Exam 2 - Lower GI Flashcards
What are some recommendation to decrease gas?
- eat slowly and chew with mouth closed
- avoid chewing gum
- avoid using straws
- limit: beans, legumes, dairy, high fiber fruits, carbonated drinks, spicy foods
Causes of constripation and MNT?
- causes: low fiber, low fluid intake, iron/calcium supplements, lack of exercise, laxative abuse, postponing urge to deficate, some diseases
- medical management: stool softeners, osmotic agents, stimulant laxatives, lubiprostone
- MNT: adequate soluble and insoluble fiber, 14g per 1000 kcals (25 g for women, 38 g for men)
What is the leading cause of nosocomial diarrhea in the US?
C diff
- best treatment is Fecal microbiota transplantation
MNT for diarrhea?
- Fluid and electrolyte replacement: oral glucose electrolyte solutions w/ K, soups, and broths, vegetable juices, isotonic liquids
- Treat the underlying cause; diarrhea is a symptom
- introduce starchy CHO’s, low fat meats, small amounts of vegetables and fruits, followed by lipids
- avoid sugar alcohols, lactose, fructose
- prebiotics and probiotics
MNT for obstructions of strictures?
GI surgeries, gastroparesis, hernias, metastatic cancer
MNT depents on area of blockage:
* fluid resiscitation
* possible low fiber
* possible liquie
* EN beyond point of obstruction
What is celiacs disease?
Autoimmune disorder that causes and adverse reaction to gluten
- GI symptoms: diarrhea, steatorrhea, malodorous stools, bloating
- intestinal mucosa damaged causes: malabsorption of nutrients, iron deficiency, osteomalacia, growth failure in kids
MNT for celiacs disease?
- Omit sources of gluten: wheat, rye, barley.
- Label reading is critical.
- Use uncontaminated corn, potato, rice, soybean, tapioca, arrowroot, amaranth, quinoa, millet, and buckwheat.
- Oats are questionable.
- Cross-contamination must be considered.
- Assess pt for nutrient deficiencies
What is lactose intolerance and what is the treatment?
- Causes: genetic or secondary deficiency of milk sugar enzyme, lactase
- Diagnosis: history, lactose tolerance test or breath hydrogen test
- Treatment: avoid large amounts of lactose, individual tolerance, foods made with lactase enzyme; processed dairy sometimes tolerated
What is the treatment of fructose malabsorption?
- FODMAP restriction promising
- Should limit consumption of free fructose:
Pears, apple, mangos, dried fruits, fruit juices, High fructose corn syrup (HFCS)
What diseases are included under Inflammatory Bowel Disease?
- Crohn’s disease or ulcerative colitis
- Both cause diarrhea, fever, weight loss, anemia, food intolerances, malnutrition, growth failure, and extraintestinal manifestations (arthritic, dermatologic, and hepatic); associated with malignancy
What are the differences between crohns disease and ulcerative colitis?
- Crohns is called a skipping disease, and can present anywhere from the mouth to anus - Could be presenting in multiple places at once
- Rectum might not be involved in crohns
- Ulcerative colitis starts in the anus and works it’s way up
- Malabsorptive issues seen in both
Crohns disease
- Presentation perianal disease, abdominal pain, mass in abdomen
- Rectum may not be involved
- Can occur anywhere along the GI tract
- Not continuous
- Thick wall, cobblestone appearance
- More inflammation
- Complications – malabsorption, cancer, strictures or fistulas, perianal disease
Ulcerative colitis
- Presentation bloody diarrhea
- Rectum always involved, moves continuously from rectum
- Thin walls, few strictures
- Low inflammation
- Deep ulcers
- Complications include toxic megacolon, cancer, strictures and fistulas rare
MNT of IBD
(Crohns and ulcerative colitis)
- Goal is to restore and maintain nutritional status.
- Nutrition support with parenteral or enteral nutrition to bring clinical remission.
- EN may lessen inflammatory response.
- Children benefit from enteral nutrition to maintain growth and reduce steroid dependence.
- Folate, vitamin B6, and vitamin B12 and iron may need supplementation.
- Watch calcium and Vit D with long term steroids
- Omega 3 supplements reduce disease activity and have a medication-sparing effect
- Probiotics helpful for UC patients, not in Crohn’s
- Address individualized food intolerances
- MCTs if fat malabsorption
Irritable bowel syndrome (IBS)
Abdominal pain or discomfort at least three days per month in the last three months with onset at least six months before diagnosis
* IBS-D – diarrhea predominant
* IBS-C – constipation predominant
* IBS-M – mixed diarrhea & constipation
pretty easy to meet criteria
