Lower GI

_______ of constipation includes slowed colonic transit time, rectal outlet obstruction, pelvic floor dysfunction, component of IBS, side effect of other conditions and medications/ supplements.

Etiology

_______ of malabsorption includes decreased villous height, enzyme production, or dysfunction of accessory organs due to disease. Another cause can be decreased transit time especially due to changes in surgical anatomy.

Etiology

Nutrition therapy for fat malabsorption includes restriction of fat to ___-____g/ day, dietary interventions, and lipase or MCT supplements

20-50

For diarrhea, it is recommended to avoid caffeinated beverages, spicy food, and to eat a small meal/ snack every ___-_____ hours.3-4

3-4

Jejunal resection of <___% is usually well tolerated. Minimum of ____cm of jejunum to entire colon is usually well tolerated.

75, 60

_____ _______ can result from cross-contamination of bacteria from the colon to the small intestine. Motility of the GI tract is delayed, and bacteria will compete with host for nutrients.

Bacterial overgrowth

In a person with ______ disease, exposure to gluten can cause damage to intestinal mucosa. It is an autoimmune disease in genetically susceptible individuals.

Celiac

________ are pouches that form in any part of the GI tract, most often the small intestine or colon. This condition is known as ________.

Diverticuli, diverticulosis

Someone with diverticulosis would benefit from a _____ fiber diet to keep things moving in the GIT. But during an episode of diverticulitis, one should be given a _____ fiber diet so as to not cause more irritation in this area.

high, low

For diarrhea, it is recommended to limit foods/ beverages that contain excessive sugar, lactose, fructose, HFCS, and sorbitol, aka ______ particles that may worsen diarrhea.

hypertonic

_____________ is an interaction of both environmental and clinical factors that cause an inappropriate immune response in genetically predisposed individuals. It results in a release of ______ and destruction of mucosa.

IBD, cytokines

The cause of ______ is unknown. Current research is targeting genetic predisposition, altered immune response stimulated by food sensitivity and an altered microbial environment, elevated inflammatory response to gastroenteritis, small intestinal and bacterial overgrowth, and abnormal release, transport or recognition of serotonin, increased sensitivity of the nervous system that causes abnormal motility and pain.

IBS

______ is a condition of abdominal pain related to defecation or a change in bowel habit that occurs in association with altered bowel habits at least 1d/ week on average over the preceding month.

IBS

The _______ ______ prevents contents of the large intestine from going into the small intestine ie intestinal bacteria.

ileocecal valve

Management of ________________ is to have the waste which is no longer controlled by voluntary excretion to be predictable and not too excessive, watery or smelly. We should decrease risk of obstruction, maintain fluid & electrolyte balance, reduce fecal output, minimize flatulence.

ileostomy/ colostomy

B12 is absorbed only at specific sites in the ________.

ileum

There are 4 subtypes of IBS. What are they & what do they mean?

IBS-Diarrhea IBS-Constipation IBS-Mixed IBS-Upper GI

Nutrition _______ required structure for elimination of the malabsorbed nutrient from the diet. We can provide medications like pancreatic enzymes, lactase, reglan to stimulate GI motility, and diet modification or elemental formulas.

intervention

Nutrition _________ for IBS depends on symptoms and food triggers. Approaches include exclusion diet (food symptom log), Fermentable oligo-, di- and monosaccharides and polyols (FODMAP) approach, and relieve symptoms associated w/ gas.

intervention

Nutrition _________ for constipation includes: increase whole grains, FV, 25-38g of fiber/ day, 2L fluid per day, probiotics & prebiotics, activity if tolerated.

intervention

Nutrition _________ of SBS includes parenteral nutrition, oral diets introduced as diarrhea decreases, slow progression to low-residue diet and lactose as tolerated, low-oxalate and low-fat diet recommended, avoid caffeine, alcohol, sugar alcohols, insoluble fiber.

intervention

Severe fluid and electrolyte loss is associated with _______ often requiring parenteral nutrition.

jejunostomy

When carbohydrate is malabsorbed, the most common is ________. This can cause gas, abd cramping, and diarrhea. Diagnosed through __ tolerance test or ___ breath hydrogen test.

lactose

Nutrition therapy for IBD includes enteral nutrition, assess energy needs and micronutrient deficiencies, maybe increased protein needs, ensure healthy weight gain and PA, limit foods high in oxalate, pre and probiotics, and...

lactose-free and low-residue diet with small frequent meals

The _______ intestine is the primary site of absorption of water and minerals.

large

Reduced intraduodenal bile acid concentration/ impaired micelle formation is often seen in patients with liver failure. This can cause lipid ___________.

malapsorption

Nutrition diagnosis for malabsorption may include...

malnutrition inadequate intake altered GI function impaired nutrient utilization underweight, unintended weight loss

In ulcerative colitis, ulcerations lead to ______ ______.

toxic megacolon

Prognosis of ______ depends on length of the remaining small bowel, presence of the ileocolic valve and distal ileum, and health of the remaining GI.

SBS

_______ is an abnormal amount of fat in the stool. Develops when lipids are not digested/ absorbed correctly.

Steatorrhea

______ ______ is a type of IBD that primarily affects the colon and rectum.

Ulcerative colitis

Following the acute phase of SBS is an _________ phase, which may extend from weeks to <2 years, but involves reduction of diarrhea volumes from changes in motility and improved absorptive capacity of the bowel. An increase in villous height leads to increase in absorptive surface area.

adaptation

Bacterial overgrowth in the small intestine can damage enterocytes and decrease absorption of nutrients, this is often due to _________ stasis.

anatomic

Malabsorption can occur due to nutrient delivery to and/or from the intestine. This is relevant for patients with lymphatic obstruction and _______ disorders.

circulatory

In Crohn's disease, ______s are replaced with fibrotic tissue. Fibrosis can cause recurrent strictures and obstructions.

fistula

The large intestine maintains the balance of intestinal _______.

flora

Someone with Celiac disease who consumes gluten will suffer from an inflammatory and innate immune response that leads to reduced height of and flattened shape of _____.

villi

Severe malabsorption occurs when the residual small bowel (<100cm) without colon in continuity. Unlikely for body to adapt if there's >____ft of intestine, ileocecal valve and distal ileum.

2

The treatment of constipation is to treat the underlying etiology. Common interventions include...

Bowel retraining Laxatives Enemas Bulking agents, stool softeners

_____ is often described as a decrease in frequency of bowel movements. Generally, > 2 days without a bowel movement indicates this condition, which often manifests in hard, pellet like bowel movements, abdominal pain, bloating and gas.

Constipation

________ _____ is a type of IBD that has a skipping patter and can occur throughout the GI tract.

Crohn's disease

Malabsorption can occur due to mucosal absorption/ mucosal loss or defect. This is usually caused by...

Intestinal resection, inflammation/ infection, genetic disorders

_______ are the most difficult for the small intestine to digest and absorb. Many processes occur in order for them to enter the lymph via passive diffusion. They must first be converted to micelles and packaged as _________.

Lipids, chylomicrons

_______ refers to the maldigestion of fat, CHO or protein.

Malabsorption

_________ diarrhea is characterized by increased water efflux due to an increase in osmolality.

Osmotic

_________ diarrhea is caused by underlying disease, causing secretions.

Secretory

two vitamins that can be synthesized by bacteria in the large intestine

Vitamin K, biotin

The protein that causes an autoimmune response from Celiac patients is ________. This protein, found in wheat, rye, malt or barley, causes infiltration of WBCs and production of antibodies that attack the intestinal mucosa.

a-gliadin

Treatment for IBD includes...

abx immunosuppressants immunomodulators biologic therapies sx

Nutrition _______ for celiac disease includes evaluation of anthropometric changes and nutrient imbalance. Also included should be exploration of social networks, knowledge and beliefs, and diet adherence.

assessment

Diverticulosis is typically _____, but when diverticuli become infected, they may experience fever, abdominal pain, GI bleeding, elevated WBC.

asymptomatic

The gold standard for diagnosing celiac disease is a ______, at least 5, to determine if there's an area of flattened villi. Initial diagnosis is through serological testing. More often, we observe for a reversal of symptoms following a gluten-free diet.

biopsy

Nutrition intervention for diverticulitis/ osis includes high fiber diet and fiber supplements for older adults and patients with acute diverticulitis will be progressed from _______ _____ to clear liquids.

bowel rest

Bacterial overgrowth can manifest as clinical problems such as maldigestion, malabsorption and weight loss. Treatment for this condition is...

broad-spectrum abx maximize nutritional intake

Endocrine and metabolic disorders can cause malabsorption. Some examples include...

diabetes hypoparathyroidism or hyperthyroidism carcinoid syndrome

Nutrition ______ for celiac disease may include impaired nutrient utilization, altered GI function, and food/ nutrition-related knowledge deficit.

diagnosis

Nutrition ______ for constipation may include inadequate fluid or fiber intake, altered GI function, or undesirable food choices.

diagnosis

Nutrition _______ for IBS may be inadequate oral intake, altered GI function, undesirable food choices, food- and nutrition-related knowledge deficit, disordered eating pattern

diagnosis

Nutrition _________ for IBD includes malnutrition, inadequate energy and oral intake, increased nutrient needs, inadequate vitamin/ mineral intake, impaired nutrient utilization, food-medication interaction and altered nutrition-related lab values.

diagnosis

This condition is characterized by watery stool; increased frequency; foul-smelling, frothy stools; presence of blood; abdominal pain and cramping, dehydration, weight loss, and electrolyte & acid-base imbalances.

diarrhea

Fecal matter can get stuck in diverticuli, causing excessive pressure against the walls of the colon. In _______, the pouches are inflamed. Complications include bleeding, obstruction, fistula, perforation.

diverticulitis

Most nutrients are absorbed in the...

duodenum, jejunum

Malabsorption can occur due to interrupted ________ circulation of bile salts, which prevents the reabsorption of bile in the ileum after being released to emulsify fat in the duodenum. This can be caused by ileal resection, Crohn's disease or drugs that bind/ precipitate bile salts.

enterohepatic

Nutrition diagnosis for diarrhea is usually associated with..

excessive losses inadequate intake

Nutrition intervention for diarrhea includes..

feeding to stimulate the GI tract oral rehydration solutions focus on decreasing motility use of pre- and probiotics

Diverticulitis/osis have historically been associated with low _____ intake, history of constipation, and increased colonic pressure. More recent focus has been on increases in inflammatory response and risk factors such as obesity, sedentary lifestyle, steroids, cigarette smoking, caffeine/ alcohol intake.

fiber

Nutrition assessment for diarrhea should include...

fluid & beverage intake energy and mineral intake medication and herbal supplement use safe food and water availability weight change biochemical data nutrition-focused physical findings past medical history

Nutrition assessment data for constipation should include...

fluid/ beverage intake dietary fiber intake bioactive substance intake beliefs/ attitudes misuse of Rx, esp laxatives activity

Refractory celiac disease is often due to unknown gluten contamination and the presence of a coexisting disease. The nutrition intervention for celiac disease is...

follow a gluten-free diet address secondary lactase deficiency if present

Diabetes, scleroderma and intestinal pseudo-obstruction may cause _______ stasis, making way for malabsorption to occur.

functional

Nutrition therapy for diarrhea includes..

no milk/ milk products grain foods w/ <2g dietary fiber per serving small portions of low fat protein fruits w/ soluble fiber

Protein malabsorption results in reduced serum protein (albumin, prealbumin, transferrin), and then peripheral edema due to reduced ______ pressure.

oncotic

Nutrition therapy for ______ includes small bites & chew thoroughly, eat meal/ snack at the same time each day, eating the largest meal in the middle of the day, avoiding spicy or fried foods, avoiding foods that may cause odors, sources of soluble fiber, enough fluid each day, and no drinking from straws, smoking, chewing gum or tobacco.

ostomies

When fat is malabsorbed, fat-soluble vitamin absorption is also compromised. There is a potential for excess ______. Symptoms include abd pain, cramping, diarrhea. Diagnostic tests include fecal fat test, D-xylose and Shillings test, small bowel x-ray

oxalate

The acute phase of SBS is the 3 weeks following surgery, there will be extensive fluid & electrolyte losses w/in large volumes of diarrhea related to hypersecretion. At this time, patients are dependent on _______ nutrition.

parenteral

Malabsorption can be traced to inadequate digestion. Several things may cause inadequate digestion, such as...

postgastrectomy deficiency or inactivation of pancreatic lipase exocrine pancreatic insufficiency Gastrinoma-acid inactivation of lipase

Protein malabsorption is commonly referred to as _____-_____ ______________. This is often due to a lack of pancreatic proteases or damage to the intestinal lining.

protein-losing enteropathy

_____ _____ ______ results from a large resection of small intestine. An extensive loss of surface area of the small intestine and colon results in malabsorption of nutrients, fluids and electrolytes.

short bowel syndrome

Nutrition assessment for malabsorption includes weight change, dietary intake of macro- and micronutrients, fluid status, malnutrition, and description of _______.

stool

The treatment and assessment for IBS is guided by_______. Solutions include antidiarrheal agents, antispasmotics, tricyclic antidepressants, bulking agents/ laxatives, agonists or antagonists, CBT.

symptoms

Clinical manifestations of Crohn's disease include...

weight loss, muscle wasting, malnutrition