up (occur in 10-25% patients)
low-residue/insoluble fiber diet
possible elemental or TPN for short time
what are high fiber food choices?
over 25 g/day
to prevent diverticulosis, and manage IBS
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.
what is residue?
total amount of poop mass
: water, bacteria, fiber, GI cells,
mucous, sugars, pectin, minerals
what are the food choices for minimal fiber?
refined bread, cereal, fruit/veggies (no skin, nuts, seeds) milk, meat, egg, fat,
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
What is an illeostomy?
surgical opening from distal ielum through abdominal wall
that bypass colon, rectum, and anus
why would someone have an ileostomy?
because massive lower GI surgery that render tissue unused
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
how would a patient prevent obstruction of ileotomy?
increase fluid, avoid high insoluble fiber (seeds), chew!
how would a patient prevent watery discharge?
avoid: spinach, broccoli, beans, prune juice,raw fruit, spicy food, beer/wine
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
what is the nutritional mgmt of an ileostomy?
gradual progression to regular diet (6 wks)
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)
how many people are lactose intolerant?
less than 70% world pop. is lactase deficient