Therapeutic nutrition exam 2

Please match the G.I. hormone with the site of release, stimulant of release and the organ affected.

Gastrin: Antral mucosa of stomach, duodenum and jejunum; polypeptides, amino acids, caffeine, alcohol and distention (stretch) of the stomach; esophagus, stomach, gallbladder, and the pancreas. Secretion: Duodenal mucosa; stomach acidity; esophagus, stomach, duodenum, pancreas and the liver. GIP: Small intestine; glucose and fat; the stomach and the pancreas. CCK-PZ ("CCK"): Dudenal mucosa; amino acids and HCL; small intestine, pancreas, and the gall bladder.

Please match the (common) G.I. disorder/disease with its correct description/Sx, and nutritional Tx/Rx

IBS: Is an intestinal disorder of unknown cause that affects the functioning of the lower bowel; this poorly understood condition causes abdominal pain altered bowel habits (such as diarrhea or constipation) and cramps; the cause(s) remain a mystery GERD: Occurs when the lower esophageal sphincter (LES) (aka: the cardiac sphincter) is weak or relaxes inappropriately allowing the stomachs contents to flow back into the esophagus; avoid foods and beverages that can weaken the LES Diverticulitis: This condition is thought to afflict about 50% to 65% of all people over the age of 80; appears to be a function of diet chronically devoid of fiber; appears as small pouches ("pebble-sized herniations") that bulge outward through weak spots; increasing the amount of fiber in the diet may reduce the Sx. Colon Cancer: non of these answers are correct Dyspepsia: chronic pain, bloating, or bloating in the upper abdomen Constipation: none of these answers are correct Crohn's Disease: none of the choices are correct Celiac Disease: may effect about 1% of individuals in the us

Which of the statements listed below regarding the accessory structures of the G.I. tract (i.e., those structures directly articulated with the G.I. tract) is/are inclusive and correct?

a. Salivary glands (located in the esophagus) produce saliva which contains salivary amylase; this substance begins starch digestion. b. Lingual glands (located in the tongue) produce lingual lipase. This substance initiates (solid) lipid digestion. c. Gastric glands (found in the stomach) produce gastric juice; this contains HCL and pepsins which "uncoil" protein molecules. d. Bile is produced by the liver and stored in the gall bladder; the gall bladder may empty up to 1/4 cup (500 ml) of bile per day. e. The pancreas releases pancreatic juice; this contains pancreatic amylase and a form of lipase which helps to digest starch and lipids. f. Brunner's glands (located in the ileum) produce a thick mucus that helps to buffer the acidic chyme. g. The vermiform appendix (found attached to the cecum) assists with the digestion of lipids. Answer: Only "c", "d", and "e" are correct statements.

Which of the statements concerning the physical properties of the G.I. tract are TRUE?

a. The stomach is roughly the size of one's fist flattened out. b. The typical length of the esophagus ranges between 10 and 12 inches. c. The average length of the large intestine (excluding the cecum) is about 5 feet. d. The average length of the jejunum and ileum combined is about 12 feet. Answer: "a", "b", and "d" are all true statements

Concerning water intoxication, which of the following statements are correct?

a. The term refers to a rare condition in which body water contents are too high in all body fluid compartments. b. Excessive water ingestion and kidney disorders that reduce urine production can cause this condition. c. Symptoms of water intoxication include: confusion and convulsions. d. Hyponatremia can be avoided by limiting fluid intake during times of heavy sweating to between 1 and 1.5 liters per hour. Answer: "a", "b", "c" and "d" are all correct

Carbohydrates are compounds composed of carbon, oxygen, and hydrogen, and are arranged as monosaccharides or multiples of monosaccharides. They all share a common formula of C(n)-- H(2n)--O(n), and all form six sided ring structures.

false

Cellulose, hemicelluloses, lignins, gums, psyllium and pectin: 1) are all considered to be soluble fibers; 2) in general, all function to delay stomach emptying and transit of chyme through intestine; 3) delay glucose absorption; 4) may lower blood cholesterol; 5) as a whole, they are most abundant in wheat bran, whole-grain breads and cereals.

false

Concerning the remaining correct sequence of events in Mechanism #2 is: angiotensin I is converted in the kidneys into angiotensin II --> angiotensin II targets the adrenal glands triggering the release of aldosterone.

false

Enteral nutrition refers to "the delivery of nutrients using the G.I. tract" (usually refers to the use of tube feedings, or intravenous infusions). While parenteral nutrition refers to the "provision of nutrients that bypass the G.I. tract".

false

Lactose Intolerance is a condition that results from an inability to digest the milk sugar galactose. It is estimated that at least 80% of both Asian Americans and Native Americans suffer from this problem.

false

Nasogastric tube feedings tend to have the highest risk of aspiration in compromised patients, while gastrostomy has the lowest risk of aspiration in compromised patients.

false

Satiety and thirst influence water intake. Both ends of this spectrum appear to be a function of changes sensed by the hypothalamus, mouth, nerves and stomach.

false

The first part of the correct sequence of events in Mechanism #1 is: H2O is lost from the blood --> Na+ concentration decreases in the blood (or extracellular fluid) --> baroreceptors in the hypothalamus respond by shrinking --> this stimulus feeds back on other cells in the hypothalamus to produce renin.

false

The types of enteral formulas include: modular formulas, disease-specific formulas, standard formulas and microfiber formulas.

false

Tube feeding complications are typically categorized as "gastrointestinal", "mechanical", "metabolic", and "hyperparabolic".

false

Water makes up 50-70+% of an adults body weight. It is of a somewhat lower proportion in females, the obese and the elderly, and is mostly located in the extracellular compartment.

false

The neural control of digestion (G.I. activity) is composed of two parts: a local system of neural feedback loops (i.e., the enteric or myenteric nervous system) and an "external" system of nerve fibers from the autonomic nervous system (ANS).

True

There are four layers that make up the small intestine. The order of these (from the outside covering to the inside lumen) is: the tunica serosa, the tunica muscularis (longitudinal muscles, and circular muscles), the tunica submucosa, and the tunica mucosa (villi and microvilli).

True

Which of the statements listed below regarding water losses and dehydration are true?

a. A 1-2% loss of a person's body weight as water will result in thirst, fatigue, weakness, vague discomfort, and loss of appetite. b. The body must excrete a minimum of 500 milliliters of water each day. c. When 5-6% of a person's body weight is lost as water, the results will likely include: difficulty in concentrating, headache, sleepiness and impaired temperature regulation. d. Typically water loss at or beyond 11% of a person's body weight will cause kidney failure. Answer: "a", "c" and "d" are the only true statements

Regarding the balance of water intake and water output, which of the statements below are true?

a. About 60% (or 50.4 oz of 84.0 oz.) of our daily water intake and output comes from beverages and urine respectively. b. Roughly 40% of our daily water intake comes from moist foods and our own metabolic reactions. c. Insensible skin and lung losses and non-exercise induced sweat accounts for about 36% or 30.22 oz. of our daily water loss. d. Metabolism amounts to about 40% or our daily water "gain" of intake Answer: Only "a", "b" and "c" are all true.

Which of the statements listed below regarding carbohydrate "myths", intake, functions, digestion and absorption are true?

a. Carbohydrate intake (in grams) may be calculated by determining 55-65% of an individual's average daily kilocalorie intake and dividing this value by 4.0 kilocalories/gram. b. An alternate approach to calculating carbohydrate intake involves simply multiplying an individual's body weight by 2.2, and adding this value to 4.0. c. Most carbohydrate digestion occurs in the small intestine, while most carbohydrate absorption occurs in the cecum. d. Excess consumption of sucrose appears to cause: cancer, heart disease, hyperactivity in children, and dental caries. e. Functions of carbohydrates include: energy, texture, spare protein spare essential fatty acids. Answer: Only "a" and "e" are correct.

Which of the statements concerning the functions of water in our bodies are correct?

a. It assists in carrying nutrients and waste products throughout the body. b. Water helps to form the structure of large molecules. c. It acts as a lubricant and cushion around joints. d. Aids in the body's temperature regulation. Answer: All of the aforementioned statements are correct

Which of the lists displaying the sequence of structures/segments comprising the lower G.I. tract is inclusive and in the correct anatomical occurrence?

a. Jejunum--Ileum--Cecum--Transverse Colon--Ascending Colon--Rectum--Anus b. Duodenum--Jejunum--Ileum--Cecum--Sigmoid Colon--Rectum--Anus c. Jejunum--Cecum--Transverse Colon--Descending Colon--Rectum--Sigmoid colon--Anus d. Duodenum--Jejunum--Ileum--Cecum--Ascending Colon--Transverse Colon--Sigmoid Colon--Anus Answer: only "a"

Which of the lists displaying the sequence of structures/ segments comprising the upper G.I. Tract is in the correct order of anatomical occurrence

a. Mouth—oral pharynx—epiglottis—esophagus—stomach (fundus, body, pyloric region) b. Mouth—upper esophageal sphincter—esophagus—stomach—(fundus, body, pyloric region) c. Mouth--Upper Esophageal Sphincter--Esophagus--Stomach (pyloric region, body, fundus) d. Mouth --Upper Esophageal Sphincter--Esophagus--Stomach (pyloric region, fundus, body) Answer: none of the above are correct

Which of the following statements concerning absorptive processes (as discussed in class) are TRUE?

a. Passive Diffusion (also known as "Simple Diffusion") is the least complicated of the absorptive processes. It requires no energy expenditure and works by differences in osmotic pressure. It is how water moves into cells. b. Endocytosis is a principal absorptive mechanism in human digestion. It involves a part of the cell membrane moving and surrounding small molecules/particles and engulfs them. c. Facilitated Diffusion (also known as "Active Transport") is an energy using process. It works by "pumping" against a concentration gradient, and is the mechanism used to move fructose into cells. d. Active Transport is an energy using process. It is how glucose and amino acids move into a cell against a concentration gradient. Like facilitated diffusion, it involves the use of a "trans-membrane protein carrier". Answer: Only "a" and "d" are both true statements..

Aldosterone signals the kidneys to retain both salts and water; this process will typically take (and last) hours to days to help restore blood volume.

true

Candidates for tube feedings (Enteral nutrition) include patients: 1) who are at risk of developing protein-energy malnutrition; 2) who have severe swallowing disorders; 3) who have GI obstructions and fistulas: 4) are experiencing mental incapacitation due to confusion, dementia or coma; and 5) who have extremely high nutrient requirements.

true

Concerning the two mechanisms that control water balance in our bodies (as discussed in class), "Mechanism #1" has evolved to "regulate fluid excretion". "Mechanism #2" has evolved to "regulate to blood volume, blood pressure and fluid loss".

true

Exocrine glands are those glands which secret materials out into the digestive tract. While endocrine glands are those which secrete their materials into the blood

true

Fiber classification systems include measures of solubility as well as other methodologies, such as techniques that assess the chemical and physical composition of individual fibers. More recently, another classification system was proposed that would distinguish fibers on the basis of their respective source or origin.

true

Gastrointestinal diseases can be classified as: Upper (from the mouth to the stomach); Lower (from the small intestine to the end of the large intestine); Organic (referring to a disease in which a definite pathological change has taken place); Functional (which refers to a disorder that is sensory, motor, absorptive or secretory in origin); and Structural or Mixed

true

Gastrointestinal tube feeding complications include: diarrhea (due in part to medication intolerance and infection of the G.I. tract). While, mechanical tube feeding complications may involve clogging of feeding tubes, and tubes becoming dislodged after placement.

true

Harmful effects of excessive fiber intake include: the inability to take in enough kcals (energy), diarrhea, and GI tract obstruction.

true

Nasogastric tube feedings are the easiest to insert and confirm placement. They also tend to be the least expensive method. Nasojejunal tubes tend to be the most difficult to insert and confirm placement (there is a high risk of tube migration into the stomach).

true

Standard formulas are provided to individuals who can digest and absorb nutrients without difficulty. These typically contain intact proteins such as whey and soy protein isolates, as well as vegetable oils (e.g., corn oil and palm kernel oil).

true

The remaining portion of the correct sequence of events in Mechanism #1 is: ADH is shuttled down the pituitary stalk to the posterior lobe of the pituitary gland --> the vasopressin then makes its way directly into the blood --> the ADH then acts on the kidneys to cause each to retain H20, hence restoring Na+ concentration in the blood.

true

Transnasal tube feeding does not require surgery or incisions for placement; tubes can be placed by a trained dietitian. While a jejunostomy is the most difficult insertion procedure and the most costly.

true

With regard to Mechanism #2 : angiotensin II targets the smooth muscle surrounding the large blood vessels (this process typically takes about 15-20 minutes to be fully effective); this acute smooth muscle contraction helps to correct the loss in blood pressure

true

With regard to the correct sequence of events in "Mechanism #2" (as discussed in class): H2O is lost from the blood --> blood volume drops --> blood pressure drops --> baroreceptors in the kidneys increase their firing rate --> renin is then released from the kidneys --> once in the blood, renin converts angiotensinogen into angiotensin I.

true