Celiac, IBS, IBD, Ostomy Care Flashcards
What are nutrients of concern for malabsorption in Celiac Disease?
Iron
Folate
Calcium
Vitamin D
Fat
Fat soluble vitamins
What are typical and atypical symptoms of celiac?
Typical:
Anorexia
Abdominal pain
Abdominal Distension
Diarrhea
Vomiting
Gas
Weight loss or Failure to thrive in infants
Atypical:
Iron deficiency, headache, tremors, fatigue, constipation
What are the Non-GI manifestations of celiac?
Hepatitis
Arthritis
Epilepsy
Poor bone health
Brain fog
Poor dentition
Can you eat oats on a gluten free diet? What are the recommendations?
Oats can be contaminated with gluten and require a gluten free label to be safe for the patient.
Avinin can still cause an autoimmune response with some people and it is recommended to avoid oats for the first 6 months of a gluten free diet (At this time disease should be considered stable)
Must not exceed 50g to 70g daily for adults and
20g to 25g daily for children
What is a skin condition they may develop in Celiacs?
Dermatitis herpetiformis - terrible itchy skin and pruritis all year round
What are the macronutrient concerns for a gluten free diet?
Products tend to be higher in saturated fats and total sugar while they have a lower fiber content
Why would folate be a concern after a patient adheres to a gluten free diet?
Gluten free products are not required to be enriched like regular flours are.
What are some supplements to consider for celiacs?
Iron should be based on individual cases - will only need it short term because once the gut heals, absorption should return
Calcium and Vitamin D
For adults: 1000mg Ca and 1000IU D
For Children: 500mg calcium and 1000IU Vitamin D
Fiber such as Metamucil
What is irritable bowel disease or syndrome?
A chronic disorder characterized by abdominal pain or discomfort associated with disordered defecation. Symptoms should have developed at least 6 months before the patient appears for formal evaluation
What is the first criteria for IBS Diagnosis?
Abdominal discomfort or pain at least 3 days per month for 3 months and should be associated with 2 or more of the following at least 25% of the time:
Improvement with defecation
Onset associated with change in stool frequency of stool
Onset associated with a change in form (appearance) of stool
What is the second diagnostic criteria for Irritable Bowel Syndrome?
No evidence of inflammatory, anatomic, metabolic or neoplastic process that explains the patient’s symptoms
What lifestyle changes can a patient with Irritable Bowel Syndrome make?
Elimination of identified irritants
Stress management
Small, frequent meals
Relaxed eating environment
FODMAPS diet
Fibre therapy - slowly and gradually increase fibre supplements but this may work for one person and not the other
What are FODMAPs?
Group of short chain CHO that are:
Rapidly absorbed in the SI
Rapidly fermented by colonic bacteria
Increase water delivery into the bowel due to their high osmolarity
What are the two subtypes of Inflammatory Bowel Disease?
Crohn’s Disease and Ulcerative Colitis
What is the pathophysiology for Ulcerative Colitis?
Mucosal Inflammation and Continuous lesions
These occur in the colon and rectum only
What is the pathophysiology for Crohn’s Disease?
Transmural Inflammation and skip lesions at any site of the GI tract (nose and mouth all the way to the anus)
What are the complications associated with Ulcerative Colitis?
Toxic Megacolon - a full blown obstruction and breaking down of the colon which then becomes necrotic
Weight loss
Malnutrition
Colon Cancer
What is the most common first presentation for Crohn’s Disease?
Ileal Crohn’s
What are complications of Crohn’s Disease?
Fistula - an abnormal passageway between two body parts which can result in drainage into other cavities
Obstruction
Stricture - narrowing of colon
Toxic Megacolon
Weight loss
malnutrition
Colon Cancer
What contributes to malnutrition in IBD?
Inadequate Intake - due to anorexia, nausea, vomiting, dietary restriction
Decreased Absorption - due to decreased absorptive capacity, inflammation, resections, strictures, fistulas
Excessive Losses - due to diarrhea, blood, protein losing enteropathy, bile salts
Increased Requirements - due to inflammation, surgery, infection, fever, repletion of stores
What are the drug nutrient effects of malnutrition when treating IBD?
Corticosteroids can increase the requirement for protein, vitamin B6, vitamin D, zinc and can result in poor bone health
Sulfasalazine - an NSAID is a folic acid inhibitor
Cholestyramine - reduces absorption of fat soluble vitamins
What deficiencies can result from a >100cm Ileum resection?
bile salt depletion
severe steatorrhea
fat soluble vitamin deficiency
hypomagnesemia and hypocalcemia
B12 deficiency
fluid and electrolyte imbalance