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DIET507 - Dietetics 1 > Gastrointestinal disease 1 > Flashcards

Gastrointestinal disease 1 Flashcards

1
Q

What organs/ tissues/ glands are involved in digestion?

A

Mouth –> Salivary glands –> Tongue –> Teeth
Oesophagus
Stomach
Liver
Gall bladder –> Common bile duct
Pancreas
Small intestine
Large intestine
Rectum
Anus

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2
Q

What is malabsorption?

A

A generic term used for any illness causing impaired digestion and/or absorption
May be nutrient specific, e.g. lactose, or may impair the absorption of all nutrients, e.g. IBD.

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3
Q

What are the clinical features of malabsorption?

A
  • Diarrhoea
  • Steatorrhea
  • Abdominal distension and flatulence
  • Weight loss and poor appetite
  • Faltering growth in children
  • Micronutrient deficiencies e.g. anaemia
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4
Q

What are some causes of malabsorption?

A

Reduced absorptive capacity
- Crohn’s disease
- Coeliac disease
- Intestinal resection
- Mucosal damage by drugs

Enzyme deficiencies
- Pancreatic insufficiency –> e.g. Cystic fibrosis
- Disaccharidase deficiency (primary alactasia/ secondary lactase deficiency)
- Bile deficiency (obstructive jaundice)

Drugs
- Antibiotics –> loose stools, increased intestinal transit time through gut, less nutrients absorbed
- Laxative
- Cholestyramine –> cholesterol reducing medication can affect gut absorption

Infection
- AIDS
- Gastroenteritis –> inflamed gut, diarrhoea, increase transit time
- Parasitic infection –> competition for nutrients from parasites

pH
- Achlorhydria –> increase stomachs pH so it is less acidic, more chance of getting infections from food eaten. Stomach acid is not killing of many bacteria

Food allergy/ intolerance –> loose stools, increase gut transit time

‘Detox’ products –> diarrhoea

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5
Q

How can you test for fat malabsorption?

A

Faecal fat test
- 70g fat/day for 6 days and stools collected
- Normal = <7g fat excreted per day
- Higher levels indicate malabsorption

Not done in practice –> more for research

Faecal fat microscopy
- Dye added to look for fat
- High amount indicates fat malabsorption

Breath tests

Faecal Elastase-1 test

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6
Q

What is steatorrhea?

A

Fatty stools/ oily residue
Floating stools
Pale/ yellow
Bulky
Loose

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7
Q

What is Faecal Elastase-1?

A

Pancreatic Elastase 1 or faecal elastase 1 is a human specific enzyme. FE-1 is enriched 5-6 fold in the faeces compared with pancreatic juices and can be used as an indicator of pancreatic exocrine function.

Identifies any pancreatic insufficiency
High marker –> poor pancreatic exocrine function

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8
Q

How can you test for carbohydrate malabsorption?

A

Hydrogen breath test
- Hydrogen produced by gut bacteria is unabsorbed disaccharides are present. Hydrogen is absorbed into blood and can be detected on the breath

Mucosal Lactase Assay
- Endoscopic biopsy

Lactose Tolerance Test
- Testing glucose absorption through lactose intake and checking blood glucose levels.
- If blood glucose levels haven’t increased then it means lactose hasn’t been broken down into glucose and hasn’t been absorbed or tolerated

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9
Q

What is breath testing in carbohydrate malabsorption tests?

A

Hydrogen breath test
- Hydrogen produced by gut bacteria is unabsorbed disaccharides are present. Hydrogen is absorbed into blood and can be detected on the breath

Many trusts/ GPs won’t pay for this service
Private companies may offer it
Used to detect lactose/ fructose intolerance
Need to avoid antibiotics for a certain time period prior to the testing
Follow a non-fermentable diet prior to testing (?)
Expensive
Not very reliable

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10
Q

What is the dietary treatment for malabsorption?

A
  • Treat primary underlying disorder
  • Dietary measures to relieve symptoms
  • Replace water/ electrolyte losses –> especially for those with loose stools
  • Restore optimal nutritional status –> especially with weight loss and protein loss
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11
Q

What is acute diarrhoea?
Causes?

A

Short term diarrhoea

  • Infection
  • Food allergy/ intolerance or excess intake
  • Side-effect of drugs
  • Anxiety
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12
Q

What is chronic diarrhoea?

A

Long term diarrhoea

  • Crohn’s
  • UC
  • CD
  • Cancer
  • Short bowel disease
  • IBS
  • Stress and anxiety
  • Drugs
  • Infection
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13
Q

What is the management of diarrhoea?

A
  • Investigate of underlying cause
  • Maintain good fluid intake –> >2L/day
  • Clear fluids better tolerated than milky drinks and fruit juices
  • Oral rehydration solutions (for electrolytes) if severe e.g. Dioralyte
  • Anti-motility drugs –> e.g. Codeine Phosphate, Loperamide
  • Supplement drinks may be tolerated, if weight loss occurs, macronutrient and micronutrient loses - case of trail/ error
  • Encourage an easily managed (light) diet –> plain foods
  • Generally avoid foods high in fibre
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14
Q

How can fat malabsorption be managed?

A
  • Pancreatic enzyme replacement therapy (PERT) are of benefit in pancreatic insufficiency e.g. Creon
  • Reduce fat intake, ideally advise a moderate fat intake (50% usual) –> not usually advised to be super low, more just avoid super fatty foods to reduce risk of symptoms
  • Don’t advise a very low diet as this can exacerbate weight loss and replace adequacy of intake of vitamin A, E, D and K
  • Medium chain triglycerides can be useful occasionally to increase energy intake, but can cause osmotic diarrhoea
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15
Q

What enzymes does Pancreatic Enzyme Replacement Therapy (PERT) have?

A

Amylase, lipase, protease
- animal based –> porcine

Must bare in mind diets, cultural or religious preferences.
No plant based alternative

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16
Q

What is lactose intolerance?

A

Caused by a deficiency of the enzymes lactase, due to either an inherited or acquired condition. Causes osmotic effect in colon

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17
Q

How is carbohydrate (lactose) malabsorption managed?

A

Management depends on cause and severity of symptoms
- Avoid milk and milk products (temporary or permanent, depending on cause)
- Lactose free infant formula for infants, if formula fed

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18
Q

What are the symptoms of lactose malabsorption?

A
  • Diarrhoea
  • Stomach pain
  • Bloating
  • Nausea
  • Frothy stools –> fermentation of lactose in gut
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19
Q

What can cause protein malabsorption?
How is it managed?

A

Protein losing enteropathies such as Crohn’s and untreated coeliac disease can cause a significant loss of protein and risk of negative nitrogen balance

  • A high protein intake of 1-1.5g/kg/day may be required
  • ONS potentially

Protein malabsorption may be due to deficiency of proteolytic enzymes in pancreatic insufficiency

  • Dietary restriction of protein is not advised
  • Pancreatic enzyme replacement therapy often necessary
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20
Q

What is IBS?
Symptoms?

A

Irritable Bowel Syndrome

Recurrent abdominal pain on average at least 1 day/ week in the last 3 months, associated with 2 or more of the following
- Related to a bowel movement
- Associated with a change in frequency of stool
- Associated with a change in the appearance of stool
ROME IV (2017) criteria

Chronic, relapsing and often life long
Estimated to affect 10-20% of population
Most commonly affects people between ages 20-30, more women
Many people do not seek medical help

Symptoms:
- Chronic fatigue
- Changed in bowel movements
- Abdominal pain
- Wind
- Bloating
- Constipation
- Diarrhoea
Sometimes back pain, depression

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21
Q

What are the sub-types of IBS?

A

IBS with constipation (IBS-C)
IBS with diarrhoea (IBS-D)
IBS with mixed bowel habits (IBS-M)
IBS unspecified (IBS-U)

Dietary treatment will depend upon which type of IBS.

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22
Q

What causes IBS?

A

Cause not really known
Often has triggers
- Stress
- Anxiety
- Major life event/ trauma
- Hormones
- Gut hypersensitivity/ disorder of gut brain axis
- Disturbed colonic motility
- Post infective bowel dysfunction e.g. from Salmonella
- Food intolerances/ diet
- Antibiotics

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23
Q

What are the red flags to rule out for IBS, according to NICE (2015)?

A
  • Unintentional and unexplained weight loss
  • Rectal bleeding
  • A family history of bowel and ovarian cancer
  • A change in bowel habit or looser stools persisting for more than 6 weeks in someone over the age of 60.

Blood tests –> FBC, CRP, coeliac screen
Faecal calprotectin
Colonoscopies

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24
Q

What is the treatment of IBS?

A
  • Anti-diarrhoeal drygs e.g. Loperamdia
  • Drugs for constipation
  • Anti-spasmodic drugs e.g. buscopan, mebeverine
  • Peppermint oil
  • Antidepressants
  • Lifestyle –> stress management, maintain/ increase activity levels
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25
Q

What is the ‘first line’ dietary advice for IBS?

A
  • Regular meals and take time to eat
  • Avoid missing meals
  • Adequate fluid –> at least 8 cups/ day
  • Reduce tea/coffee/alcohol/fizzy drinks –> decaf may also have effects, depending on severity
  • Limit high fibre food –> particularly insoluble fibre (bran)
  • Limit fruit to 3 portions a day
  • Reduce intake of resistant starch
  • Avoid sorbitol –> found in fruits, sugar free products (mints and gum), has laxative affect
  • If symptoms of wind –> oats (soluble fibre)/ linseeds may help
26
Q

What is the ‘second line’ dietary advice for IBS?

A

FODMAP diet

F - Fermentable
O - Ogliosaccharides (fructans and galactans)
D - Disaccharides (lactose)
M - Monosaccharides (fructose)
A - And
P - Polyols (sorbitol, mannitol. xylitol and maltitol

27
Q

What is the low FODMAP diet?

A

Second line dietary advice for IBS

F - Fermentable
O - Ogliosaccharides (fructans and galactans)
D - Disaccharides (lactose)
M - Monosaccharides (fructose)
A - And
P - Polyols (sorbitol, mannitol. xylitol and maltitol

3 common functional properties:
- Poorly absorbed in small intestine
- Osmotically-active molecules
- Rapidly fermented by bacteria –> wind

Should be followed for 4-8 weeks then requires a further 6-10 weeks to do the challenges after to find what food they’re intolerant to. Must commit to around 16 weeks

Lots of evidence its helpful at reducing symptoms in around 70% of patients
Not suitable for those a low weight, anorexia nervosa

28
Q

What are the components of the low FODMAP diet that are resricted?

A

Fructans
- Wheat, barley, rye
- Onion, garlic, brassicas (cauliflower, broccoli)
- FOS, inulin (additives in food)

Galactans
- Beans and pulses
- Cashew and pistachio nuts

Polyols
- Sorbitol e.g. sweetener
- Xylitol e.g. sugar free mints
- Manitol
- Stone fruit

Lactose
- Mammalian milk
- Mammalian yoghurt
- Processed cheese
- Reduced fat cheese
- Cottage cheese, quark, ricotta

Fructose
- Honey
- Mango
- Sugar snap peas
- Fructose sweetener

29
Q

Can probiotics help with IBS?

A

Probiotics can potentially re-populate the gut with beneficial bacteria and restore or rebalance the intestinal microbiota. There is a growing body of evidence to support their use in IBS patients. However the proven beneficial effects are does and strain dependent. The greatest evidence is for the bacteria - bifidobacteria and lactobacilli
Whorwell 2009

Probiotics do not appear to be harmful (unless they come from an unreliable source) and they might benefit people with IBS. The should be advised to take the product for at least 12 weeks while monitoring the effect
NICE 2015

Try a mixed probiotic for 4 weeks
If helps carry on
If doesn’t then stop

30
Q

How is food re-introduced after the low FODMAP diet?

A

Introduce a single food in a low amount, see if any symptoms.
If symptoms –> remove from diet, wait 3 days then try another food to reintroduce
If no symptoms –> gradually increase amount over 3 days to see if any symptoms appear
Then remove food and reintroduce a new food and repeat process

31
Q

What is coeliac disease?

A

A chronic and permanent inflammatory disease of the small intestinal mucosa.
It causes malabsorption of several nutrients, such as iron and calcium
It is triggered in susceptible people by eating gluten, a type of protein found in wheat, barley and rye.
It is closely related to dermatitis herpetiformis, with similar intestinal changes and a skin rash
Not the same a wheat allergy, or non-coeliac gluten sensitivity.
Linked to a non-dominant Human Leucocyte Antigen (HLA) genotype
Possible 10% prevalence in families with a history of CD
Higher prevalence in T1D

32
Q

Do oats contain gluten?
Suitable for coeliac disease?

A

Oats to be introduced with caution and follow closely for evidence of a reaction
Safe to have uncontaminated oat
Pure uncontaminated oats not toxic in over 95% of patients with CD.

33
Q

What are the symptoms of coeliac disease?
Adults & children

A

In some cases there are no presenting symptoms

Adults:
- Sometimes weight loss
- Diarrhoea
- Weakness
- Abdominal distension and pain
- Anaemia
- Bone and joint pain
- Muscle pain
- Infertility
- Brain fog
- Dizziness
- 15-30% vitamin D deficiency
- 85% iron/ folate deficiency
- Secondary lactose intolerance –> microvilli damage, lactase enzyme production damaged

Children:
- Vomiting
- Diarrhoea
- Abdominal pain
- Constipation
- Slow rate of weight gain
- Food refusal at weaning
Recommended to not introduce gluten before 6 months of age

34
Q

How is coeliac disease diagnosed?

A

Blood tests
- IgA, tTg presence
- EMA
The prevalence of seronegative CD is 6-22% of all diagnosed cases.

Endoscopy and biopsy
3 Marsh classification –> mucosa with villous atrophy

Tests must be whilst following a diet with gluten
A GF diet on testing can show negative results

35
Q

What are the long-term consequences of coeliac disease?

A
  • Osteoporosis –> calcium malabsorption, decreased bone mineral density
  • Intestinal malignancy –> non-Hodgkin’s Lymphoma, small bowel adenocarcinoma (rare, only if eating gluten)
36
Q

What is the legislation about gluten free product labelling?

A

Gluten free –> <20mg per 1kg food or 20ppm
‘Very low gluten –> <100mg per 1 kg food, also expressed as 100ppm –> not suitable for those with coeliac disease

Cross grain symbol –> must be certified by a license system

37
Q

What is the dietary management of coeliac disease?

A
  • Exclude all dietary sources of gluten
  • Prevent cross contamination –> toasted, crumbs in butter, jam, condiments etc, pre-grated cheese is coated in flour, frying oil
  • Consume a balanced diet –> high in calcium and iron
  • Prevent constipation
  • Prevent associated diseases e.g. osteoporosis (check via DEXA scan)
  • Check for nutritional deficiencies

Recommended to have 1000mg of calcium per day
Avoid consuming tea when having a haem-iron meal

38
Q

What are common deficiencies in coeliac disease?

A
  • Iron
  • Folate
  • Vitamin B12
  • Vitamin D
  • Zinc
  • Magnesium

Approximately 20-38% of patients have nutritional complications:
- calorie/ protein imbalance
- low fibre intake
- mineral and vitamin deficiencies

39
Q

What is the health care professional annual review checklist for Coeliac Disease?
Coeliac UK

A

Membership of Coeliac UK?

Measure weight, height and BMI
- weight gain after diagnosis is common due to improved absorption
- unintentional weight loss?

Review symptoms
- any new or unchanged symptoms?

Assess the need for specific blood tests
- anaemia screening –> FBC and ferritin
- associated autoimmune conditions –> thyroid function tests, liver function tests
- assessment of nutritional deficiencies –> folate, B12, vitamin D and serum calcium

40
Q

What is diarrhoea?
Types?

A

The passage of three or more loose or liquid stools per day - or more frequent passage than is normal

Clinical types
- Acute watery diarrhoea –> Lasts several hours or days
- Acute bloody diarrhoea –> Dysentery
- Persistent diarrhoea –> Lasts 14 days or longs
- Chronic –> More than four weeks

41
Q

What are some of the causes of diarrhoea?

A

Acute
- Bacteria or viral infection
- Medication
- Anxiety
- Food allergy
- Acute appendicitis

Chronic
- IBS
- Diet
- IBD
- Coeliac disea
- Bowel cancer

42
Q

What should as assessment of diarrhoea include?

A
  • Determining onset, duration, frequency and severity of symptoms
  • Identifying red flags e.g. blood, unexplained weight loss
  • Ascertaining the underlying causes
  • Looking for complications e.g. dehydration

A stool sample can be used for microbiology investigation in cases of acute diarrhoea

Investigations for chronic diarrhoea should be tailored to the individual, but blood tests should be requested in all people presenting with diarrhoea. This should include FBC, U&Es, LFTs, calcium, VB12, ferritin, folate, thyroid, ESR, CRP and coeliac screening.

43
Q

What is considered normal stool frequency?

A

Between three per day and three per week with some degree of urgency, straining, and incomplete evacuation also being considered normal.

44
Q

What is constipation?
Types?

A

A symptom based disorder which describes defecation that is unsatisfactory because of infrequent stools, difficulty passing stools, or the sensation of incomplete emptying
The Rome IV diagnostic criteria for constipation includes spontaneous bowel movements occurring fewer than three times a week.

Types
- Chronic –> Symptoms present for at least 3 months
- Functional (primary or idiopathic) –> Chronic constipation without a known cause
- Secondary (organic) –> Caused by a drug or underlying medical condition

Assessment
- Red flag signs and symptoms identification
- Exploration of the person’s understanding of constipation and their normal pattern of defecation including the frequency and consistency of stools, symptoms of faecal impaction and/or incontinence
- Assessment of associated rectal, abdominal, or urinary symptoms
- Severity and impact of symptoms on daily life and functioning
- Any risk factors or possible secondary causes
- Any self-help measures or drug treatments tried
- Abdominal and rectal examination

45
Q

Can stress and anxiety cause GI problems?

A

Stress and anxiety can disrupt digestion either slowing it down causing bloating, constipation and pain or speeding it up and causing diarrhoea.
Chronic stress can increase the production of adrenocorticotropic hormone which has shown to slow/delay digestion that can cause GI problems
Chronic stress has also been linked to IBS and the severity of symptoms people experience (Phillips et al. 2013).

Stress can also affect gut bacteria health as it causes inflammation and can lead to leaky gut. This allows bacteria into circulation resulting in an inflammatory response. This can result in water and ion transport changes that causes diarrhoea.
Inflammation also causes loss of surface area and therefor digestive enzymes affecting the breakdown and absorption of protein and fat, which could lead to bloating, gas and discomfort.

IBS is known as a ‘stress-sensitive disorder’. Evidence shows that stress and anxiety impact intestinal sensitivity, secretion, permeability and motility and these could result in an immune response

Philips et al (2013) ‘Psychological predictors of irritable bowel syndrome diagnosis and severity’ Journal of Psychosomatic Research.

46
Q

Can stress and anxiety cause GI problems?

A

Stress and anxiety can disrupt digestion either slowing it down causing bloating, constipation and pain or speeding it up and causing diarrhoea.
Chronic stress can increase the production of adrenocorticotropic hormone which has shown to slow/delay digestion that can cause GI problems
Chronic stress has also been linked to IBS and the severity of symptoms people experience (Phillips et al. 2013).

Stress can also affect gut bacteria health as it causes inflammation and can lead to leaky gut. This allows bacteria into circulation resulting in an inflammatory response. This can result in water and ion transport changes that causes diarrhoea.
Inflammation also causes loss of surface area and therefor digestive enzymes affecting the breakdown and absorption of protein and fat, which could lead to bloating, gas and discomfort.

IBS is known as a ‘stress-sensitive disorder’. Evidence shows that stress and anxiety impact intestinal sensitivity, secretion, permeability and motility and these could result in an immune response

Philips et al (2013) ‘Psychological predictors of irritable bowel syndrome diagnosis and severity’ Journal of Psychosomatic Research.

47
Q

What can blood in vomit indicate?

A

Vomiting blood –> Haematemesis
- Gastritis
- Stomach ulcers
- Heart burn and acid reflux
- Alcohol-related liver disease
- Oesophageal damage from being sick or coughing a lot
- Oesophageal cancer
- Stomach cancer
- Blood conditions e.g. Haemophillia
- Some medications e.g. aspirin
- Poisoning
Depending on location blood may appear bright red, brown, black or appear the texture of coffee grounds

48
Q

What could blood in stools indicate?

A

Blood in stool
- Angiodysplasia
- Oesophageal, stomach, colon and rectal cancers –> Colour of blood indicates bleeding site
- Colorectal tumours, Polys –>GI tract growths that can become cancerous. Formed as a results of mucosal maturation of inflammation
- Colitis –> Colon inflammation. Can be seen in colon ulceration from CD and UC
- Diverticular disease –> Small pockets in lining of the LI that can push outwards and become inflamed or infected
- Crohn’s disease
- Gastritis –> Stomach lining inflammation, can be from NSAIDs use, infections, Crohn’s, injuries, autoimmune conditions
- Haemorrhoids or anal fissure
- Peptic ulcers –> Can be gastric or duodenal

49
Q

What common infections in hospitals can cause nausea and diarrhoea?

A

Gastroenteritis
- Gram-negative bacteria that are highly antibiotic resistant
- Spread via touch or food that is prepared by an infected person
- Can recover without treatment but may require over counter meds to ease symptoms
- Most common causes are Norovirus, Rotavirus, Adenovirus and Astrovirus

Norovirus
- ‘Winter vomiting bug’
- RNA virus –> human enteric pathogen that causes substantial morbidity across healthcare and community settings
- When hospital outbreak occurs ward must be shut to control spread
- Causes stomach and/or intestinal inflammation
- Symptoms present 12-48 hours after viral exposure and illness usually improves after 1-3 days
- More serious for those immunosuppressed or medically vulnerable due to hospitalisation

Clostridium Difficile
- C. Difficile bacteria is present in humans bowels however from taking antibiotics it can cause an imbalance of bowel bacteria which leads to infection
- Symptoms of diarrhoea, fever, nausea, vomiting and stomach-ache
- Spread via fecal-oral route
- Hand washing in hospitals is very important
- High proportion of patients take antibiotics in hospitals which is why they are classed as a popular area for the spread.
- Adds an extra 6 days on in hospital
- Recommended treatments is to stop taking any antibiotics and taking another antibiotic to treat infection
- Hydration highly advised
- May take 1-2 weeks to clear
- Most at risk, over 65s, antibiotic users, those who have had C.diff before, PPI, weakened immune system, people that spend time in hospitals or care homes

50
Q

Why can stools samples identify?
Sources and common bacteria found?

A

Stool culture can identify pathogenic bacteria, parasites, worms or if there is an overgrowth of ‘good’ bacteria in the GI.
Can also help diagnose cancer and IBD

Sources of pathogenic bacteria
- Contaminated food or water
- Consuming raw or undercooked eggs, beef or poultry, unpasteurised milk or water from lakes and streams
- Travel abroad and being exposed to unfamiliar strains of bacteria

Common pathogenic bacteria
- Salmonella –> raw eggs, poultry and in reptiles
- Campylobacter –> raw or undercooked poultry (most common bacterial diarrhoea in UK)
- E. Coli –> Raw of undercooked hamburger, beef or unpasteurised cider

51
Q

Is IBS genetic?

A

A common disorder than has been shown to aggregate in families and affect multiple generations
Increases risk by 2-3 –> if 1 family member has symptoms of IBS there is a 1 in 3 chance of another member having similar symptoms

52
Q

What are the psychological of having a GI disorder?

A

Food
- Avoidance/ restriction
- Social isolation
- Eating disorder risk
- Not having enjoyment when eating

Mental health
- Anxiety e.g. toilet frequency and leaving the house
- Depression
- Eating disorders

Occupation
- GI symptoms could affect ability to carry out daily tasks and job

Relationships
- People may not feel comfortable within themselves
- May withdraw from others

Travelling
- Not having access to a toilet could cause stress or anxiety

53
Q

How can diarrhoea be managed?

A
  • Avoid dehydration, aim for 2 litres of fluids per day, take small sips is nausea is present
  • Limit caffeine intake
  • Avoid sugar free drinks, sweets, mints and chewing gum containing mannitol, sorbitol or xylitol due to laxative effect
  • Frequent small meals if loss of appetite
  • Dry bland foods
  • Avoid spicy and fatty foods
  • Each potassium rich food
  • Not too much fibre as it can cause bowel irritation
54
Q

What are some tips for managing nausea?

A
  • Small frequent meals or snacks
  • Avoid getting too full
  • Have plain, low fat foods
  • Choose foods that are easier to eat
  • Dry bland foods e.g. crackers, toast, biscuits
  • Avoid strong smelling foods
  • Ginger or peppermint tea may help with nausea
  • Have ice lollies or sip cold liquids
  • Avoid drinking large quantities before a meal to prevent filling up
  • Regular toothbrushing or using mouth wash
  • Eat what you feel like eating
55
Q

What can help with loss of appetite?

A
  • Diet high in protein and energy
  • Eat small amounts more often during the days
  • Eat when hungry
  • Don’t drink before meals as this may fill you up
  • Avoid fizzy drinks as they reduce hunger
  • A short walk before a meal can induce hunger
  • Avoid light or diet versions of food
  • Consider fortifying foods e.g. adding beans ,pulses, nuts, milk, cream, cheese
  • ONS
56
Q

What is the role of fibre in diarrhoea and constipation treatment?

A

Constipation
- Some types of soluble fibre might help
- Can make it worse, especially if consumed in excess
- Slowly increase fibre intake if low

Diarrhoea
- Soluble fibre can help as it absorbs water
- Insoluble fibre may make it worse making the bowel secrete more water
- FODMAP can cause abdominal pain/ discomfort, distension and flatulence in IBC patients

57
Q

What is an occult blood test?

A

A diagnostic test looking for occult blood in the stool. Faecal occult bleeding can be secondary to different causes.

58
Q

What is a barium enema test?

A

A test that highlights the large bowel under X-ray. A white liquid is passed into the bowel via bottom.
Carried out to diagnose conditions such as bowel cancer, polyps growth, IBD, diverticular disease
Not used as much, more CT or colonoscopy

59
Q

What is a rectal biopsy?

A

Small piece of tissue removed for examination.
Determines cause of abnormal growths
Abnormal results
- Abscesses
- Colorectal polyps
- Infection
- Inflammation
- Tumour
- IBD

60
Q

What is the role of diet in the treatment of IBS?

A
  • Avoid missing meals
  • Slow eating
  • Reducing high fibre foods especially insoluble
  • Limiting fruit to 3 portions per day
  • Adequate fluid intake
  • Reduce intake of resistant starch
  • Avoid sorbitol
  • Avoid fizzy drinks

Low FODMAP
- Foods that are poorly absorbed, highly osmotic, rapidly fermented by GI bacteria, leading to increased water and gas in GI tract –> bloating, distention, GI motility, discomfort and flatulence.

DIET507 - Dietetics 1 (11 decks)

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