MNT UPPER GI QUESTIONS WITH CORRECT ANSWERS |LATEST UPDATE 100%
SOLVED| GRADED A+
PUD Primary Cause -Helicobacter pylori
-80-90% of gastric and duodednal ulcers caused by bacteria not stress
-92% duodenal and 70% gastric ulcers related to H. Pylori
-H. Pylori increases risk of gastric cancer, mucosa-associated lymphoid tissue (MALT) lymphoma
-Diagnosis with endoscopy and tissue biopsy
-Not all people have H. Pylori; 2/3 of world's population do not carry bacteria
-Not all people who have H. Pylori develop ulcers (2-20%) they need to be triggered
-Thought that people become contaminated via food or water
H. Pylori -spiral shapes, flagellated, gram-negative bacteria
-lives under mucus layer of stomach
-attaches to mucus secreting cells that line the stomach
-bacteria break down urea (to ammonia), neutralized acid in the area, therefore increases
survival
-bacteria produce proteins that damage mucosal cells and attract lymphocytes causing
inflammation
-mucus protects stomach from HCl
Other causes of PUD 1. Excessive volumes of food
,-increased fat, increased sugar, increased caeffeine, spices, alcohol
2. Chronic ASA/NSAIDS
3. Cigarette smoking/any type of tobacco
-decreased HCO3 secretion
-impairs antacid function
-decreases LES pressure
4. Alcohol
5. Cancerous or non-cancerous tumors in stomach, small intestine, or pancreas
PUD Treatment Primary treatment: meds
- 3-4 types of medicines available
- 7-14 course of 2 antibiotics with bismuth and a proton-pump inhibitor
-86-98% effective with compliance
-meds cause N/V, abdomen pain so poor compliance (people don't like taking the meds
because they hurt)
-10% discontinue early
PUD Medical Management Meds that promote healing by decreasing acidic environment
,Antacids
Histamine receptor blockers
Proton pump inhibitors
Stomach lining protectors
PUD MNT Goals Support medical treatment
-look at S/S of drugs
--diarrhea consider electrolytes
--bone fracture risk: Ca and Vit D status
--proton pump inhibitors: increase risk B12 deficiency
Maintain/improve nutritional status
-provide a diet that decreases PUD symptoms aka decrease and neutralize gastric acid
secretions
--ID trigger foods for your pt
Elimination diet initially eliminate foods then re-introduce certain foods to see if pt can
tolerate it
PUD Old MNT "Sippy diet"
-restrict irritating foods
, -provide constant buffering foods (milk or cream to coat stomach but dairy foods may have a
protein content that stimulate GI secretions)
Small meals
-to limit gastric stretch and acid secretion
Frequent meals
-provide constant buffering
PUD Current MNT INDIVIDUALIZE
-not all foods affect everyone the same
-foods known to increase acid include black and red pepper, caffeine, coffee including decaf
and EtOH
Limit caeffeine and EtOH
Avoid cigarettes and all tobacco
Eat 3 meals/d, avoid skipping meals
Avoid bed time snacks
-avoid lying down after eating
SOLVED| GRADED A+
PUD Primary Cause -Helicobacter pylori
-80-90% of gastric and duodednal ulcers caused by bacteria not stress
-92% duodenal and 70% gastric ulcers related to H. Pylori
-H. Pylori increases risk of gastric cancer, mucosa-associated lymphoid tissue (MALT) lymphoma
-Diagnosis with endoscopy and tissue biopsy
-Not all people have H. Pylori; 2/3 of world's population do not carry bacteria
-Not all people who have H. Pylori develop ulcers (2-20%) they need to be triggered
-Thought that people become contaminated via food or water
H. Pylori -spiral shapes, flagellated, gram-negative bacteria
-lives under mucus layer of stomach
-attaches to mucus secreting cells that line the stomach
-bacteria break down urea (to ammonia), neutralized acid in the area, therefore increases
survival
-bacteria produce proteins that damage mucosal cells and attract lymphocytes causing
inflammation
-mucus protects stomach from HCl
Other causes of PUD 1. Excessive volumes of food
,-increased fat, increased sugar, increased caeffeine, spices, alcohol
2. Chronic ASA/NSAIDS
3. Cigarette smoking/any type of tobacco
-decreased HCO3 secretion
-impairs antacid function
-decreases LES pressure
4. Alcohol
5. Cancerous or non-cancerous tumors in stomach, small intestine, or pancreas
PUD Treatment Primary treatment: meds
- 3-4 types of medicines available
- 7-14 course of 2 antibiotics with bismuth and a proton-pump inhibitor
-86-98% effective with compliance
-meds cause N/V, abdomen pain so poor compliance (people don't like taking the meds
because they hurt)
-10% discontinue early
PUD Medical Management Meds that promote healing by decreasing acidic environment
,Antacids
Histamine receptor blockers
Proton pump inhibitors
Stomach lining protectors
PUD MNT Goals Support medical treatment
-look at S/S of drugs
--diarrhea consider electrolytes
--bone fracture risk: Ca and Vit D status
--proton pump inhibitors: increase risk B12 deficiency
Maintain/improve nutritional status
-provide a diet that decreases PUD symptoms aka decrease and neutralize gastric acid
secretions
--ID trigger foods for your pt
Elimination diet initially eliminate foods then re-introduce certain foods to see if pt can
tolerate it
PUD Old MNT "Sippy diet"
-restrict irritating foods
, -provide constant buffering foods (milk or cream to coat stomach but dairy foods may have a
protein content that stimulate GI secretions)
Small meals
-to limit gastric stretch and acid secretion
Frequent meals
-provide constant buffering
PUD Current MNT INDIVIDUALIZE
-not all foods affect everyone the same
-foods known to increase acid include black and red pepper, caffeine, coffee including decaf
and EtOH
Limit caeffeine and EtOH
Avoid cigarettes and all tobacco
Eat 3 meals/d, avoid skipping meals
Avoid bed time snacks
-avoid lying down after eating
