Term
| What are the types of GI tract movement? |
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Definition
| Propulsive (peristalsis) and mixing |
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Term
| What are stimuli for peristalsis? |
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Definition
- Stretch stimulus of gut wall (resulting in serotonin release -> smooth muscle contraction)
- Chemical or physical irritation of epithelial gut lining
- Strong parasympathetic stimulation
- Vagal stimulation (in the esophagus and stomach)
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Term
| What is the half emptying time for water or isotonic saline from the stomach? |
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Definition
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Term
| How does an NG tube affect the rate of gastric emptying? |
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Definition
| Rate of gastric emptying is faster with NG tube |
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Term
| What is the rate of gastric emptying in terms of kcal? |
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Definition
| Rate of gastric emptying amounts to about 200 kcal per hour for liquids up to 1 molar concentration |
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Term
| What factors influence the rate of solids emptying from the stomach? |
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Definition
| Meal particle size, calorie content, fat content, osmolality |
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Term
| What is the half empyting time for solids in the stomach? |
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Definition
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Term
| What type of foods are recommended for cancer patients with nausea? |
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Definition
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Term
| What can be done when the tip of an ND tube fails to cross the pylorus? |
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Definition
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Term
| How does placing a feeding tube in the jejunum (bypassing the duodenum) affect gastric emptying time? |
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Definition
| Placing a tube in the jejunum (bypassing the duodenum) may cause a significant decrease in gastric emptying time |
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Term
| What is the normal frequency for bowel movements in developed countries? |
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Definition
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Term
| What is the predominant cause of SBO? |
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Definition
| Intra-abdominal adhesions account for 75% of SBO |
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Term
| What is the appropriate treatment for ileus? |
|
Definition
- NG suction
- Bowel rest
- IVF and lytes
- Minimal use of sedatives
- PN may be required if >7 days bowel rest anticipated
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Term
|
Definition
| Psuedomembranous colitis (PMC) refers to intestinal inflammation accompanied by presence of pseudomembranes on intestinal mucosa. |
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Term
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Definition
| All cases of PMC are related to C diff infection |
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Term
| When is sigmoidoscopy indicated in the context of diarrhea? |
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Definition
| Sigmoidoscopy is indicated with bloody diarrhea or suspected PMC or C diff |
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Term
| What is the recommended diet advancement schedule for diarrhea? |
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Definition
| Initiation with caffeine-free clear liquids. Advancement to low-lactose, low-fiber, low-fat diet. |
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Term
| When is soluble fiber NOT recommended for diarrhea patients? |
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Definition
| Soluble fiber is not recommended when diarrhea is related to hyperosmolar agents or C diff |
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Term
| What are the recommendations for fiber in critically ill patients? |
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Definition
| Insoluble fiber should be avoided in critically ill patients. Hemodynamically unstable patients should not receive any type of fiber. |
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Term
| What is the recommendation for severe or refractory diarrhea? |
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Definition
| Bowel rest until diet can be advanced or TPN can be initiated (7 days) |
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Term
| Are probiotics recommended for in cases of C diff? |
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Definition
| Probiotics may be provided, but evidence base is weak |
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Term
| What are common causes of gastroparesis? |
|
Definition
| Diabetes, surgery, idiopathic |
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Term
| What medications are used for gastroparesis? |
|
Definition
| Prokinetic agents such as metoclopramide and domperidone (also erythromycin) |
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Term
| What is the dietary treatment for gastroparesis? |
|
Definition
- Small, frequent meals
- Drinking fluids with meals
- Limiting fat and fiber
- Maintaining good glucose control
- When necessary, feeding past pylorus
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Term
| What is the recommended dietary treatment for constipation? |
|
Definition
- Gradual increase fiber to 25 to 30 g/day
- Increase fluid to 6 to 8 cups per day
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Term
| What are the disadvantages to using mineral oil for constipation? |
|
Definition
- Binds fat-soluble vitamins
- Can produce lipoid pneumonia if aspirated
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Term
| What anatomical alteration can result in dumping syndrome? |
|
Definition
| Bypass or destruction of pulorus |
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Term
| How are symptoms of dumping syndrome classified? |
|
Definition
| Early (30 to 60 minutes) and late (2 to 3 hours) dumping |
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|
Term
| What medication is sometimes used in patients with severe dumping syndrome or when dietary interventions fail? |
|
Definition
|
|
Term
| What is the dietary treatment for dumping syndrome? |
|
Definition
- Slow introduction of solid food
- Elimination of simple sugars
- Frequent small meals
- No liquids with meals
- Lying down after eating
- Addition of fiber to delay gastric emptying
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Term
| How do caffeine and alcohol affect acid secretion? |
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Definition
| Caffeine and alcohol stimulate acid production |
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Term
| How many mL of gastric secretions are secreted each day? |
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Definition
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|
Term
| What effects does the destruction of parietal cells have? |
|
Definition
- Achlorhydria (absence of acid)
- Pernicious anemia and B12 deficiency due to lack of intrinsic factor
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|
Term
| What condition can cause destruction of parietal cells? |
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Definition
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|
Term
| What condition can result in white stools? |
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Definition
| Biliary obstruction because bile acids (which are responsible for brown color) are prevented from entering colon |
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|
Term
| How much bile is secreted each day? |
|
Definition
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|
Term
| What serum enzyme levels are used to diagnose pancreatitis? |
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Definition
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|
Term
| Are people with lactose intolerance able to tolerate yogurt? |
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Definition
| People with lactose intolerance can often tolerate yogurt because bacteria produce lactase |
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Term
| What substances can the stomach absorb? |
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Definition
| The only substances that the stomach can absorb in appreciable amounts are alcohol and aspirin |
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Term
| How much fluid enters the small intestine daily? How much of that is absorbed? |
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Definition
| 9 liters of fluid enter the SI daily, all but 1.5 L is absorbed |
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Term
| What is the source breakdown of fluid that enters the small intestine? |
|
Definition
| 2L from dietary fluid, 7 L from digestive secretions |
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Term
| What is Hartnup Syndrome? |
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Definition
| A genetic disorder in which neutral amino acids are not absorbed, may present similar pellagra. Notable because it is one of the few diseases that affects protein absorption. |
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Term
| What is the only form of iron that can be absorbed? |
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Definition
| The ferrous form (most dietary sources are ferric and must be converted) |
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Term
| How does bowel rest affect the gut mucosa? |
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Definition
| Complete bowel rest results in gut mucosal atrophy after a few days |
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|
Term
| How does PN affect gut mucosal atrophy? |
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Definition
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|
Term
| What change can be made to PN to reduce atrophic changes during bowel rest? |
|
Definition
| Glutamine supplementation, as it si a principal metabolic fuel for intestinal cells |
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Term
| How does enteral nutrition affect bacterial translocation? |
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Definition
| EN helps to maintain the tight junctions between epithelial cells and reduces the risk of bacteria from the lumen of the gut migrating across gut barriers |
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