O'Dwyer Final Exam Part II
Chapter 20 and 21 - Enteral Nutrition Support and Parenteral Nutrition, Chapter 19 - Medications, Diet-Drug Interactions, and Herbal Products, Chapter 22 - Metabolic and Respiratory Stress, Chapters 23 & 24- Upper and Lower Gastrointestinal Disorders, Chapters 25-29 Chronic Diseases
Terms in this set (70)
An inability to transfer food from the mouth and pharynx to the esophagus; usually caused by a neurological or muscular disorder. (Symptoms: Inability to initiate swallowing,
Coughing during or after swallowing (due to aspiration), and
An inability to move food through the esophagus; usaually caused by an obstruction or a motility disorder.
(Symptoms:The sensation of food "sticking" in the esophagus after swallowing)
Most common motility disorder, is a degenerative nerve condition affecting the esophagus
Explain how dietary interventions can help with dysphagia management.
The textures of food can be altered to make them easier to swallow:
Define GERD and discuss the complications from GERD. What are the dietary treatments used to manage GERD
Gastroesophageal Reflux Disease; Complications: inflammation (esophagitis), esophageal ulcers, healing and scarring narrows the diameter of the esophagus (esophageal stricture), pulmonary disease, chronic reflux (Barrett's esophagus).
Treatments: Acid-suppressing medication, dietary and lifestyle modifications, medications that suppress gastric acid secretion, proton-pump inhibitors, and histamine-2 receptor blockers.
a feeling of pain, bloating, or discomfort in the upper abdominal area, often called indigestion; a symptom of illness rather than the disease itself.
absence of gastric acid secretions.
abnormally low gastic acid secretions
common condition of the elderly population and results from chronic gastritis, leading to atrophy (tissue death) of the mucosal cells in the stomach.
abnormal passages between organs or tissues that permit the passage of fluids or secretions.
surgery to create an opening (stoma) from an area inside the body to the outside
How do proton pump inhibitors control symptoms of GERD? What long term nutrient deficiencies might these medications cause?
Proton-Pump inhibitors: a class of drugs that inhibit the enzyme that pumps hydrogen ions (protons) into the stomach. Most effective of the antisecretory agents and are used both for rapid healing of the esophagus and as a maintenance treatment.
arising spontaneously or from an obscure or unknown cause
Describe how H. pylori can be beneficial
effects metabolism in such a way as to reduce the risk obesity
Describe how H. pylori can be dangerous to health.
What are the causes, symptoms and treatment of peptic ulcer disease (PUD)?
H.pylori infection. Symptoms: discomfort, hunger pain, a sensation of gnawing, burning pain in the stomach--relieved by food and recur hours after meal. Treatment: combination of antibiotics to eradicate H.pylori infection and/or discontinuing the use of aspirin and other NSAIDS, which irritate gastric mucosa and delay healing.
What is the Bristol stool chart?
A medical aid designed to classify the form of human faeces into seven categories.
Besides poor diet, what are some other causes of constipation?
Low-fiber diet, low food intake, inadequate fluid intake, or low level physical activity, diabetes mellitus, hypothyroidism, some medications.
increase stool weight and aid in formation of soft, bulky stools.
Stimulant (irritant laxatives)
act as local irritants to colonic tissue; stimulate peristalsis and mucosal secretions.
Osmotic laxatives (non absorbable salts)
unabsorbed salts attract and retain water in the large intestine and stimulate contractions.
Osmotic laxatives (irritant laxatives)
unabsorbed sugars attract water to the large intestine and promote softer stools.
Describe the three types of diarrhea.
*Osmotic: due to the ingesting of a substance that is hypertonic, which could also be unabsorbed nutrients.
*Secretory: caused by the inability of the cells lining the intestinal tract to absorb fluid and electrolytes. Bacterial infections and diseases that damage the lining of the GI tract can cause secretory diarrhea.
*Disordered motility: can cause diarrhea because the chyme travels through the intestinal tract at such a fast pace, the cells don't get a chance to absorb it. Then the unabsorbed food can lead to an osmotic diarrhea. Irritable bowel syndrome (IBS) is an example of disordered motility.
Define SIBO, the causes of SIBO, and discuss how SIBO impacts digestive function and integrity.
*Small intestine bacterial overgrowth, AKA bacterial overgrowth-the causes of SIBO include too high of a pH in the stomach (acid lowering drugs or conditions associated with impaired acid secretion), impaired GI motility (IBS and other conditions), damage to the intestinal tract (Crohns or Ulcerative Colitis) or contamination. But also, SIBO can be caused by antibiotic therapy and improper diet.
*It can blunt the absorptive capacity of the microvilli, it can effect motility-leading to either diarrhea or constipation, and even disrupt the tight spaces (called tight junctions) between the cells lining the gut-leading to leaky gut syndrome.
Define and give examples of probiotics and prebiotics
*Probiotics: living microorganisms found in foods that, when consumed in sufficient quantities, are beneficial to health.
*Prebiotics: indigestible substances in foods (such as fibers) that stimulate the growth of nonpathogenic bacteria within the large intestine.
What is gluten and what foods contain gluten?
The protein in wheat (also in rye and barley) that gives bread its chew.
Breads, soy sauce, cream soups, bloody mary drink mix, ketchup.
How does celiac disease affect the intestinal mucosa? What are the possible environmental causes of celiac disease?
In affected areas the absorptive surface appears flattened due to the shortening or absence of villi and overdevelopment of crypts.
Possible environmental causes:
The Hygiene Hypothesis
The 21st century diet
Describe the two types of inflammatory bowel disease. How do they differ from each other?
(1) Chrohn's Disease (CD): Chrohn's disease affects the entire GI tract, from mouth to anus, but generally the small intestine. Skip lesions are a result of Chrohn's disease (healthy segments of the GI tract alternating with inflamed cells). Chrohn's disease can result in significant malabsorption due to the involvement of the small intestine.
(2) Ulcerative Colitis (UC): involves the colon only and inflammation is limited to the mucosa and submucosa layers of the large intestine.
What does "diagnosis of exclusion" mean and what disorder is diagnosed by this method?
Diagnosis of a medical condition reached by a process of elimination. Gluten interolance, IBS.
Describe the difference in diet treatment between diverticulosis and diverticulitis (also, define these conditions).
Diverticulosis: the formation of pouches that herniate from the colon.
Treatment: high fiber foods
Diverticulitis: Diverticulitis is an infection of the diverticula.
Treatment: it is recommended to be on a low residue diet to reduce irritation
Describe the functions of the liver.
It stores nutrients and then ships them off to areas of the body when needed.
It neutralizes toxins and eliminates them through the feces or bile.
The liver metabolizes the monosaccharides- fructose and galactose, into glucose.
Makes fatty acids into triglycerides in a process called lipogenesis.
Manufactures non-essential amino acids from the essential amino acids.
Storage site of many kinds of vitamins and minerals. These include the fat soluble vitamins, vitamin C and B12 as well as iron.
a cell of the main tissue of the liver.
"relating to the liver"
"abnormal fat retention"
enlargement of the liver.
liver inflammation associated with fatty liver.
accumulation of bilirubin; yellow discoloration of the tissues that can be visibly seen-especially in the whites of the eyes
a by-product of hemoglobin degeneration
Describe cirrhosis of the liver and the medical manifestations caused by cirrhosis.
An advanced stage of liver disease in which extensive scarring replaces healthy liver tissue, causing impaired liver function and liver failure.
Manifestations: portal hypertension(rise in blood pressure within portal vein), collaterals and gastroesophagea varices(build from pressure and can rupture), ascites(large accumulation of fluid in abdominal cavity).
What is the most common type of diabetes?
Type 1: The type of diabetes that accounts for 5% to 10% of diabetes cases and usually results from autoimmune destruction of pancreatic beta cells.
**Type 2: The type of diabetes that accounts for 90% to 95% of diabetes cases and usually results from insulin resistance coupled with insufficient insulin secretion.
an immune response directed against the body's own tissues
cells fail to respond to the normal actions of the hormone insulin
abnormally high levels of insulin in the blood
damage to or disease of a kidney
damage to or disease of the retina
damage to or disease of the brain.
Abnormally low concentrations of blood glucose
elevated blood glucose concentrations.
the metabolic products of the incomplete breakdown of fat when glucose is not available in cells.
Polyuria, polydipsia, polyphagia
Polyuria: Excessive urine production
Polydipsia: Excessive thirst
Polyphagia: Excessive appetite or food intake
the presence of glucose in the urine.
the blood concentration of a substance that exceeds the kidneys' capacity for reabsorption, causing the substance to be passed into the urine.
an acidosis (lowering of blood pH) that results from the excessive production of ketones.
The metabolic products of the incomplete breakdown of fat when glucose is not available in the cells.
disorders that affect the large blood vessels, including the coronary arteries and the arteries of the limbs.
disorders that affect the small blood vessels and capillaries, including those in the retina and kidneys.
Peripheral vascular disease
disorders characterized by impaired blood circulation in the limbs.
the presence of albumin (a blood protein) in the urine, a sign of diabetic nephropathy.
Describe the differences between DKA and HHS.
*DKA (diabetic ketoacidosis): occurs in people with type 1 diabetes.
The lack of insulin production, leads to an increase in counter regulatory hormones-like glucagon, epinephrine, and cortisol. Body goes into starvation mode- the counter regulatory hormones start catabolizing fat and protein tissue to produce energy. The liver turns some of the amino acids into glucose through the process of gluconeogenesis, thus driving up the blood glucose levels. The fatty acids are released into the blood stream for energy; however, they need glucose to be properly metabolized through the citric acid cycle. These fatty acids are incompletely broken down into ketone bodies. Result: dehydration and acidosis.
*HHS: occurs in people with type 1 diabetes.
Caused by very high levels of glucose in the blood stream which increases the osmolality of the blood. This causes the body to draw water from all sources in the body to excrete the excessive glucose through the urine (polyuria). Result: dehydration and electrolyte loss
What is atherosclerosis?
Some times called "hardening of the arteries", is the most common form of arteriosclerosis, a more general term for arterial diseases that are characterized by abnormally thickened walls and lost elasticity.
List the common causes of Atherosclerosis and briefly describe the typical progression of the disease.
Begins developing in early childhood or adolescence and progresses over several decades. Arises in response to minimal but chronic injuries that damage the inner arterial wall. The first lesions tend to develop in regions where the arteries branch or bend because the blood flow is disturbed in those areas.
How does oxidized LDL relate to heart disease?
LDL (very-low-density lipoproteins): High levels of LDL can both initiate and worsen atherosclerosis (LDL transport cholesterol in the blood)
Which type of DM is the most prevalent? What is the typical BMI for a large majority of the patients with type 2 DM as compared to type 1? What is the primary defect or cause for each type of diabetes? What cells in the pancreas secrete insulin? What are the treatment/therapies for each type of diabetes (insulin therapy, weight loss, exercise, etc)?
Type 2 is the most prevalent form of DM.
The typical BMI for a large majority of patients with Type 2: overweight to obese
The typical BMI for patients with Type 1: underweight to normal
Type 1 caused by autoimmune destruction of the pancreatic beta cells.
Treatment for Type 1: insulin therapy.
Type 2 is insulin resistance, reduced sensitivity to insulin in muscle, adipose, and liver cells.
Treatment for Type 2: nutrition therapy and exercise->diabetic meds or insulin.
Beta cells secrete insulin.
Describe the functions of the kidneys.
-filtering the blood
-removing excess fluid and wastes for elimination in urine
-regulating blood pressure
-producing the hormone erythropoietin which stimulates the production of red blood cells
-converts vitamin D into its active form.
What are the main causes of chronic kidney disease?
Inflammatory, immunological and hereditary diseases that directly involve the kidneys
Define nephrotic syndrome, proteinuria, anuria, oliguria, hypoalbuminemia.
Nephrotic syndrome: A syndrome associated with kidney disorders that damage the glomerulus and cause urinary protein losses exceeding 3 ½ g/day
Proteinuria: loss of protein, mostly albumin, in the urine; also known as albuminuria
Anuria: The absence of urine; clinically identified as urine output less than 50 mL/day
Oliguria: Abnormally low amount of urine, often less than 400 mL/day
Hypoalbuminemia: Low plasma albumin concentrations
Describe the different types of dialysis.
Hemodialysis: a treatment that removes fluids and wasts from the blood by passing the blood through a dialyzer.
Peritoneal dialysis: a treatment that removes fluids and wastes from the blood by using the body's peritoneal membrane as a filter.
What is the pathophysiology of cancer cell development?
A carcinogen is something that causes or helps cancer grow.
Normal cells actually have many control mechanisms that monitor cellular division, while cancer cells do not abide by these regulations.
Three steps(normal cell to cancer cell): initiation, promotion, progession.
Define angiogenesis and metastasis
Angiogenesis: the formation of new blood cells
Metastasis: the spread of cancer cells from their original site of growth.
What compounds are these fatty acids(omega-3 and omega-6) derived from?
The omega-3 fatty acids, primarily from fish oil- eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)—have the most potent anti-inflammatory activities. The body builds 20 carbon EPA and DHA from alpha-linolenic acid (an omega-3 fatty acid that is 18 carbons in length). Linoleic acid (the omega-6 essential fatty acid) is used to build arachidonic acid (AA). EPA and DHA oppose the actions of AA.
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