Gastro Flashcards

1
Q

Irritable Bowel Syndrome (IBS)

A

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.

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2
Q

FODMAPs

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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.

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3
Q

Diverticular Disease

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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.

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4
Q

Constipation

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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.

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5
Q

First-Line IBS Dietary Advice

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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).

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6
Q

Fibre Overview

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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.

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7
Q

Toileting Habits for Constipation

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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.

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8
Q

Treatment Options for Constipation

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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.

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9
Q

High-Fiber Food Examples

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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).

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10
Q

Diverticulosis Recommendations

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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.

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11
Q

Definition of IBD

A

Chronic inflammatory condition including Crohn’s Disease (CD) and Ulcerative Colitis (UC).

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12
Q

IBD Nutritional Requirements

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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.

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13
Q

Nutritional Strategies for Active IBD

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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.

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14
Q

IBD Micronutrient Management

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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.

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15
Q

IBD Dietary Patterns & Prevention

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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.

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16
Q

EN & PN in IBD

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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.

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17
Q

IBD Post Surgical Nutrition

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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.

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18
Q

IBD Management During Remission

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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.

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19
Q

Osteoporosis risk in IBD

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Common in IBD; ensure regular DEXA scans and supplement with calcium and vitamin D.

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20
Q

Dehydration Management in IBD

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Critical in patients with high-output stomas or severe diarrhea; consider tailored oral rehydration solutions.

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21
Q

IBD General Overview

A

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.

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22
Q

IBD Nutritional Status Considerations

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Risk of malnutrition, growth retardation (children), and osteoporosis (prolonged steroid use).

Micronutrient deficiencies: iron, B12, vitamin C, vitamin D, calcium, fat-soluble vitamins, zinc, folate.

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23
Q

IBD Dietary Modification Considerations

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CD: Low-fat, low-fiber diets during active disease (LOFLEX protocol).

UC: Avoid specific food triggers; balanced diet.

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24
Q

Dietary management in active IBD

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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.

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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.
26
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.
27
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.
28
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.
29
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.
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LOWFLEX protocol
Low fat, fibre limited exclusive diet Initial low-fat (50g/day), low-fiber (10g/day) diet for 2–4 weeks. Gradual reintroduction of foods to identify triggers.
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IBD Nutritional Management in Special Situations
Acute Phase: Modified fibre, low lactose, vitamin and mineral supplements, PN if needed. Long-Term: General healthy eating guidelines, individualized to maintain remission.
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Additional IBD considerations
Hydration: Adequate fluids for patients with diarrhea or stomas. Fat Malabsorption: Assess and treat as needed. Prolonged Steroid Use: Manage associated risks like osteoporosis and micronutrient depletion.
33
Steroid Use in IBD
Purpose: Steroids (e.g., prednisone, budesonide) manage acute IBD flare-ups by reducing inflammation. Common Side Effects: Arise with high doses or prolonged use.
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Short-term side effects of steroids
Increased Appetite & Weight Gain: Fat deposition in the face, neck, and abdomen. Mood Swings: Anxiety, irritability, or mood disorders. Insomnia: Difficulty falling or staying asleep. Increased Blood Sugar: Higher risk in pre-diabetic or diabetic individuals. Fluid Retention & Swelling: Sodium and water retention causing swelling in extremities and face.
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Long-term side effects of steroids
Osteoporosis: Weakening of bones; higher fracture risk. Cataracts: Vision problems from prolonged use. Skin Changes: Fragile, thin skin prone to bruising. Muscle Weakness: Reduced muscle mass and strength. Suppressed Immunity: Increased infection risk. Growth Retardation (Children): Potential impact on growth and development. Adrenal Gland Suppression: Reduced cortisol production, leading to insufficiency when steroids are tapered off.
36
Steroid impact on nutrient malabsorption
Calcium: Reduced absorption and increased excretion → osteoporosis risk. Potassium: Increased urinary loss → hypokalemia. Sodium: Retention → high blood pressure, electrolyte imbalances. Protein: Increased breakdown → muscle wasting. Vitamin C: Reduced absorption → decreased antioxidant levels. Vitamin D: Impaired metabolism → reduced calcium utilization and bone health.
37
Steroid Use Management Strategies in IBD
Lowest Effective Dose: Use steroids at the minimum effective dose and duration. Nutritional Support: - Supplement calcium, vitamin D, and potassium as needed. - Include high-protein foods to offset muscle breakdown. - Monitor nutrient levels (e.g., vitamin C, protein, and electrolytes). Alternative Therapies: Consider non-steroidal medications to reduce reliance on steroids.
38
Definition of eosinophilic oesophagitis
Allergic condition causing inflammation in the esophagus, leading to impaired contraction.
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Prevalence of eosinophilic oesophagitis
More common in men than women.
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Dietary management of eosinophilic oesophagitis
6-food elimination diet: Avoid animal milk, wheat, egg, soy, nuts, fish, and shellfish. 2-food elimination diet: Focus on eliminating milk and wheat first.
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GORD definition
Reflux occurring more than twice a week due to an incompetent esophageal sphincter.
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Medical management of GORD
Antacids: Gaviscon. Prokinetics: Promote stomach emptying. PPIs: Omeprazole (take 30-60 minutes before meals). H-2 Receptor Blockers: Reduce acid production. Some medications can worsen symptoms.
43
Surgical management of GORD
Laparoscopic Nissen Fundoplication
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MNT of GORD
Aim for BMI ≤ 25; a BMI reduction of 3.5 can reduce symptoms by 40%. Avoid alcohol, caffeine, fatty foods, acidic/creamy/fizzy foods, and peppermint tea. Sit upright after meals; avoid drinking with meals. Stop gum chewing.
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Complications associated with GORD
Barrett's esophagus, dysphagia, ulceration, odynophagia, otitis media, chest pain.
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Causes of GORD
Overweight, age, genetics, pregnancy, trauma, hiatus hernia.
47
Overview of absorption in the GI tracts (stomach -> lower GI)
Stomach: Intrinsic factor binds to B12; pancreatic enzymes released. Small Intestine: Jejunum: Absorbs CHO, protein, water-soluble vitamins. Ileum: Primary site for bile salt and B12 absorption. Lower GI Tract: Absorbs water, vitamin K, Na, K, and SCFA.
48
Normal stoma outputs (ileostomy & colostomy)
Normal output: 600–1000 ml/day, toothpaste consistency. Colostomy: Normal output: 300–400 ml/day, semi-solid stool.
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Definition & causes of high output stomas
Defined as 1500–2000 ml/day. Causes: Inflammation, infection, SIBO, obstruction, bile salt malabsorption, medications.
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High stoma output management
ORS (Oral Rehydration Solution) with high salt diet. Starch CHO to thicken output. Low fiber intake.
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Oral rehydration solution recipe
St Mark's solution: 3.5 g salt. 2.5 g sodium bicarbonate. 20 g glucose. 1L water or 2 sachets of Dioralyte.
52
What is the definition of short bowel syndrome?
A disorder causing malabsorption, diarrhea, steatorrhea, fluid/electrolyte disturbances, and malnutrition due to inadequate functional bowel.
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What length of bowel is considered high risk for short bowel syndrome?
<200cm of bowel
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What is the most common cause of short bowel syndrome?
Crohn's disease
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What is the normal Na+ concentration in the bowel?
~90–120 mmol
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What should the sodium concentration in oral rehydration solutions (ORS) for short bowel syndrome be?
90–120 mmol, with CHO concentration ~60 mmol.
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What type of enteral feeds are recommended for short bowel syndrome?
Isotonic feeds with an osmolarity of 300–500 osm/kg.
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Why should elemental feeds be avoided in short bowel syndrome?
They are hypertonic and can exacerbate symptoms.
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When is parenteral nutrition (PN) not required in short bowel syndrome?
If the ileum is intact and large portions of the jejunum remain functional.
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What is the minimum bowel length needed to avoid PN in patients without a colon?
At least 100 cm of bowel.
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Which medication is used to decrease stomach acid in short bowel syndrome?
Proton pump inhibitors (PPIs), such as omeprazole.
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Which medication can be used as an antimotility agent in short bowel syndrome?
Codeine phosphate.
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What supplements are necessary in short bowel syndrome due to malabsorption in the ileum?
Vitamin B12 and bile salts.
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What is the gold standard diagnostic test for coeliac disease?
Small bowel biopsy
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How is lactose intolerance diagnosed?
Hydrogen breath test
66
How is IBS diagnosed?
Based on symptom criteria and excluding other conditions
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What diagnostic tools are used for ulcerative colitis?
Blood tests, endoscopy, stool tests, scans, colonoscopy
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What tests are used to diagnose Crohn's disease?
Faecal calprotectin, MRI, CT scan
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How is diverticular disease diagnosed?
Colonoscopy, CT, X-ray, barium enema
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Which tests are used to diagnose GORD?
Endoscopy, 24hr pH monitoring, oesophageal manometry
71
What are the diagnostic tests for peptic ulcer disease?
Endoscopy & H. Pylori testing (breath or stool)
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How can faecal calprotectin be used in differentiating between IBS & IBD?
Detects inflammation = present in IBD, not IBS
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What are other inflammatory markers used in GI diagnostics?
Erythrocyte sedimentation rate (ESR) & CRP