RD Exam: MNT Domain II
Dumping syndrome correct answers GI Disorder
Food is dumped into small intestine
a. Follows a gastrectomy (Billroth I, II [surgeries])
b. Cramps, rapid pulse, weakness, perspiration, dizziness
c. When rapidly hydrolyzed carbohydrate enters the jejunum, water is drawn in to
achieve osmotic balance. This causes a rapid decrease in the vascular fluid
compartment and a decrease in peripheral vascular resistance. Blood pressure drops
and signs of cardiac insufficiency appear. About two hours later the CHO is digested
and absorbed rapidly. Blood sugar rises, stimulating an overproduction of insulin,
causing a drop in blood sugar below fasting. THIS IS REACTIVE OR ALIMENTARY
HYPOGLYCEMIA
d. gastric surgery
Billroth I correct answers Gastroduodenostomy
Attaches the remaining stomach to the duodenum
Billroth II correct answers GASTROJEJUNOSTOMY
ATTACHES TO THE JEJUNUM.
When food bypasses the duodenum, the secretion of secretin and pancreozymin by the
duodenum is reduced. These hormones normally stimulate the pancreas, so there is
now little pancreatic secretion. CALCIUM (MOST RAPID ABSORPTION IN
DUODENUM) AND IRON ABSORPTION (REQUIRES ACID) ARE ADVERSELY
AFFECTED
More serious than Billroth I
Anemia caused by Billroth II correct answers B12 deficiency - LACK OF INTRINSIC
FACTOR and bacterial overgrowth in loop of intestine being bypassed interfere with
B12 absorption (PERNICIOUS ANEMIA DIAGNOSED USING THE SCHILLING TEST)
Folate deficiency - NEEDS B12 for transport inside the cell; also from poor folate intake
and low serum iron (cofactor in folate metabolism)
Schilling test look for intrinsic factor
Billroth Feedings correct answers Frequent, small, DRY FEEDINGS, fluids before or
after meals (to slow passage), restrict hypertonic concentrated sweets, give 50-60%
complex CHO, protein at each meal, moderate fat, B12 injections may be needed.
Lactose may be poorly tolerated due to rapid transport.
,Gastroparesis correct answers GI Disorder
a. Delayed gastric emptying: surgery, diabetes, viral infections, obstructions
b. Moderate to severe hyperglycemia: detrimental effects on gastric nerves
c. Prokinetics (erythromycin, metoclopramide) increase stomach contractility
d. Small, frequent meals; pureed foods, avoid high fiber, avoid high fat (liquid fat may be
better tolerated)
---good source of fat cals in gastroparesis = oil
e. Bezoar formation may be due to undigested food or medications; treatment includes
enzyme or endoscopic therapy
Tropical Sprue (bacterial, viral, parasitic infection) correct answers GI Disorder
a. Chronic GI disease, intestinal lesions, may also affect stomach
b. Diarrhea, malnutrition, deficiencies of B12 and folate due to decreased HCL and
intrinsic factor
c. Antibiotics, high calories, high protein, IM B12 and oral folate supplements
Non-tropical Sprue, Celiac Disease, Gluten-induced Enteropathy correct answers GI
Disorder
a. Gluten refers to storage proteins (prolamins: gliadin in wheat, secalin in rye, hordein
in barley, avenin in oats)
b. REACTION TO GLIADIN - AFFECTS JEJUNUM AND ILEUM (PROXIMAL
INTESTINE)
c. Malabsorption (leads to loss of fat-soluble vitamins), macrocytic anemia, weight loss,
diarrhea, steatorrhea, iron deficiency anemia
d. NEED (GLIADIN FREE) GLUTEN-RESTRICTED DIET: NO WHEAT, RYE, OATS (IF
HARVESTED AND MILLED WITH WHEAT), BARLEY, (BUCKWHEAT MAY BE
CONTAMINATED WITH W.R.O.B); NO BRAN, GRAHAM, MALT, BULGUR,
COUSCOUS, DURUM, ORZO, THICKENING AGENTS
e. OK: corn, potato, rice, soybean, tapioca, arrowroot, carob bean, guar gum, flax
Constipation correct answers GI Disorder
a. Sometimes due to an atonic colon (weakened muscles)
b. High fluid, high fiber diet, exercise
Diverticulosis correct answers GI Disorder
the presence of diverticula - small mucosal sacs that protrude through the intestinal wall
due to structural weakness. Related to constipation and lifelong intra-colonic pressures
(1) High fiber diet - increases volume and weight of residue, provides rapid transit
Diverticulitis correct answers GI Disorder
, when diverticula become inflamed as a result of food and residue accumulation and
bacterial action
(1) Clear liquids, low-residue or elemental, gradual return to high fiber
Fiber correct answers Provides indigestible bulk, promotes intestinal function
(1) Dietary fiber: nondigestible CHOs and lignin, binds water, increases fecal bulk; found
in legumes, wheat bran, fruits, vegetables, whole grains
(2) Oat bran and soluble fibers decrease serum cholesterol by binding bile acids
converting more cholesterol into bile
(3) Soluble fibers (pectins, gums) delay gastric emptying, absorb water, form soft gels in
small intestine; this slows passage and delays or inhibits absorption of glucose and
cholesterol; fruits, vegetables, legumes, oats, barley, carrots, apples, citrus fruits,
strawberries, bananas
(4) Adequate Intake 38 g males, 25 g females per day recommended
(5) A high fiber diet may increase the need for Ca, Mg, P, Cu, Se, Zn, Fe
(6) A low fiber diet may lead to constipation
Gastritis correct answers GI Disorder
Inflammation of stomach; anorexia, nausea, vomiting, diarrhea
Diet: clear liquids, advance as tolerated, avoid gastric irritants
Inflammatory Bowel Disease (IBD) correct answers GI Disorder
Regional enteritis (Crohn's disease)
(1) affects TERMINAL ILEUM; weight loss, anorexia, diarrhea
(2) B12 DEFICIENCY leads to megaloblastic anemia
(3) iron deficiency anemia due to blood loss, decreased absorption
CHRONIC ULCERATIVE COLITIS (UC)
(1) Ulcerative disease of the COLON, BEGINS IN RECTUM
(2) CHRONIC BLOODY DIARRHEA, weight loss, anorexia, ELECTROLYTE (Na, K)
DISTURBANCE, dehydration, anemia, fever, negative nitrogen balance
TREATMENT
(1) MAINTAIN FLUID AND ELECTROLYTE BALANCE; antidiarrheal agent
(sulfasalazine)
(2) acute Crohn's flare-ups, bowel rest, parenteral nutrition or minimal residue
(3) acute UC, elemental diet may be needed to minimize fecal volume
(4) energy needs according to current BMI, LIMIT FAT ONLY IF STEATORRHEA IS
PRESENT; water soluble and fat soluble vitamins; iron, folate; assess Ca, Mg, Zn; MCT
oil, watch lactose, frequent feedings. HIGH FAT MAY IMPROVE ENERGY BALANCE
(5) When IBD is in remission/under control, high fiber to stimulate peristalsis
