Gastro Flashcards
Irritable Bowel Syndrome (IBS)
Definition: Chronic condition with recurrent abdominal pain and bowel habit changes.
Prevalence: Affects ~30% of Australians.
Symptoms & Triggers: Abdominal pain, bloating, constipation/diarrhea; triggered by stress, food intolerances, certain medications.
Management: Low FODMAP diet (75% effective), high-fiber foods, reduced gas-producing foods, gut-directed hypnotherapy.
FODMAPs
Definition: Poorly absorbed short-chain carbs causing gas and bloating.
Types:
Oligosaccharides: Fructans (wheat, garlic), GOS (legumes).
Disaccharides: Lactose (dairy).
Monosaccharides: XS fructose (fruit, honey).
Polyols: Sugar alcohols (sorbitol, mannitol).
Diet Phases:
Elimination: Avoid high FODMAPs (2-6 weeks).
Reintroduction: Gradually reintroduce foods (6-8 weeks).
Maintenance: Sustainable, less restrictive diet.
Diverticular Disease
Diverticulosis: Formation of pouches in the colon, typically asymptomatic.
Diverticulitis: Inflamed or infected pouches, causing severe pain, fever, nausea, and bowel habit changes.
Treatment:
Diverticulosis: High-fiber diet, fluid intake, probiotics.
Diverticulitis: Low-residue diet during flares; severe cases require antibiotics or surgery.
Constipation
Definition: Infrequent passage of stools with straining or discomfort.
Types:
Primary: Functional (normal or slow transit, pelvic floor dysfunction).
Secondary: Due to medical conditions, medications, or structural issues.
Prevalence: Up to 24%; 80% in elderly.
Dietary Goals: 25-30g fiber/day, adequate hydration, physical activity.
First-Line IBS Dietary Advice
Include: High-fiber foods (whole grains, legumes, fruits, vegetables).
Avoid/Limit: Gas-producing foods (onion, cabbage), lactose, alcohol, artificial sweeteners.
Key Foods to Avoid: Garlic, onion, apples, mushrooms, bread, chickpeas (high FODMAP).
Fibre Overview
Types:
Soluble: Found in oats, beans, and fruit; lowers cholesterol, stabilizes blood sugar.
Insoluble: Found in whole grains, fruit skins, vegetables; promotes regularity.
Resistant Starch: Found in cooled rice, underripe bananas; feeds healthy gut bacteria.
Daily Targets: 25g for women, 30g for men.
Toileting Habits for Constipation
Optimal Timing: After waking or meals when the bowel is most active.
Posture: Knees above hips, feet flat.
Avoid Distractions: Reading or phone use during toileting.
Treatment Options for Constipation
Mild Cases: High-fiber diet, fluid intake, physical activity, trial probiotics.
Severe Cases: Use of fiber supplements, laxatives (bulking agents, stool softeners, stimulants).
Advanced: Colonic transit study, pelvic floor therapy, or medical intervention.
High-Fiber Food Examples
Grains: Wholemeal pasta (7.9g/cup), rolled oats (4.5g/½ cup).
Vegetables: Carrot (6.9g), broccoli (3.8g).
Fruits: Dried apricots (2.5g), apple (2.2g).
Legumes: Kidney beans (6.5g/100g).
Nuts: Almonds (3g/30g).
Diverticulosis Recommendations
Dietary Goals: Gradual fiber increase (25-30g/day) and hydration (35-45 ml/kg/day).
Other Tips: Avoid alcohol/caffeine; don’t restrict nuts/seeds unnecessarily.
Probiotics: Optional, avoid during acute diverticulitis.
Definition of IBD
Chronic inflammatory condition including Crohn’s Disease (CD) and Ulcerative Colitis (UC).
IBD Nutritional Requirements
Energy Needs: Generally 30-35 kcal/kg/day; may increase during active disease due to inflammation.
Protein Needs: Increased during active disease (1.2-1.5 g/kg/day); similar to general population during remission (~1 g/kg/day).
Micronutrient Monitoring: Annual assessment for deficiencies, focusing on iron, vitamin D, zinc, selenium, and vitamin B12.
Nutritional Strategies for Active IBD
Exclusive Enteral Nutrition (EEN): First-line treatment for inducing remission in pediatric CD; alternative for adults with mild to moderate CD who cannot tolerate drugs.
Crohn’s Disease Exclusion Diet (CDED): Effective in combination with partial enteral nutrition, especially in pediatric patients.
Diet Texture: Modified or liquid diets for patients with strictures or intestinal obstruction.
Supplementation: Address deficiencies of calcium, vitamin D, and iron based on active disease and treatment plans.
IBD Micronutrient Management
Iron: Oral iron is preferred in mild anemia and inactive disease. Intravenous iron recommended for severe anemia or active inflammation.
Vitamin D & Calcium: Supplement in corticosteroid use or suspected deficiencies to prevent osteoporosis.
B12 & Folate: Essential after ileocecal resection or methotrexate/sulfasalazine treatment.
Fat-Soluble Vitamins (A, D, E, K): Supplement in cases of fat malabsorption or prolonged disease activity.
IBD Dietary Patterns & Prevention
Dietary Risk Factors: Ultra-processed foods and emulsifiers may increase IBD risk; fiber and omega-3 intake offer protection.
Breastfeeding: Reduces risk of developing IBD.
Dietary Goals: Healthy, balanced diet focusing on fruits, vegetables, whole grains, and lean proteins during remission.
EN & PN in IBD
EN as Supportive Therapy: Used when oral feeding is insufficient; standard polymeric diets are preferred.
PN Indications: Severe malabsorption, short bowel syndrome, or gastrointestinal obstruction.
Administration: Nasogastric or nasoenteric routes preferred; pump feeding is optimal for jejunal feeding.
IBD Post Surgical Nutrition
Assessment: Evaluate nutritional status before and after surgery.
Nutritional Support: Oral nutrition with supplements preferred post-surgery; PN if oral or EN is not feasible.
Micronutrient Focus: Maintain adequate levels of iron, B12, calcium, and vitamins D, A, E, and K.
IBD Management During Remission
Dietary Advice: Maintain a healthy diet and avoid known food triggers.
Nutritional Supplements: Use oral supplements or EN if malnutrition persists.
Lifestyle Considerations: Encourage regular meal patterns and physical activity to maintain nutritional health.
Osteoporosis risk in IBD
Common in IBD; ensure regular DEXA scans and supplement with calcium and vitamin D.
Dehydration Management in IBD
Critical in patients with high-output stomas or severe diarrhea; consider tailored oral rehydration solutions.
IBD General Overview
IBD Types: Crohn’s Disease (CD) and Ulcerative Colitis (UC).
Disease Characteristics:
CD: Inflammation from mouth to anus; affects all bowel layers.
UC: Limited to the mucosal lining of the colon and rectum.
Symptoms: Abdominal pain, diarrhea, malabsorption, weight loss, fatigue, and nutrient deficiencies.
IBD Nutritional Status Considerations
Risk of malnutrition, growth retardation (children), and osteoporosis (prolonged steroid use).
Micronutrient deficiencies: iron, B12, vitamin C, vitamin D, calcium, fat-soluble vitamins, zinc.
IBD Dietary Modification Considerations
CD: Low-fat, low-fiber diets during active disease (LOFLEX protocol).
UC: Avoid specific food triggers; balanced diet.
Dietary management in active IBD
General Guidelines:
High-protein (1.2–1.5 g/kg/day).
Energy needs: 30–35 kcal/kg/day.
Elemental Diet: Pre-digested nutrients, suitable for severe disease but may exacerbate diarrhea due to high osmolarity.
Polymeric Diet: Standard feeds with intact nutrients; fiber contraindicated during active flares.
Exclusive Enteral Nutrition (EEN):
First-line therapy in pediatric CD.
Partial EN with tailored diets for adults with UC or CD.
Nutritional Management During IBD Exacerbations
Goals: Minimise nutrient losses, manage symptoms, and maintain intake.
Interventions:
Oral nutritional supplements (ONS).
Enteral Nutrition (EN) if oral intake is insufficient.
Parenteral Nutrition (PN) for severe malabsorption or bowel dysfunction.
Modified Fiber Diet: Low fiber, low lactose, adequate fluids during diarrhea.
Nutritional Strategies During IBD Remission
Goals: Maintain nutritional status and prevent relapse.
Diet Recommendations:
Healthy, varied diet: focus on fruits, vegetables, whole grains, and lean proteins.
Modified high-energy, high-protein diet if indicated.
Micronutrient monitoring: vitamin D, calcium, iron, zinc.
Exclusive EN: Alternative to steroids in maintaining remission, especially in pediatric CD.
Surgery and Post-Surgical Nutrition in IBD
Surgical Options:
- UC: Total colectomy can be curative.
- CD: Surgery to manage symptoms; not curative.
Nutritional Impact: Ileostomy/colostomy increases fluid loss and reduces absorption.
Dietary Adjustments:
- Avoid high-fibre, odorous foods; manage flatulence and stool frequency.
- Balanced diet and supplementation to maintain nutrition.
IBD Micronutrient Management
Iron & B12: Address anemia and deficiencies due to malabsorption or ileal damage.
Vitamin D & Calcium: Prevent osteoporosis, especially during steroid use.
Fat-Soluble Vitamins (ADEK): Supplement in cases of fat malabsorption.
Zinc & Folate: Supplement to support immune function and repair.
MNT for Paediatric IBD
Focus on Growth: Early intervention with EN to support growth and nutritional status.
CDED (Crohn’s Disease Exclusion Diet):
- Combined with partial EN for achieving remission.
- Gradual reintroduction of foods to identify triggers.
