Lower GI Flashcards
What is the cause for Celiac disease?
Celiac disease is a genetically inherited autoimmune disease
It is a sensitivity to the proteins forund in grains, wheat, rye and barley called gluten —> this triggers an immune response that causes damage to the lining of the small intestine
That causes malabsorption
What is the MNT for celiac disease?
Complete avoidance of wheat, rye, barley and oats (unless they are certified gluten free)
Complete avoidance of gliadin
Instead use corn, peas, buckwheat, potato, rice, soybeans, etc
What is the MNT for the treatment of diarrhea
For adults - identify and treat the underlying problem
manage fluid and electrolyte replacement using oral glucose electrolyte solutions
Initiate minimum residue diet
Avoid large amounts of sugar and sugar alcohol
Prebiotics and probiotics
Infant - immediately replace fluid and electrolytes
Oral rehydration solitions (pedialyte)
60% of food is still absorbed
Refeeding early is good (banana, rice, potatoes etc)
What are the major causes of diarrhea?
Osmotic diarrhea - osmotically active solute present (simple CHO/PRO) (dumping syndrome)
Secretory diarrhea - active secretion of electrolytes and water by intestinal cells caused by bacterial toxins and viruses (fasting does not help)
Exudative diarrhea - caused by mucosal damage, outpour of mucus, blood, fluid, plasma proteins which leads to an accumulation of electrolytes and water (due to crohn’s disease, radiation or ulcerative colitis)
what is the cause for lactose intolerance?
Deficiency in brush border enzyme lactase –> incomplete digestion of lactose and osmotic pull of water into the gut –> bacterial fermentation of lactose —>SCFA and gas formation –> cramps, bloating, flatulence and diarrhea
can be genetic or secondary (Celiac disease)
It is not an allergy or an autoimmune disease
What is the MNT for lactose intolerance?
Consume only 6-12 g lactose per day Dont consume on an empty stomach Spread out throughout the day Some tolerate in small amounts at room temperature rather than cold Some tolerate chocolate milk better Check labels Substitute - LAct-aid, acidophilus milk or soy milk, almond milk Solid dairy is probably tolerated
How do you diagnose lactose intolerance?
Diagnosed by:
Lactose tolerance test - give 50g lactose –> measure glucose & galactose in blood
Hydrogen breath test - Give lactose –> measure hydrogen in breath (if increased, lactose is not absorbed)
CO2 in breath - give lactose –> measure CO2 in breath (if increased lactose is absorbed and metabolized to CO2,)
Bowel biopsy
What is the MNT for diverticulosis?
Collection of herniations in the colonic wall
Cause not known –> rare in countries with high fiber diet
INcreases with age
High fiber diet (25g women, 38g men) - slowly increase
Adequate fluid important
No data to support restriction of seeds or nuts
What is the MNT for divertivulitis?
Accumulation of fecal matter in the diverticular pockets –> inflammation, obstruction and spesis
During acute flare up –>low residue or elemental diet, TPN if necessary
Follow up with gradual increase of fiber as flare subsides
Low fat diet initially
What is the MNT for treating inflammatory bowel disease?
No special diet has been proven effective for preventing or treating this disease
Some find their symptoms are made worse by milk, alcohol, hot spices, or fiber
People are encouaged to follow a nutritious diet and avoid any foods that seem to worsen symptoms
No consistent rules
Energy increased - if weight loss High protein Vitamin and mineral supplements Small frequent feedings Drink plenty of fluids (8 cups/day) Pre and probiotics Include whole grains, fruits, vegetables Start new foods one at a time in small amounts Omega -3 may help reduce inflammation
In acute flare - parenteral (TPN) or enteral nutrition
Minimal residue diet, if eating
Limit fat and oils to <8 tsp/day, avoid fried fatty foods
What is the MNT for patients who have had their colons removed?
Cooked, shredded or pureed fruits or vegetables are absorbed better then uncooked, whole fruits and vegetables
Some patients should avoid very fibrous vegetables and be advised to chew all foods well to avoid a food bolus getting stuck
Foods that tend to cause odor are legumes, onions, garlic, cabbage, eggs, fish, some medications and some vitamin and mineral supplements
Steatorrhea, partial digestion and bacterial fermentation also cause odor
What are the symptoms for celiac disease?
The symptoms are: weight loss fatigue, weakness frequent bowel movements & flatulence diarrhea, steatorrhea etc.
What are the problems with inflammatory bowel disease?
Diarrhea, wt loss, poor growth and bowel obstruction
What are the symptoms for irritable bowel syndrome?
discomfort after meals, painless diarrhea, chronic constipation, abdominal pain, flatulence, mucus in stool
Causes are unknown
