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